The Effect of Cooperative Gaming Techniques on Teacher Confidence toward At-Risk Students.

ERIC Educational Resources Information Center

Barrington, Kyle D.

1995-01-01

Three groups of secondary school teachers received different types of training with regard to teaching at-risk students. Teachers who learned techniques of experiential cooperative gaming for use with at-risk students demonstrated an increase in self-confidence in dealing with at-risk students, while teachers who received only information…

Increasing stress on disaster-risk finance due to large floods

NASA Astrophysics Data System (ADS)

Jongman, Brenden; Hochrainer-Stigler, Stefan; Feyen, Luc; Aerts, Jeroen C. J. H.; Mechler, Reinhard; Botzen, W. J. Wouter; Bouwer, Laurens M.; Pflug, Georg; Rojas, Rodrigo; Ward, Philip J.

2014-04-01

Recent major flood disasters have shown that single extreme events can affect multiple countries simultaneously, which puts high pressure on trans-national risk reduction and risk transfer mechanisms. So far, little is known about such flood hazard interdependencies across regions and the corresponding joint risks at regional to continental scales. Reliable information on correlated loss probabilities is crucial for developing robust insurance schemes and public adaptation funds, and for enhancing our understanding of climate change impacts. Here we show that extreme discharges are strongly correlated across European river basins. We present probabilistic trends in continental flood risk, and demonstrate that observed extreme flood losses could more than double in frequency by 2050 under future climate change and socio-economic development. We suggest that risk management for these increasing losses is largely feasible, and we demonstrate that risk can be shared by expanding risk transfer financing, reduced by investing in flood protection, or absorbed by enhanced solidarity between countries. We conclude that these measures have vastly different efficiency, equity and acceptability implications, which need to be taken into account in broader consultation, for which our analysis provides a basis.

Multiple risk factors related to familial predisposition to anterior cruciate ligament injury: fraternal twin sisters with anterior cruciate ligament ruptures

PubMed Central

Hewett, T E; Lynch, T R; Myer, G D; Ford, K R; Gwin, R C; Heidt, R S

2014-01-01

Objective A multifactorial combination of predictors may increase anterior cruciate ligament (ACL) injury risk in athletes. The objective of this twin study was to examine these risk factors to identify commonalities in risk factors that predisposed female fraternal twins to ACL injury. Methods Female twins in high-risk sports were prospectively measured prior to an injury for neuromuscular control using three-dimensional motion analysis during landing, hamstrings and quadriceps muscular strength on a dynamometer and joint laxity using a modified Beighton–Horan index and a Compu-KT arthrometer. Intraoperative measures of femoral intercondylar notch width were recorded during ACL reconstruction. Results Abduction angles were increased at one knee in both of the twin sister athletes relative to uninjured controls at initial contact and at maximum displacement during landing. The twin female athletes that went on to ACL injury also demonstrated decreased peak knee flexion motion at both knees than uninjured females during landing. The twin athletes also had increased joint laxity and decreased hamstrings to quadriceps (H/Q) torque ratios compared to controls. Femoral intercondylar notch widths were also below the control mean in the twin siblings. Conclusions Prescreened mature female twins that subsequently experienced ACL injury demonstrated multiple potential risk factors including: increased knee abduction angles, decreased knee flexion angles, increased general joint laxity, decreased H/Q ratios and femoral intercondylar notch width. PMID:19158132

Evaluation of a rural demonstration program to increase seat belt use in the Great Lakes Region.

DOT National Transportation Integrated Search

2009-03-01

Six States in the Great Lakes Region (Region 5) participated in a Rural Demonstration Program to increase seat belt : use in rural areas and among high-risk occupants, such as young males and occupants of pickup trucks. These : efforts, which include...

Efficacy of anti-osteoporotic medications in patients with type 1 and 2 diabetes mellitus: a systematic review.

PubMed

Anagnostis, Panagiotis; Paschou, Stavroula A; Gkekas, Nifon N; Artzouchaltzi, Aikaterini-Maria; Christou, Konstantinos; Stogiannou, Dimitrios; Vryonidou, Andromachi; Potoupnis, Michael; Goulis, Dimitrios G

2018-06-01

Both type 1 (T1DM) and type 2 diabetes mellitus (T2DM) have been associated with bone fragility and increased fracture risk. However, little is known regarding the effect of anti-osteoporotic treatment on bone mineral density (BMD) and/or fracture risk in these patients. We aimed to systematically investigate the efficacy of anti-osteoporotic medications in patients with diabetes in comparison with non-diabetic subjects. MEDLINE and Scopus databases were searched (up to 31st October 2017). Nine studies fulfilled the pre-defined inclusion criteria [patients with T2DM (n = 8) or either T1DM or T2DM (n = 1)]. Regarding fracture risk, five studies were identified. Alendronate demonstrated comparable vertebral anti-fracture efficacy in patients with and without diabetes (n = 2), whereas non-vertebral fracture risk was either the same (n = 1) or higher in diabetic patients (n = 1). Raloxifene also demonstrated comparable vertebral anti-fracture efficacy in both groups (n = 2), without any effect on non-vertebral fractures in either group. In one study, diabetic patients exposed to raloxifene demonstrated the same vertebral and non-vertebral fracture risk with non-diabetic patients. Teriparatide (n = 1) demonstrated the same non-vertebral fracture rates in both patients with and without T2DM. Regarding BMD, equal increases in spine BMD were observed with alendronate (n = 4), risedronate (n = 1), and teriparatide (n = 1). With respect to hip BMD, similar increases were observed with teriparatide (n = 1), whereas data regarding alendronate were controversial (n = 3). No eligible study was found for zoledronic acid, ibandronate, strontium ranelate, denosumab, or bazedoxifene. The presence of diabetes does not alter anti-osteoporotic treatment response, regarding BMD increase and vertebral fracture risk reduction.

Distal & Proximal Influences on Men's Intentions to Resist Condoms: Alcohol, Sexual Aggression History, Impulsivity, and Social-Cognitive Factors

PubMed Central

Davis, Kelly Cue; Danube, Cinnamon L.; Neilson, Elizabeth C.; Stappenbeck, Cynthia A.; Norris, Jeanette; George, William H.; Kajumulo, Kelly F.

2015-01-01

Recent scientific evidence demonstrates that many young men commonly resist condom use with their female sex partners and that both alcohol intoxication and a history of sexual aggression may increase the risk of condom use resistance (CUR). Using a community sample of heterosexual male non-problem drinkers with elevated sexual risk (N=311), this alcohol administration study examined the direct and indirect effects of intoxication and sexual aggression history on men's CUR intentions through a sexual risk analogue. State impulsivity, CUR-related attitudes, and CUR-related self-efficacy were assessed as mediators. Results demonstrated that alcohol intoxication directly increased CUR intentions, and sexual aggression history both directly and indirectly increased CUR intentions. These findings highlight the importance of addressing both alcohol use and sexual aggression in risky sex prevention programs, as well as indicate the continued worth of research regarding the intersection of men's alcohol use, sexual aggression, and sexual risk behaviors, especially CUR. PMID:26156881

HIV and antiretroviral therapy: lipid abnormalities and associated cardiovascular risk in HIV-infected patients.

PubMed

Kotler, Donald P

2008-09-01

It has been demonstrated that patients on highly active antiretroviral therapy are at increased risk for developing metabolic abnormalities that include elevated levels of serum triglycerides and low-density lipoprotein cholesterol and reduced levels of high-density lipoprotein cholesterol. This dyslipidemia is similar to that seen in the metabolic syndrome, raising the concern that highly active antiretroviral therapy also potentially increases the risk for cardiovascular complications. This paper reviews the contribution of both HIV infection and the different components of highly active antiretroviral therapy to dyslipidemia and the role of these abnormalities toward increasing the risk of cardiovascular disease in HIV-infected patients; therapeutic strategies to manage these risks are also considered.

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.

Risk-dependent reward value signal in human prefrontal cortex

PubMed Central

Tobler, Philippe N.; Christopoulos, George I.; O'Doherty, John P.; Dolan, Raymond J.; Schultz, Wolfram

2009-01-01

When making choices under uncertainty, people usually consider both the expected value and risk of each option, and choose the one with the higher utility. Expected value increases the expected utility of an option for all individuals. Risk increases the utility of an option for risk-seeking individuals, but decreases it for risk averse individuals. In 2 separate experiments, one involving imperative (no-choice), the other choice situations, we investigated how predicted risk and expected value aggregate into a common reward signal in the human brain. Blood oxygen level dependent responses in lateral regions of the prefrontal cortex increased monotonically with increasing reward value in the absence of risk in both experiments. Risk enhanced these responses in risk-seeking participants, but reduced them in risk-averse participants. The aggregate value and risk responses in lateral prefrontal cortex contrasted with pure value signals independent of risk in the striatum. These results demonstrate an aggregate risk and value signal in the prefrontal cortex that would be compatible with basic assumptions underlying the mean-variance approach to utility. PMID:19369207

Increased plantar force and impulse in American football players with high arch compared to normal arch

PubMed Central

Carson, Daniel W.; Myer, Gregory D.; Hewett, Timothy E.; Heidt, Robert S.; Ford, Kevin R.

2014-01-01

Background Risk of overuse injury among athletes is high due in part to repeated loading of the lower extremities. Compared to individuals with normal arch (NA) structure, those with high (HA) or low arch (LA) may be at increased risk of specific overuse injuries, including stress fractures. A high medial longitudinal arch may result in decreased shock absorbing properties due to increased rigidity in foot mechanics. While the effect of arch structure on dynamic function has been examined in straight line walking and running, the relationship between the two during multi-directional movements remains unstudied. Objective The purpose of this study was to determine if differences in plantar loading in football players occur during both walking and pivoting movements. Method Plantar loading was examined in 9 regions of the foot for 26 participants (16 NA, 10 HA). Results High arch athletes demonstrated increased maximum force in the lateral rear foot and medial forefoot, and force time integral in the medial forefoot while walking. HA athletes also demonstrated increased maximum force in the medial rear foot and medial and central forefoot during rapid pivoting. Conclusions The current findings demonstrate that loading patterns differ between football players with high and normal arch structure, which could possibly influence injury risk in this population. PMID:23141809

Wearing a Bicycle Helmet Can Increase Risk Taking and Sensation Seeking in Adults

PubMed Central

Gamble, Tim; Walker, Ian

2016-01-01

Humans adapt their risk-taking behavior on the basis of perceptions of safety; this risk-compensation phenomenon is typified by people taking increased risks when using protective equipment. Existing studies have looked at people who know they are using safety equipment and have specifically focused on changes in behaviors for which that equipment might reduce risk. Here, we demonstrated that risk taking increases in people who are not explicitly aware they are wearing protective equipment; furthermore, this happens for behaviors that could not be made safer by that equipment. In a controlled study in which a helmet, compared with a baseball cap, was used as the head mount for an eye tracker, participants scored significantly higher on laboratory measures of both risk taking and sensation seeking. This happened despite there being no risk for the helmet to ameliorate and despite it being introduced purely as an eye tracker. The results suggest that unconscious activation of safety-related concepts primes globally increased risk propensity. PMID:26740528

Eliciting affect via immersive virtual reality: a tool for adolescent risk reduction.

PubMed

Hadley, Wendy; Houck, Christopher D; Barker, David H; Garcia, Abbe Marrs; Spitalnick, Josh S; Curtis, Virginia; Roye, Scott; Brown, Larry K

2014-04-01

A virtual reality environment (VRE) was designed to expose participants to substance use and sexual risk-taking cues to examine the utility of VR in eliciting adolescent physiological arousal. 42 adolescents (55% male) with a mean age of 14.54 years (SD = 1.13) participated. Physiological arousal was examined through heart rate (HR), respiratory sinus arrhythmia (RSA), and self-reported somatic arousal. A within-subject design (neutral VRE, VR party, and neutral VRE) was utilized to examine changes in arousal. The VR party demonstrated an increase in physiological arousal relative to a neutral VRE. Examination of individual segments of the party (e.g., orientation, substance use, and sexual risk) demonstrated that HR was significantly elevated across all segments, whereas only the orientation and sexual risk segments demonstrated significant impact on RSA. This study provides preliminary evidence that VREs can be used to generate physiological arousal in response to substance use and sexual risk cues.

Impaired glucose tolerance and impaired fasting glucose--a review of diagnosis, clinical implications and management.

PubMed

Petersen, John L; McGuire, Darren K

2005-02-01

The diagnostic categories of impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) were stablished in an effort to identify populations at risk for developing type 2 diabetes mellitus (T2DM). Both IGT and IFG are associated with increased risk of developing T2DM, but recent analyses found that the thresholds of risk vary among different populations and an even lower diagnostic threshold of IFG may be appropriate. IGT has been linked with an increased risk of cardiovascular events and some analyses have demonstrated an increased mortality risk compared with patients with normal glucose tolerance. In contrast, a continuum of increased risk of microvascular manifestations of T2DM has been demonstrated with IFG but an association of IFG with cardiovascular events has not been well established. Although both IGT and IFG are associated with resistance to insulin and increased insulin secretion, they do not identify the identical patient populations and are not equivalent in predicting development of T2DM or cardiovascular events. IFG and IGT have been associated with other features of insulin resistance, including dyslipidaemia, hypertension, abdominal obesity, microalbuminuria, endothelial dysfunction, and markers of inflammation and hypercoagulability, traits collectively referred to as the metabolic syndrome. Analyses of combinations of these components have also been associated with progression to T2DM, cardiovascular disease and increased mortality. The foundation of treatment for IGT, IFG, and the metabolic syndrome is lifestyle modification, including both dietary change and routine exercise. To date, several clinical trials have found that lifestyle modification is the most efficacious strategy to prevent progression to T2DM. Alternative treatments include pharmacotherapy with metformin or acarbose, both of which have been demonstrated to decrease the development of T2DM. Ongoing clinical trials are evaluating newer pharmacotherapies, including angiotensin converting enzyme inhibitors, angiotensin receptor antagonists, metglitinides and thiazolidinediones, to prevent both T2DM and cardiovascular events. In combination with lifestyle modification, these therapies offer hope for effective prevention of T2DM and its consequences in high-risk patients.

Adding Fuel to the Fire: The Impacts of Non-Native Grass Invasion on Fire Management at a Regional Scale

PubMed Central

Setterfield, Samantha A.; Rossiter-Rachor, Natalie A.; Douglas, Michael M.; Wainger, Lisa; Petty, Aaron M.; Barrow, Piers; Shepherd, Ian J.; Ferdinands, Keith B.

2013-01-01

Background Widespread invasion by non-native plants has resulted in substantial change in fire-fuel characteristics and fire-behaviour in many of the world's ecosystems, with a subsequent increase in the risk of fire damage to human life, property and the environment. Models used by fire management agencies to assess fire risk are dependent on accurate assessments of fuel characteristics but there is little evidence that they have been modified to reflect landscape-scale invasions. There is also a paucity of information documenting other changes in fire management activities that have occurred to mitigate changed fire regimes. This represents an important limitation in information for both fire and weed risk management. Methodology/Principal Findings We undertook an aerial survey to estimate changes to landscape fuel loads in northern Australia resulting from invasion by Andropogon gayanus (gamba grass). Fuel load within the most densely invaded area had increased from 6 to 10 t ha−1 in the past two decades. Assessment of the effect of calculating the Grassland Fire Danger Index (GFDI) for the 2008 and 2009 fire seasons demonstrated that an increase from 6 to 10 t ha−1 resulted in an increase from five to 38 days with fire risk in the ‘severe’ category in 2008 and from 11 to 67 days in 2009. The season of severe fire weather increased by six weeks. Our assessment of the effect of increased fuel load on fire management practices showed that fire management costs in the region have increased markedly (∼9 times) in the past decade due primarily to A. gayanus invasion. Conclusions/Significance This study demonstrated the high economic cost of mitigating fire impacts of an invasive grass. This study demonstrates the need to quantify direct and indirect invasion costs to assess the risk of further invasion and to appropriately fund fire and weed management strategies. PMID:23690917

Adding fuel to the fire: the impacts of non-native grass invasion on fire management at a regional scale.

PubMed

Setterfield, Samantha A; Rossiter-Rachor, Natalie A; Douglas, Michael M; Wainger, Lisa; Petty, Aaron M; Barrow, Piers; Shepherd, Ian J; Ferdinands, Keith B

2013-01-01

Widespread invasion by non-native plants has resulted in substantial change in fire-fuel characteristics and fire-behaviour in many of the world's ecosystems, with a subsequent increase in the risk of fire damage to human life, property and the environment. Models used by fire management agencies to assess fire risk are dependent on accurate assessments of fuel characteristics but there is little evidence that they have been modified to reflect landscape-scale invasions. There is also a paucity of information documenting other changes in fire management activities that have occurred to mitigate changed fire regimes. This represents an important limitation in information for both fire and weed risk management. We undertook an aerial survey to estimate changes to landscape fuel loads in northern Australia resulting from invasion by Andropogon gayanus (gamba grass). Fuel load within the most densely invaded area had increased from 6 to 10 t ha(-1) in the past two decades. Assessment of the effect of calculating the Grassland Fire Danger Index (GFDI) for the 2008 and 2009 fire seasons demonstrated that an increase from 6 to 10 t ha(-1) resulted in an increase from five to 38 days with fire risk in the 'severe' category in 2008 and from 11 to 67 days in 2009. The season of severe fire weather increased by six weeks. Our assessment of the effect of increased fuel load on fire management practices showed that fire management costs in the region have increased markedly (∼9 times) in the past decade due primarily to A. gayanus invasion. This study demonstrated the high economic cost of mitigating fire impacts of an invasive grass. This study demonstrates the need to quantify direct and indirect invasion costs to assess the risk of further invasion and to appropriately fund fire and weed management strategies.

Does sports participation (including level of performance and previous injury) increase risk of osteoarthritis? A systematic review and meta-analysis

PubMed Central

Tran, Gui; Smith, Toby O; Grice, Adam; Kingsbury, Sarah R; McCrory, Paul; Conaghan, Philip G

2016-01-01

Background To assess the relationship between sport and osteoarthritis (OA), and specifically to determine whether previous participation, in terms of level (elite or non-elite), type of sport, intensity or previous injury, was associated with OA. Methods This systematic review was developed using PRISMA guidelines. Databases were searched (to May 2016). Narrative review and meta-analysis (with risk ratio (RR) and 95% CIs) approaches were undertaken where appropriate. Study quality was assessed using GRADE. Results 46 studies were included. Narratively, 31 studies reported an increased risk of OA, with 19 demonstrating an increased risk in elite athletes. There was an increased risk after sports exposure (irrespective of type; RR 1.37; 95% CI 1.14 to 1.64; 21 studies). It remained uncertain whether there was a difference in risk of OA between elite and non-elite athletes (RR 1.37; 95% CI 0.84 to 2.22; 17 studies). The risk was higher in soccer (RR 1.42; 95% CI 1.14 to 1.77; 15 studies) but lower in runners (RR 0.86; 95% CI 0.53 to 1.41; 12 studies). 9 studies showed an association with the intensity of sport undertaken and OA. 5 studies demonstrated a higher prevalence of OA following meniscectomies and anterior cruciate ligament tears. Overall, the evidence was of GRADE ‘very low’ quality. Conclusions There was very low-quality evidence to support an increased relationship between sports participation and OA in elite participants. It is unclear whether there is a difference in risk between elite and non-elite participants with further prospective studies needed to evaluate this. Pooled findings suggested that significant injuries were associated with OA in soccer players. PMID:27683348

Ohio's At-Risk Student Population: A Decade of Rising Risk

ERIC Educational Resources Information Center

Vesely, Randall S.

2013-01-01

Educators face increasing demands to raise student achievement, to improve classroom instruction, and to demonstrate accountability in an environment of high stakes testing. However, meeting these demands is challenging in the face of numerous risk factors that jeopardize the academic success of elementary and secondary students. To that end, the…

Digital media and sexually transmitted infections.

PubMed

Gilliam, Melissa; Chor, Julie; Hill, Brandon

2014-10-01

Digital media, including the Internet, social networking sites, text messaging, and mobile applications, are ubiquitous among adolescents and young adults. These platforms enable users to obtain important information on a multitude of health topics, they may facilitate risk-taking behaviors, and they can be key components of health interventions. The purpose of this article is to review the recent literature on digital media and sexually transmitted infections, discussing their role in potentiating and reducing risk. This review demonstrates adolescents' use of digital media to gather information on health topics and discusses significant privacy concerns regarding using media to explore sexual health information. Although several studies demonstrate an association between social media and increased sexual risk-taking behaviors, this relationship is not fully understood. Digital media-based interventions are increasingly being developed to either reduce risk or improve management of sexually transmitted infections. As greater numbers of adolescents use digital media, the potential for these platforms to influence sexual risk-taking behaviors is significant. Additional research is needed to better understand the impact of digital media on sexually transmitted infection risk and to develop social media-based interventions to improve sexually transmitted infection outcomes.

Epidemiology of ischemic heart disease in HIV.

PubMed

Triant, Virginia A; Grinspoon, Steven K

2017-11-01

The purpose of this review is to summarize and synthesize recent data on the risk of ischemic heart disease (IHD) in HIV-infected individuals. Recent studies in the field demonstrate an increasing impact of cardiovascular disease (CVD) on morbidity and mortality in HIV relative to AIDS-related diagnoses. Studies continue to support an approximately 1.5 to two-fold increased risk of IHD conferred by HIV, with specific risk varying by sex and virologic/immunologic status. Risk factors include both traditional CVD risk factors and novel, HIV-specific factors including inflammation and immune activation. Specific antiretroviral therapy (ART) drugs may increase CVD risk, yet the net effect of ART with viral suppression is beneficial with regard to CVD risk. Management of cardiovascular risk and prevention of CVD is complex, because current general population strategies target traditional CVD risk factors only. Extensive investigation is being directed at developing tailored CVD risk prediction algorithms and interventions to reduce CVD risk in HIV. Increased IHD risk is a significant clinical and public health challenge in HIV. The development and application of HIV-specific interventions to manage CVD risk factors and reduce CVD risk will improve the long-term health of this ageing population.

The effect of conformation on orthopaedic health and performance in a cohort of National Hunt racehorses: preliminary results.

PubMed

Weller, R; Pfau, T; Verheyen, K; May, S A; Wilson, A M

2006-11-01

There is a lack of scientific data and studies on the effect of conformation on performance or on orthopaedic health. To investigate the relationship between conformation, injury and performance in racehorses used for racing over fences. Over 2 years, 108 National Hunt racehorses were followed and their medical and performance data recorded. Conformation was measured in 3D with a computerised motion analysis system. Linear multiple regression models were used to evaluate the effect of conformation on measures of race performance and stepwise forward logistic regression models to assess the effect on risk of injury. An increase in intermandibular width, flexor angle of the shoulder joint and coxal angle (the angle between the ilium and ischium) was demonstrated to have a positive effect on performance. Performance decreased with increasing girth, length of the hind digit and valgus conformation of the metacarpophalangeal joint. The risk of suffering from superficial digital flexor tendon injury increased with increasing metacarpophalangeal joint angle and with carpus valgus conformation. The risk of pelvic fracture increased with valgus conformation of the tarsus and decreased with an increasing coxal angle. Valgus deformation was demonstrated to be detrimental to performance or increased risk of injury, perhaps resulting in higher loads on musculoskeletal structures. The coxal angle was the only parameter to have an effect on both risk of injury and performance. An alignment of the muscles with the axis of the pelvis may be beneficial for force transmission and decrease the bending moment of the muscles on the bones. The statistical power of this study is limited, however it provides preliminary data necessary for the planning of a larger scale study on the effect of conformation on performance and risk of injury. Studies of the effects of conformation on performance and risk of injury may aid in identifying individuals likely to perform well on the racecourse and avoid risks of injury.

HIV risk, partner violence, and relationship power among Filipino young women: testing a structural model.

PubMed

Lucea, Marguerite B; Hindin, Michelle J; Kub, Joan; Campbell, Jacquelyn C

2012-01-01

A person's ability to minimize HIV risk is embedded in a complex, multidimensional context. In this study, we tested a model of how relationship power impacts IPV victimization, which in turn impacts HIV risk behaviors. We analyzed data from 474 young adult women (aged 15-31) in Cebu Province, Philippines, using structural equation modeling, and demonstrated good fit for the models. High relationship power is directly associated with increased IPV victimization, and IPV victimization is positively associated with increased HIV risk. We highlight in this article the complex dynamics to consider in HIV risk prevention among these young women.

HIV Risk, Partner Violence, and Relationship Power Among Filipino Young Women: Testing a Structural Model

PubMed Central

LUCEA, MARGUERITE B.; HINDIN, MICHELLE J.; KUB, JOAN; CAMPBELL, JACQUELYN C.

2012-01-01

A person’s ability to minimize HIV risk is embedded in a complex, multidimensional context. In this study, we tested a model of how relationship power impacts IPV victimization, which in turn impacts HIV risk behaviors. We analyzed data from 474 young adult women (aged 15–31) in Cebu Province, Philippines, using structural equation modeling, and demonstrated good fit for the models. High relationship power is directly associated with increased IPV victimization, and IPV victimization is positively associated with increased HIV risk. We highlight in this article the complex dynamics to consider in HIV risk prevention among these young women. PMID:22420674

Design and Demonstration of Emergency Control Modes for Enhanced Engine Performance

NASA Technical Reports Server (NTRS)

Liu, Yuan; Litt, Jonathan S.; Guo, Ten-Huei

2013-01-01

A design concept is presented for developing control modes that enhance aircraft engine performance during emergency flight scenarios. The benefits of increased engine performance to overall vehicle survivability during these situations may outweigh the accompanied elevated risk of engine failure. The objective involves building control logic that can consistently increase engine performance beyond designed maximum levels based on an allowable heightened probability of failure. This concept is applied to two previously developed control modes: an overthrust mode that increases maximum engine thrust output and a faster response mode that improves thrust response to dynamic throttle commands. This paper describes the redesign of these control modes and presents simulation results demonstrating both enhanced engine performance and robust maintenance of the desired elevated risk level.

[New populations at increased cardiovascular risk: Cardiovascular disease in dermatological diseases].

PubMed

Godoy-Gijón, Elena; Meseguer-Yebra, Carmen; Palacio-Aller, Lucía; Godoy-Rocati, Diego Vicente; Lahoz-Rallo, Carlos

2016-01-01

The increased cardiovascular risk in some dermatological diseases has been demonstrated in recent decades. Diseases such as psoriasis and systemic lupus erythematosus are currently included in the guidelines for prevention of cardiovascular disease. Other diseases such as androgenic alopecia, polycystic ovary syndrome, hidradenitis suppurativa or lichen planus have numerous studies that point to an increased risk, however, they have not been included in these guidelines. In this article we review the evidence supporting this association, in order to alert the clinician to the need for greater control in cardiovascular risk factors in these patients. Copyright © 2015 Sociedad Española de Arteriosclerosis. Published by Elsevier España. All rights reserved.

Do insulin-like growth factors mediate the effect of alcohol on breast cancer risk?

PubMed

Yu, H; Berkel, J

1999-06-01

Despite a large number of epidemiologic studies demonstrating an increased risk of breast cancer in association with alcohol consumption, a causal relationship between alcohol intake and breast cancer risk remains to be determined. Several biological mechanisms have been proposed, but none of them explains well the features of the association, i.e. a modest increase in risk, a limited range of dose-response relationship and no further increase in risk among heavy drinkers. A new mechanism underlying a possible biological role of alcohol in breast cancer is proposed in this paper. Moderate consumption of alcohol increases the production of insulin-like growth factors (IGFs) by the liver and elevated IGFs via circulation stimulate or promote the development and/or growth of breast cancer. The effect of alcohol on IGF production declines among heavy drinkers as alcohol-caused liver-function damage results in no further increase in IGF production. Therefore, compared to moderate drinkers, heavy alcohol users do not have a higher risk of breast cancer.

Does employee resistance during a robbery increase the risk of customer injury?

PubMed

Yau, Rebecca K; Casteel, Carri; Nocera, Maryalice; Bishop, Stephanie F; Peek-Asa, Corinne

2015-04-01

Retail business robberies can lead to employee and customer injury. Previous work demonstrates that employee resistance increases employee injury risk; limited research has investigated customer injuries. This study examines associations between employee resistance against perpetrators and the risk of customer injury. Retail and service robbery reports were obtained from a metropolitan police department. Generalized estimating equations estimated risk ratios and 95% confidence intervals (CIs). Customers were injured in 75 out of 697 robberies. Employees resisted the perpetrator in 32 out of 697 robberies. Customers had higher injury risk when employees resisted the perpetrator, compared with robberies where employees did not resist (adjusted risk ratio [95% CI], 2.6 [1.5 to 4.5]). Employee resistance against a perpetrator during a robbery increased customer injury risk. Businesses can train employees to not resist during a robbery, providing benefits for both customers and the business itself.

The risk of kidney stones following bariatric surgery: a systematic review and meta-analysis.

PubMed

Thongprayoon, Charat; Cheungpasitporn, Wisit; Vijayvargiya, Priya; Anthanont, Pimjai; Erickson, Stephen B

2016-01-01

With rising prevalence of morbid obesity, the number of bariatric surgeries performed each year has been increasing worldwide. The objective of this meta-analysis was to assess the risk of kidney stones following bariatric surgery. A literature search was performed using MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews from inception through July 2015. Only studies reporting relative risks, odd ratios or hazard ratios (HRs) to compare risk of kidney stones in patients who underwent bariatric surgery versus no surgery were included. Pooled risk ratios (RR) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method. Four studies (One randomized controlled trial and three cohort studies) with 11,348 patients were included in analysis to assess the risk of kidney stones following bariatric surgery. The pooled RR of kidney stones in patients undergoing bariatric surgery was 1.22 (95% CI, 0.63-2.35). The type of bariatric surgery subgroup analysis demonstrated an increased risk of kidney stones in patients following Roux-en-Y gastric bypass (RYGB) with the pooled RR of 1.73 (95% CI, 1.30-2.30) and a decreased risk of kidney stones in patients following restrictive procedures including laparoscopic banding or sleeve gastrectomy with the pooled RR of 0.37 (95% CI, 0.16-0.85). Our meta-analysis demonstrates an association between RYGB and increased risk of kidney stones. Restrictive bariatric surgery, on the other hand, may decrease kidney stone risk. Future study with long-term follow-up data is needed to confirm this potential benefit of restrictive bariatric surgery.

Stressful life experiences, alcohol consumption, and alcohol use disorders: the epidemiologic evidence for four main types of stressors

PubMed Central

Keyes, Katherine M.; Hatzenbuehler, Mark L.; Hasin, Deborah S.

2013-01-01

Background Exposure to stress is potentially important in the pathway to alcohol use and alcohol use disorders. Stressors occur at multiple time points across the life course, with varying degrees of chronicity and severity. Method We review evidence from epidemiologic studies on the relationship between four different stressors (fateful/catastrophic events, child maltreatment, common adult stressful life events in interpersonal, occupational, financial, and legal domains, and minority stress) and alcohol consumption and alcohol use disorders. Results Studies generally demonstrate an increase in alcohol consumption in response to exposure to terrorism or other disasters. Research has demonstrated little increase in incident alcohol use disorders, but individuals with a history of alcohol use disorders are more likely to report drinking to cope with the traumatic event. Childhood maltreatment is a consistent risk factor for early onset of drinking in adolescence and adult alcohol use disorders, and accumulating evidence suggests that specific polymorphisms may interact with child maltreatment to increase risk for alcohol consumption and disorder. Stressful life events such as divorce and job loss increase the risk of alcohol disorders, but epidemiologic consensus on the specificity of these associations across gender has not been reached. Finally, both perceptions of discrimination and objective indicators of discrimination are associated with alcohol use and alcohol use disorders among racial/ethnic and sexual minorities. Conclusion Taken together, these literatures demonstrate that exposure to stress is an important component in individual differences in risk for alcohol consumption and alcohol use disorders. However, many areas of this research remain to be studied, including greater attention to the role of various stressors in the course of alcohol use disorders and potential risk moderators when individuals are exposed to stressors. PMID:21373787

Impact of a Universal School-Based Violence Prevention Program on Violent Delinquency: Distinctive Benefits for Youth with Maltreatment Histories

ERIC Educational Resources Information Center

Crooks, Claire V.; Scott, Katreena; Ellis, Wendy; Wolfe, David A.

2011-01-01

Objective: Child maltreatment constitutes a strong risk factor for violent delinquency in adolescence, with cumulative experiences of maltreatment creating increasingly greater risk. Our previous work demonstrated that a universal school-based violence prevention program could provide a protective impact for youth at risk for violent delinquency…

Association of body mass index and aerobic physical fitness with cardiovascular risk factors in children☆

PubMed Central

Gonçalves, Reginaldo; Szmuchrowski, Leszek Antony; Damasceno, Vinícius Oliveira; de Medeiros, Marcelo Lemos; Couto, Bruno Pena; Lamounier, Joel Alves

2014-01-01

Objective: To identify the association between both, body mass index and aerobic fitness, with cardiovascular disease risk factors in children. Methods: Cross-sectional study, carried out in Itaúna-MG, in 2010, with 290 school children ranging from 6 to 10 years-old of both sexes, randomly selected. Children from schools located in the countryside and those with medical restrctions for physical activity were not included. Blood sample was collected after a 12-hour fasting period. Blood pressure, stature and weight were evaluated in accordance with international standards. The following were considered as cardiovascular risk factors: high blood pressure, high total cholesterol, LDL, triglycerides and insulin levels, and low HDL. The statistical analysis included the Spearman's coefficient and the logistic regression, with cardiovascular risk factors as dependent variables. Results: Significant correlations were found, in both sexes, among body mass index and aerobic fitness with most of the cardiovascular risk factors. Children of both sexes with body mass index in the fourth quartile demonstrated increased chances of having high blood insulin and clustering cardiovascular risk factors. Moreover, girls with aerobic fitness in the first quartile also demonstrated increased chances of having high blood insulin and clustering cardiovascular risk factors. Conclusion: The significant associations and the increased chances of having cardiovascular risk factors in children with less aerobic fitness and higher levels of body mass index justify the use of these variables for health monitoring in Pediatrics. PMID:25479851

Eliciting Affect via Immersive Virtual Reality: A Tool for Adolescent Risk Reduction

PubMed Central

Houck, Christopher D.; Barker, David H.; Garcia, Abbe Marrs; Spitalnick, Josh S.; Curtis, Virginia; Roye, Scott; Brown, Larry K.

2014-01-01

Objective A virtual reality environment (VRE) was designed to expose participants to substance use and sexual risk-taking cues to examine the utility of VR in eliciting adolescent physiological arousal. Methods 42 adolescents (55% male) with a mean age of 14.54 years (SD = 1.13) participated. Physiological arousal was examined through heart rate (HR), respiratory sinus arrhythmia (RSA), and self-reported somatic arousal. A within-subject design (neutral VRE, VR party, and neutral VRE) was utilized to examine changes in arousal. Results The VR party demonstrated an increase in physiological arousal relative to a neutral VRE. Examination of individual segments of the party (e.g., orientation, substance use, and sexual risk) demonstrated that HR was significantly elevated across all segments, whereas only the orientation and sexual risk segments demonstrated significant impact on RSA. Conclusions This study provides preliminary evidence that VREs can be used to generate physiological arousal in response to substance use and sexual risk cues. PMID:24365699

Parent birds assess nest predation risk and adjust their reproductive strategies

USGS Publications Warehouse

Fontaine, J.J.; Martin, T.E.

2006-01-01

Avian life history theory has long assumed that nest predation plays a minor role in shaping reproductive strategies. Yet, this assumption remains conspicuously untested by broad experiments that alter environmental risk of nest predation, despite the fact that nest predation is a major source of reproductive failure. Here, we examined whether parents can assess experimentally reduced nest predation risk and alter their reproductive strategies. We experimentally reduced nest predation risk and show that in safer environments parents increased investment in young through increased egg size, clutch mass, and the rate they fed nestlings. Parents also increased investment in female condition by increasing the rates that males fed incubating females at the nest, and decreasing the time that females spent incubating. These results demonstrate that birds can assess nest predation risk at large and that nest predation plays a key role in the expression of avian reproductive strategies. ?? 2006 Blackwell Publishing Ltd/CNRS.

Second primary malignancies after autologous hematopoietic cell transplantation for multiple myeloma.

PubMed

Krishnan, Amrita Y; Mei, Matthew; Sun, Can-Lan; Thomas, Sandra H; Teh, Jennifer Berano; Kang, Tongjun; Htut, Myo; Somlo, George; Sahebi, Firoozeh; Forman, Stephen J; Bhatia, Smita

2013-02-01

Recent studies demonstrate an increased risk of second primary malignancies (SPMs) in patients with multiple myeloma (MM) receiving maintenance lenalidomide after autologous stem cell transplantation (ASCT). We explored the possibility of other risk factors driving post-ASCT SPMs in patients with MM through analysis of our large transplantation database in conjunction with our Long-Term Follow-Up Program. We conducted a retrospective cohort study of 841 consecutive patients with MM who underwent ASCT at City of Hope between 1989 and 2009, as well as a nested case-control analysis evaluating the role of all therapeutic exposures before, during, and after ASCT. Median duration of follow-up for the entire cohort was 3.4 years (range, 0.3-19.9 years). Sixty cases with a total of 70 SPMs were identified. The overall cumulative incidence of SPMs was 7.4% at 5 years and 15.9% at 10 years when nonmelanoma skin cancers (NMSCs) were included and 5.3% at 5 years and 11.2% at 10 years when NMSCs were excluded. Multivariate analysis of the entire cohort revealed associations of both older age (≥55 years; relative risk, 2.3; P < .004) and race (non-Hispanic white; relative risk, 2.4; P = .01) with an increased risk of SPM. Furthermore, thalidomide exposure demonstrated a trend toward increased risk (odds ratio, 3.5; P = .15); however, an insufficient number of patients were treated with lenalidomide to allow us to accurately assess the risk of this agent. Exclusion of NMSCs retained the association with these variables but was accompanied by loss of statistical significance. This large single-institution analysis identified associations between race and older age and increased risk of developing SPM. The trend toward increased risk with thalidomide exposure suggests a class effect from immunomodulatory drugs that might not be restricted to lenalidomide. Copyright © 2013 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

The impact of obesity in urology.

PubMed

Mydlo, Jack H

2004-05-01

The incidence and progression of urologic diseases, as well as several urologic cancers.depend on many interrelated factors, such as obesity, diet, genetics, environment, age, and the immune system. Obesity is a risk factor for stress urinary incontinence, ED, infertility, and renal calculi. Numerous publications have demonstrated that a high dietary intake of fat increases prostate cancer risk, although the mechanisms are not clear. Although some reports may demonstrate an association between obesity and prostate cancer, it may be hard to establish because, in general, men with obesity have a high-fat diet. Obesity, recurrent urinary tract infections, increased intake of protein and fried foods, and female sex seem to increase the risk of renal cancer. Environmental toxins seem to be the major factors affecting the incidence of bladder cancers. Thus, dietary modification and other public health measures directed at reducing weight may reduce the incidence of urologic illnesses. More studies are necessary to determine the therapeutic effects of weight loss and dietary modification on the incidence and progression of urologic tumors.

Smoking, body weight, physical exercise, and risk of lower limb total joint replacement in a population-based cohort of men.

PubMed

Mnatzaganian, George; Ryan, Philip; Norman, Paul E; Davidson, David C; Hiller, Janet E

2011-08-01

To assess the associations of smoking, body weight, and physical activity with risk of undergoing total joint replacement (TJR) in a population-based cohort of men. A cohort study of 11,388 men that integrated clinical data with hospital morbidity data and mortality records was undertaken. The risk of undergoing TJR was modeled on baseline weight, height, comorbidity, socioeconomic status, years of smoking, and exercise in 3 separate age groups, using Cox proportional hazards regressions and competing risk regressions (CRRs). Dose-response relationships between weight and risk of TJR and between smoking and risk of TJR were observed. Being overweight independently increased the risk of TJR, while smoking lowered the risk. The decreased risk among smokers was demonstrated in both Cox and CRR models and became apparent after 23 years of exposure. Men who were in the highest quartile (≥48 years of smoking) were 42-51% less likely to undergo TJR than men who had never smoked. Tests for trend in the log hazard ratios (HRs) across both smoking and weight quantiles yielded significant P values. Vigorous exercise increased the hazard of TJR; however, the association reached statistical significance only in the 70-74-year-old age group (adjusted HR 1.64 [95% confidence interval 1.19-2.24]). Adjusting for Deyo-Charlson Index or Elixhauser's comorbidity measures did not eliminate these associations. Our findings indicate that being overweight and reporting vigorous physical activity increase the risk of TJR. This study is the first to demonstrate a strong inverse dose-response relationship between duration of smoking and risk of TJR. More research is needed to better understand the role of smoking in the pathogenesis of osteoarthritis. Copyright © 2011 by the American College of Rheumatology.

Evaluating Anthropogenic Risk of Grassland and Forest Habitat Degradation Using Land-Cover Data

EPA Science Inventory

The effects of landscape context on habitat quality are receiving increased attention in conservation biology. The objective of this research is to demonstrate an approach to mapping and evaluating the anthropogenic risks of grassland and forest habitat degradation by examining ...

Lessons from the atomic bomb about secondary MDS.

PubMed

Hata, Tomoko; Imanishi, Daisuke; Miyazaki, Yasushi

2014-12-01

Myelodysplastic syndromes (MDSs) is a hematological neoplasm defined by ineffective hematopoiesis, dysplasia of hematopoietic cells, and risk of progression to acute leukemia. MDS occurs as de novo or secondary, and chemoradiotherapy for cancers is thought to increase the risk of MDS among patients. Recently, an epidemiological study for MDS among A-bomb survivors was performed, and it clearly demonstrated that the exposure to external radiation significantly increased the risk of MDS. Precise epidemiological data among survivors have revealed important clinical factors related to the risk of leukemias. In this review, by comparing data for secondary MDS and leukemia/MDS among survivors, several factors which would affect the risk of MDS, especially secondary MDS, are discussed.

The risk of predation favors cooperation among breeding prey

PubMed Central

Krama, Tatjana; Berzins, Arnis; Rantala, Markus J

2010-01-01

Empirical studies have shown that animals often focus on short-term benefits under conditions of predation risk, which reduces the likelihood that they will cooperate with others. However, some theoretical studies predict that animals in adverse conditions should not avoid cooperation with their neighbors since it may decrease individual risks and increase long-term benefits of reciprocal help. We experimentally tested these two alternatives to find out whether increased predation risk enhances or diminishes the occurrence of cooperation in mobbing, a common anti-predator behavior, among breeding pied flycatchers, Ficedula hypoleuca. Our results show that birds attended mobs initiated by their neighbors more often, approached the stuffed predator significantly more closely, and mobbed it at a higher intensity in areas where the perceived risk of predation was experimentally increased. This study demonstrates a positive impact of predation risk on cooperation in breeding songbirds, which might help to explain the emergence and evolution of cooperation. PMID:20714404

The cardiovascular safety trials of DPP-4 inhibitors, GLP-1 agonists, and SGLT2 inhibitors.

PubMed

Secrest, Matthew H; Udell, Jacob A; Filion, Kristian B

2017-04-01

In this paper, we review the results of large, double-blind, placebo-controlled randomized trials mandated by the US Food and Drug Administration to examine the cardiovascular safety of newly-approved antihyperglycemic agents in patients with type 2 diabetes. The cardiovascular effects of dipeptidyl peptidase-4 (DPP-4) inhibitors remain controversial: while these drugs did not reduce or increase the risk of primary, pre-specified composite cardiovascular outcomes, one DPP-4 inhibitor (saxagliptin) increased the risk of hospitalization for heart failure in the overall population; another (alogliptin) demonstrated inconsistent effects on heart failure hospitalization across subgroups of patients, and a third (sitagliptin) demonstrated no effect on heart failure. Evidence for cardiovascular benefits of glucagon-like peptide-1 (GLP-1) agonists has been similarly heterogeneous, with liraglutide and semaglutide reducing the risk of composite cardiovascular outcomes, but lixisenatide having no reduction or increase in cardiovascular risk. The effect of GLP-1 agonists on retinopathy remains a potential concern. In the only completed trial to date to assess a sodium-glucose cotransporter-2 (SGLT2) inhibitor, empagliflozin reduced the risk of composite cardiovascular endpoints, predominantly through its impact on cardiovascular mortality and heart failure hospitalization. Copyright © 2017 Elsevier Inc. All rights reserved.

Subclinical hyperthyroidism and cardiovascular risk: recommendations for treatment.

PubMed

Palmeiro, Christopher; Davila, Maria I; Bhat, Mallika; Frishman, William H; Weiss, Irene A

2013-01-01

Subclinical hyperthyroidism (SHy), the mildest form of hyperthyroidism, is diagnosed in patients having a persistently low or undetectable serum concentration of thyroid-stimulating hormone (TSH) with normal free T4 and T3 concentrations. Although overt hyperthyroidism is associated with an increased risk of adverse cardiovascular outcomes, the cardiovascular risk of SHy is controversial. Multiple studies have demonstrated an increased risk of atrial fibrillation, especially in older individuals with TSH levels <0.1 mU/L. The effects of SHy on all-cause and cardiovascular mortality are not clear, but recent meta-analyses suggest a modest increase in mortality, with the risk increasing with age and associated with the lowest TSH levels. The long-term consequences of SHy in young- and middle-aged adults, and in those with TSH levels are mildly low, are uncertain. For these reasons, guidelines for treatment are based on patient age, the degree of TSH suppression, symptoms consistent with hyperthyroidism, and overall cardiovascular and osteoporotic fracture risks.

Climate warming enhances snow avalanche risk in the Western Himalayas

PubMed Central

Ballesteros-Cánovas, J. A.; Trappmann, D.; Madrigal-González, J.; Eckert, N.; Stoffel, M.

2018-01-01

Ongoing climate warming has been demonstrated to impact the cryosphere in the Indian Himalayas, with substantial consequences for the risk of disasters, human well-being, and terrestrial ecosystems. Here, we present evidence that the warming observed in recent decades has been accompanied by increased snow avalanche frequency in the Western Indian Himalayas. Using dendrogeomorphic techniques, we reconstruct the longest time series (150 y) of the occurrence and runout distances of snow avalanches that is currently available for the Himalayas. We apply a generalized linear autoregressive moving average model to demonstrate linkages between climate warming and the observed increase in the incidence of snow avalanches. Warming air temperatures in winter and early spring have indeed favored the wetting of snow and the formation of wet snow avalanches, which are now able to reach down to subalpine slopes, where they have high potential to cause damage. These findings contradict the intuitive notion that warming results in less snow, and thus lower avalanche activity, and have major implications for the Western Himalayan region, an area where human pressure is constantly increasing. Specifically, increasing traffic on a steadily expanding road network is calling for an immediate design of risk mitigation strategies and disaster risk policies to enhance climate change adaption in the wider study region. PMID:29535224

Changes in Cross-Correlations as an Indicator for Systemic Risk

NASA Astrophysics Data System (ADS)

Zheng, Zeyu; Podobnik, Boris; Feng, Ling; Li, Baowen

2012-11-01

The 2008-2012 global financial crisis began with the global recession in December 2007 and exacerbated in September 2008, during which the U.S. stock markets lost 20% of value from its October 11 2007 peak. Various studies reported that financial crisis are associated with increase in both cross-correlations among stocks and stock indices and the level of systemic risk. In this paper, we study 10 different Dow Jones economic sector indexes, and applying principle component analysis (PCA) we demonstrate that the rate of increase in principle components with short 12-month time windows can be effectively used as an indicator of systemic risk--the larger the change of PC1, the higher the increase of systemic risk. Clearly, the higher the level of systemic risk, the more likely a financial crisis would occur in the near future.

Are health-based payments a feasible tool for addressing risk segmentation?

PubMed

Rogal, D L; Gauthier, A K

1998-01-01

As they attempt to increase health insurance coverage and improve the efficiency of the market, researchers, policymakers, and health plan representatives have been addressing the issue of risk segmentation. Many risk assessment tools and risk-adjusted payment methodologies have been developed and demonstrated for a variety of populations and payers experiencing various market constraints. The evidence shows that risk-adjusted payments are feasible for most populations receiving acute care, while technical obstacles, political issues, and some research gaps remain.

[Association of body mass index and aerobic physical fitness with cardiovascular risk factors in children].

PubMed

Gonçalves, Reginaldo; Szmuchrowski, Leszek Antony; Damasceno, Vinícius Oliveira; de Medeiros, Marcelo Lemos; Couto, Bruno Pena; Lamounier, Joel Alves

2014-09-01

To identify the association between both, body mass index and aerobic fitness, with cardiovascular disease risk factors in children. Cross-sectional study, carried out in Itaúna-MG, in 2010, with 290 school children ranging from 6 to 10 years-old of both sexes, randomly selected. Children from schools located in the countryside and those with medical restrctions for physical activity were not included. Blood sample was collected after a 12-hour fasting period. Blood pressure, stature and weight were evaluated in accordance with international standards. The following were considered as cardiovascular risk factors: high blood pressure, high total cholesterol, LDL, triglycerides and insulin levels, and low HDL. The statistical analysis included the Spearman's coefficient and the logistic regression, with cardiovascular risk factors as dependent variables. Significant correlations were found, in both sexes, among body mass index and aerobic fitness with most of the cardiovascular risk factors. Children of both sexes with body mass index in the fourth quartile demonstrated increased chances of having high blood insulin and clustering cardiovascular risk factors. Moreover, girls with aerobic fitness in the first quartile also demonstrated increased chances of having high blood insulin and clustering cardiovascular risk factors. The significant associations and the increased chances of having cardiovascular risk factors in children with less aerobic fitness and higher levels of body mass index justify the use of these variables for health monitoring in Pediatrics. Copyright © 2014 Sociedade de Pediatria de São Paulo. Publicado por Elsevier Editora Ltda. All rights reserved.

Effects of a school-based intensive intervention on systemic inflammation and disease risk in Mexican-American children

USDA-ARS?s Scientific Manuscript database

Childhood obesity is associated with an increased risk for cardiovascular disease and type 2 Diabetes mellitus. Systemic inflammation is thought to mediate this relationship. We have previously demonstrated that an intervention designed specifically for Mexican-American children that incorporates bo...

Do as I Say: Using Communication Role-Plays to Assess Sexual Assertiveness Following an Intervention

ERIC Educational Resources Information Center

Mercer Kollar, Laura M.; Davis, Teaniese L.; Monahan, Jennifer L.; Samp, Jennifer A.; Coles, Valerie B.; Bradley, Erin L. P.; Sales, Jessica McDermott; Comer, Sarah K.; Worley, Timothy; Rose, Eve; DiClemente, Ralph J.

2016-01-01

Sexual risk reduction interventions are often ineffective for women who drink alcohol. The present study examines whether an alcohol-related sexual risk reduction intervention successfully trains women to increase assertive communication behaviors and decrease aggressive communication behaviors. Women demonstrated their communication skills during…

GPSS computer simulation of aircraft passenger emergency evacuations.

DOT National Transportation Integrated Search

1978-06-01

The costs of civil air transport emergency evacuation demonstrations using human subjects have risen as seating capacities of these aircraft have increased. Repeated tests further increase the costs and also the risks of injuries to participants. A m...

Bradycardia as a Marker of Chronic Cocaine Use: A Novel Cardiovascular Finding.

PubMed

Sharma, Jyoti; Rathnayaka, Nuvan; Green, Charles; Moeller, F Gerard; Schmitz, Joy M; Shoham, Daniel; Dougherty, Anne Hamilton

2016-01-01

Few studies have examined the effects of chronic cocaine use on the resting surface electrocardiogram (ECG) between exposures to cocaine. Researchers compared 12-lead ECGs from 97 treatment-seeking cocaine-dependent patients, with ECG parameters from 8,513 non-cocaine-using control patients from the Atherosclerosis Risk in Communities study. After matching and adjusting for relevant covariates, cocaine use demonstrated large and statistically reliable effects on early repolarization, bradycardia, severe bradycardia, and heart rate. Current cocaine dependence corresponds to an increased odds of demonstrating early repolarization by a factor of 4.92 and increased odds of bradycardia and severe bradycardia by factors 3.02 and 5.11, respectively. This study demonstrates the novel finding that long-lasting effects of cocaine use on both the cardiac conduction and the autonomic nervous system pose a risk of adverse cardiovascular events between episodes of cocaine use, and that bradycardia is a marker of chronic cocaine use.

Assessment of the Relationship between the Shape of the Lateral Meniscus and the Risk of Extrusion Based on MRI Examination of the Knee Joint.

PubMed

Szarmach, Arkadiusz; Luczkiewicz, Piotr; Skotarczak, Monika; Kaszubowski, Mariusz; Winklewski, Pawel J; Dzierzanowski, Jaroslaw; Piskunowicz, Maciej; Szurowska, Edyta; Baczkowski, Bogusław

2016-01-01

Meniscus extrusion is a serious and relatively frequent clinical problem. For this reason the role of different risk factors for this pathology is still the subject of debate. The goal of this study was to verify the results of previous theoretical work, based on the mathematical models, regarding a relationship between the cross-section shape of the meniscus and the risk of its extrusion. Knee MRI examination was performed in 77 subjects (43 men and 34 women), mean age 34.99 years (range: 18-49 years), complaining of knee pain. Patients with osteoarthritic changes (grade 3 and 4 to Kellgren classification), varus or valgus deformity and past injuries of the knee were excluded from the study. A 3-Tesla MR device was used to study the relationship between the shape of the lateral meniscus (using slope angle, meniscus-cartilage height and meniscus-bone angle) and the risk of extrusion. Analysis revealed that with values of slope angle and meniscus-bone angle increasing by one degree, the risk of meniscus extrusion raises by 1.157 and 1.078 respectively. Also, an increase in meniscus-cartilage height by 1 mm significantly elevates the risk of extrusion. At the same time it was demonstrated that for meniscus-bone angle values over 42 degrees and slope angle over 37 degrees the risk of extrusion increases significantly. This was the first study to demonstrate a tight correlation between slope angle, meniscus-bone angle and meniscus-cartilage height values in the assessment of the risk of lateral meniscus extrusion. Insertion of the above parameters to the radiological assessment of the knee joint allows identification of patients characterized by an elevated risk of development of this pathology.

Physical contact and financial risk taking.

PubMed

Levav, Jonathan; Argo, Jennifer J

2010-06-01

We show that minimal physical contact can increase people's sense of security and consequently lead them to increased risk-taking behavior. In three experiments, with both hypothetical and real payoffs, a female experimenter's light, comforting pat on the shoulder led participants to greater financial risk taking. Further, this effect was both mediated and moderated by feelings of security in both male and female participants. Finally, we established the boundary conditions for the impact of physical contact on risk-taking behaviors by demonstrating that the effect does not occur when the touching is performed by a male and is attenuated when the touch consists of a handshake. The results suggest that subtle physical contact can be strongly influential in decision making and the willingness to accept risk.

Sex differences and HIV risk behaviors: the interaction between the experience of multiple types of abuse and self-restraint on HIV risk behaviors.

PubMed

Conrad, Selby M; Swenson, Rebecca R; Hancock, Evan; Brown, Larry K

2014-01-01

Adolescents with abuse histories have been shown to be at increased risk to acquire human immunodeficiency virus and sexually transmitted infections. In addition, teens with lower levels of self-restraint or higher levels of distress, such as those with psychiatric concerns, have also demonstrated increased sexual risk behaviors. This study explored sex differences in sexual risk behaviors among a sample of adolescents in a therapeutic/alternative high school setting. Moderated regression analysis showed that a lower level of self-restraint was associated with sexual risk behaviors in boys but not in girls. Rather, the interaction of self-restraint and multiple types of abuse was associated with greater sex risk within girls in this sample. Results suggest that girls and boys with abuse histories and low levels of self-restraint may have different intervention needs related to sexual risk behaviors.

A PARENT–ADOLESCENT INTERVENTION TO INCREASE SEXUAL RISK COMMUNICATION: RESULTS OF A RANDOMIZED CONTROLLED TRIAL

PubMed Central

Villarruel, Antonia M.; Cherry, Carol Loveland; Cabriales, Esther Gallegos; Ronis, David L.; Zhou, Yan

2009-01-01

This article reports results of a randomized controlled trial designed to test an intervention to increase parent–adolescent sexual risk communication among Mexican parents. Data were analyzed from parents (n = 791) randomly assigned to an HTV risk reduction or health promotion intervention. Measures were administered at pretest, posttest, and 6– and 12–month follow–ups. Generalized estimation equation (GEE) analysis indicates parents in the HIV risk reduction intervention reported significantly more general communication (p < .005), more sexual risk communication (p < .001) and more comfort with communication (p < .001) than parents in the control intervention. Behavioral, normative, and control beliefs significantly mediated the effect of the intervention on all communication outcomes. This study demonstrates the efficacy of an intervention to increase the quality and quantity of parent–adolescent communication related to general and sex–specific communication. PMID:18956979

Disasters as a necessary part of benefit-cost analyses.

PubMed

Mark, R K; Stuart-Alexander, D E

1977-09-16

Benefit-cost analyses for water projects generally have not included the expected costs (residual risk) of low-probability disasters such as dam failures, impoundment-induced earthquakes, and landslides. Analysis of the history of these types of events demonstrates that dam failures are not uncommon and that the probability of a reservoir-triggered earth-quake increases with increasing reservoir depth. Because the expected costs from such events can be significant and risk is project-specific, estimates should be made for each project. The cost of expected damage from a "high-risk" project in an urban area could be comparable to project benefits.

Evaluating Potential Response-Modifying Factors for Associations between Ozone and Health Outcomes: A Weight-of-Evidence Approach

EPA Science Inventory

Epidemiologic and experimental studies have demonstrated a variety of health effects in response to ozone (O3) exposure. Studies have demonstrated that some populations may be at increased risk of O3-related health effects. Objectives: To identify populations and lifestages pote...

The media and genetically modified foods: evidence in support of social amplification of risk.

PubMed

Frewer, Lynn J; Miles, Susan; Marsh, Roy

2002-08-01

Empirical examinations of the "social amplification of risk" framework are rare, partly because of the difficulties in predicting when conditions likely to result in amplification effects will occur. This means that it is difficult to examine changes in risk perception that are contemporaneous with increases and/or decreases in social or media discussion of the risks associated with a particular risk event. However, the collection of attitude data before, during, and after the increased reporting of the risks of genetically modified food in the United Kingdom (spring 1999) has demonstrated that people's risk perceptions do increase and decrease in line with what might be expected upon examination of the amplification and attenuation mechanisms integral to the framework. Perceptions of benefit, however, appeared to be permanently depressed by negative reporting about genetically modified food. Trust in regulatory institutions with responsibility for protecting the public was not affected. It was concluded that the social amplification of risk framework is a useful framework for beginning to explain the potential impact on risk perceptions of a risk event, particularly if that risk event is presented to the public as a new hazard occurring in a crisis context.

Epigenetics of inflammation, maternal infection and nutrition

USDA-ARS?s Scientific Manuscript database

Studies have demonstrated that epigenetic changes such as DNA methylation, histone modification, and chromatin remodeling are linked to an increased inflammatory response as well as increased risk for chronic disease development. A few studies have begun to investigate whether dietary nutrients play...

Usefulness of two clinical chorioamnionitis definitions in predicting neonatal infectious outcomes: a systematic review.

PubMed

Avila, Cecilia; Willins, Jennifer L; Jackson, Matthew; Mathai, Jacob; Jabsky, Marina; Kong, Alex; Callaghan, Fiona; Ishkin, Selda; Shroyer, A Laurie W

2015-09-01

To assess the usefulness of two definitions of acute clinical chorioamnionitis (ACCA) in predicting risk of neonatal infectious outcomes (NIO) and mortality, the first definition requiring maternal fever alone (Fever), and the second requiring ≥ 1 Gibbs criterion besides fever (Fever + 1). PubMed, Web of Science, and the Cochrane Database of Systematic Reviews were searched from January 1, 1979 to April 9, 2013. Twelve studies were reviewed (of 316 articles identified): three studies with term patients, four with preterm premature rupture of membranes (PPROM) patients, and five mixed studies with mixed gestational ages and/or membrane status (intact and/or ruptured). Both definitions demonstrated an increased NIO risk for ACCA versus non-ACCA patients, with an odds ratio increase for the Fever + 1 definition that was about twofold larger than the Fever definition. As the Fever definition demonstrated increased NIO risk for ACCA versus non-ACCA patients, the Fever alone ACCA definition should be used to trigger future clinical treatment in many clinical situations. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Assessing cardiac risks in police officers.

PubMed

Brown, J; Trottier, A

1995-12-01

It is necessary to assess the cardiovascular risks of police officers in order to address the issue of police officer safety, as well as the issue of public safety. In the past there has been a tendency to determine these risks according to the presence or absence of demonstrable ischaemia. Increased understanding of pathophysiology of coronary vascular disease leads to a different approach to this problem. This modified approach is discussed.

Gender specific effect of psychological stress and cortisol reactivity on adolescent risk taking.

PubMed

Daughters, Stacey B; Gorka, Stephanie M; Matusiewicz, Alexis; Anderson, Katelyn

2013-07-01

The purpose of this study was to evaluate how psychological stress, gender and cortisol response to stress relate to risk behavior among 132 14-18 year old adolescents. Participants completed a laboratory based risk task prior to and immediately after a computerized psychological stress task, and salivary cortisol was collected from pre-stress to 60 min following initial stress exposure. Results indicate that adolescent boys (n = 59) and girls (n = 73) demonstrate different patterns of risk taking (RT) in response to stress, such that boys evidenced an increase in RT following stress exposure, whereas girls evidenced a decrease in RT. In addition, a gender by cortisol interaction demonstrated that for boys, both a smaller total cortisol output (AUCg) and peak cortisol response to stress (PC) was associated with greater stress-induced RT. Both cortisol measures were unrelated to stress-induced RT among girls. Taken together, data suggest that among boys, a blunted cortisol response to stress underlies an increase in risk taking in the context of psychological stress. Further research with an additional behavioral stress task is needed prior to drawing conclusions regarding the relation between female gender, cortisol response to stress, and risk taking in the context of psychological stress.

Injury Prevention: What Music Teachers Can Do

ERIC Educational Resources Information Center

Guptill, Christine; Zaza, Christine

2010-01-01

The risk of injury in musicians has been well established over the past twenty-five years. Concerns about the risk of becoming injured have been increasingly present in the music world. Research in performing arts medicine has demonstrated that approximately 25 percent of music students experience a playing-related injury. Since musicians'…

Youth Risk Behavior Surveillance--United States, 1999. CDC Surveillance Summaries.

ERIC Educational Resources Information Center

MMWR: Morbidity and Morality Weekly Report, 2000

2000-01-01

In the United States, approximately three-fourths of all deaths among persons aged 10-24 years result from only four causes: motor-vehicle crashes, other unintentional injuries, homicide, and suicide. Results from this 1999 national Youth Risk Behavior Survey demonstrate that numerous high school students engage in behaviors that increase the…

Parental Characteristics and Resiliency in Identification Rates for Special Education

ERIC Educational Resources Information Center

Anderson, Jeffrey A.; Howland, Allison A.; McCoach, D. Betsy

2015-01-01

Even with increased risks, many children demonstrate resiliency and avoid being labeled for special education; however, research on risk and resilience has been problematic because of inadequate statistical models, limitations of available data, and the exclusion of key protective factors. This study used a national sample to examine the influence…

Just-in-Time Training for High-Risk Low-Volume Therapies: An Approach to Ensure Patient Safety.

PubMed

Helman, Stephanie; Lisanti, Amy Jo; Adams, Ann; Field, Cynthia; Davis, Katherine Finn

2016-01-01

High-risk low-volume therapies are those therapies that are practiced infrequently and yet carry an increased risk to patients because of their complexity. Staff nurses are required to competently manage these therapies to treat patients' unique needs and optimize outcomes; however, maintaining competence is challenging. This article describes implementation of Just-in-Time Training, which requires validation of minimum competency of bedside nurses managing high-risk low-volume therapies through direct observation of a return-demonstration competency checklist.

Falls and Fall Prevention in Older Adults With Early-Stage Dementia: An Integrative Review.

PubMed

Lach, Helen W; Harrison, Barbara E; Phongphanngam, Sutthida

2017-05-01

Older adults with mild cognitive impairment (MCI) and early-stage dementia have an increased risk of falling, with risks to their health and quality of life. The purpose of the current integrative review was to evaluate evidence on fall risk and fall prevention in this population. Studies were included if they examined falls or fall risk factors in older adults with MCI or early-stage dementia, or reported interventions in this population; 40 studies met criteria. Evidence supports the increased risk of falls in individuals even in the early stages of dementia or MCI, and changes in gait, balance, and fear of falling that may be related to this increased fall risk. Interventions included exercise and multifactorial interventions that demonstrated some potential to reduce falls in this population. Few studies had strong designs to provide evidence for recommendations. Further study in this area is warranted. [Res Gerontol Nurs. 2017; 10(03):139-148.]. Copyright 2016, SLACK Incorporated.

Ensemble Flow Forecasts for Risk Based Reservoir Operations of Lake Mendocino in Mendocino County, California

NASA Astrophysics Data System (ADS)

Delaney, C.; Hartman, R. K.; Mendoza, J.; Evans, K. M.; Evett, S.

2016-12-01

Forecast informed reservoir operations (FIRO) is a methodology that incorporates short to mid-range precipitation or flow forecasts to inform the flood operations of reservoirs. Previous research and modeling for flood control reservoirs has shown that FIRO can reduce flood risk and increase water supply for many reservoirs. The risk-based method of FIRO presents a unique approach that incorporates flow forecasts made by NOAA's California-Nevada River Forecast Center (CNRFC) to model and assess risk of meeting or exceeding identified management targets or thresholds. Forecasted risk is evaluated against set risk tolerances to set reservoir flood releases. A water management model was developed for Lake Mendocino, a 116,500 acre-foot reservoir located near Ukiah, California. Lake Mendocino is a dual use reservoir, which is owned and operated for flood control by the United State Army Corps of Engineers and is operated by the Sonoma County Water Agency for water supply. Due to recent changes in the operations of an upstream hydroelectric facility, this reservoir has been plagued with water supply reliability issues since 2007. FIRO is applied to Lake Mendocino by simulating daily hydrologic conditions from 1985 to 2010 in the Upper Russian River from Lake Mendocino to the City of Healdsburg approximately 50 miles downstream. The risk-based method is simulated using a 15-day, 61 member streamflow hindcast by the CNRFC. Model simulation results of risk-based flood operations demonstrate a 23% increase in average end of water year (September 30) storage levels over current operations. Model results show no increase in occurrence of flood damages for points downstream of Lake Mendocino. This investigation demonstrates that FIRO may be a viable flood control operations approach for Lake Mendocino and warrants further investigation through additional modeling and analysis.

Diabetes Drugs and Cardiovascular Safety

PubMed Central

2016-01-01

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

Factoring attitudes towards armed conflict risk into selection of protected areas for conservation

PubMed Central

Hammill, E.; Tulloch, A. I. T.; Possingham, H. P.; Strange, N.; Wilson, K. A.

2016-01-01

The high incidence of armed conflicts in biodiverse regions poses significant challenges in achieving international conservation targets. Because attitudes towards risk vary, we assessed different strategies for protected area planning that reflected alternative attitudes towards the risk of armed conflicts. We find that ignoring conflict risk will deliver the lowest return on investment. Opting to completely avoid conflict-prone areas offers limited improvements and could lead to species receiving no protection. Accounting for conflict by protecting additional areas to offset the impacts of armed conflicts would not only increase the return on investment (an effect that is enhanced when high-risk areas are excluded) but also increase upfront conservation costs. Our results also demonstrate that fine-scale estimations of conflict risk could enhance the cost-effectiveness of investments. We conclude that achieving biodiversity targets in volatile regions will require greater initial investment and benefit from fine-resolution estimates of conflict risk. PMID:27025894

Factoring attitudes towards armed conflict risk into selection of protected areas for conservation.

PubMed

Hammill, E; Tulloch, A I T; Possingham, H P; Strange, N; Wilson, K A

2016-03-30

The high incidence of armed conflicts in biodiverse regions poses significant challenges in achieving international conservation targets. Because attitudes towards risk vary, we assessed different strategies for protected area planning that reflected alternative attitudes towards the risk of armed conflicts. We find that ignoring conflict risk will deliver the lowest return on investment. Opting to completely avoid conflict-prone areas offers limited improvements and could lead to species receiving no protection. Accounting for conflict by protecting additional areas to offset the impacts of armed conflicts would not only increase the return on investment (an effect that is enhanced when high-risk areas are excluded) but also increase upfront conservation costs. Our results also demonstrate that fine-scale estimations of conflict risk could enhance the cost-effectiveness of investments. We conclude that achieving biodiversity targets in volatile regions will require greater initial investment and benefit from fine-resolution estimates of conflict risk.

PROBABILISTIC RISK ASSESSMENT FOR THE EFFECTS OF SOLAR ULTRAVIOLET RADIATION ON AMPHIBIANS

EPA Science Inventory

Several studies have demonstrated that exposure to solar ultraviolet (UV) radiation can cause elevated mortality and an increased prevalence of eye and limb malformations in developing amphibian larvae. From these observations scientists have hypothesized that recent increases in...

Cervical HSV-2 infection causes cervical remodeling and increases risk for ascending infection and preterm birth.

PubMed

McGee, Devin; Smith, Arianna; Poncil, Sharra; Patterson, Amanda; Bernstein, Alison I; Racicot, Karen

2017-01-01

Preterm birth (PTB), or birth before 37 weeks gestation, is the leading cause of neonatal mortality worldwide. Cervical viral infections have been established as risk factors for PTB in women, although the mechanism leading to increased risk is unknown. Using a mouse model of pregnancy, we determined that intra-vaginal HSV2 infection caused increased rates of preterm birth following an intra-vaginal bacterial infection. HSV2 infection resulted in histological changes in the cervix mimicking cervical ripening, including significant collagen remodeling and increased hyaluronic acid synthesis. Viral infection also caused aberrant expression of estrogen and progesterone receptor in the cervical epithelium. Further analysis using human ectocervical cells demonstrated a role for Src kinase in virus-mediated changes in estrogen receptor and hyaluronic acid expression. In conclusion, HSV2 affects proteins involved in tissue hormone responsiveness, causes significant changes reminiscent of premature cervical ripening, and increases risk of preterm birth. Studies such as this improve our chances of identifying clinical interventions in the future.

Cervical HSV-2 infection causes cervical remodeling and increases risk for ascending infection and preterm birth

PubMed Central

McGee, Devin; Poncil, Sharra; Patterson, Amanda

2017-01-01

Preterm birth (PTB), or birth before 37 weeks gestation, is the leading cause of neonatal mortality worldwide. Cervical viral infections have been established as risk factors for PTB in women, although the mechanism leading to increased risk is unknown. Using a mouse model of pregnancy, we determined that intra-vaginal HSV2 infection caused increased rates of preterm birth following an intra-vaginal bacterial infection. HSV2 infection resulted in histological changes in the cervix mimicking cervical ripening, including significant collagen remodeling and increased hyaluronic acid synthesis. Viral infection also caused aberrant expression of estrogen and progesterone receptor in the cervical epithelium. Further analysis using human ectocervical cells demonstrated a role for Src kinase in virus-mediated changes in estrogen receptor and hyaluronic acid expression. In conclusion, HSV2 affects proteins involved in tissue hormone responsiveness, causes significant changes reminiscent of premature cervical ripening, and increases risk of preterm birth. Studies such as this improve our chances of identifying clinical interventions in the future. PMID:29190738

Temporal association of cannabis use with symptoms in individuals at clinical high risk for psychosis.

PubMed

Corcoran, Cheryl M; Kimhy, David; Stanford, Arielle; Khan, Shamir; Walsh, Julie; Thompson, Judy; Schobel, Scott; Harkavy-Friedman, Jill; Goetz, Ray; Colibazzi, Tiziano; Cressman, Victoria; Malaspina, Dolores

2008-12-01

Cannabis use is reported to increase the risk for psychosis, but no prospective study has longitudinally examined drug use and symptoms concurrently in clinical high risk cases. We prospectively followed for up to 2 years 32 cases who met research criteria for prodromal psychosis to examine the relationship between substance use and clinical measures. Cases with a baseline history of cannabis use (41%) were older, but did not differ in clinical measures. Longitudinal assessments showed these cases had significantly more perceptual disturbances and worse functioning during epochs of increased cannabis use that were unexplained by concurrent use of other drugs or medications. These data demonstrate that cannabis use may be a risk factor for the exacerbation of subthreshold psychotic symptoms, specifically perceptual disturbances, in high risk cases.

The increased risk of predation enhances cooperation

PubMed Central

Krams, Indrikis; Bērziņš, Arnis; Krama, Tatjana; Wheatcroft, David; Igaune, Kristīne; Rantala, Markus J.

2010-01-01

Theory predicts that animals in adverse conditions can decrease individual risks and increase long-term benefits by cooperating with neighbours. However, some empirical studies suggest that animals often focus on short-term benefits, which can reduce the likelihood that they will cooperate with others. In this experimental study, we tested between these two alternatives by evaluating whether increased predation risk (as a correlate of environmental adversity) enhances or diminishes the occurrence of cooperation in mobbing, a common anti-predator behaviour, among breeding pied flycatchers Ficedula hypoleuca. We tested whether birds would join their mobbing neighbours more often and harass a stuffed predator placed near their neighbours' nests more intensely in areas with a higher perceived risk of predation. Our results show that birds attended mobs initiated by their neighbours more often, approached the stuffed predator significantly more closely, and mobbed it at a higher intensity in areas where the perceived risk of predation was experimentally increased. In such high-risk areas, birds also were more often involved in between-pair cooperation. This study demonstrates the positive impact of predation risk on cooperation in breeding songbirds, which might help in explaining the emergence and evolution of cooperation. PMID:19846454

Long-term effects of ovulation-stimulating drugs on cancer risk.

PubMed

Brinton, Louise

2007-07-01

Although nulliparity has been extensively related to the risk of ovarian, breast and endometrial cancers, with many studies showing the relationship largely attributable to infertility, treatment effects on cancer risk are poorly understood. Two early studies raised substantial concern when ovulation-stimulating drugs were linked with large increases in ovarian cancer, supporting the notion of an important aetiological role of incessant ovulation. Subsequent studies have been mainly reassuring, although some have suggested possible risk increases among nulligravid women, those with extensive follow-up, and those developing borderline tumours. Results regarding effects of fertility drugs on breast cancer risk are conflicting, with some showing no associations and others demonstrating possible risk increases, although for varying subgroups. In contrast, endometrial cancer results are more consistent, with two recent studies showing increased risks related to clomiphene usage. This is of interest given that clomiphene is structurally similar to tamoxifen, a drug extensively linked with this cancer. Given the recent marketing of fertility drugs and the fact that exposed women are only beginning to reach the cancer age range, further follow-up is necessary. This will also be important to fully resolve effects of exposures such as gonadotrophins, used more recently in conjunction with IVF.

76 FR 9772 - Adequacy of Arizona Municipal Solid Waste Landfill Permit Program

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-22

...) permit program to allow the State to issue research, development, and demonstration (RD&D) permits for... environment. The Director may provide a variance from existing requirements of MSWLF criteria for run-on... demonstrate that compliance with the RD&D permit will not increase risk to human heath and the environment...

Upper gastrointestinal bleeding following transcatheter aortic valve replacement: A retrospective analysis.

PubMed

Stanger, Dylan E; Abdulla, Alym H; Wong, Frank T; Alipour, Sina; Bressler, Brian L; Wood, David A; Webb, John G

2017-08-01

The aim of this study was to identify the incidence of upper gastrointestinal bleeding (UGIB) in the postprocedural period following transcatheter aortic valve replacement (TAVR). As TAVR moves into intermediate- and low-risk patients, it has become increasingly important to understand its extracardiac complications. The patient population undergoing TAVR have clinical and demographic characteristics that place them at significant risk of UGIB. Practical aspects of TAVR, including use of antithrombotic therapy, further increase risk of UGIB. A retrospective single-center evaluation of 841 patients who underwent TAVR between January 2005 and August 2014 was performed in conjunction with analysis of referral patterns to the gastroenterology service for UGIB at the same site. The overall risk of UGIB following TAVR was found to be 2.0% (n = 17/841). Additionally, the risk of UGIB in patients receiving triple antithrombotic therapy was found to be 10-fold greater than patients not receiving triple antithrombotic therapy (11.8% vs 1.0%). Endoscopy findings demonstrated five high-risk esophageal lesions including erosive esophageal ulcers, visible vessels at the GE junction, erosions at distal esophagus, and an actively bleeding esophageal ring that had been intubated through by the transesophageal echocardiography (TEE) probe. This large cohort study demonstrates that TAVR is associated with a moderate risk of severe UGIB. The results of this study suggest that patients on triple antithrombotic therapy are at highest risk for severe UGIB. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Obesity and hormonal contraceptive efficacy.

PubMed

Robinson, Jennifer A; Burke, Anne E

2013-09-01

Obesity is a major public health concern affecting an increasing proportion of reproductive-aged women. Avoiding unintended pregnancy is of major importance, given the increased risks associated with pregnancy, but obesity may affect the efficacy of hormonal contraceptives by altering how these drugs are absorbed, distributed, metabolized or eliminated. Limited data suggest that long-acting, reversible contraceptives maintain excellent efficacy in obese women. Some studies demonstrating altered pharmacokinetic parameters and increased failure rates with combined oral contraceptives, the contraceptive patch and emergency contraceptive pills suggest decreased efficacy of these methods. It is unclear whether bariatric surgery affects hormonal contraceptive efficacy. Obese women should be offered the full range of contraceptive options, with counseling that balances the risks and benefits of each method, including the risk of unintended pregnancy.

Summary of studies on the blue-green autofluorescence and light transmission of the ocular lens

NASA Astrophysics Data System (ADS)

Van Best, Jaap A.; Kuppens, Esmeralda V.

1996-07-01

This paper reviews previous work done to demonstrate the clinical relevance of the measurement of blue-green autofluorescence and light transmission of the ocular lens. These can be determined quantitatively with fluorophotometry in a few seconds. Autofluorescence and transmission values are determined in healthy volunteers, in patients with insulin-dependent diabetes mellitus, and in patients with untreated glaucoma or untreated ocular hypertension. The lens autofluorescence of healthy volunteers increased linearly and transmission decreased exponentially with age. Each year of diabetes induced an increase of autofluorescence equal to one extra year of age. Untreated glaucoma or ocular hypertension had no significant effect on lens autofluorescence and transmission. Increased autofluorescence and decreased transmission values in comparison with values of a healthy population are proved to be indicative for an increased risk of developing cataract and the clinical usefulness of these measures is demonstrated. Diabetes is a risk factor for developing cataracts while untreated glaucoma or ocular hypertension is not.

A risk factor-based predictive model of outcomes in carotid endarterectomy: the National Surgical Quality Improvement Program 2005-2010.

PubMed

Bekelis, Kimon; Bakhoum, Samuel F; Desai, Atman; Mackenzie, Todd A; Goodney, Philip; Labropoulos, Nicos

2013-04-01

Accurate knowledge of individualized risks and benefits is crucial to the surgical management of patients undergoing carotid endarterectomy (CEA). Although large randomized trials have determined specific cutoffs for the degree of stenosis, precise delineation of patient-level risks remains a topic of debate, especially in real world practice. We attempted to create a risk factor-based predictive model of outcomes in CEA. We performed a retrospective cohort study involving patients who underwent CEAs from 2005 to 2010 and were registered in the American College of Surgeons National Quality Improvement Project database. Of the 35 698 patients, 20 015 were asymptomatic (56.1%) and 15 683 were symptomatic (43.9%). These patients demonstrated a 1.64% risk of stroke, 0.69% risk of myocardial infarction, and 0.75% risk of death within 30 days after CEA. Multivariate analysis demonstrated that increasing age, male sex, history of chronic obstructive pulmonary disease, myocardial infarction, angina, congestive heart failure, peripheral vascular disease, previous stroke or transient ischemic attack, and dialysis were independent risk factors associated with an increased risk of the combined outcome of postoperative stroke, myocardial infarction, or death. A validated model for outcome prediction based on individual patient characteristics was developed. There was a steep effect of age on the risk of myocardial infarction and death. This national study confirms that that risks of CEA vary dramatically based on patient-level characteristics. Because of limited discrimination, it cannot be used for individual patient risk assessment. However, it can be used as a baseline for improvement and development of more accurate predictive models based on other databases or prospective studies.

Covariance between predation risk and nutritional preferences confound interpretations of giving-up density experiments.

PubMed

McMahon, Jordan D; Lashley, Marcus A; Brooks, Christopher P; Barton, Brandon T

2018-04-26

Giving-up density (GUD) experiments have been a foundational method to evaluate perceived predation risk, but rely on the assumption that food preferences are absolute, so that areas with higher GUDs can be interpreted as having higher risk. However, nutritional preferences are context dependent and can change with risk. We used spiders and grasshoppers to test the hypothesis that covariance in nutritional preferences and risk may confound the interpretation of GUD experiments. We presented grasshoppers with carbohydrate-rich and protein-rich diets, in the presence and absence of spider predators. Predators reduced grasshopper preference for the protein-rich food, but increased their preference for the carbohydrate-rich food. We then measured GUDs with both food types under different levels of risk (spider density, 0 - 5). As expected, GUDs increased with spider density indicating increasing risk, but only when using protein-rich food. With carbohydrate-rich food, GUD was independent of predation risk. Our results demonstrate that predation risk and nutritional preferences covary and can confound interpretation of GUD experiments. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Evaluating anthropogenic risk of grassland and forest habitat degradation using land-cover data

Treesearch

Kurt Riitters; James Wickham; Timothy Wade

2009-01-01

The effects of landscape context on habitat quality are receiving increased attention in conservation biology. The objective of this research is to demonstrate a landscape-level approach to mapping and evaluating the anthropogenic risks of grassland and forest habitat degradation by examining habitat context as defined by intensive anthropogenic land uses at multiple...

Risk-based HLB surveys: for southern California, statewide and targeted - an analysis of the increasing risk of HLB over the last five years

USDA-ARS?s Scientific Manuscript database

Evidence from Florida, and other citrus-producing areas of the world, clearly demonstrates that huanglongbing (HLB) is not a disease that can be managed effectively by individual growers. Rather, it is a disease which confronts the whole production industry and other stakeholders simultaneously. The...

An Integrated Approach to Change the Outcome Part II: Targeted Neuromuscular Training Techniques to Reduce Identified ACL Injury Risk Factors

PubMed Central

Myer, Gregory D.; Ford, Kevin R.; Brent, Jensen L.; Hewett, Timothy E.

2014-01-01

Prior reports indicate that female athletes who demonstrate high knee abduction moments (KAMs) during landing are more responsive to neuromuscular training designed to reduce KAM. Identification of female athletes who demonstrate high KAM, which accurately identifies those at risk for noncontact anterior cruciate ligament (ACL) injury, may be ideal for targeted neuromuscular training. Specific neuromuscular training targeted to the underlying biomechanical components that increase KAM may provide the most efficient and effective training strategy to reduce noncontact ACL injury risk. The purpose of the current commentary is to provide an integrative approach to identify and target mechanistic underpinnings to increased ACL injury in female athletes. Specific neuromuscular training techniques will be presented that address individual algorithm components related to high knee load landing patterns. If these integrated techniques are employed on a widespread basis, prevention strategies for noncontact ACL injury among young female athletes may prove both more effective and efficient. PMID:22580980

The risk of bladder cancer in patients with urinary calculi: a meta-analysis.

PubMed

Yu, Zhang; Yue, Wu; Jiuzhi, Li; Youtao, Jiang; Guofei, Zhang; Wenbin, Guo

2018-01-05

The objective of this meta-analysis was to evaluate the association between a history of urinary calculi (UC) and the risk of bladder cancer (BC). A literature search was performed from inception until July 2017. Studies that reported odds ratios (OR), relative risks or hazard ratios comparing the risk of BC in patients with the history of UC vs those without the history of UC were included. Pooled odds ratios and 95% confidence interval (CI) were calculated using a random-effect or fixed-effect method. Thirteen studies were included in our analysis to assess the association between a history of UC and risk of BC. The pooled OR of BC in patients with UC was 1.87 (95% CI, 1.45-2.41). Bladder calculi [OR, 2.17 (95% CI, 1.52-3.08)] had a higher risk of BC than kidney calculi [OR, 1.39 (95% CI, 1.06-1.82)]. The subjects had a history of UC that was associated with increased BC risk both in males [OR, 2.04 (95% CI, 1.41-2.96)] and in females [OR, 2.99 (95% CI, 2.37-3.76)]. The subgroup analysis demonstrated that UC increasing risk of BC both in case-control studies [OR, 1.75 (95% CI, 1.25-2.45)] and cohort studies [OR, 2.27 (95% CI, 1.55-3.32)]. The pooled OR of BC risk in patients with UC were 1.60 (95% CI, 1.15-2.24) in America, 1.36 (95% CI, 1.14-1.64) in Europe and 3.05 (95% CI, 2.21-4.21) in Asia, respectively. Our study demonstrates a significant increased risk of BC in patients with prior UC. This finding suggests that a history of UC is associated with BC and may impact clinical management and cancer surveillance. Further studies still needed to confirm the findings.

Analysis of Lrrk2 R1628P as a risk factor for Parkinson's disease.

PubMed

Ross, Owen A; Wu, Yih-Ru; Lee, Mei-Ching; Funayama, Manabu; Chen, Meng-Ling; Soto, Alexandra I; Mata, Ignacio F; Lee-Chen, Guey-Jen; Chen, Chiung Mei; Tang, Michelle; Zhao, Yi; Hattori, Nobutaka; Farrer, Matthew J; Tan, Eng-King; Wu, Ruey-Meei

2008-07-01

Common genetic variants that increase the risk for Parkinson's disease may differentiate patient subgroups and influence future individualized therapeutic strategies. Herein we show evidence for leucine-rich repeat kinase 2 (LRRK2) c.4883G>C (R1628P) as a risk factor in ethnic Chinese populations. A study of 1,986 individuals from 3 independent centers in Taiwan and Singapore demonstrates that Lrrk2 R1628P increases risk for Parkinson's disease (odds ratio, 1.84; 95% confidence interval, 1.20-2.83; p = 0.006). Haplotype analysis suggests an ancestral founder for carriers approximately 2,500 years ago. These findings support the importance of LRRK2 variants in sporadic Parkinson's disease. Ann Neurol 2008.

Sexually transmitted infections and pre-exposure prophylaxis: challenges and opportunities among men who have sex with men in the US.

PubMed

Scott, Hyman M; Klausner, Jeffrey D

2016-01-01

Pre-Exposure Prophylaxis (PrEP) has shown high efficacy in preventing human immunodeficiency virus (HIV) infection among men who have sex with men (MSM) in several large clinical trials, and more recently in "real world" reports of clinical implementation and a PrEP demonstration project. Those studies also demonstrated high bacterial sexually transmitted infection (STI) incidence and raised the discussion of how PrEP may impact STI control efforts, especially in the setting of increasing Neisseria gonorrhoeae antimicrobial resistance and the increase in syphilis cases among MSM. Here, we discuss STIs as a driver of HIV transmission risk among MSM, and the potential opportunities and challenges for STI control afforded by expanded PrEP implementation among high-risk MSM.

Perceived risk and modal choice: risk compensation in transportation systems.

PubMed

Noland, R B

1995-08-01

A transportation mode choice analysis is performed that examines behavioral responses to perceived risk in the choice of mode for daily commute trips. This methodology provides a technique for examining, by means of disaggregate individual level data, risk-compensating effects in transportation systems. Various measures of perceived risk are examined for explaining modal choice. Other studies have described how safety regulations have resulted in increases in "driving intensity." This study defines one component of driving intensity to be the increased probability of commuting by automobile. The results show that modal shifts occur when risk perceptions for a given mode are reduced. To demonstrate potential risk-compensating effects within the transportation system, an estimate of changes in accident fatalities due to commuting is derived using rough estimates of fatalities per person-mile travelled. It is shown that a given change in the perceived risk of commuting by automobile results in a less than proportionate change in net commuting fatalities. The relative magnitude is dependent on how objective reductions in risk translate into perceived reductions in risk. This study also shows that perceived safety improvements in bicycle transportation have an aggregate elasticity value that is greater than one. This means that bicycle safety improvements attract proportionately more people to bicycle commuting (i.e. a 10% increase in safety results in a greater than 10% increase in the share of people bicycle commuting).

Gender and Age Impacts on the Association Between Thyroid Function and Metabolic Syndrome in Chinese

PubMed Central

Meng, Zhaowei; Liu, Ming; Zhang, Qing; Liu, Li; Song, Kun; Tan, Jian; Jia, Qiang; Zhang, Guizhi; Wang, Renfei; He, Yajing; Ren, Xiaojun; Zhu, Mei; He, Qing; Wang, Shen; Li, Xue; Hu, Tianpeng; Liu, Na; Upadhyaya, Arun; Zhou, Pingping; Zhang, Jianping

2015-01-01

Abstract The relationship between thyroid dysfunction and metabolic syndrome (MS) is complex. We aimed to explore the impact of gender and age on their association in a large Chinese cohort. This cross-sectional study enrolled 13,855 participants (8532 male, 5323 female), who self-reported as healthy without any known previous diseases. Clinical data including anthropometric measurements, thyroid function, and serum metabolic parameters were collected. The associations between thyroid function and MS of both genders were analyzed separately after dividing thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), and age into subgroups. MS risks were calculated by binary logistic regression models. Young males had significantly higher MS prevalence than females, yet after menopause, females had higher prevalence than males. Females had higher incidence of thyroid dysfunction than males. By using TSH quartiles as the categorical variables and the lowest quartile as reference, significantly increased MS risk was demonstrated in quartile 4 for males, yet quartiles 3 and 4 for females. By using FT3 quartiles as the categorical variables, significantly increased MS risk was demonstrated in quartile 2 to 4 for females only. By using age subgroups as the categorical variables, significantly increased MS risk was shown in both genders, with females (4.408–58.455) higher than males (2.588–4.943). Gender and age had substantial influence on thyroid function and MS. Females with high TSH and high FT3 had higher MS risks than males. Aging was a risk for MS, especially for females. Urgent need is necessary to initiate interventional programs. PMID:26683929

[Cardiovascular disease and systemic inflammatory diseases].

PubMed

Cuende, José I; Pérez de Diego, Ignacio J; Godoy, Diego

2016-01-01

More than a century of research has shown that atherosclerosis is an inflammatory process more than an infiltrative or thrombogenic process. It has been demonstrated epidemiologically and by imaging techniques, that systemic inflammatory diseases (in particular, but not exclusively, rheumatoid arthritis and systemic lupus erythematosus) increase the atherosclerotic process, and has a demonstrated pathophysiological basis. Furthermore, treatments to control inflammatory diseases can modify the course of the atherosclerotic process. Although there are no specific scales for assessing cardiovascular risk in patients with these diseases, cardiovascular risk is high. A number of specific risk scales are being developed, that take into account specific factors such as the degree of inflammatory activity. Copyright © 2015 Sociedad Española de Arteriosclerosis. Published by Elsevier España. All rights reserved.

The Association Between Body Adiposity Measures, Postural Balance, Fear of Falling, and Fall Risk in Older Community-Dwelling Women.

PubMed

Neri, Silvia Gonçalves Ricci; Gadelha, André Bonadias; de David, Ana Cristina; Ferreira, Aparecido Pimentel; Safons, Marisete Peralta; Tiedemann, Anne; Lima, Ricardo M

2017-12-07

Recent investigations demonstrate an association between obesity and the propensity of older adults to fall. The aim of this study was to investigate the association between body adiposity measures, postural balance, fear of falling, and risk of falls in older women. One hundred forty-seven volunteers took part in this cross-sectional study. Participants underwent body composition assessment using dual-energy x-ray absorptiometry and had body mass index, waist circumference (WC), and body adiposity index measured. Postural balance was assessed using a force platform, while fear of falling and risk of falls were, respectively, evaluated by the Falls Efficacy Scale-International and the QuickScreen Clinical Falls Risk Assessment. All adiposity measures were correlated to at least 1 postural stability parameter and to fear of falling (ρ= 0.163, P < .05 to r = 0.337, P < .001); however, WC was the index most strongly correlated to risk of falls (ρ= 0.325; P < .001). When obesity was classified using WC, it was observed that compared with nonobese individuals (n = 51), obese individuals (n = 96) exhibited greater center of pressure displacement in the anteroposterior and mediolateral axes, especially during conditions with feet apart (P < .05). The obese group also exhibited an increased fear of falling (28.04 vs 24.59; P = .002) and had a higher proportion of individuals with increased fall risk (72% vs 35%; P < .001). In summary, adiposity measures are associated with risk of falls in older women, which might be mediated by reduced postural balance and increased fear of falling. Among these indices, WC, an easy and low-cost assessment, demonstrated the strongest association with falls-related outcomes.

Association of Heart-Type Fatty Acid-Binding Protein with Cardiovascular Risk Factors and All-Cause Mortality in the General Population: The Takahata Study

PubMed Central

Otaki, Yoichiro; Watanabe, Tetsu; Takahashi, Hiroki; Hirayama, Atushi; Narumi, Taro; Kadowaki, Shinpei; Honda, Yuki; Arimoto, Takanori; Shishido, Tetsuro; Miyamoto, Takuya; Konta, Tsuneo; Shibata, Yoko; Fukao, Akira; Daimon, Makoto; Ueno, Yoshiyuki; Kato, Takeo; Kayama, Takamasa; Kubota, Isao

2014-01-01

Background Despite many recent advances in medicine, preventing the development of cardiovascular diseases remains a challenge. Heart-type fatty acid-binding protein (H-FABP) is a marker of ongoing myocardial damage and has been reported to be a useful indicator for future cardiovascular events. However, it remains to be determined whether H-FABP can predict all-cause and cardiovascular deaths in the general population. Methods and Results This longitudinal cohort study included 3,503 subjects who participated in a community-based health checkup with a 7-year follow-up. Serum H-FABP was measured in registered subjects. The results demonstrated that higher H-FABP levels were associated with increasing numbers of cardiovascular risk factors, including hypertension, diabetes mellitus, obesity, and metabolic syndrome. There were 158 deaths during the follow-up period, including 50 cardiovascular deaths. Deceased subjects had higher H-FABP levels compared to surviving subjects. Multivariate Cox proportional hazard regression analysis revealed that H-FABP is an independent predictor of all-cause and cardiovascular deaths after adjustments for confounding factors. Subjects were divided into four quartiles according to H-FABP level, and Kaplan-Meier analysis demonstrated that the highest H-FABP quartile was associated with the greatest risks for all-cause and cardiovascular deaths. Net reclassification index and integrated discrimination index were significantly increased by addition of H-FABP to cardiovascular risk factors. Conclusions H-FABP level was increased in association with greater numbers of cardiovascular risk factors and was an independent risk factor for all-cause and cardiovascular deaths. H-FABP could be a useful indicator for the early identification of high-risk subjects in the general population. PMID:24847804

Cardiovascular risk in women with polycystic ovary syndrome.

PubMed

Cho, L W; Atkin, S L

2007-12-01

Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women that has received an immense amount of attention in the recent years due to the possible associated risk of cardiovascular disease. Women with PCOS demonstrate an adverse cardiovascular profile characteristic of the cardiometabolic syndrome and an established risk of progression to type 2 diabetes. Despite the presence of cardiovascular risk factors and increased surrogate markers of cardiovascular disease, it is unclear if they develop accelerated atherosclerosis. This article summarized the recent development and findings of cardiovascular risk in women with PCOS, and finally the therapeutic options will be discussed.

What happens to the heart in chronic kidney disease?

PubMed

Rutherford, E; Mark, P B

2017-03-01

Cardiovascular disease is common in patients with chronic kidney disease. The increased risk of cardiovascular disease seen in this population is attributable to both traditional and novel vascular risk factors. Risk of sudden cardiac or arrhythmogenic death is greatly exaggerated in chronic kidney disease, particularly in patients with end stage renal disease where the risk is roughly 20 times that of the general population. The reasons for this increased risk are not entirely understood and while atherosclerosis is accelerated in the presence of chronic kidney disease, premature myocardial infarction does not solely account for the excess risk. Recent work demonstrates that the structure and function of the heart starts to alter early in chronic kidney disease, independent of other risk factors. The implications of cardiac remodelling and hypertrophy may predispose chronic kidney disease patients to heart failure, arrhythmia and myocardial ischaemia. Further research is needed to minimise cardiovascular risk associated with structural and functional heart disease associated with chronic kidney disease.

Early-Life Persistent Vitamin D Deficiency Alters Cardiopulmonary Responses to Particulate Matter-Enhanced Atmospheric Smog in Adult Mice

EPA Science Inventory

This study demonstrates that early-life persistent vitamin D deficiency alters the cardiopulmonary response to smog in mice and may increase risk of adverse effects. Early life nutritional deficiencies can lead to increased cardiovascular susceptibility to environme...

Parenchymal Texture Analysis in Digital Breast Tomosynthesis for Breast Cancer Risk Estimation: A Preliminary Study

PubMed Central

Kontos, Despina; Bakic, Predrag R.; Carton, Ann-Katherine; Troxel, Andrea B.; Conant, Emily F.; Maidment, Andrew D.A.

2009-01-01

Rationale and Objectives Studies have demonstrated a relationship between mammographic parenchymal texture and breast cancer risk. Although promising, texture analysis in mammograms is limited by tissue superimposition. Digital breast tomosynthesis (DBT) is a novel tomographic x-ray breast imaging modality that alleviates the effect of tissue superimposition, offering superior parenchymal texture visualization compared to mammography. Our study investigates the potential advantages of DBT parenchymal texture analysis for breast cancer risk estimation. Materials and Methods DBT and digital mammography (DM) images of 39 women were analyzed. Texture features, shown in studies with mammograms to correlate with cancer risk, were computed from the retroareolar breast region. We compared the relative performance of DBT and DM texture features in correlating with two measures of breast cancer risk: (i) the Gail and Claus risk estimates, and (ii) mammographic breast density. Linear regression was performed to model the association between texture features and increasing levels of risk. Results No significant correlation was detected between parenchymal texture and the Gail and Claus risk estimates. Significant correlations were observed between texture features and breast density. Overall, the DBT texture features demonstrated stronger correlations with breast percent density (PD) than DM (p ≤0.05). When dividing our study population in groups of increasing breast PD, the DBT texture features appeared to be more discriminative, having regression lines with overall lower p-values, steeper slopes, and higher R2 estimates. Conclusion Although preliminary, our results suggest that DBT parenchymal texture analysis could provide more accurate characterization of breast density patterns, which could ultimately improve breast cancer risk estimation. PMID:19201357

Bradycardia as a Marker of Chronic Cocaine Use: A Novel Cardiovascular Finding

PubMed Central

Sharma, Jyoti; Rathnayaka, Nuvan; Green, Charles; Moeller, F. Gerard; Schmitz, Joy M.; Shoham, Daniel; Dougherty, Anne Hamilton

2014-01-01

Background Few studies have examined the effects of chronic cocaine use on the resting surface electrocardiogram (ECG) between exposures to cocaine. Methods 12-lead ECGs from 97 treatment-seeking cocaine-dependent subjects were compared to ECG parameters from 8513 non-cocaine-using control subjects from the Atherosclerosis Risk in Communities study. Results After matching and adjusting for relevant covariates, cocaine use demonstrated large and statistically reliable effects on early repolarization, bradycardia, severe bradycardia, and heart rate. Current cocaine dependence corresponds to an increased odds of demonstrating early repolarization by a factor of 4.92 and increased odds of bradycardia and severe bradycardia by factors 3.02 and 5.11, respectively. Conclusion This study demonstrates the novel finding that long-lasting effects of cocaine use on both the cardiac conduction and the autonomic nervous system pose a risk of adverse cardiovascular events between episodes of cocaine use, and that bradycardia is a marker of chronic cocaine use. PMID:24621090

A global framework for future costs and benefits of river-flood protection in urban areas

NASA Astrophysics Data System (ADS)

Ward, Philip J.; Jongman, Brenden; Aerts, Jeroen C. J. H.; Bates, Paul D.; Botzen, Wouter J. W.; Diaz Loaiza, Andres; Hallegatte, Stephane; Kind, Jarl M.; Kwadijk, Jaap; Scussolini, Paolo; Winsemius, Hessel C.

2017-09-01

Floods cause billions of dollars of damage each year, and flood risks are expected to increase due to socio-economic development, subsidence, and climate change. Implementing additional flood risk management measures can limit losses, protecting people and livelihoods. Whilst several models have been developed to assess global-scale river-flood risk, methods for evaluating flood risk management investments globally are lacking. Here, we present a framework for assessing costs and benefits of structural flood protection measures in urban areas around the world. We demonstrate its use under different assumptions of current and future climate change and socio-economic development. Under these assumptions, investments in dykes may be economically attractive for reducing risk in large parts of the world, but not everywhere. In some regions, economically efficient investments could reduce future flood risk below today’s levels, in spite of climate change and economic growth. We also demonstrate the sensitivity of the results to different assumptions and parameters. The framework can be used to identify regions where river-flood protection investments should be prioritized, or where other risk-reducing strategies should be emphasized.

Residents examine factors associated with 30-day, same-cause hospital readmissions on an internal medicine service.

PubMed

Moran, Jennifer; Colbert, Colleen Y; Song, Juhee; Hull, Joshua; Rajan, Sabitha; Varghees, Sunita; Arroliga, Alejandro C; Reddy, Santosh P

2013-01-01

In recent years, there has been increased interest in stemming the tide of hospital readmissions in an attempt to improve quality of care. This study presents the Phase I results of a resident-led quality improvement initiative to determine the percentage of and risk factors for same-cause readmissions (SCRs; defined as hospital readmission within 30 days of hospital discharge for treatment of the same condition) to the internal medicine service of a multispecialty teaching hospital in central Texas. Results indicate that patients diagnosed with chronic obstructive pulmonary disease/asthma or anemia may be at increased risk for SCRs. Those patients who are insured by Medicaid and those who require assistance from social services also demonstrated an increased risk for SCRs. This study appears to be the first resident-led initiative in the field to examine 30-day SCRs to an internal medicine service for demographic and clinical risk factors.

Cancer Risks in Aluminum Reduction Plant Workers

PubMed Central

Labrèche, France

2014-01-01

Objective and Methods: This review examines epidemiological evidence relating to cancers in the primary aluminum industry where most of what is known relates to Söderberg operations or to mixed Söderberg/prebake operations. Results and Conclusions: Increased lung and bladder cancer risks have been reported in Söderberg workers from several countries, but not in all. After adjustment for smoking, these cancer risks still increase with cumulative exposure to benzo(a)pyrene, used as an index of coal tar pitch volatiles exposure. Limited evidence has been gathered in several cohorts for an increased risk of tumors at other sites, including stomach, pancreas, rectum/rectosigmoid junction, larynx, buccal cavity/pharynx, kidney, brain/nervous system, prostate, and lymphatic/hematopoietic tissues (in particular non-Hodgkin lymphoma, Hodgkin disease, and leukemia). Nevertheless, for most of these tumor sites, the relationship with specific exposures has not been demonstrated clearly and further follow-up of workers is warranted. PMID:24806725

Changes in Cross-Correlations as an Indicator for Systemic Risk

PubMed Central

Zheng, Zeyu; Podobnik, Boris; Feng, Ling; Li, Baowen

2012-01-01

The 2008–2012 global financial crisis began with the global recession in December 2007 and exacerbated in September 2008, during which the U.S. stock markets lost 20% of value from its October 11 2007 peak. Various studies reported that financial crisis are associated with increase in both cross-correlations among stocks and stock indices and the level of systemic risk. In this paper, we study 10 different Dow Jones economic sector indexes, and applying principle component analysis (PCA) we demonstrate that the rate of increase in principle components with short 12-month time windows can be effectively used as an indicator of systemic risk—the larger the change of PC1, the higher the increase of systemic risk. Clearly, the higher the level of systemic risk, the more likely a financial crisis would occur in the near future. PMID:23185692

Social Networks, Sexual Networks and HIV Risk in Men Who Have Sex with Men

PubMed Central

Amirkhanian, Yuri A.

2014-01-01

Worldwide, men who have sex with men (MSM) remain one of the most HIV-vulnerable community populations. A global public health priority is developing new methods of reaching MSM, understanding HIV transmission patterns, and intervening to reduce their risk. Increased attention is being given to the role that MSM networks play in HIV epidemiology. This review of MSM network research studies demonstrates that: (1) Members of the same social network often share similar norms, attitudes, and HIV risk behavior levels; (2) Network interventions are feasible and powerful for reducing unprotected sex and potentially for increasing HIV testing uptake; (3) HIV vulnerability among African American MSM increases when an individual enters a high-risk sexual network characterized by high density and racial homogeneity; and (4) Networks are primary sources of social support for MSM, particularly for those living with HIV, with greater support predicting higher care uptake and adherence. PMID:24384832

Impact of elevated cardiac biomarkers on mortality after vascular surgery procedures.

PubMed

Buckley, Ryan; Stevens, Scott L

2014-12-01

Concurrent cardiac disease is an important cause of morbidity and mortality in vascular surgical patients. Increasingly, cardiac biomarkers are used to identify cardiac injury in these high-risk patients. This review provides data demonstrating that perioperative troponin elevation correlates with poor short- and long-term outcomes for vascular surgical patients. In addition, the data demonstrate that patients with high circulating troponin levels fair worse than those with lower levels. Early identification of patients with cardiac injury using biomarkers allows timely diagnosis, risk stratification, and aggressive medical therapy for vascular surgical patients. Copyright © 2014 Elsevier Inc. All rights reserved.

Reconstructive microsurgery of the female reproductive tract using a CO 2 laser

NASA Astrophysics Data System (ADS)

Bellina, J. H.

1982-04-01

Laser tubal microsurgery was carried out on a sample of 82 patients. Employing current laser surgical systems, 21 conceptions occured in 20 patients, after limited exposure to conception risk during the 13-month study. This represents 48% of the 42 patients at risk. Tubal patency was demonstrated in 94% of the 82 cases. Based upon experience to date, more conceptions are expected as more patients become at risk and as exposure increases.

Real and hypothetical monetary rewards modulate risk taking in the brain.

PubMed

Xu, Sihua; Pan, Yu; Wang, You; Spaeth, Andrea M; Qu, Zhe; Rao, Hengyi

2016-07-07

Both real and hypothetical monetary rewards are widely used as reinforcers in risk taking and decision making studies. However, whether real and hypothetical monetary rewards modulate risk taking and decision making in the same manner remains controversial. In this study, we used event-related potentials (ERP) with a balloon analogue risk task (BART) paradigm to examine the effects of real and hypothetical monetary rewards on risk taking in the brain. Behavioral data showed reduced risk taking after negative feedback (money loss) during the BART with real rewards compared to those with hypothetical rewards, suggesting increased loss aversion with real monetary rewards. The ERP data demonstrated a larger feedback-related negativity (FRN) in response to money loss during risk taking with real rewards compared to those with hypothetical rewards, which may reflect greater prediction error or regret emotion after real monetary losses. These findings demonstrate differential effects of real versus hypothetical monetary rewards on risk taking behavior and brain activity, suggesting a caution when drawing conclusions about real choices from hypothetical studies of intended behavior, especially when large rewards are used. The results have implications for future utility of real and hypothetical monetary rewards in studies of risk taking and decision making.

The Obesity, Metabolic Syndrome, and Type 2 Diabetes Mellitus Pandemic: Part I. Increased Cardiovascular Disease Risk and the Importance of Atherogenic Dyslipidemia in Persons With the Metabolic Syndrome and Type 2 Diabetes Mellitus

PubMed Central

Ginsberg, Henry N.; MacCallum, Paul R.

2010-01-01

Both the metabolic syndrome (MS) and type 2 diabetes mellitus (T2DM) confer an increased risk of coronary heart disease and cardiovascular disease (CVD). As MS and T2DM become more prevalent, there will be an associated rise in the number of individuals with or at risk for CVD and its related disorders. One major underlying cause of CVD in patients with MS or T2DM is a characteristic form of atherogenic dyslipidemia. This article reviews the evidence that demonstrates that individuals with MS or T2DM are at increased risk for CVD and highlights atherogenic dyslipidemia as an important risk factor for the development of CVD in these individuals. In an accompanying article, current pharmacotherapies available for the management of atherogenic dyslipidemia in individuals with MS or T2DM are discussed. PMID:19614799

Time-based collision risk modeling for air traffic management

NASA Astrophysics Data System (ADS)

Bell, Alan E.

Since the emergence of commercial aviation in the early part of last century, economic forces have driven a steadily increasing demand for air transportation. Increasing density of aircraft operating in a finite volume of airspace is accompanied by a corresponding increase in the risk of collision, and in response to a growing number of incidents and accidents involving collisions between aircraft, governments worldwide have developed air traffic control systems and procedures to mitigate this risk. The objective of any collision risk management system is to project conflicts and provide operators with sufficient opportunity to recognize potential collisions and take necessary actions to avoid them. It is therefore the assertion of this research that the currency of collision risk management is time. Future Air Traffic Management Systems are being designed around the foundational principle of four dimensional trajectory based operations, a method that replaces legacy first-come, first-served sequencing priorities with time-based reservations throughout the airspace system. This research will demonstrate that if aircraft are to be sequenced in four dimensions, they must also be separated in four dimensions. In order to separate aircraft in four dimensions, time must emerge as the primary tool by which air traffic is managed. A functional relationship exists between the time-based performance of aircraft, the interval between aircraft scheduled to cross some three dimensional point in space, and the risk of collision. This research models that relationship and presents two key findings. First, a method is developed by which the ability of an aircraft to meet a required time of arrival may be expressed as a robust standard for both industry and operations. Second, a method by which airspace system capacity may be increased while maintaining an acceptable level of collision risk is presented and demonstrated for the purpose of formulating recommendations for procedures regulating air traffic management methods and industry standards governing performance requirements for avionics designed to support trajectory based operations.

Black women with polycystic ovary syndrome (PCOS) have increased risk for metabolic syndrome and cardiovascular disease compared with white women with PCOS [corrected].

PubMed

Hillman, Jennifer K; Johnson, Lauren N C; Limaye, Meghana; Feldman, Rebecca A; Sammel, Mary; Dokras, Anuja

2014-02-01

To determine the prevalence of metabolic syndrome (MetSyn) and Framingham cardiovascular disease (CVD) risk in white and black adolescents and adult women with polycystic ovary syndrome (PCOS) compared with controls. Retrospective cohort study. Center for PCOS. Subjects with PCOS with data on race and cardiometabolic risk (n = 519). Controls were age and race matched from the National Health and Nutrition Examination Survey (NHANES) population (1999-2006). None. MetSyn, coronary heart disease risk, and general CVD risk. Black adolescents and young adults with PCOS had an increased prevalence of MetSyn compared with their white counterparts (adolescents relative risk 2.65 [95% confidence interval 1.29-5.4], adults relative risk 1.44 [95% confidence interval 1.21-2.6]). In contrast, there was no difference in risk of MetSyn between black and white adolescents and adult women in the NHANES dataset. After controlling for age and body mass index, black women with PCOS had a significantly increased prevalence of low high-density lipoprotein and high glucose. The general CVD risk was significantly increased in black adults with PCOS. This is the first study to comprehensively demonstrate increased risk of MetSyn in both black adolescents and adult women with PCOS compared with white subjects with PCOS. This racial disparity was not present in the NHANES controls. Longitudinal studies are needed to assess the independent impact of PCOS and race on CVD risk in women. Copyright © 2014 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Will HIV Vaccination Reshape HIV Risk Behavior Networks? A Social Network Analysis of Drug Users' Anticipated Risk Compensation

PubMed Central

Young, April M.; Halgin, Daniel S.; DiClemente, Ralph J.; Sterk, Claire E.; Havens, Jennifer R.

2014-01-01

Background An HIV vaccine could substantially impact the epidemic. However, risk compensation (RC), or post-vaccination increase in risk behavior, could present a major challenge. The methodology used in previous studies of risk compensation has been almost exclusively individual-level in focus, and has not explored how increased risk behavior could affect the connectivity of risk networks. This study examined the impact of anticipated HIV vaccine-related RC on the structure of high-risk drug users' sexual and injection risk network. Methods A sample of 433 rural drug users in the US provided data on their risk relationships (i.e., those involving recent unprotected sex and/or injection equipment sharing). Dyad-specific data were collected on likelihood of increasing/initiating risk behavior if they, their partner, or they and their partner received an HIV vaccine. Using these data and social network analysis, a "post-vaccination network" was constructed and compared to the current network on measures relevant to HIV transmission, including network size, cohesiveness (e.g., diameter, component structure, density), and centrality. Results Participants reported 488 risk relationships. Few reported an intention to decrease condom use or increase equipment sharing (4% and 1%, respectively). RC intent was reported in 30 existing risk relationships and vaccination was anticipated to elicit the formation of five new relationships. RC resulted in a 5% increase in risk network size (n = 142 to n = 149) and a significant increase in network density. The initiation of risk relationships resulted in the connection of otherwise disconnected network components, with the largest doubling in size from five to ten. Conclusions This study demonstrates a new methodological approach to studying RC and reveals that behavior change following HIV vaccination could potentially impact risk network connectivity. These data will be valuable in parameterizing future network models that can determine if network-level change precipitated by RC would appreciably impact the vaccine's population-level effectiveness. PMID:24992659

Acute changes in foot strike pattern and cadence affect running parameters associated with tibial stress fractures.

PubMed

Yong, Jennifer R; Silder, Amy; Montgomery, Kate L; Fredericson, Michael; Delp, Scott L

2018-05-18

Tibial stress fractures are a common and debilitating injury that occur in distance runners. Runners may be able to decrease tibial stress fracture risk by adopting a running pattern that reduces biomechanical parameters associated with a history of tibial stress fracture. The purpose of this study was to test the hypothesis that converting to a forefoot striking pattern or increasing cadence without focusing on changing foot strike type would reduce injury risk parameters in recreational runners. Running kinematics, ground reaction forces and tibial accelerations were recorded from seventeen healthy, habitual rearfoot striking runners while running in their natural running pattern and after two acute retraining conditions: (1) converting to forefoot striking without focusing on cadence and (2) increasing cadence without focusing on foot strike. We found that converting to forefoot striking decreased two risk factors for tibial stress fracture: average and peak loading rates. Increasing cadence decreased one risk factor: peak hip adduction angle. Our results demonstrate that acute adaptation to forefoot striking reduces different injury risk parameters than acute adaptation to increased cadence and suggest that both modifications may reduce the risk of tibial stress fractures. Copyright © 2018 Elsevier Ltd. All rights reserved.

The High Cost of Harsh Discipline and Its Disparate Impact

ERIC Educational Resources Information Center

Rumberger, Russell W.; Losen, Daniel J.

2016-01-01

School suspension rates have been rising since the early 1970s, especially for children of color. One body of research has demonstrated that suspension from school is harmful to students, as it increases the risk of retention and school dropout. Another has demonstrated that school dropouts impose huge social costs on their states and localities,…

The effect of prediabetes on hepatocellular carcinoma risk: a systematic review and meta-analysis.

PubMed

Xu, Wei-Guo; Qian, Yun-Feng; Wu, Jun

2017-04-01

Some studies suggested an increased risk of hepatocellular carcinoma (HCC) risk in subjects with prediabetes, whereas other studies have reported negative results. Therefore, we did this meta-analysis to assess the role of prediabetes on HCC risk. We searched studies from PubMed, Embase, and Web of Science databases. The strength of association between prediabetes and HCC risk was assessed by calculating hazard ratio (HR) with 95% CI. A total of 8 cohort studies and 1 case-control study with 1384594 individuals were included. Patients with prediabetes showed an increased HCC risk (HR=1.21; 95% CI, 1.13-1.30; P<0.00001). Subgroup analyses were performed according to race and gender. The results showed that both Asians with prediabetes (HR=1.19; 95% CI, 1.11-1.28; P<0.00001) and Caucasians with prediabetes (HR=2.12; 95% CI, 1.36-3.31; P=0.001 were significantly associated with increased risk of HCC, respectively. In the subgroup analysis by gender, both male patients with prediabetes (HR=1.49; 95% CI, 1.03-2.15; P=0.03) and female patients with prediabetes (HR=1.24; 95% CI, 1.01-1.52; P=0.04) showed increased risk of HCC, respectively. In conclusion, this meta-analysis demonstrated that prediabetes might be a risk factor of HCC.

Uteroplacental insufficiency temporally exacerbates salt-induced hypertension associated with a reduced natriuretic response in male rat offspring.

PubMed

Gallo, Linda A; Walton, Sarah L; Mazzuca, Marc Q; Tare, Marianne; Parkington, Helena C; Wlodek, Mary E; Moritz, Karen M

2018-03-31

Low weight at birth increases the risk of developing chronic diseases in adulthood A diet that is high in salt is known to elevate blood pressure, which is a major risk factor for cardiovascular and kidney diseases The present study demonstrates that growth restricted male rats have a heightened sensitivity to high dietary salt, in the context of raised systolic blood pressure, reduced urinary sodium excretion and stiffer mesenteric resistance vessels Other salt-induced effects, such as kidney hyperfiltration, albuminuria and glomerular damage, were not exacerbated by being born small The present study demonstrates that male offspring born small have an increased cardiovascular susceptibility to high dietary salt, such that that minimizing salt intake is probably of particular benefit to this at-risk population ABSTRACT: Intrauterine growth restriction increases the risk of developing chronic diseases in adulthood. Lifestyle factors, such as poor dietary choices, may elevate this risk. We determined whether being born small increases the sensitivity to a dietary salt challenge, in the context of hypertension, kidney disease and arterial stiffness. Bilateral uterine vessel ligation or sham surgery (offspring termed Restricted and Control, respectively) was performed on 18-day pregnant Wistar Kyoto rats. Male offspring were allocated to receive a diet high in salt (8% sodium chloride) or remain on standard rat chow (0.52% sodium chloride) from 20 to 26 weeks of age for 6 weeks. Systolic blood pressure (tail-cuff), renal function (24 h urine excretions) and vascular stiffness (pressure myography) were assessed. Restricted males were born 15% lighter than Controls and remained smaller throughout the study. Salt-induced hypertension was exacerbated in Restricted offspring, reaching a peak systolic pressure of ∼175 mmHg earlier than normal weight counterparts. The natriuretic response to high dietary salt in Restricted animals was less than in Controls and may explain the early rise in arterial pressure. Growth restricted males allocated to a high salt diet also had increased passive arterial stiffness of mesenteric resistance arteries. Other aspects of renal function, including salt-induced hyperfiltration, albuminuria and glomerular damage, were not exacerbated by uteroplacental insufficiency. The present study demonstrates that male offspring exposed to uteroplacental insufficiency and born small have an increased sensitivity to salt-induced hypertension and arterial remodelling. © 2018 The Authors. The Journal of Physiology © 2018 The Physiological Society.

Celiac disease and the risk of kidney diseases: A systematic review and meta-analysis.

PubMed

Wijarnpreecha, Karn; Thongprayoon, Charat; Panjawatanan, Panadeekarn; Thamcharoen, Natanong; Pachariyanon, Pavida; Nakkala, Kiran; Cheungpasitporn, Wisit

2016-12-01

Previous epidemiologic studies attempting to demonstrate the risk of kidney diseases among patients with celiac disease (CD) have yielded inconsistent results. This meta-analysis was conducted with the aims to summarize all available evidence. A literature search was performed using MEDLINE and EMBASE from inception to May 2016. Studies that provided relative risks, odd ratios, or hazard ratios examining the risk of kidney diseases among patients with CD versus individuals without CD were included. Pooled risk ratios (RR) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method. Eight studies met our eligibility criteria and were included in our analysis. A pooled RR of overall kidney diseases in patients with CD was 2.01 (95% CI, 1.44-2.81, I 2 =76%). The pooled RR of end-stage renal disease in patients with CD was 2.57 (95% CI, 2.03-3.24). Subgroup analyses showed that significant risks were increased for diabetic nephropathy (pooled RR of 1.49, 95% CI, 1.09-2.02) and IgA nephropathy (pooled RR of 2.62, 95% CI, 1.27-5.42) in patients with CD. Our study demonstrates a significantly increased risk of kidney diseases among patients with CD. These findings may influence clinical management and primary prevention of kidney diseases in patients with CD. Copyright © 2016 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Changes in step-width during dual-task walking predicts falls.

PubMed

Nordin, E; Moe-Nilssen, R; Ramnemark, A; Lundin-Olsson, L

2010-05-01

The aim was to evaluate whether gait pattern changes between single- and dual-task conditions were associated with risk of falling in older people. Dual-task cost (DTC) of 230 community living, physically independent people, 75 years or older, was determined with an electronic walkway. Participants were followed up each month for 1 year to record falls. Mean and variability measures of gait characteristics for 5 dual-task conditions were compared to single-task walking for each participant. Almost half (48%) of the participants fell at least once during follow-up. Risk of falling increased in individuals where DTC for performing a subtraction task demonstrated change in mean step-width compared to single-task walking. Risk of falling decreased in individuals where DTC for carrying a cup and saucer demonstrated change compared to single-task walking in mean step-width, mean step-time, and step-length variability. Degree of change in gait characteristics related to a change in risk of falling differed between measures. Prognostic guidance for fall risk was found for the above DTCs in mean step-width with a negative likelihood ratio of 0.5 and a positive likelihood ratio of 2.3, respectively. Findings suggest that changes in step-width, step-time, and step-length with dual tasking may be related to future risk of falling. Depending on the nature of the second task, DTC may indicate either an increased risk of falling, or a protective strategy to avoid falling. Copyright 2010. Published by Elsevier B.V.

Dobutamine cardiac "stress" test reveals increased arrhythmia risk in conscious rats after a single exposure to acrolein

EPA Science Inventory

Mild-to-moderate exercise is often used to stress the cardiovascular (CV) system of patients while monitoring them for electrocardiogram (ECG) abnormalities that may indicate underlying CV disease. We previously demonstrated that dobutamine, which increases heart rate (HR) and co...

Genetic counseling and testing for Alzheimer disease: joint practice guidelines of the American College of Medical Genetics and the National Society of Genetic Counselors.

PubMed

Goldman, Jill S; Hahn, Susan E; Catania, Jennifer Williamson; LaRusse-Eckert, Susan; Butson, Melissa Barber; Rumbaugh, Malia; Strecker, Michelle N; Roberts, J Scott; Burke, Wylie; Mayeux, Richard; Bird, Thomas

2011-06-01

Alzheimer disease is the most common cause of dementia. It occurs worldwide and affects all ethnic groups. The incidence of Alzheimer disease is increasing due, in part, to increased life expectancy and the aging baby boomer generation. The average lifetime risk of developing Alzheimer disease is 10-12%. This risk at least doubles with the presence of a first-degree relative with the disorder. Despite its limited utility, patients express concern over their risk and, in some instances, request testing. Furthermore, research has demonstrated that testing individuals for apolipoprotein E can be valuable and safe in certain contexts. However, because of the complicated genetic nature of the disorder, few clinicians are prepared to address the genetic risks of Alzheimer disease with their patients. Given the increased awareness in family history thanks to family history campaigns, the increasing incidence of Alzheimer disease, and the availability of direct to consumer testing, patient requests for information is increasing. This practice guideline provides clinicians with a framework for assessing their patients' genetic risk for Alzheimer disease, identifying which individuals may benefit from genetic testing, and providing the key elements of genetic counseling for AD.

Comparative Study of School Leaders Use of Learning Consultants to Support At-Risk Students

ERIC Educational Resources Information Center

Forester, GinaMarie

2013-01-01

The education system continues to change and the needs of the 21st century learner are increasing. More students are being identified as at-risk. Statistics in New Jersey demonstrate trends that indicate the number of students being classified for special education is rising. Supervisors in schools need to develop and support programs to provide…

Clinical utility of lenalidomide in the treatment of myelodysplastic syndromes

PubMed Central

Abou Zahr, Abdallah; Saad Aldin, Ehab; Komrokji, Rami S; Zeidan, Amer M

2015-01-01

Myelodysplastic syndromes (MDS) represent a heterogeneous group of acquired clonal hematopoietic disorders characterized by peripheral blood cytopenias, paradoxical BM hypercellularity, ineffective hematopoiesis, and increased risk of leukemic transformation. Risk stratification, using different prognostic scores and markers, is at the core of MDS management. Deletion 5q [del(5q)] MDS is a distinct class of MDS characterized by the haploinsufficiency of specific genes, microRNAs, and proteins, which has been linked to increased sensitivity to the drug lenalidomide. Phase II and III clinical trials have demonstrated the efficacy of lenalidomide in improving clinical outcomes of patients with del(5q) MDS, including reduction in red blood cell transfusion requirements and improvements in quality of life. Lenalidomide has also demonstrated some activity in non-del(5q) lower-risk MDS as well as higher-risk MDS, especially in combination with other agents. In this paper, we review the pathogenesis of del(5q) MDS, the proposed mechanisms of action of lenalidomide, the major clinical trials that documented the activity of lenalidomide in different MDS populations, potential predictors of benefit from the drug and suggested mechanisms of resistance, and the use of combination strategies to expand the clinical utility of lenalidomide in MDS. PMID:25565910

Systemic trade risk of critical resources.

PubMed

Klimek, Peter; Obersteiner, Michael; Thurner, Stefan

2015-11-01

In the wake of the 2008 financial crisis, the role of strongly interconnected markets in causing systemic instability has been increasingly acknowledged. Trade networks of commodities are susceptible to cascades of supply shocks that increase systemic trade risks and pose a threat to geopolitical stability. We show that supply risk, scarcity, and price volatility of nonfuel mineral resources are intricately connected with the structure of the worldwide trade networks spanned by these resources. At the global level, we demonstrate that the scarcity of a resource is closely related to the susceptibility of the trade network with respect to cascading shocks. At the regional level, we find that, to some extent, region-specific price volatility and supply risk can be understood by centrality measures that capture systemic trade risk. The resources associated with the highest systemic trade risk indicators are often those that are produced as by-products of major metals. We identify significant strategic shortcomings in the management of systemic trade risk, in particular in the European Union.

Systemic trade risk of critical resources

PubMed Central

Klimek, Peter; Obersteiner, Michael; Thurner, Stefan

2015-01-01

In the wake of the 2008 financial crisis, the role of strongly interconnected markets in causing systemic instability has been increasingly acknowledged. Trade networks of commodities are susceptible to cascades of supply shocks that increase systemic trade risks and pose a threat to geopolitical stability. We show that supply risk, scarcity, and price volatility of nonfuel mineral resources are intricately connected with the structure of the worldwide trade networks spanned by these resources. At the global level, we demonstrate that the scarcity of a resource is closely related to the susceptibility of the trade network with respect to cascading shocks. At the regional level, we find that, to some extent, region-specific price volatility and supply risk can be understood by centrality measures that capture systemic trade risk. The resources associated with the highest systemic trade risk indicators are often those that are produced as by-products of major metals. We identify significant strategic shortcomings in the management of systemic trade risk, in particular in the European Union. PMID:26702431

Decision-making under risk in children, adolescents, and young adults.

PubMed

Paulsen, David J; Platt, Michael L; Huettel, Scott A; Brannon, Elizabeth M

2011-01-01

Adolescents often make risky and impulsive decisions. Such behavior has led to the common assumption that a dysfunction in risk-related decision-making peaks during this age. Differences in how risk has been defined across studies, however, make it difficult to draw conclusions about developmental changes in risky decision-making. Here, we developed a non-symbolic economic decision-making task that can be used across a wide age span and that uses coefficient of variation (CV) in reward as an index of risk. We found that young children showed the strongest preference for risky compared to sure bet options of equal expected value, adolescents were intermediate in their risk preference, and young adults showed the strongest risk aversion. Furthermore, children's preference for the risky option increased for larger CVs, while adolescents and young adults showed the opposite pattern, favoring the sure bet more often as CV increased. Finally, when faced with two gambles in a risk-return tradeoff, all three age groups exhibited a greater preference for the option with the lower risk and return as the disparity in risk between the two options increased. These findings demonstrate clear age-related differences in economic risk preferences that vary with choice set and risk. Importantly, adolescence appears to represent an intermediate decision-making phenotype along the transition from childhood to adulthood, rather than an age of heightened preference for economic risk.

The Current Waist Circumference Cut Point Used for the Diagnosis of Metabolic Syndrome in Sub-Saharan African Women Is Not Appropriate

PubMed Central

Crowther, Nigel J.; Norris, Shane A.

2012-01-01

The waist circumference cut point for diagnosing the metabolic syndrome in sub-Saharan African subjects is based on that obtained from studies in European populations. The aim of this study was to measure the prevalence of obesity and related metabolic disorders in an urban population of African females, a group at high risk for such diseases, and to determine the appropriate waist cut point for diagnosing the metabolic syndrome. Anthropometry and fasting lipid, glucose and insulin levels were measured in a cohort of 1251 African females participating in the Birth to Twenty cohort study in Soweto, Johannesburg. The waist circumference cut points for diagnosing metabolic syndrome (as defined using the new harmonised guidelines), insulin resistance, dysglycaemia, hypertension and dyslipidaemia were obtained using receiver operator characteristic curve analysis. The prevalence of obesity, type 2 diabetes and metabolic syndrome were 50.1%, 14.3% and 42.1%, respectively. The appropriate waist cut point for diagnosing metabolic syndrome was found to be 91.5 cm and was similar to the cuts points obtained for detecting increased risk of insulin resistance (89.0 cm), dysglycaemia (88.4 cm), hypertension (90.1 cm), hypo-high density lipoproteinaemia (87.6 cm) and hyper-low density lipoproteinaemia (90.5 cm). The present data demonstrates that urban, African females have a high prevalence of obesity and related disorders and the waist cut point currently recommended for the diagnosis of the metabolic syndrome (80.0 cm) in this population should be increased to 91.5 cm. This latter finding demonstrates a clear ethnic difference in the relationship between abdominal adiposity and metabolic disease risk. The similar waist cut points identified for the detection of the individual components of the metabolic syndrome and related cardiovascular risk factors demonstrates that the risk for different metabolic diseases increases at the same level of abdominal adiposity suggesting a common aetiological pathway. PMID:23145009

Relationship between cigarette smoking and other coronary risk factors in atherosclerosis: risk of cardiovascular disease and preventive measures.

PubMed

Leone, Aurelio

2003-01-01

Among the major Coronary Risk Factors (CRF) cigarette smoking has shown undoubtedly harmful effects on the heart and blood vessels either as active smoking (smoking a cigarette) or passive smoking (exposure to environmental tobacco smoke -ETS). The strong relationship between cigarette smoking and cardiovascular disease has been seen independent of the other CRF in a number of well-designated epidemiologic studies. However, a strong increase in the excess of cardiovascular risk has been defined along with the interaction of cigarette smoking and other major CRF. Thousands of pharmacologically active substances are present in tobacco smoke, and a large number of direct and indirect effects have been demonstrated. Different responses are also related to these types of exposure: active exposure or passive exposure. The cardiovascular risk increases with increasing levels of blood pressure and/or serum cholesterol and diabetes mellitus, and at each level of these three risk factors, distributed with different rates according to age and gender in individuals, the risk in active smokers or passive smokers is greater than the risk in nonsmokers. Further analytical and methodological observations are needed for better understanding of the chemical and biological synergism. Nevertheless, evidence is clear that cigarette smoking greatly increases the risk of cardiovascular diseases in individuals already at increased risk because of other CRF. Preventive measures must be absolutely conducted to prevent the CRF interaction. These are the changes in lifestyle (i.e. to give up smoking and make physical activity), drug administration, diet supplementation especially by those substances with antioxidant effects.

Semantic memory activation in individuals at risk for developing Alzheimer disease.

PubMed

Seidenberg, M; Guidotti, L; Nielson, K A; Woodard, J L; Durgerian, S; Antuono, P; Zhang, Q; Rao, S M

2009-08-25

To determine whether whole-brain, event-related fMRI can distinguish healthy older adults with known Alzheimer disease (AD) risk factors (family history, APOE epsilon4) from controls using a semantic memory task involving discrimination of famous from unfamiliar names. Sixty-nine cognitively asymptomatic adults were divided into 3 groups (n = 23 each) based on AD risk: 1) no family history, no epsilon4 allele (control [CON]); 2) family history, no epsilon4 allele (FH); and 3) family history and epsilon4 allele (FH+epsilon4). Separate hemodynamic response functions were extracted for famous and unfamiliar names using deconvolution analysis (correct trials only). Cognitively intact older adults with AD risk factors (FH and FH+epsilon4) exhibited greater activation in recognizing famous relative to unfamiliar names than a group without risk factors (CON), especially in the bilateral posterior cingulate/precuneus, bilateral temporoparietal junction, and bilateral prefrontal cortex. The increased activation was more apparent in the FH+epsilon4 than in the FH group. Unlike the 2 at-risk groups, the control group demonstrated greater activation for unfamiliar than familiar names, predominately in the supplementary motor area, bilateral precentral, left inferior frontal, right insula, precuneus, and angular gyrus. These results could not be attributed to differences in demographic variables, cerebral atrophy, episodic memory performance, global cognitive functioning, activities of daily living, or depression. Results demonstrate that a low-effort, high-accuracy semantic memory activation task is sensitive to Alzheimer disease risk factors in a dose-related manner. This increased activation in at-risk individuals may reflect a compensatory brain response to support task performance in otherwise asymptomatic older adults.

Ignoring correlation in uncertainty and sensitivity analysis in life cycle assessment: what is the risk?

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

Groen, E.A., E-mail: Evelyne.Groen@gmail.com; Heijungs, R.; Leiden University, Einsteinweg 2, Leiden 2333 CC

Life cycle assessment (LCA) is an established tool to quantify the environmental impact of a product. A good assessment of uncertainty is important for making well-informed decisions in comparative LCA, as well as for correctly prioritising data collection efforts. Under- or overestimation of output uncertainty (e.g. output variance) will lead to incorrect decisions in such matters. The presence of correlations between input parameters during uncertainty propagation, can increase or decrease the the output variance. However, most LCA studies that include uncertainty analysis, ignore correlations between input parameters during uncertainty propagation, which may lead to incorrect conclusions. Two approaches to include correlationsmore » between input parameters during uncertainty propagation and global sensitivity analysis were studied: an analytical approach and a sampling approach. The use of both approaches is illustrated for an artificial case study of electricity production. Results demonstrate that both approaches yield approximately the same output variance and sensitivity indices for this specific case study. Furthermore, we demonstrate that the analytical approach can be used to quantify the risk of ignoring correlations between input parameters during uncertainty propagation in LCA. We demonstrate that: (1) we can predict if including correlations among input parameters in uncertainty propagation will increase or decrease output variance; (2) we can quantify the risk of ignoring correlations on the output variance and the global sensitivity indices. Moreover, this procedure requires only little data. - Highlights: • Ignoring correlation leads to under- or overestimation of the output variance. • We demonstrated that the risk of ignoring correlation can be quantified. • The procedure proposed is generally applicable in life cycle assessment. • In some cases, ignoring correlation has a minimal effect on decision-making tools.« less

Occult central venous stenosis leading to airway obstruction after subtotal parathyroidectomy.

PubMed

Meiklejohn, Duncan A; Chan, Dylan K; Lalakea, M Lauren

2016-07-01

Subtotal parathyroidectomy may be indicated in patients with chronic renal failure and tertiary hyperparathyroidism, a population at increased risk for central venous stenosis (CVS) due to repeated vascular access. Here we report a case of complete upper airway obstruction precipitated by subtotal parathyroidectomy with ligation of anterior jugular vein collaterals in a patient with occult CVS. This case demonstrates a previously unreported risk of anterior neck surgery in patients with chronic renal failure. We present a review of the literature and discuss elements of the history and physical examination suggestive of occult CVS, with additional workup proposed for appropriate cases. Recommendations are discussed for perioperative and postoperative care in patients at increased risk for CVS.

14 CFR 417.205 - General.

Code of Federal Regulations, 2013 CFR

2013-01-01

... flight safety analysis must demonstrate that a launch operator will, for each launch, control the risk to... isolation of the hazards, to demonstrate control of the risk to the public. (1) Risk assessment. When demonstrating control of risk through risk assessment, the analysis must demonstrate that any risk to the public...

14 CFR 417.205 - General.

Code of Federal Regulations, 2012 CFR

2012-01-01

... flight safety analysis must demonstrate that a launch operator will, for each launch, control the risk to... isolation of the hazards, to demonstrate control of the risk to the public. (1) Risk assessment. When demonstrating control of risk through risk assessment, the analysis must demonstrate that any risk to the public...

14 CFR 417.205 - General.

Code of Federal Regulations, 2011 CFR

2011-01-01

... flight safety analysis must demonstrate that a launch operator will, for each launch, control the risk to... isolation of the hazards, to demonstrate control of the risk to the public. (1) Risk assessment. When demonstrating control of risk through risk assessment, the analysis must demonstrate that any risk to the public...

14 CFR 417.205 - General.

Code of Federal Regulations, 2014 CFR

2014-01-01

... flight safety analysis must demonstrate that a launch operator will, for each launch, control the risk to... isolation of the hazards, to demonstrate control of the risk to the public. (1) Risk assessment. When demonstrating control of risk through risk assessment, the analysis must demonstrate that any risk to the public...

Time-Varying Risk Factors and Sexual Aggression Perpetration Among Male College Students.

PubMed

Thompson, Martie P; Kingree, Jeffrey Brooks; Zinzow, Heidi; Swartout, Kevin

2015-12-01

Preventing sexual aggression (SA) can be informed by determining if time-varying risk factors differentiate men who follow different sexual aggression risk trajectories. Data are from a longitudinal study with 795 college males surveyed at the end of each of their 4 years of college in 2008-2011. Repeated measures general linear models tested if changes in risk factors corresponded with sexual aggression trajectory membership. Changes in the risk factors corresponded with SA trajectories. Men who came to college with a history of SA but decreased their perpetration likelihood during college showed concurrent decreases in sexual compulsivity, impulsivity, hostile attitudes toward women, rape supportive beliefs, perceptions of peer approval of forced sex, and perceptions of peer pressure to have sex with many different women, and smaller increases in pornography use over their college years. Conversely, men who increased levels of SA over time demonstrated larger increases in risk factors in comparison to other trajectory groups. The odds that males engaged in sexual aggression corresponded with changes in key risk factors. Risk factors were not static and interventions designed to alter them may lead to changes in sexual aggression risk. Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Mangroves as a protection from storm surges in a changing climate.

PubMed

Blankespoor, Brian; Dasgupta, Susmita; Lange, Glenn-Marie

2017-05-01

Adaptation to climate change includes addressing sea-level rise (SLR) and increased storm surges in many coastal areas. Mangroves can substantially reduce vulnerability of the adjacent coastal land from inundation but SLR poses a threat to the future of mangroves. This paper quantifies coastal protection services of mangroves for 42 developing countries in the current climate, and a future climate change scenario with a 1-m SLR and 10  % intensification of storms. Findings demonstrate that while SLR and increased storm intensity would increase storm surge areas, the greatest impact is from the expected loss of mangroves. Under current climate and mangrove coverage, 3.5 million people and GDP worth roughly US $400 million are at risk. In the future climate change scenario, vulnerable population and GDP at risk would increase by 103 and 233  %. The greatest risk is in East Asia, especially in Indonesia and the Philippines as well as Myanmar.

Perceptions of risk among households in two Australian coastal communities

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

Elrick-Barr, Carmen E.; Smith, Timothy F.; Thomsen, Dana C.

There is limited knowledge of risk perceptions in coastal communities despite their vulnerability to a range of risks including the impacts of climate change. A survey of 400 households in two Australian coastal communities, combined with semi-structured interviews, provides insight into household perceptions of the relative importance of climatic and non-climatic risks and the subsequent risk priorities that may inform household adaptive action. In contrast to previous research, the results demonstrated that geographic location and household characteristics might not affect perceptions of vulnerability to environmental hazards. However, past experience was a significant influence, raising the priority of environmental concerns. Overall,more » the results highlight the priority concerns of coastal households (from finance, to health and environment) and suggest to increase the profile of climate issues in coastal communities climate change strategies need to better demonstrate links between climate vulnerability and other household concerns. Moreover, promoting generic capacities in isolation from understanding the context in which households construe climate risks is unlikely to yield the changes required to decrease the vulnerability of coastal communities.« less

Perceptions of risk among households in two Australian coastal communities

DOE PAGES

Elrick-Barr, Carmen E.; Smith, Timothy F.; Thomsen, Dana C.; ...

2015-04-20

There is limited knowledge of risk perceptions in coastal communities despite their vulnerability to a range of risks including the impacts of climate change. A survey of 400 households in two Australian coastal communities, combined with semi-structured interviews, provides insight into household perceptions of the relative importance of climatic and non-climatic risks and the subsequent risk priorities that may inform household adaptive action. In contrast to previous research, the results demonstrated that geographic location and household characteristics might not affect perceptions of vulnerability to environmental hazards. However, past experience was a significant influence, raising the priority of environmental concerns. Overall,more » the results highlight the priority concerns of coastal households (from finance, to health and environment) and suggest to increase the profile of climate issues in coastal communities climate change strategies need to better demonstrate links between climate vulnerability and other household concerns. Moreover, promoting generic capacities in isolation from understanding the context in which households construe climate risks is unlikely to yield the changes required to decrease the vulnerability of coastal communities.« less

Evolution of natural risk: research framework and perspectives

NASA Astrophysics Data System (ADS)

Hufschmidt, G.; Crozier, M.; Glade, T.

2005-05-01

This study presents a conceptual framework for addressing temporal variation in natural risk. Numerous former natural risk analyses and investigations have demonstrated that time and related changes have a crucial influence on risk. For natural hazards, time becomes a factor for a number of reasons. Using the example of landslides to illustrate this point, it is shown that: 1. landslide history is important in determining probability of occurrence, 2. the significance of catchment variables in explaining landslide susceptibility is dependent on the time scale chosen, 3. the observer's perception of the geosystem's state changes with different time spans, and 4. the system's sensitivity varies with time. Natural hazards are not isolated events but complex features that are connected with the social system. Similarly, elements at risk and their vulnerability are highly dynamic through time, an aspect that is not sufficiently acknowledged in research. Since natural risk is an amalgam of hazard and vulnerability, its temporal behaviour has to be considered as well. Identifying these changes and their underlying processes contributes to a better understanding of natural risk today and in the future. However, no dynamic models for natural risks are currently available. Dynamic behaviour of factors affecting risk is likely to create increasing connectivity and complexity. This demands a broad approach to natural risk, since the concept of risk encapsulates aspects of many disciplines and has suffered from single-discipline approaches in the past. In New Zealand, dramatic environmental and social change has occurred in a relatively short period of time, graphically demonstrating the temporal variability of the geosystem and the social system. To understand these changes and subsequent interactions between both systems, a holistic perspective is needed. This contribution reviews available frameworks, demonstrates the need for further concepts, and gives research perspectives on a New Zealand example.

A decision support tool to compare waterborne and foodborne infection and/or illness risks associated with climate change.

PubMed

Schijven, Jack; Bouwknegt, Martijn; de Roda Husman, Ana Maria; Rutjes, Saskia; Sudre, Bertrand; Suk, Jonathan E; Semenza, Jan C

2013-12-01

Climate change may impact waterborne and foodborne infectious disease, but to what extent is uncertain. Estimating climate-change-associated relative infection risks from exposure to viruses, bacteria, or parasites in water or food is critical for guiding adaptation measures. We present a computational tool for strategic decision making that describes the behavior of pathogens using location-specific input data under current and projected climate conditions. Pathogen-pathway combinations are available for exposure to norovirus, Campylobacter, Cryptosporidium, and noncholera Vibrio species via drinking water, bathing water, oysters, or chicken fillets. Infection risk outcomes generated by the tool under current climate conditions correspond with those published in the literature. The tool demonstrates that increasing temperatures lead to increasing risks for infection with Campylobacter from consuming raw/undercooked chicken fillet and for Vibrio from water exposure. Increasing frequencies of drought generally lead to an elevated infection risk of exposure to persistent pathogens such as norovirus and Cryptosporidium, but decreasing risk of exposure to rapidly inactivating pathogens, like Campylobacter. The opposite is the case with increasing annual precipitation; an upsurge of heavy rainfall events leads to more peaks in infection risks in all cases. The interdisciplinary tool presented here can be used to guide climate change adaptation strategies focused on infectious diseases. © 2013 Society for Risk Analysis.

Risk Based Reservoir Operations Using Ensemble Streamflow Predictions for Lake Mendocino in Mendocino County, California

NASA Astrophysics Data System (ADS)

Delaney, C.; Mendoza, J.; Whitin, B.; Hartman, R. K.

2017-12-01

Ensemble Forecast Operations (EFO) is a risk based approach of reservoir flood operations that incorporates ensemble streamflow predictions (ESPs) made by NOAA's California-Nevada River Forecast Center (CNRFC). With the EFO approach, each member of an ESP is individually modeled to forecast system conditions and calculate risk of reaching critical operational thresholds. Reservoir release decisions are computed which seek to manage forecasted risk to established risk tolerance levels. A water management model was developed for Lake Mendocino, a 111,000 acre-foot reservoir located near Ukiah, California, to evaluate the viability of the EFO alternative to improve water supply reliability but not increase downstream flood risk. Lake Mendocino is a dual use reservoir, which is owned and operated for flood control by the United States Army Corps of Engineers and is operated for water supply by the Sonoma County Water Agency. Due to recent changes in the operations of an upstream hydroelectric facility, this reservoir has suffered from water supply reliability issues since 2007. The EFO alternative was simulated using a 26-year (1985-2010) ESP hindcast generated by the CNRFC, which approximates flow forecasts for 61 ensemble members for a 15-day horizon. Model simulation results of the EFO alternative demonstrate a 36% increase in median end of water year (September 30) storage levels over existing operations. Additionally, model results show no increase in occurrence of flows above flood stage for points downstream of Lake Mendocino. This investigation demonstrates that the EFO alternative may be a viable approach for managing Lake Mendocino for multiple purposes (water supply, flood mitigation, ecosystems) and warrants further investigation through additional modeling and analysis.

Low Molecular Weight Heparin Improves Endothelial Function in Pregnant Women at High Risk of Preeclampsia.

PubMed

McLaughlin, Kelsey; Baczyk, Dora; Potts, Audrey; Hladunewich, Michelle; Parker, John D; Kingdom, John C P

2017-01-01

Low molecular weight heparin (LMWH) has been investigated for the prevention of severe preeclampsia, although the mechanisms of action are unknown. The objective of this study was to investigate the cardiovascular effects of LMWH in pregnant women at high risk of preeclampsia. Pregnant women at high risk of preeclampsia (n=25) and low-risk pregnant controls (n=20) at 22 to 26 weeks' gestation underwent baseline cardiovascular assessments. High-risk women were then randomized to LMWH or saline placebo (30 mg IV bolus and 1 mg/kg subcutaneous dose). Cardiovascular function was assessed 1 and 3 hours post randomization. The in vitro endothelial effects of patient serum and exogenous LMWH on human umbilical venous endothelial cells were determined. High-risk women demonstrated a reduced cardiac output, high resistance hemodynamic profile with impaired radial artery flow-mediated dilation compared with controls. LMWH increased flow-mediated dilation in high-risk women 3 hours after randomization compared with baseline and increased plasma levels of placental growth factor, soluble fms-like tyrosine kinase-1, and myeloperoxidase. Serum from high-risk women impaired endothelial cell angiogenesis and increased PlGF-1 and PlGF-2 transcription compared with serum from low-risk controls. Coexposure of high-risk serum with LMWH improved the in vitro angiogenic response such that it was equivalent to that of low-risk serum and promoted placental growth factor secretion. LMWH improves maternal endothelial function in pregnant women at high risk of developing preeclampsia, possibly mediated through increased placental growth factor bioavailability. © 2016 American Heart Association, Inc.

Utility of three anthropometric indices in assessing the cardiometabolic risk profile in children.

PubMed

Buchan, Duncan S; Boddy, Lynne M; Grace, Fergal M; Brown, Elise; Sculthorpe, Nicholas; Cunningham, Conor; Murphy, Marie H; Dagger, Rebecca; Foweather, Lawrence; Graves, Lee E F; Hopkins, Nicola D; Stratton, Gareth; Baker, Julien S

2017-05-06

To evaluate the ability of BMI, WC, and WHtR to identify increased cardiometabolic risk in pre-adolescents. This is a cross-sectional study involving 192 children (10.92 ± 0.58 years, 56% female) from the United Kingdom between 2010 and 2013. Receiver operating characteristic curves determined the discriminatory ability of BMI, WC and WHtR to identify individuals with increased cardiometabolic risk (increased clustered triglycerides, HDL-cholesterol, systolic blood pressure, cardiorespiratory fitness, and glucose). A WHtR ≥ 0.5 increased the odds by 5.2 (95% confidence interval 2.6 - 10.3) of having increased cardiometabolic risk. Similar associations were observed for BMI and WC. Both BMI-z and WHtR were fair predictors of increased cardiometabolic risk, although BMI-z demonstrated the best trade-off between sensitivity and specificity, 76.1% and 63.6%, compared with 68.1% and 65.5% for WHtR. Cross-validation analysis revealed that BMI-z and WHtR correctly classified 84% of individuals (kappa score = 0.671, 95% CI 0.55, 0.79). The sensitivity of the cut-points suggests that 89.3% of individuals were correctly classified as being at risk with only 10.7% misdiagnosed whereas the specificity of the cut-points indicated that 77.8% of individuals were correctly identified as being healthy with 22.2% of individuals incorrectly diagnosed as being at risk. Findings suggest that WHtR provides similar cardiometabolic risk estimates to age and sex adjusted BMI. © 2016 Wiley Periodicals, Inc.

Determining clinical benefits of drug-eluting coronary stents according to the population risk profile: a meta-regression from 31 randomized trials.

PubMed

Moreno, Raul; Martin-Reyes, Roberto; Jimenez-Valero, Santiago; Sanchez-Recalde, Angel; Galeote, Guillermo; Calvo, Luis; Plaza, Ignacio; Lopez-Sendon, Jose-Luis

2011-04-01

The use of drug-eluting stents (DES) in unfavourable patients has been associated with higher rates of clinical complications and stent thrombosis, and because of that concerns about the use of DES in high-risk settings have been raised. This study sought to demonstrate that the clinical benefit of DES increases as the risk profile of the patients increases. A meta-regression analysis from 31 randomized trials that compared DES and bare-metal stents, including overall 12,035 patients, was performed. The relationship between the clinical benefit of using DES (number of patients to treat [NNT] to prevent one episode of target lesion revascularization [TLR]), and the risk profile of the population (rate of TLR in patients allocated to bare-metal stents) in each trial was evaluated. The clinical benefit of DES increased as the risk profile of each study population increased: NNT for TLR=31.1-1.2 (TLR for bare-metal stents); p<0.001. The use of DES was safe regardless of the risk profile of each study population, since the effect of DES in mortality, myocardial infarction, and stent thrombosis, was not adversely affected by the risk profile of each study population (95% confidence interval for β value 0.09 to 0.11, -0.12 to 0.19, and -0.03 to-0.15 for mortality, myocardial infarction, and stent thrombosis, respectively). The clinical benefit of DES increases as the risk profile of the patients increases, without affecting safety. Copyright © 2009 Elsevier Ireland Ltd. All rights reserved.

Decision-Making Under Risk in Children, Adolescents, and Young Adults

PubMed Central

Paulsen, David J.; Platt, Michael L.; Huettel, Scott A.; Brannon, Elizabeth M.

2011-01-01

Adolescents often make risky and impulsive decisions. Such behavior has led to the common assumption that a dysfunction in risk-related decision-making peaks during this age. Differences in how risk has been defined across studies, however, make it difficult to draw conclusions about developmental changes in risky decision-making. Here, we developed a non-symbolic economic decision-making task that can be used across a wide age span and that uses coefficient of variation (CV) in reward as an index of risk. We found that young children showed the strongest preference for risky compared to sure bet options of equal expected value, adolescents were intermediate in their risk preference, and young adults showed the strongest risk aversion. Furthermore, children's preference for the risky option increased for larger CVs, while adolescents and young adults showed the opposite pattern, favoring the sure bet more often as CV increased. Finally, when faced with two gambles in a risk–return tradeoff, all three age groups exhibited a greater preference for the option with the lower risk and return as the disparity in risk between the two options increased. These findings demonstrate clear age-related differences in economic risk preferences that vary with choice set and risk. Importantly, adolescence appears to represent an intermediate decision-making phenotype along the transition from childhood to adulthood, rather than an age of heightened preference for economic risk. PMID:21687443

Personalized assessment and management of women at risk for breast cancer in North America.

PubMed

Pruthi, Sandhya; Heisey, Ruth; Bevers, Therese

2015-03-01

Many women at increased risk for breast cancer would benefit from referral for genetic testing, enhanced screening, preventive therapy or risk-reducing surgery. We present a visual model and a step-wise approach to assist with a personalized risk stratification and management of these women. We present current recommendations with respect to lifestyle behaviors and mammographic screening, and we review the current evidence regarding enhanced screening and risk-reducing therapies. We discuss the usefulness of three risk-assessment tools in determining whether a woman qualifies for genetic testing, enhanced screening or preventive therapy and present four cases to demonstrate the usefulness of this approach in the clinical setting.

The Formative Years: Pathways to Substance Abuse among Girls and Young Women Ages 8-22.

ERIC Educational Resources Information Center

Columbia Univ., New York, NY. National Center on Addiction and Substance Abuse.

This report presents a comprehensive analysis of the reasons why girls and young women smoke, drink and use drugs, and what increases or lowers their risk of substance abuse. It demonstrates that certain key risk factors for substance abuse are unique to girls and young women and pose a greater threat to them than to boys and young men. This…

Psychosocial Adjustment and Sibling Relationships in Siblings of Children with Autism Spectrum Disorder: Risk and Protective Factors

ERIC Educational Resources Information Center

Walton, Katherine M.; Ingersoll, Brooke R.

2015-01-01

This study compared sibling adjustment and relationships in siblings of children with Autism Spectrum Disorder (ASD-Sibs; n = 69) and siblings of children with typical development (TD-Sibs; n = 93). ASD-Sibs and TD-Sibs demonstrated similar emotional/behavioral adjustment. Older male ASD-Sibs were at increased risk for difficulties. Sibling…

Circadian misalignment increases cardiovascular disease risk factors in humans

PubMed Central

Morris, Christopher J.; Purvis, Taylor E.; Hu, Kun; Scheer, Frank A. J. L.

2016-01-01

Shift work is a risk factor for hypertension, inflammation, and cardiovascular disease. This increased risk cannot be fully explained by classic risk factors. One of the key features of shift workers is that their behavioral and environmental cycles are typically misaligned relative to their endogenous circadian system. However, there is little information on the impact of acute circadian misalignment on cardiovascular disease risk in humans. Here we show—by using two 8-d laboratory protocols—that short-term circadian misalignment (12-h inverted behavioral and environmental cycles for three days) adversely affects cardiovascular risk factors in healthy adults. Circadian misalignment increased 24-h systolic blood pressure (SBP) and diastolic blood pressure (DBP) by 3.0 mmHg and 1.5 mmHg, respectively. These results were primarily explained by an increase in blood pressure during sleep opportunities (SBP, +5.6 mmHg; DBP, +1.9 mmHg) and, to a lesser extent, by raised blood pressure during wake periods (SBP, +1.6 mmHg; DBP, +1.4 mmHg). Circadian misalignment decreased wake cardiac vagal modulation by 8–15%, as determined by heart rate variability analysis, and decreased 24-h urinary epinephrine excretion rate by 7%, without a significant effect on 24-h urinary norepinephrine excretion rate. Circadian misalignment increased 24-h serum interleukin-6, C-reactive protein, resistin, and tumor necrosis factor-α levels by 3–29%. We demonstrate that circadian misalignment per se increases blood pressure and inflammatory markers. Our findings may help explain why shift work increases hypertension, inflammation, and cardiovascular disease risk. PMID:26858430

Prenatal and Perinatal Risk Factors in a Twin Study of Autism Spectrum Disorders

PubMed Central

Froehlich-Santino, Wendy; Tobon, Amalia Londono; Cleveland, Sue; Torres, Andrea; Phillips, Jennifer; Cohen, Brianne; Torigoe, Tiffany; Miller, Janet; Fedele, Angie; Collins, Jack; Smith, Karen; Lotspeich, Linda; Croen, Lisa A.; Ozonoff, Sally; Lajonchere, Clara; Grether, Judith K.; O’Hara, Ruth; Hallmayer, Joachim

2014-01-01

Introduction Multiple studies associate prenatal and perinatal complications with increased risks for autism spectrum disorders (ASDs). The objectives of this study were to utilize a twin study design to 1) Investigate whether shared gestational and perinatal factors increase concordance for ASDs in twins, 2) Determine whether individual neonatal factors are associated with the presence of ASDs in twins, and 3) Explore whether associated factors may influence males and females differently. Methods Data from medical records and parent response questionnaires from 194 twin pairs, in which at least one twin had an ASD, were analyzed. Results Shared factors including parental age, prenatal use of medications, uterine bleeding, and prematurity did not increase concordance risks for ASDs in twins. Among the individual factors, respiratory distress demonstrated the strongest association with increased risk for ASDs in the group as a whole (OR 2.11, 95% CI 1.27–3.51). Furthermore, respiratory distress (OR 2.29, 95% CI 1.12–4.67) and other markers of hypoxia (OR 1.99, 95% CI 1.04–3.80) were associated with increased risks for ASDs in males, while jaundice was associated with an increased risk for ASDs in females (OR 2.94, 95% CI 1.28–6.74). Conclusions Perinatal factors associated with respiratory distress and other markers of hypoxia appear to increase risk for autism in a subgroup of twins. Future studies examining potential gender differences and additional prenatal, perinatal and postnatal environmental factors are required for elucidating the etiology of ASDs and suggesting new methods for treatment and prevention. PMID:24726638

Mild-to-moderate ulcerative colitis: your role in patient compliance and health care costs.

PubMed

Tindall, William N; Boltri, John M; Wilhelm, Sheila M

2007-09-01

Ulcerative colitis (UC) is a chronic relapsing disease necessitating lifelong treatment. Most patients present with mild-to-moderate disease characterized by alternating periods of remission and clinical relapse. Continued disease progression and relapse of UC over time are associated with an increased risk of colorectal cancer (CRC). To discuss the latest treatment options for mild-to-moderate UC, to review the current data involving the economics of UC, and to demonstrate the relationship between treatment adherence, clinical relapse, inflammation severity, CRC risk, and treatment outcomes. One of the main goals of therapy in UC is to induce and maintain a long-lasting remission of disease to reduce or avoid the high personal and financial costs of relapse. In recent studies, researchers have demonstrated a link between increased colonic inflammation and CRC risk, highlighting the importance of preventing relapse, which can lead to costly surgical procedures and hospital stays and thus increase the cost of treatment 2- to 20-fold. The risk of disease relapse is affected by several factors, of which the most prominent is nonadherence to maintenance therapy. Nonadherence to therapy can be associated with several other factors, including forgetfulness, male sex, complicated dosing regimens, treatment delivery methods (oral vs. rectal), and pill burden. In the treatment of mild-to-moderate UC, 5-aminosalicyclic acid (5-ASA) is the standard first-line therapy and the treatment of choice for maintaining remission of disease. Novel formulations of 5-ASA and newly devised high-dose 5-ASA regimens offer more options for the treatment of UC and thus may lead to improved treatment adherence, longer remission, and improved patient well-being. Periods of remission during UC treatment must be aggressively maintained to prevent relapse and decrease the risk of an unfavorable outcome. By controlling the risks and conditions that lead to therapeutic nonadherence and relapse among patients with UC, clinicians can increase the likelihood of long-term remission and ensure favorable long-term outcomes.

Assessment of nurses' knowledge on evidence-based preventive practices for pressure ulcer risk reduction in patients with impaired mobility.

PubMed

Akese, M I; Adejumo, P O; Ilesanmi, R E; Obilor, H N

2014-09-01

The increase in the prevalence of pressure ulcer among patients with impaired physical mobility has currently been associated with nurses' inadequate knowledge of preventive interventions. To assess nurses' knowledge of pressure ulcer identification/staging, risk factors and evidence-based preventive practices. This descriptive study was carried out at the University Teaching Hospital Maiduguri (UMTH), Borno State, Nigeria. Total sampling technique was utilized in the recruitment of the study participants. An adapted 75-item-pressure ulcer questionnaire was used for data collection. The data were analyzed using SPSS version 16. The hypotheses on nurses' knowledge were tested at 0.05 level of significance using Chi square test. A total of 219 nurses participated in this study with response rate of 68.0%. The nurses' years of professional practice ranged from 1 to 35 years with a mean of 11.7 (± 7.8) years. Approximately, 73% of the nurses demonstrated a low level of knowledge of pressure ulcer identification/staging, 69.4% demonstrated an average level of knowledge of risk factors and 79.9% demonstrated high level of knowledge of preventive practices. The relationship between nurses' knowledge of risk factors and knowledge of preventive practices (p = 0.37) was not significant. Nurses demonstrated a knowledge deficit in core areas on pressure ulcer identification/staging, risk factors' assessment and evidence-based preventive practices. In order to address this dearth, there is a need to institute an educational-based practice-guideline on pressure ulcer prevention for nurses.

Heightened Activity in Social Reward Networks is Associated with Adolescents’ Risky Sexual Behaviors

PubMed Central

Eckstrand, Kristen L.; Choukas-Bradley, Sophia; Mohanty, Arpita; Cross, Marissa; Allen, Nicholas B.; Silk, Jennifer S.; Jones, Neil P.; Forbes, Erika E.

2018-01-01

Adolescent sexual risk behavior can lead to serious health consequences, yet few investigations have addressed its neurodevelopmental mechanisms. Social neurocircuitry is postulated to underlie the development of risky sexual behavior, and response to social reward may be especially relevant. Typically developing adolescents (N=47; 18M, 29F; 16.3±1.4 years; 42.5% sexual intercourse experience) completed a social reward fMRI task and reported their sexual risk behaviors (e.g., lifetime sexual partners) on the Youth Risk Behavior Survey (YRBS). Neural response and functional connectivity to social reward were compared for adolescents with higher- and lower-risk sexual behavior. Adolescents with higher-risk sexual behaviors demonstrated increased activation in the right precuneus and the right temporoparietal junction during receipt of social reward. Adolescents with higher-risk sexual behaviors also demonstrated greater functional connectivity between the precuneus and the temporoparietal junction bilaterally, dorsal medial prefrontal cortex, and left anterior insula/ventrolateral prefrontal cortex. The greater activation and functional connectivity in self-referential, social reward, and affective processing regions among higher sexual risk adolescents underscores the importance of social influence underlying sexual risk behaviors. Furthermore, results suggest an orientation towards and sensitivity to social rewards among youth engaging in higher-risk sexual behavior, perhaps as a consequence of or vulnerability to such behavior. PMID:28755632

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

PubMed

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

2013-04-01

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

Social living mitigates the costs of a chronic illness in a cooperative carnivore

USGS Publications Warehouse

Almberg, Emily S.; Cross, Paul C.; Dobson, Andrew P.; Smith, Douglas W.; Metz, Matthew C; Stahler, Daniel R.; Hudson, Peter J.

2015-01-01

Infection risk is assumed to increase with social group size, and thus be a cost of group living. We assess infection risk and costs with respect to group size using data from an epidemic of sarcoptic mange (Sarcoptes scabiei) among grey wolves (Canis lupus). We demonstrate that group size does not predict infection risk and that individual costs of infection, in terms of reduced survival, can be entirely offset by having sufficient numbers of pack-mates. Infected individuals experience increased mortality hazards with increasing proportions of infected pack-mates, but healthy individuals remain unaffected. The social support of group hunting and territory defence are two possible mechanisms mediating infection costs. This is likely a common phenomenon among other social species and chronic infections, but difficult to detect in systems where infection status cannot be measured continuously over time.

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

PubMed

Scott, Bobby R

2018-01-01

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

Carotid revascularization: risks and benefits

PubMed Central

O’Brien, Marlene; Chandra, Ankur

2014-01-01

Despite a decline during the recent decades in stroke-related death, the incidence of stroke has remained unchanged or slightly increased, and extracranial carotid artery stenosis is implicated in 20%–30% of all strokes. Medical therapy and risk factor modification are first-line therapies for all patients with carotid occlusive disease. Evidence for the treatment of patients with symptomatic carotid stenosis greater than 70% with either carotid artery stenting (CAS) or carotid endarterectomy (CEA) is compelling, and several trials have demonstrated a benefit to carotid revascularization in the symptomatic patient population. Asymptomatic carotid stenosis is more controversial, with the largest trials only demonstrating a 1% per year risk stroke reduction with CEA. Although there are sufficient data to advocate for aggressive medical therapy as the primary mode of treatment for asymptomatic carotid stenosis, there are also data to suggest that certain patient populations will benefit from a stroke risk reduction with carotid revascularization. In the United States, consensus and practice guidelines dictate that CEA is reasonable in patients with high-grade asymptomatic stenosis, a reasonable life expectancy, and perioperative risk of less than 3%. Regarding CAS versus CEA, the best-available evidence demonstrates no difference between the two procedures in early perioperative stroke, myocardial infarction, or death, and no difference in 4-year ipsilateral stroke risk. However, because of the higher perioperative risks of stroke in patients undergoing CAS, particularly in symptomatic, female, or elderly patients, it is difficult to recommend CAS over CEA except in populations with prohibitive cardiac risk, previous carotid surgery, or prior neck radiation. Current treatment paradigms are based on identifying the magnitude of perioperative risk in patient subsets and on using predictive factors to stratify patients with high-risk asymptomatic stenosis. PMID:25045271

Adult Brtl/+ mouse model of osteogenesis imperfecta demonstrates anabolic response to sclerostin antibody treatment with increased bone mass and strength.

PubMed

Sinder, B P; White, L E; Salemi, J D; Ominsky, M S; Caird, M S; Marini, J C; Kozloff, K M

2014-08-01

Treatments to reduce fracture rates in adults with osteogenesis imperfecta are limited. Sclerostin antibody, developed for treating osteoporosis, has not been explored in adults with OI. This study demonstrates that treatment of adult OI mice respond favorably to sclerostin antibody therapy despite retention of the OI-causing defect. Osteogenesis imperfecta (OI) is a heritable collagen-related bone dysplasia, characterized by brittle bones with increased fracture risk. Although OI fracture risk is greatest before puberty, adults with OI remain at risk of fracture. Antiresorptive bisphosphonates are commonly used to treat adult OI, but have shown mixed efficacy. New treatments which consistently improve bone mass throughout the skeleton may improve patient outcomes. Neutralizing antibodies to sclerostin (Scl-Ab) are a novel anabolic therapy that have shown efficacy in preclinical studies by stimulating bone formation via the canonical wnt signaling pathway. The purpose of this study was to evaluate Scl-Ab in an adult 6 month old Brtl/+ model of OI that harbors a typical heterozygous OI-causing Gly > Cys substitution on Col1a1. Six-month-old WT and Brtl/+ mice were treated with Scl-Ab (25 mg/kg, 2×/week) or Veh for 5 weeks. OCN and TRACP5b serum assays, dynamic histomorphometry, microCT and mechanical testing were performed. Adult Brtl/+ mice demonstrated a strong anabolic response to Scl-Ab with increased serum osteocalcin and bone formation rate. This anabolic response led to improved trabecular and cortical bone mass in the femur. Mechanical testing revealed Scl-Ab increased Brtl/+ femoral stiffness and strength. Scl-Ab was successfully anabolic in an adult Brtl/+ model of OI.

Communicating risks and benefits about ethically controversial topics: the case of induced pluripotent stem (iPS) cells.

PubMed

Longstaff, Holly; McDonald, Michael; Bailey, Jennifer

2013-08-01

Many are supportive of approaches that incorporate lay citizens into policy making and risk management decisions. However, a great deal of learning must first take place about how citizen engagement for controversial topics is best accomplished. Online risk communication efforts are increasing in popularity but there is little empirical evidence accrued to demonstrate the effectiveness of such methods. The intention of our overall study is to create a powerful method for in-depth two-way communication with the public and expert communities about complex and sensitive issues at the heart of stem cell (SC) research. The fundamental objective is to raise awareness of SC science with lay citizens by fostering more holistic or "all things considered" ethical judgments. Our risk communication study demonstrates that lay citizens are both interested in, and capable of learning about, complex scientific issues provided the right tools are used to convey information and assess understanding. Our results show that it is worth the time and effort for SC researchers to continue posting podcasts and FAQ's about their work for non-expert communities to view. In addition, despite having increased our participants' risk perceptions about induced pluripotent stem (iPS) cell research, almost all were very supportive of this type of research in Canada by the end of the survey. In other words, participants understood that this research did in fact pose some risks and learned a great deal about both the risks and benefits of iPS cell research, and still thought this research was worthwhile to pursue.

Impacts of extreme heat on emergency medical service calls in King County, Washington, 2007-2012: relative risk and time series analyses of basic and advanced life support.

PubMed

Calkins, Miriam M; Isaksen, Tania Busch; Stubbs, Benjamin A; Yost, Michael G; Fenske, Richard A

2016-01-28

Exposure to excessive heat kills more people than any other weather-related phenomenon, aggravates chronic diseases, and causes direct heat illness. Strong associations between extreme heat and health have been identified through increased mortality and hospitalizations and there is growing evidence demonstrating increased emergency department visits and demand for emergency medical services (EMS). The purpose of this study is to build on an existing regional assessment of mortality and hospitalizations by analyzing EMS demand associated with extreme heat, using calls as a health metric, in King County, Washington (WA), for a 6-year period. Relative-risk and time series analyses were used to characterize the association between heat and EMS calls for May 1 through September 30 of each year for 2007-2012. Two EMS categories, basic life support (BLS) and advanced life support (ALS), were analyzed for the effects of heat on health outcomes and transportation volume, stratified by age. Extreme heat was model-derived as the 95th (29.7 °C) and 99th (36.7 °C) percentile of average county-wide maximum daily humidex for BLS and ALS calls respectively. Relative-risk analyses revealed an 8 % (95 % CI: 6-9 %) increase in BLS calls, and a 14 % (95 % CI: 9-20 %) increase in ALS calls, on a heat day (29.7 and 36.7 °C humidex, respectively) versus a non-heat day for all ages, all causes. Time series analyses found a 6.6 % increase in BLS calls, and a 3.8 % increase in ALS calls, per unit-humidex increase above the optimum threshold, 40.7 and 39.7 °C humidex respectively. Increases in "no" and "any" transportation were found in both relative risk and time series analyses. Analysis by age category identified significant results for all age groups, with the 15-44 and 45-64 year old age groups showing some of the highest and most frequent increases across health conditions. Multiple specific health conditions were associated with increased risk of an EMS call including abdominal/genito-urinary, alcohol/drug, anaphylaxis/allergy, cardiovascular, metabolic/endocrine, diabetes, neurological, heat illness and dehydration, and psychological conditions. Extreme heat increases the risk of EMS calls in King County, WA, with effects demonstrated in relatively younger populations and more health conditions than those identified in previous analyses.

The Role of Alcohol Use during Sexual Situations in the Relationship between Sexual Revictimization and Women’s Intentions to Engage in Unprotected Sex

PubMed Central

Parkhill, Michele R.; Norris, Jeanette; Cue Davi, Kelly

2015-01-01

Research has demonstrated relationships among childhood sexual abuse, adult sexual assault, and sexual risk taking. This study proposes that one mechanism through which the victimization-sexual risk taking relationship works is through an increased likelihood of drinking during sexual situations. Using path analysis, the current study explores this hypothesis in a sample of 230 women. The model illustrates that women with a history of child and adult sexual victimization reported greater intentions to engage in unprotected sex and that this relationship is in part accounted for by an increased likelihood of drinking in sexual situations. The results suggest that sexual risk reduction programs and sexual assault treatment programs should educate women about the alcohol-involved sexual risk taking that often follows sexual assault victimization. PMID:25069152

Econometric analysis of the impact of the relationship of GDP and the pension capital

NASA Astrophysics Data System (ADS)

Nepp, A. N.; Amiryan, A. A.

2016-12-01

The article demonstrates the impact of institutional risks on indicators of compulsory pension insurance and describes the results of a comparative analysis of investment risks faced by the pension systems of the Russian Federation and OECD countries. Efficiency of private companies managing pension funds in Russia and OECD countries is compared and analyzed to show the necessity to liberalize requirements placed on investments of pension savings funds. On the basis of the available statistical data, the article puts forward and discusses the hypothesis that increasing of the basic indicators of the pension system is possible by reducing its institutional risks. It is concluded that if the institutional risks are reduced and the level of trust increases, there will be enhance growth in the pension system key indicators, such as pension payments and the replacement rate.

Relationship between occupational exposure to lead and local arterial stiffness and left ventricular diastolic function in individuals with arterial hypertension

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

Poreba, Rafal, E-mail: sogood@poczta.onet.pl; Gac, Pawel; Poreba, Malgorzata

Relationship between occupational exposure to lead and frequency of complications in persons with arterial hypertension has been poorly investigated. This study aimed at evaluation of the relationship between occupational exposure to lead and manifestation of an increased local arterial stiffness and left ventricular diastolic dysfunction. The studies included 105 men (mean age: 44.47 {+-} 9.12 years) with arterial hypertension, treated with hypotensive drugs: group I - men occupationally exposed to lead (n = 53), and group II - men not exposed to lead (n = 52). In echocardiographic examination, the left ventricular diastolic dysfunction was diagnosed significantly more frequently inmore » group I than in group II. In eTracking examination mean values of stiffness parameter ({beta}), augmentation index (AI) and one-point pulse wave velocity (PWV-{beta}) were significantly higher and mean values of arterial compliance (AC) were significantly lower in group I than in group II. The logistic regression showed that in the group of persons with arterial hypertension occupationally exposed to lead a more advanced age, higher blood lead concentration and higher mean values of augmentation index represent independent risk factors of left ventricular diastolic dysfunction. The multifactorial regression showed that amongst persons with arterial hypertension occupationally exposed to lead higher blood zinc protoporphyrin concentration, a more advanced age and higher value of body mass index (BMI) represent independent risk factors of an increased local arterial stiffness. In summary, we should note that in the group of persons with arterial hypertension occupationally exposed to lead the study has demonstrated a significantly more frequent manifestation of left ventricular diastolic dysfunction and an increase in local arterial stiffness. - Highlights: > Amongst persons with AH exposed to Pb higher ZnPP represent independent risk factor of increased local arterial stiffness. > Higher Pb-B represent independent risk factor of left ventricular diastolic dysfunction. > The study has demonstrated a more frequent manifestation of left ventricular diastolic dysfunction in group exposed to Pb. > Also, in this group the study has demonstrated a more frequent manifestation of increase in local arterial stiffness.« less

The impact of serum lipids on risk for microangiopathy in patients with type 2 diabetes mellitus.

PubMed

Toth, Peter P; Simko, Robert J; Palli, Swetha Rao; Koselleck, Dawn; Quimbo, Ralph A; Cziraky, Mark J

2012-09-14

Few large-scale, real-world studies have assessed the relative associations of lipid fractions with diabetic microvascular events. The main objective of this study was to evaluate the association of the lipid profile components, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), triglycerides (TG), and non-high density lipoprotein cholesterol (non-HDL-C) with microvascular complications (MVCs) in type 2 diabetes mellitus (T2DM) patients. This observational cohort study queried the HealthCore Integrated Research Database (HIRDSM) for newly-diagnosed (Index Date) 18-64-year-old patients with diabetes mellitus between 01/01/2005-06/30/2010. Inclusion required ≥ 12 months pre-index continuous health plan eligibility and ≥ 1 pre-index lipid profile result. Patients with polycystic ovary syndrome and prior MVCs were excluded. Incident complications were defined as the earliest occurrence of diabetic retinopathy, peripheral neuropathy, and/or nephropathy post-index. Cox proportional models and Kaplan-Meier (KM) curves were used to evaluate associations among variables. Of the patients (N=72,267), 50.05% achieved HDL-C, 64.28% LDL-C, 59.82% TG, and 56.79% non-HDL-C American Diabetes Association goals at baseline. During follow-up (mean, 21.74 months), there were 5.21 microvascular events per 1,000 patient-months. A 1-mg/dL increase in HDL-C was associated with 1% decrease in any MVC risk (P< .0001), but for LDL-C, TG, and non-HDL-C, 1-mg/dL increase resulted in increases of 0.2% (P< .0001), 0.1% (P<0.001) and 0.3% (P<0.001) in MVC risk. Patients achieving HDL-C goals had a 11% lower risk of MVC versus non-achievers (RR 0.895, [95% CI, 0.852-0.941], P< .0001). Similarly, TG goal attainment was associated with a lowered risk for any MVC (RR 0.849, [95% CI, 0.808-0.892], P< .0001). Evaluation of KM survival curves demonstrated no significant difference in the risk of MVCs between patients achieving vs. not achieving LDL-C goals, but did demonstrate a difference in MVC risk between patients achieving vs. not achieving non-HDL-C goals. This study demonstrates significant independent associations among lipid fractions and risk for microangiopathy. These findings suggest that attaining established ADA goals for HDL-C, TG, and non-HDL-C may reduce risk for microvascular events among patients with diabetes.

Intraoperative transfusion of 1 U to 2 U packed red blood cells is associated with increased 30-day mortality, surgical-site infection, pneumonia, and sepsis in general surgery patients.

PubMed

Bernard, Andrew C; Davenport, Daniel L; Chang, Phillip K; Vaughan, Taylor B; Zwischenberger, Joseph B

2009-05-01

Transfusion of packed red blood cells (PRBCs) increases morbidity and mortality in select surgical specialty patients. The impact of low-volume, leukoreduced RBC transfusion on general surgery patients is less well understood. The American College of Surgeons National Surgical Quality Improvement Program participant use file was queried for general surgery patients recorded in 2005 to 2006 (n = 125,223). Thirty-day morbidity (21 uniformly defined complications) and mortality, demographic, preoperative, and intraoperative risk variables were obtained. Infectious complications and composite morbidity and mortality were stratified across intraoperative PRBCs units received. Multivariable logistic regression was used to assess influence of transfusion on outcomes, while adjusting for transfusion propensity, procedure type, wound class, operative duration, and 30+ patient risk factors. After adjustment for transfusion propensity, procedure group, wound class, operative duration, and all other important risk variables, 1 U PRBCs significantly (p < 0.05) increased risk of 30-day mortality (odds ratio [OR] = 1.32), composite morbidity (OR = 1.23), pneumonia (OR = 1.24), and sepsis/shock (OR = 1.29). Transfusion of 2 U additionally increased risk for these outcomes (OR = 1.38, 1.40, 1.25, 1.53, respectively; p

RTEL1 and TERT polymorphisms are associated with astrocytoma risk in the Chinese Han population.

PubMed

Jin, Tian-Bo; Zhang, Jia-Yi; Li, Gang; Du, Shu-Li; Geng, Ting-Ting; Gao, Jing; Liu, Qian-Ping; Gao, Guo-Dong; Kang, Long-Li; Chen, Chao; Li, Shan-Qu

2013-12-01

Common variants of multiple genes play a role in glioma onset. However, research related to astrocytoma, the most common primary brain neoplasm, is rare. In this study, we chose 21 tagging SNPs (tSNPs), previously reported to be associated with glioma risk in a Chinese case-control study from Xi'an, China, and identified their contributions to astrocytoma susceptibility. We found an association with astrocytoma susceptibility for two tSNPs (rs6010620 and rs2853676) in two different genes: regulator of telomere elongation helicase 1 (RTEL1) and telomerase reverse transcriptase (TERT), respectively. We confirmed our results using recessive, dominant, and additive models. In the recessive model, we found two tSNPs (rs2297440 and rs6010620) associated with increased astrocytoma risk. In the dominant model, we found that rs2853676 was associated with increased astrocytoma risk. In the additive model, all three tSNPs (rs2297440, rs2853676, and rs6010620) were associated with increased astrocytoma risk. Our results demonstrate, for the first time, the potential roles of RTEL1 and TERT in astrocytoma development.

Genetic counseling and testing for Alzheimer disease: Joint practice guidelines of the American College of Medical Genetics and the National Society of Genetic Counselors

PubMed Central

Goldman, Jill S.; Hahn, Susan E.; Catania, Jennifer Williamson; LaRusse-Eckert, Susan; Butson, Melissa Barber; Rumbaugh, Malia; Strecker, Michelle N.; Roberts, J. Scott; Burke, Wylie; Mayeux, Richard; Bird, Thomas

2012-01-01

Alzheimer disease is the most common cause of dementia. It occurs worldwide and affects all ethnic groups. The incidence of Alzheimer disease is increasing due, in part, to increased life expectancy and the aging baby boomer generation. The average lifetime risk of developing Alzheimer disease is 10–12%. This risk at least doubles with the presence of a first-degree relative with the disorder. Despite its limited utility, patients express concern over their risk and, in some instances, request testing. Furthermore, research has demonstrated that testing individuals for apoli-poprotein E can be valuable and safe in certain contexts. However, because of the complicated genetic nature of the disorder, few clinicians are prepared to address the genetic risks of Alzheimer disease with their patients. Given the increased awareness in family history thanks to family history campaigns, the increasing incidence of Alzheimer disease, and the availability of direct to consumer testing, patient requests for information is increasing. This practice guideline provides clinicians with a framework for assessing their patients’ genetic risk for Alzheimer disease, identifying which individuals may benefit from genetic testing, and providing the key elements of genetic counseling for AD. PMID:21577118

Social learning strategies and predation risk: minnows copy only when using private information would be costly

PubMed Central

Webster, M.M; Laland, K.N

2008-01-01

Animals can acquire information from the environment privately, by sampling it directly, or socially, through learning from others. Generally, private information is more accurate, but expensive to acquire, while social information is cheaper but less reliable. Accordingly, the ‘costly information hypothesis’ predicts that individuals will use private information when the costs associated with doing so are low, but that they should increasingly use social information as the costs of using private information rise. While consistent with considerable data, this theory has yet to be directly tested in a satisfactory manner. We tested this hypothesis by giving minnows (Phoxinus phoxinus) a choice between socially demonstrated and non-demonstrated prey patches under conditions of low, indirect and high simulated predation risk. Subjects had no experience (experiment 1) or prior private information that conflicted with the social information provided by the demonstrators (experiment 2). In both experiments, subjects spent more time in the demonstrated patch than in the non-demonstrated patch, and in experiment 1 made fewer switches between patches, when risk was high compared with when it was low. These findings are consistent with the predictions of the costly information hypothesis, and imply that minnows adopt a ‘copy-when-asocial-learning-is-costly’ learning strategy. PMID:18755676

Centaur Test Bed (CTB) for Cryogenic Fluid Management

NASA Technical Reports Server (NTRS)

Sakla, Steven; Kutter, Bernard; Wall, John

2006-01-01

Future missions such as NASA s space exploration vision and DOD satellite servicing will require significant increases in the understanding and knowledge of space based cryogenic fluid management (CFM), including the transfer and storage of cryogenic fluids. Existing CFM capabilities are based on flight of upper stage cryogenic vehicles, scientific dewars, a few dedicated flight demonstrations and ground testing. This current capability is inadequate to support development of the CEV cryogenic propulsion system, other aspects of robust space exploration or the refueling of satellite cryo propulsion systems with reasonable risk. In addition, these technologies can provide significant performance increases for missions beyond low-earth orbit to enable manned missions to the Moon and beyond. The Centaur upper-stage vehicle can provide a low cost test platform for performing numerous flight demonstrations of the full breadth of required CFM technologies to support CEV development. These flight demonstrations can be performed as secondary mission objectives using excess LH2 and/or LO2 from the main vehicle propellant tanks following primary spacecraft separation at minimal cost and risk.

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

Psychiatric diagnosis and differential risks of offending following discharge.

PubMed

Coid, Jeremy W; Yang, Min; Ullrich, Simone; Hickey, Nicole; Kahtan, Nadji; Freestone, Mark

2015-01-01

Psychiatric diagnosis is not considered a risk factor for offending following discharge. However, treatment interventions and aftercare are strongly influenced by clinical primary diagnosis. We compared differential risks of reoffending of patients falling into six primary diagnostic categories following discharge from Medium Secure Units in the UK: schizophrenia/schizoaffective disorder; delusional disorder; mania/hypomania; depressive disorder; organic brain syndrome; personality disorder. We followed up 1344 patients, on average 6.2 years (SD=2.1) at risk, discharged from 7 of 14 Regional Medium Secure services in England and Wales. Outcomes were period prevalence, incidence, and cumulative probability of criminal conviction. Established demographic and criminal history predictors of reoffending were observed across different diagnostic categories. Risks of all offending were increased for personality disorder, violence/acquisitive offending for delusional disorder, sexual offending for mania/hypomania and violence/acquisitive offending for organic brain syndrome. Patterns of risk over time differed markedly between categories of mental disorder. Most patients with personality disorder who offended violently did so within 4 years of discharge. A subgroup with delusional disorder demonstrated increased risk of violent offending 5 years after discharge. Differential risks of reoffending are observed between different diagnostic groups. Clinical diagnosis should be included together with established risk measures in risk management following discharge. Close supervision of patients with personality disorder should begin immediately after discharge when risks of reoffending are greatest. For delusional disorder further investigation is needed into the marked increase in risk of violence after 5 years. Copyright © 2015 Elsevier Ltd. All rights reserved.

Dysphagia in the elderly: management and nutritional considerations

PubMed Central

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

2012-01-01

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

The impact of diabetes and diabetes medications on bone health.

PubMed

Gilbert, Matthew P; Pratley, Richard E

2015-04-01

Patients with type 2 diabetes mellitus (T2DM) have an increased risk of fragility fractures despite increased body weight and normal or higher bone mineral density. The mechanisms by which T2DM increases skeletal fragility are unclear. It is likely that a combination of factors, including a greater risk of falling, regional osteopenia, and impaired bone quality, contributes to the increased fracture risk. Drugs for the treatment of T2DM may also impact on the risk for fractures. For example, thiazolidinediones accelerate bone loss and increase the risk of fractures, particularly in older women. In contrast, metformin and sulfonylureas do not appear to have a negative effect on bone health and may, in fact, protect against fragility fracture. Animal models indicate a potential role for incretin hormones in bone metabolism, but there are only limited data on the impact of dipeptidyl peptidase-4 inhibitors and glucagon-like peptide-1 agonists on bone health in humans. Animal models also have demonstrated a role for amylin in bone metabolism, but clinical trials in patients with type 1 diabetes with an amylin analog (pramlintide) have not shown a significant impact on bone metabolism. The effects of insulin treatment on fracture risk are inconsistent with some studies showing an increased risk and others showing no effect. Finally, although there is limited information on the latest class of medications for the treatment of T2DM, the sodium-glucose co-transporter-2 inhibitors, these drugs do not seem to increase fracture risk. Because diabetes is an increasingly common chronic condition that can affect patients for many decades, further research into the effects of agents for the treatment of T2DM on bone metabolism is warranted. In this review, the physiological mechanisms and clinical impact of diabetes treatments on bone health and fracture risk in patients with T2DM are described.

Development of a Melanoma Risk Prediction Model Incorporating MC1R Genotype and Indoor Tanning Exposure: Impact of Mole Phenotype on Model Performance

PubMed Central

Penn, Lauren A.; Qian, Meng; Zhang, Enhan; Ng, Elise; Shao, Yongzhao; Berwick, Marianne; Lazovich, DeAnn; Polsky, David

2014-01-01

Background Identifying individuals at increased risk for melanoma could potentially improve public health through targeted surveillance and early detection. Studies have separately demonstrated significant associations between melanoma risk, melanocortin receptor (MC1R) polymorphisms, and indoor ultraviolet light (UV) exposure. Existing melanoma risk prediction models do not include these factors; therefore, we investigated their potential to improve the performance of a risk model. Methods Using 875 melanoma cases and 765 controls from the population-based Minnesota Skin Health Study we compared the predictive ability of a clinical melanoma risk model (Model A) to an enhanced model (Model F) using receiver operating characteristic (ROC) curves. Model A used self-reported conventional risk factors including mole phenotype categorized as “none”, “few”, “some” or “many” moles. Model F added MC1R genotype and measures of indoor and outdoor UV exposure to Model A. We also assessed the predictive ability of these models in subgroups stratified by mole phenotype (e.g. nevus-resistant (“none” and “few” moles) and nevus-prone (“some” and “many” moles)). Results Model A (the reference model) yielded an area under the ROC curve (AUC) of 0.72 (95% CI = 0.69, 0.74). Model F was improved with an AUC = 0.74 (95% CI = 0.71–0.76, p<0.01). We also observed substantial variations in the AUCs of Models A & F when examined in the nevus-prone and nevus-resistant subgroups. Conclusions These results demonstrate that adding genotypic information and environmental exposure data can increase the predictive ability of a clinical melanoma risk model, especially among nevus-prone individuals. PMID:25003831

Mitochondrial Haplogroups Modify the Effect of Diabetes Duration and HbA1c on Proliferative Diabetic Retinopathy Risk in Patients With Type 2 Diabetes.

PubMed

Mitchell, Sabrina L; Neininger, Abigail C; Bruce, Carleigh N; Chocron, Isaac M; Bregman, Jana A; Estopinal, Christopher B; Muhammad, Ayesha; Umfress, Allison C; Jarrell, Kelli L; Warden, Cassandra; Harlow, Paula A; Wellons, Melissa; Samuels, David C; Brantley, Milam A

2017-12-01

We previously demonstrated an association between European mitochondrial haplogroups and proliferative diabetic retinopathy (PDR). The purpose of this study was to determine how the relationship between these haplogroups and both diabetes duration and hyperglycemia, two major risk factors for diabetic retinopathy (DR), affect PDR prevalence. Our population consisted of patients with type 2 diabetes with (n = 377) and without (n = 480) DR. A Kruskal-Wallis test was used to compare diabetes duration and hemoglobin A1c (HbA1c) among mitochondrial haplogroups. Logistic regressions were performed to investigate diabetes duration and HbA1c as risk factors for PDR in the context of European mitochondrial haplogroups. Neither diabetes duration nor HbA1c differed among mitochondrial haplogroups. Among DR patients from haplogroup H, longer diabetes duration and increasing HbA1c were significant risk factors for PDR (P = 0.0001 and P = 0.011, respectively). Neither diabetes duration nor HbA1c was a significant risk factor for PDR in DR patients from haplogroup UK. European mitochondrial haplogroups modify the effects of diabetes duration and HbA1c on PDR risk in patients with type 2 diabetes. In our patient population, longer diabetes duration and higher HbA1c increased PDR risk in patients from haplogroup H, but did not affect PDR risk in patients from haplogroup UK. This relationship has not been previously demonstrated and may explain, in part, why some patients with nonproliferative DR develop PDR and others do not, despite similar diabetes duration and glycemic control.

Mortality and cardiovascular morbidity within 30 days of discharge following acute coronary syndrome in a contemporary European cohort of patients: How can early risk prediction be improved? The six-month GRACE risk score.

PubMed

Raposeiras-Roubín, Sergio; Abu-Assi, Emad; Cambeiro-González, Cristina; Álvarez-Álvarez, Belén; Pereira-López, Eva; Gestal-Romaní, Santiago; Pedreira-López, Milagros; Rigueiro-Veloso, Pedro; Virgós-Lamela, Alejandro; García-Acuña, José María; González-Juanatey, José Ramón

2015-06-01

Given the increasing focus on early mortality and readmission rates among patients with acute coronary syndrome (ACS), this study was designed to evaluate the accuracy of the GRACE risk score for identifying patients at high risk of 30-day post-discharge mortality and cardiovascular readmission. This was a retrospective study carried out in a single center with 4229 ACS patients discharged between 2004 and 2010. The study endpoint was the combination of 30-day post-discharge mortality and readmission due to reinfarction, heart failure or stroke. One hundred and fourteen patients had 30-day events: 0.7% mortality, 1% reinfarction, 1.3% heart failure, and 0.2% stroke. After multivariate analysis, the six-month GRACE risk score was associated with an increased risk of 30-day events (HR 1.03, 95% CI 1.02-1.04; p<0.001), demonstrating good discrimination (C-statistic: 0.79 ± 0.02) and optimal fit (Hosmer-Lemeshow p=0.83). The sensitivity and specificity were adequate (78.1% and 63.3%, respectively), and negative predictive value was excellent (99.1%). In separate analyses for each event of interest (all-cause mortality, reinfarction, heart failure and stroke), assessment of the six-month GRACE risk score also demonstrated good discrimination and fit, as well as adequate predictive values. The six-month GRACE risk score is a useful tool to predict 30-day post-discharge death and early cardiovascular readmission. Clinicians may find it simple to use with the online and mobile app score calculator and applicable to clinical daily practice. Copyright © 2014 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

Obesity during childhood and adolescence increases susceptibility to multiple sclerosis after accounting for established genetic and environmental risk factors.

PubMed

Gianfrancesco, Milena A; Acuna, Brigid; Shen, Ling; Briggs, Farren B S; Quach, Hong; Bellesis, Kalliope H; Bernstein, Allan; Hedstrom, Anna K; Kockum, Ingrid; Alfredsson, Lars; Olsson, Tomas; Schaefer, Catherine; Barcellos, Lisa F

2014-01-01

To investigate the association between obesity and multiple sclerosis (MS) while accounting for established genetic and environmental risk factors. Participants included members of Kaiser Permanente Medical Care Plan, Northern California Region (KPNC) (1235 MS cases and 697 controls). Logistic regression models were used to estimate odds ratios (ORs) with 95% confidence intervals (95% CI). Body mass index (BMI) or body size was the primary predictor of each model. Both incident and prevalent MS cases were studied. In analyses stratified by gender, being overweight at ages 10 and 20 were associated with MS in females (p<0.01). Estimates trended in the same direction for males, but were not significant. BMI in 20s demonstrated a linear relationship with MS (p-trend=9.60×10(-4)), and a twofold risk of MS for females with a BMI≥30kg/m(2) was observed (OR=2.15, 95% CI 1.18, 3.92). Significant associations between BMI in 20s and MS in males were not observed. Multivariate modelling demonstrated that significant associations between BMI or body size with MS in females persisted after adjusting for history of infectious mononucleosis and genetic risk factors, including HLA-DRB1*15:01 and established non-HLA risk alleles. Results show that childhood and adolescence obesity confer increased risk of MS in females beyond established heritable and environmental risk factors. Strong evidence for a dose-effect of BMI in 20s and MS was observed. The magnitude of BMI association with MS is as large as other known MS risk factors. Copyright © 2014 Asian Oceanian Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.

Obesity during childhood and adolescence increases susceptibility to multiple sclerosis after accounting for established genetic and environmental risk factors

PubMed Central

Gianfrancesco, Milena A.; Acuna, Brigid; Shen, Ling; Briggs, Farren B.S.; Quach, Hong; Bellesis, Kalliope H.; Bernstein, Allan; Hedstrom, Anna K.; Kockum, Ingrid; Alfredsson, Lars; Olsson, Tomas; Schaefer, Catherine; Barcellos, Lisa F.

2014-01-01

Objective To investigate the association between obesity and multiple sclerosis (MS) while accounting for established genetic and environmental risk factors. Methods Participants included members of Kaiser Permanente Medical Care Plan, Northern California Region (KPNC) (1,235 MS cases and 697 controls). Logistic regression models were used to estimate odds ratios (ORs) with 95% confidence intervals (95% CI). Body mass index (BMI) or body size was the primary predictor of each model. Both incident and prevalent MS cases were studied. Results In analyses stratified by gender, being overweight at age 10 and 20 were associated with MS in females (p<0.01). Estimates trended in the same direction for males, but were not significant. BMI in 20’s demonstrated a linear relationship with MS (p-trend=9.60 × 10−4), and a twofold risk of MS for females with a BMI ≥ 30 kg/m2 was observed (OR = 2.15, 95% CI 1.18, 3.92). Significant associations between BMI in 20’s and MS in males were not observed. Multivariate modeling demonstrated that significant associations between BMI or body size with MS in females persisted after adjusting for history of infectious mononucleosis and genetic risk factors, including HLA-DRB1*15:01 and established non-HLA risk alleles. Interpretation Results show that childhood and adolescence obesity confer increased risk of MS in females beyond established heritable and environmental risk factors. Strong evidence for a dose-effect of BMI in 20’s and MS was observed. The magnitude of BMI association with MS is as large as other known MS risk factors. PMID:25263833

Nutrition and Nonmotor Symptoms of Parkinson's Disease.

PubMed

Mischley, Laurie K

2017-01-01

To date, no guidelines exist for the screening, evaluation, and management of nutritional status in PD. Dozens of studies demonstrate an association between diet in adulthood with subsequent risk of developing PD. Individuals with PD are at increased risk of malnutrition due to the increased metabolic demands and disease pathophysiology. Risk of malnutrition is further complicated by anosmia, swallowing difficulties, constipation, and drug-nutrient interactions. An emerging body of evidence suggests that the intestinal tract is affected early in the disease, creating therapeutic opportunities for early intervention. Dietary modification and nutritional supplementation may improve symptoms of constipation, depression, insomnia, dystonia, and help prevent cognitive dysfunction. This review summarizes the state of the science related to nutrition and nonmotor symptoms of PD. © 2017 Elsevier Inc. All rights reserved.

Plasma triglyceride determination can identify increased risk of statin-induced type 2 diabetes: a hypothesis.

PubMed

Armato, J; Ruby, R; Reaven, G

2015-04-01

To evaluate the ability of plasma triglyceride (TG) measurements to identify statin-treated persons at accentuated risk of statin-induced type 2 diabetes (T2DM). The experimental population consisted of nondiabetic, statin-treated patients (n = 469), classified as being at high risk for T2DM, subdivided on the basis of a plasma TG concentration of 1.7 mmol/L. Comparisons were made of demographic characteristics, concentrations of fasting glucose, insulin, HbA1c, and hs-CRP, oral glucose tolerance tests, estimates of insulin action and secretion, and lipid/lipoprotein profiles. Despite similar fasting glucose and HbA1c concentrations, patients with elevated TG concentrations displayed markers of increased risk of T2DM (insulin resistance and compensatory hyperinsulinemia), more adverse lipid/lipoprotein profiles, and increased prevalence of abnormal hs-CRP values. These findings demonstrate that plasma TG concentrations ≥ 1.7 mmol/L identified a subset of individuals at enhanced risk of developing statin-induced diabetes within a population classified prior to statin treatment as being at high risk of T2DM. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Traditional marijuana, high‐potency cannabis and synthetic cannabinoids: increasing risk for psychosis

PubMed Central

Murray, Robin M.; Quigley, Harriet; Quattrone, Diego; Englund, Amir; Di Forti, Marta

2016-01-01

Epidemiological evidence demonstrates that cannabis use is associated with an increased risk of psychotic outcomes, and confirms a dose‐response relationship between the level of use and the risk of later psychosis. High‐potency cannabis and synthetic cannabinoids carry the greatest risk. Experimental administration of tetrahydrocannabinol, the active ingredient of cannabis, induces transient psychosis in normal subjects, but this effect can be ameliorated by co‐administration of cannabidiol. This latter is a constituent of traditional hashish, but is largely absent from modern high‐potency forms of cannabis. Argument continues over the extent to which genetic predisposition is correlated to, or interacts with, cannabis use, and what proportion of psychosis could be prevented by minimizing heavy use. As yet, there is not convincing evidence that cannabis use increases risk of other psychiatric disorders, but there are no such doubts concerning its detrimental effect on cognitive function. All of the negative aspects are magnified if use starts in early adolescence. Irrespective of whether use of cannabis is decriminalized or legalized, the evidence that it is a component cause of psychosis is now sufficient for public health messages outlining the risk, especially of regular use of high‐potency cannabis and synthetic cannabinoids. PMID:27717258

Applying the Wildland Fire Decision Support System (WFDSS) to support risk-informed decision making: The Gold Pan Fire, Bitterroot National Forest, Montana, USA

Treesearch

Erin K. Noonan-Wright; Tonja S. Opperman

2015-01-01

In response to federal wildfire policy changes, risk-informed decision-making by way of improved decision support, is increasingly becoming a component of managing wildfires. As fire incidents escalate in size and complexity, the Wildland Fire Decision Support System (WFDSS) provides support with different analytical tools as fire conditions change. We demonstrate the...

Proximity to pollution sources and risk of amphibian limb malformation.

PubMed

Taylor, Brynn; Skelly, David; Demarchis, Livia K; Slade, Martin D; Galusha, Deron; Rabinowitz, Peter M

2005-11-01

The cause of limb deformities in wild amphibian populations remains unclear, even though the apparent increase in prevalence of this condition may have implications for human health. Few studies have simultaneously assessed the effect of multiple exposures on the risk of limb deformities. In a cross-sectional survey of 5,264 hylid and ranid metamorphs in 42 Vermont wetlands, we assessed independent risk factors for nontraumatic limb malformation. The rate of nontraumatic limb malformation varied by location from 0 to 10.2%. Analysis of a subsample did not demonstrate any evidence of infection with the parasite Ribeiroia. We used geographic information system (GIS) land-use/land-cover data to validate field observations of land use in the proximity of study wetlands. In a multiple logistic regression model that included land use as well as developmental stage, genus, and water-quality measures, proximity to agricultural land use was associated with an increased risk of limb malformation (odds ratio = 2.26; 95% confidence interval, 1.42-3.58; p < 0.001). The overall discriminant power of the statistical model was high (C = 0.79). These findings from one of the largest systematic surveys to date provide support for the role of chemical toxicants in the development of amphibian limb malformation and demonstrate the value of an epidemiologic approach to this problem.

A review of the evidence for use of thymoglobulin induction in renal transplantation.

PubMed

Gaber, A Osama; Knight, R J; Patel, S; Gaber, L W

2010-06-01

Depleting antilymphocyte, or antithymocyte antibodies, have long been an integral part of induction regimens and continue today to be used in the management of patients at risk of early rejection or those in whom the introduction of calcineurins or other immune suppressants must be delayed. Registry data demonstrate that the most commonly used depleting antibody, rabbit anti-human thymocyte globulin (rATG), is associated with improved outcomes following renal transplantation in high-risk patients, particularly in conjunction with steroid-avoidance regimens. Two prospective randomized trials in high-risk renal allograft patients have also demonstrated an advantage of r-ATG induction compared to the nondepleting interleukin receptor (IL2RA) antibodies. In low-immunologic-risk patients, however, r-ATG induction and IL2RA induction appear to be equivalent in terms of rejection prophylaxis and long-term function. Other studies have shown that sequential rATG-containing regimens were superior to no induction and allowed for successful late introduction of calcineurin inhibitors. The side effect profile of the depleting antibody included increased incidence of fever, hematologic abnormalities, cytomegalovirus infections when prophylaxis was not employed, and in some studies, increased incidence of posttransplant lymphoproliferative disease. This review describes the evidence supporting the use of depleting ATGs in kidney transplantation.

A plausibly causal functional lupus-associated risk variant in the STAT1-STAT4 locus.

PubMed

Patel, Zubin; Lu, Xiaoming; Miller, Daniel; Forney, Carmy R; Lee, Joshua; Lynch, Arthur; Schroeder, Connor; Parks, Lois; Magnusen, Albert F; Chen, Xiaoting; Pujato, Mario; Maddox, Avery; Zoller, Erin E; Namjou, Bahram; Brunner, Hermine I; Henrickson, Michael; Huggins, Jennifer L; Williams, Adrienne H; Ziegler, Julie T; Comeau, Mary E; Marion, Miranda C; Glenn, Stuart B; Adler, Adam; Shen, Nan; Nath, Swapan K; Stevens, Anne M; Freedman, Barry I; Pons-Estel, Bernardo A; Tsao, Betty P; Jacob, Chaim O; Kamen, Diane L; Brown, Elizabeth E; Gilkeson, Gary S; Alarcón, Graciela S; Martin, Javier; Reveille, John D; Anaya, Juan-Manuel; James, Judith A; Sivils, Kathy L; Criswell, Lindsey A; Vilá, Luis M; Petri, Michelle; Scofield, R Hal; Kimberly, Robert P; Edberg, Jeffrey C; Ramsey-Goldman, Rosalind; Bang, So-Young; Lee, Hye-Soon; Bae, Sang-Cheol; Boackle, Susan A; Cunninghame Graham, Deborah; Vyse, Timothy J; Merrill, Joan T; Niewold, Timothy B; Ainsworth, Hannah C; Silverman, Earl D; Weisman, Michael H; Wallace, Daniel J; Raj, Prithvi; Guthridge, Joel M; Gaffney, Patrick M; Kelly, Jennifer A; Alarcón-Riquelme, Marta E; Langefeld, Carl D; Wakeland, Edward K; Kaufman, Kenneth M; Weirauch, Matthew T; Harley, John B; Kottyan, Leah C

2018-04-18

Systemic Lupus Erythematosus (SLE or lupus) (OMIM: 152700) is a chronic autoimmune disease with debilitating inflammation that affects multiple organ systems. The STAT1-STAT4 locus is one of the first and most highly-replicated genetic loci associated with lupus risk. We performed a fine-mapping study to identify plausible causal variants within the STAT1-STAT4 locus associated with increased lupus disease risk. Using complementary frequentist and Bayesian approaches in trans-ancestral Discovery and Replication cohorts, we found one variant whose association with lupus risk is supported across ancestries in both the Discovery and Replication cohorts: rs11889341. In B cell lines from patients with lupus and healthy controls, the lupus risk allele of rs11889341 was associated with increased STAT1 expression. We demonstrated that the transcription factor HMGA1, a member of the HMG transcription factor family with an AT-hook DNA-binding domain, has enriched binding to the risk allele compared to the non-risk allele of rs11889341. We identified a genotype-dependent repressive element in the DNA within the intron of STAT4 surrounding rs11889341. Consistent with expression quantitative trait locus (eQTL) analysis, the lupus risk allele of rs11889341 decreased the activity of this putative repressor. Altogether, we present a plausible molecular mechanism for increased lupus risk at the STAT1-STAT4 locus in which the risk allele of rs11889341, the most probable causal variant, leads to elevated STAT1 expression in B cells due to decreased repressor activity mediated by increased binding of HMGA1.

Flood risk and adaptation strategies under climate change and urban expansion: A probabilistic analysis using global data.

PubMed

Muis, Sanne; Güneralp, Burak; Jongman, Brenden; Aerts, Jeroen C J H; Ward, Philip J

2015-12-15

An accurate understanding of flood risk and its drivers is crucial for effective risk management. Detailed risk projections, including uncertainties, are however rarely available, particularly in developing countries. This paper presents a method that integrates recent advances in global-scale modeling of flood hazard and land change, which enables the probabilistic analysis of future trends in national-scale flood risk. We demonstrate its application to Indonesia. We develop 1000 spatially-explicit projections of urban expansion from 2000 to 2030 that account for uncertainty associated with population and economic growth projections, as well as uncertainty in where urban land change may occur. The projections show that the urban extent increases by 215%-357% (5th and 95th percentiles). Urban expansion is particularly rapid on Java, which accounts for 79% of the national increase. From 2000 to 2030, increases in exposure will elevate flood risk by, on average, 76% and 120% for river and coastal floods. While sea level rise will further increase the exposure-induced trend by 19%-37%, the response of river floods to climate change is highly uncertain. However, as urban expansion is the main driver of future risk, the implementation of adaptation measures is increasingly urgent, regardless of the wide uncertainty in climate projections. Using probabilistic urban projections, we show that spatial planning can be a very effective adaptation strategy. Our study emphasizes that global data can be used successfully for probabilistic risk assessment in data-scarce countries. Copyright © 2015 Elsevier B.V. All rights reserved.

Current opinion in germ cell cancer 2000.

PubMed

Oliver, R T

2000-05-01

Despite its relative rarity compared with the common adult cancers, scientific and clinical interest in germ cell cancer is increasing. From the point of view of epidemiology, the controversy about the relative importance of intrauterine versus postpubertal risk factors has continued. Evidence to support the importance of intrauterine factors comes from reports from Norway, Canada, and the US, confirming the Danish observation that the rising incidence of germ cell cancer is linked to a birth cohort effect; evidence in support of the importance of postpubertal risk comes from three case/control studies demonstrating increased risk linked to postpubertal exposures such as pesticides, plastics, electromagnetic radiation, trauma, and infections. There has been increasing interest in human endogenous retrovirus K10 as a possible factor explaining genetic susceptibility and providing a linkage between the two groups of risk factors. In cytogenetics, progress was reported in identifying the deletion point of the suspected tumor suppressor gene responsible for the i12p marker chromosome abnormality and development of FISH probes for diagnostic purposes. In molecular biology, the importance of DNA repair deficiency in normal germ cells as a factor in the exquisite chemosensitivity of germ cell cancer has been high-lighted by a report demonstrating a low level of the xeroderma pigmentosa group A (XPA) protein and induction of resistance in vitro by adding XPA. In the clinic, progress in positron emission tomography scanning and laparoscopic lymph node staging are leading to changes in outlook on management of stage 1 cases and patients with small residual masses postchemotherapy. Salvage chemotherapy regimens integrating dose dense and vertical dose intensification strategies reported 60% progression-free survival. New drugs such as gemcitabine demonstrated continued therapeutic potential for chemotherapy in these tumors. A report demonstrating the inadequacies of hormone replacement after bilateral orchidectomy and a report of the first child born after testis-conserving therapy highlight the need for more attention to testis conservation as a quality of life issue. With the cure rates so high, the need for central referral is once again debated both for stage 1 and metastatic disease. With new ways of defining poor risk stage 1 patients and reports on impact of experience highlighting the worse outcome of patients treated in centers treating small numbers, views on this issue remain clearcut.

Introduced mammalian predators induce behavioural changes in parental care in an endemic New Zealand bird

USGS Publications Warehouse

Massaro, M.; Starling-Windhof, A.; Briskie, J.V.; Martin, T.E.

2008-01-01

The introduction of predatory mammals to oceanic islands has led to the extension of many birds. Although introduced predators should favour changes that reduce predation risk in surviving bird species, the ability of island birds to respond to such novel changes remains unstudied. We tested whether novel predation risk imposed by introduced mammalian predators has altered the parental behaviour of the endemic New Zealand bellbird (Anthomis melanura). We examined parental behaviour of billbnirds at three woodlands sites in New Zealand that differed in predation risk: 1) a mainland site with exotic predators present (high predation risk), 2) a mainland site with exotic predators experimentally removed (low risk recently) and, 3) an off-shore island where exotic predators were never introduced (low risk always). We also compared parental behavior of bellbirds with two closely related Tasmanian honeyeaters (Phylidonyris spp) that evolved with native nest predators (high risk always). Increased nest predation risk has been postulated to favour reduced parental activity, and we tested whether island bellbirds responded to variation in predation risk. We found that females spent more time on the nest per incubating bout with increased risk of predation, a strategy that minimised activity at the nest during incubation. Parental activity during the nestling period, measured as number of feeding visits/hr, also decreased with increasing nest predation risk across sites, and was lowest among the honeyeaters in Tasmania that evolved with native predators. These results demonstrates that some island birds are able to respond to increased risk of predation by novel predators in ways that appear adaptive. We suggest that conservation efforts may be more effective if they take advantage of the ability of island birds to respond to novel predators, especially when the elimination of exotic predators is not possible.

Heat stress related dairy cow mortality during heat waves and control periods in rural Southern Ontario from 2010-2012.

PubMed

Bishop-Williams, Katherine E; Berke, Olaf; Pearl, David L; Hand, Karen; Kelton, David F

2015-11-27

Heat stress is a physiological response to extreme environmental heat such as heat waves. Heat stress can result in mortality in dairy cows when extreme heat is both rapidly changing and has a long duration. As a result of climate change, heat waves, which are defined as 3 days of temperatures of 32 °C or above, are an increasingly frequent extreme weather phenomenon in Southern Ontario. Heat waves are increasing the risk for on-farm dairy cow mortality in Southern Ontario. Heat stress indices (HSIs) are generally based on temperature and humidity and provide a relative measure of discomfort which can be used to predict increased risk of on-farm dairy cow mortality. In what follows, the heat stress distribution was described over space and presented with maps. Similarly, on-farm mortality was described and mapped. The goal of this study was to demonstrate that heat waves and related HSI increases during 2010-2012 were associated with increased on-farm dairy cow mortality in Southern Ontario. Mortality records and farm locations for all farms registered in the CanWest Dairy Herd Improvement Program in Southern Ontario were retrieved for 3 heat waves and 6 three-day control periods from 2010 to 2012. A random sample of controls (2:1) was taken from the data set to create a risk-based hybrid design. On-farm heat stress was estimated using data from 37 weather stations and subsequently interpolated across Southern Ontario by geostatistical kriging. A Poisson regression model was applied to assess the on-farm mortality in relation to varying levels of the HSI. For every one unit increase in HSI the on-farm mortality rate across Southern Ontario increases by 1.03 times (CI95% (IRR) = (1.025,1.035); p = ≤ 0.001). With a typical 8.6 unit increase in HSI from a control period to a heat wave, mortality rates are predicted to increase by 1.27 times. Southern Ontario was affected by heat waves, as demonstrated by high levels of heat stress and increased on-farm mortality. Farmers should be aware of these risks, and informed of appropriate methods to mitigate such risks.

Residential building codes, affordability, and health protection: a risk-tradeoff approach.

PubMed

Hammitt, J K; Belsky, E S; Levy, J I; Graham, J D

1999-12-01

Residential building codes intended to promote health and safety may produce unintended countervailing risks by adding to the cost of construction. Higher construction costs increase the price of new homes and may increase health and safety risks through "income" and "stock" effects. The income effect arises because households that purchase a new home have less income remaining for spending on other goods that contribute to health and safety. The stock effect arises because suppression of new-home construction leads to slower replacement of less safe housing units. These countervailing risks are not presently considered in code debates. We demonstrate the feasibility of estimating the approximate magnitude of countervailing risks by combining the income effect with three relatively well understood and significant home-health risks. We estimate that a code change that increases the nationwide cost of constructing and maintaining homes by $150 (0.1% of the average cost to build a single-family home) would induce offsetting risks yielding between 2 and 60 premature fatalities or, including morbidity effects, between 20 and 800 lost quality-adjusted life years (both discounted at 3%) each year the code provision remains in effect. To provide a net health benefit, the code change would need to reduce risk by at least this amount. Future research should refine these estimates, incorporate quantitative uncertainty analysis, and apply a full risk-tradeoff approach to real-world case studies of proposed code changes.

Maternal house dust mite exposure during pregnancy enhances severity of house dust mite-induced asthma in murine offspring.

PubMed

Richgels, Phoebe K; Yamani, Amnah; Chougnet, Claire A; Lewkowich, Ian P

2017-11-01

Atopic status of the mother and maternal exposure to environmental factors are associated with increased asthma risk. Moreover, animal models demonstrate that exposure to allergens in strongly sensitized mothers influences offspring asthma development, suggesting that in utero exposures can influence offspring asthma. However, it is unclear whether maternal exposure to common human allergens such as house dust mite (HDM), in the absence of additional adjuvants, influences offspring asthma development. We sought to determine whether maternal HDM exposure influences asthma development in offspring. Pregnant female mice were exposed to PBS or HDM during pregnancy. Using offspring of PBS- or HDM-exposed mothers, the magnitude of HDM or Aspergillus fumigatus (AF) extract-induced airway hyperresponsiveness (AHR), airway inflammation, immunoglobulin production, T H 2-associated cytokine synthesis, and pulmonary dendritic cell activity was assessed. Compared with offspring of PBS-exposed mothers, offspring of HDM-exposed mothers demonstrate increased AHR, airway inflammation, T H 2 cytokine production, and immunoglobulin levels and a modest decrease in the phagocytic capacity of pulmonary macrophage populations following HDM exposure. Increased sensitivity to AF-induced airway disease was not observed. Offspring of HDM-exposed B-cell-deficient mothers also demonstrated increased HDM-induced AHR, suggesting that transfer of maternal immunoglobulins is not required. Our data demonstrate that maternal exposure to HDM during pregnancy increases asthma sensitivity in offspring in an HDM-specific manner, suggesting that vertical transmission of maternal immune responses may be involved. These findings have important implications for regulation of asthma risk, and suggest that exposure to HDM in the developed world may have underappreciated influences on the overall prevalence of allergic asthma. Copyright © 2017 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

[Air pollution, cardiovascular risk and hypertension].

PubMed

Soldevila Bacardit, N; Vinyoles Bargalló, E; Agudo Ugena, J; Camps Vila, L

2018-04-24

Air pollution is a worrying factor and has an impact on public health. Multiple studies relate exposure to air pollutants with an increase in cardiovascular events, cardiovascular mortality and mortality for all causes. A relationship has also been demonstrated between increased pollution and high blood pressure, as well as a higher prevalence of hypertension. Pollutants that play a more relevant role in this association are particulate matters, nitrogen dioxide and sulphur dioxide. The objective of this review is to understand the mechanisms involved in this increase and to find the most recent publications that relate pollution, cardiovascular risk and hypertension. Copyright © 2018 SEH-LELHA. Publicado por Elsevier España, S.L.U. All rights reserved.

Sexual Behaviors of US Women at Risk of HIV Acquisition: A Longitudinal Analysis of Findings from HPTN 064.

PubMed

Justman, J; Befus, M; Hughes, J; Wang, J; Golin, C E; Adimora, A A; Kuo, I; Haley, D F; Del Rio, C; El-Sadr, W M; Rompalo, A; Mannheimer, S; Soto-Torres, L; Hodder, S

2015-07-01

We describe the sexual behaviors of women at elevated risk of HIV acquisition who reside in areas of high HIV prevalence and poverty in the US. Participants in HPTN 064, a prospective HIV incidence study, provided information about individual sexual behaviors and male sexual partners in the past 6 months at baseline, 6- and 12-months. Independent predictors of consistent or increased temporal patterns for three high-risk sexual behaviors were assessed separately: exchange sex, unprotected anal intercourse (UAI) and concurrent partnerships. The baseline prevalence of each behavior was >30 % among the 2,099 participants, 88 % reported partner(s) with >1 HIV risk characteristic and both individual and partner risk characteristics decreased over time. Less than high school education and food insecurity predicted consistent/increased engagement in exchange sex and UAI, and partner's concurrency predicted participant concurrency. Our results demonstrate how interpersonal and social factors may influence sustained high-risk behavior by individuals and suggest that further study of the economic issues related to HIV risk could inform future prevention interventions.

Diagnostic Accuracy of Fall Risk Assessment Tools in People With Diabetic Peripheral Neuropathy

PubMed Central

Pohl, Patricia S.; Mahnken, Jonathan D.; Kluding, Patricia M.

2012-01-01

Background Diabetic peripheral neuropathy affects nearly half of individuals with diabetes and leads to increased fall risk. Evidence addressing fall risk assessment for these individuals is lacking. Objective The purpose of this study was to identify which of 4 functional mobility fall risk assessment tools best discriminates, in people with diabetic peripheral neuropathy, between recurrent “fallers” and those who are not recurrent fallers. Design A cross-sectional study was conducted. Setting The study was conducted in a medical research university setting. Participants The participants were a convenience sample of 36 individuals between 40 and 65 years of age with diabetic peripheral neuropathy. Measurements Fall history was assessed retrospectively and was the criterion standard. Fall risk was assessed using the Functional Reach Test, the Timed “Up & Go” Test, the Berg Balance Scale, and the Dynamic Gait Index. Sensitivity, specificity, positive and negative likelihood ratios, and overall diagnostic accuracy were calculated for each fall risk assessment tool. Receiver operating characteristic curves were used to estimate modified cutoff scores for each fall risk assessment tool; indexes then were recalculated. Results Ten of the 36 participants were classified as recurrent fallers. When traditional cutoff scores were used, the Dynamic Gait Index and Functional Reach Test demonstrated the highest sensitivity at only 30%; the Dynamic Gait Index also demonstrated the highest overall diagnostic accuracy. When modified cutoff scores were used, all tools demonstrated improved sensitivity (80% or 90%). Overall diagnostic accuracy improved for all tests except the Functional Reach Test; the Timed “Up & Go” Test demonstrated the highest diagnostic accuracy at 88.9%. Limitations The small sample size and retrospective fall history assessment were limitations of the study. Conclusions Modified cutoff scores improved diagnostic accuracy for 3 of 4 fall risk assessment tools when testing people with diabetic peripheral neuropathy. PMID:22836004

Rheumatoid Arthritis and Cardiovascular Disease: Update on Treatment Issues

PubMed Central

Barbhaiya, Medha; Solomon, Daniel H.

2016-01-01

Purpose of review This review examines thresholds for treatment of traditional cardiovascular disease (CVD) risk factors among RA patients and whether RA-specific treatment modulates cardiovascular risk. Recent findings There are substantial data demonstrating an increased CVD risk among patients with RA. Both traditional CVD risk factors and inflammation contribute to this risk. Recent epidemiologic studies strengthen the case that aggressive immunosuppression with biologic DMARDs, such as TNF antagonists, is associated with a reduced risk of CVD events. However, to data, there are no randomized controlled trials published regarding the management of CVD in RA. Summary Epidemiologic evidence continues to accumulate regarding the relationship between the effects of traditional CVD risk factors and RA-specific treatments on CV outcomes in RA. The field needs randomized controlled trials to better guide management. PMID:23466960

Helicobacter pylori-related chronic gastritis as a risk factor for colonic neoplasms.

PubMed

Inoue, Izumi; Kato, Jun; Tamai, Hideyuki; Iguchi, Mikitaka; Maekita, Takao; Yoshimura, Noriko; Ichinose, Masao

2014-02-14

To summarize the current views and insights on associations between Helicobacter pylori (H. pylori)-related chronic gastritis and colorectal neoplasm, we reviewed recent studies to clarify whether H. pylori infection/H. pylori-related chronic gastritis is associated with an elevated risk of colorectal neoplasm. Recent studies based on large databases with careful control for confounding variables have clearly demonstrated an increased risk of colorectal neoplasm associated with H. pylori infection. The correlation between H. pylori-related chronic atrophic gastritis (CAG) and colorectal neoplasm has only been examined in a limited number of studies. A recent large study using a national histopathological database, and our study based on the stage of H. pylori-related chronic gastritis as determined by serum levels of H. pylori antibody titer and pepsinogen, indicated that H. pylori-related CAG confers an increased risk of colorectal neoplasm, and more extensive atrophic gastritis will probably be associated with even higher risk of neoplasm. In addition, our study suggested that the activity of H. pylori-related chronic gastritis is correlated with colorectal neoplasm risk. H. pylori-related chronic gastritis could be involved in an increased risk of colorectal neoplasm that appears to be enhanced by the progression of gastric atrophy and the presence of active inflammation.

Helicobacter pylori-related chronic gastritis as a risk factor for colonic neoplasms

PubMed Central

Inoue, Izumi; Kato, Jun; Tamai, Hideyuki; Iguchi, Mikitaka; Maekita, Takao; Yoshimura, Noriko; Ichinose, Masao

2014-01-01

To summarize the current views and insights on associations between Helicobacter pylori (H. pylori)-related chronic gastritis and colorectal neoplasm, we reviewed recent studies to clarify whether H. pylori infection/H. pylori-related chronic gastritis is associated with an elevated risk of colorectal neoplasm. Recent studies based on large databases with careful control for confounding variables have clearly demonstrated an increased risk of colorectal neoplasm associated with H. pylori infection. The correlation between H. pylori-related chronic atrophic gastritis (CAG) and colorectal neoplasm has only been examined in a limited number of studies. A recent large study using a national histopathological database, and our study based on the stage of H. pylori-related chronic gastritis as determined by serum levels of H. pylori antibody titer and pepsinogen, indicated that H. pylori-related CAG confers an increased risk of colorectal neoplasm, and more extensive atrophic gastritis will probably be associated with even higher risk of neoplasm. In addition, our study suggested that the activity of H. pylori-related chronic gastritis is correlated with colorectal neoplasm risk. H. pylori-related chronic gastritis could be involved in an increased risk of colorectal neoplasm that appears to be enhanced by the progression of gastric atrophy and the presence of active inflammation. PMID:24587623

Diet, cigarettes and alcohol in laryngeal cancer

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

Freudenheim, J.L.; Graham, S.; Byers, T.E.

Diet and other risk factors for cancer of the larynx were examined in a case-control study among white males in Western New York, conducted in 1975-1985. Incident, pathologically-confirmed cases and age- and neighborhood-matched controls were interviewed to determine usual diet, and lifetime use of tobacco and alcohol. Because response rates were low for both cases and controls, this cannot be considered a population-based study. A strong association of risk with cigarette but not pipe and cigar smoking was found. Beer and hard liquor but not wine were associated with increased risk. After control for cigarettes, alcohol and education, the uppermore » quartile odds ratio for fat was 2.40, while the odds ratio for high intake of carotenoids was 0.51. There was effect modification by smoking. Carotenoids were most negatively associated with risk among lighter smokers; dietary fat was most positively associated with risk among heavier smokers. Total calories, protein, and retinol were associated with increased risk; there was no relationship between laryngeal cancer and vitamins C and E or carbohydrate. This study again demonstrates the strong association between tobacco and alcohol and laryngeal cancer and also suggests that diets low in carotenoids and high fat may increase risk.« less

Factor VIII, Protein C and Cardiovascular Disease Risk: The REasons for Geographic and Racial Differences in Stroke Study (REGARDS).

PubMed

Zakai, Neil A; Judd, Suzanne E; Kissela, Brett; Howard, George; Safford, Monika M; Cushman, Mary

2018-06-11

 Haemostatic balance represented by low protein C (PC) and elevated factor VIII (FVIII) has been inconsistently associated with stroke and coronary heart disease (CHD) risk.  This article assesses whether an elevated FVIII and a low PC would increase cardiovascular risk more than either individually.  REGARDS recruited 30,239 black and white U.S. participants aged ≥ 45 years between 2003 and 2007. FVIII and PC were measured in a case-cohort sample of 646 stroke, 654 CHD, and a 1,104-person random sample with follow-up for approximately 4.5 years. Hazard ratios (HRs) were estimated using Cox models adjusted for demographic and cardiovascular risk factors.  Elevated FVIII (per standard deviation [SD] increase) was associated with increased risk of both stroke (HR, 1.26; 95% confidence interval [CI], 1.08, 1.46) and CHD (HR, 1.52; 95% CI, 1.29, 1.79), while there was no association of PC per SD decrease. For PC, there was a trend towards increased cardiovascular disease risk in the lowest values (bottom 5%). For stroke, there was no interaction between FVIII and low PC ( p interaction  = 0.55). For CHD, the adjusted HR of FVIII per SD increase was significantly greater with PC in the bottom 5% (HR, 3.59; 95% CI, 1.39, 8.29) than PC in the upper 95% (HR, 1.45; 95% CI, 1.23, 1.71; p interaction  = 0.07).  Higher FVIII was associated with both CHD and stroke risk and the risk potentiated by low PC for CHD. Findings demonstrate that risks for cardiovascular diseases conferred by adverse levels of haemostasis biomarkers may be augmented by levels of other biomarkers. Schattauer GmbH Stuttgart.

The impact of changes in work stressors and coping resources on the risk of new-onset suicide ideation among Chinese petroleum industry workers.

PubMed

Xiao, Jing; Guan, Suzhen; Ge, Hua; Tao, Ning; Zhang, Yanxia; Jiang, Yu; Ning, Li; Liu, Jiwen; Lian, Yulong

2017-05-01

Little is known about the relationship between changing psychosocial work conditions and suicidality. We examined whether or not changed work stressors and coping resources increase the risk of new-onset suicidal ideation. A total of 1384 workers from the Occupational Health Study of Petroleum Industry Workers were included in this study. A baseline evaluation of work-related stress and coping resources was followed by a final evaluation after 2 years. The changes in task stressors and coping resources were measured using the Occupation Stress Inventory-Revised Edition, and changes in job control and organizational stressors were evaluated using the Instrument for Stress-Related Job Analysis (v. 6.0). Increased task stressors (RR = 2.87, 95% CI = 1.48, 6.15) and decreased coping resources (RR = 2.53, 95% CI = 1.31, 5.34) were associated with an elevated risk of new-onset suicidal ideation incidence. Effect magnitudes were higher than known suicidal risk factors. The main risk factors were increased role overload, increased role insufficiency, increased accident risk, and decreased recreation. Decreased coping resources also increased the negative effect of task stressors on new-onset suicidal ideation. However, increased coping resources did not decrease the effect. These findings demonstrate that changes in work stressors and coping resources have a strong influence on new-onset suicidal ideation, highlighting the importance of preventive measures against adverse psychosocial work conditions and reduced coping resources for workplace suicide behavior prevention. Copyright © 2016 Elsevier Ltd. All rights reserved.

Social living mitigates the costs of a chronic illness in a cooperative carnivore.

PubMed

Almberg, E S; Cross, P C; Dobson, A P; Smith, D W; Metz, M C; Stahler, D R; Hudson, P J

2015-07-01

Infection risk is assumed to increase with social group size, and thus be a cost of group living. We assess infection risk and costs with respect to group size using data from an epidemic of sarcoptic mange (Sarcoptes scabiei) among grey wolves (Canis lupus). We demonstrate that group size does not predict infection risk and that individual costs of infection, in terms of reduced survival, can be entirely offset by having sufficient numbers of pack-mates. Infected individuals experience increased mortality hazards with increasing proportions of infected pack-mates, but healthy individuals remain unaffected. The social support of group hunting and territory defence are two possible mechanisms mediating infection costs. This is likely a common phenomenon among other social species and chronic infections, but difficult to detect in systems where infection status cannot be measured continuously over time. © 2015 The Authors Ecology Letters published by John Wiley & Sons Ltd and CNRS.

Emotional functioning, attachment style, and attributions as predictors of child abuse potential in domestic violence victims.

PubMed

Rodriguez, Christina M

2006-04-01

To explore cognitive and emotional factors that may exacerbate child-abuse potential among domestic violence victims, 80 participants reported on their depression, hopelessness, anxiety, and anger as well as their attachment style and attributional style. Increased emotional difficulties as well as insecure attachment styles were significantly positively correlated with child abuse potential, although depression and anxiety were the strongest predictors. Externalizing blame for the spousal abuse was not associated with abuse risk. Women residing in shelters demonstrated significantly greater abuse risk than those in transitional housing programs, suggesting that greater temporal proximity to the spousal abuse may in part account for the increased abuse potential. Depression and hopelessness, however, appeared particularly relevant to increased abuse risk in domestic violence victims in the transitional housing system. Implications of these findings for working with battered women in terms of their emotional functioning and attachment style are discussed.

Safety of topical minoxidil solution: a one-year, prospective, observational study.

PubMed

Shapiro, Jerry

2003-01-01

Topical minoxidil solution (TMS) is widely used for androgenetic alopecia (AGA), and this is the first report of a large safety trial. The aim of the study was to evaluate the safety profile of TMS by comparing hospitalization and death rates among subjects using TMS with controls. Cardiovascular safety and pregnancy outcomes were evaluated, and usage patterns were described. All subjects were followed at baseline, 3, 6, 9, and 12 months. Usage patterns, pregnancy status, overnight hospital stays, and cardiovascular risk factors were evaluated. Subjects rated effectiveness of TMS in the treatment of AGA. Statistical analyses were conducted to determine if TMS was associated with an increased risk of death or hospitalization. TMS is a safe and effective treatment for AGA. There were no increases in cardiovascular events and no apparent increased risk for adverse pregnancy outcomes. This large, prospective study demonstrated the overall safety of TMS in the treatment of AGA.

MSH3 rs26279 polymorphism increases cancer risk: a meta-analysis

PubMed Central

Miao, Hui-Kai; Chen, Li-Ping; Cai, Dong-Ping; Kong, Wei-Ju; Xiao, Li; Lin, Jie

2015-01-01

Previous studies have investigated the association of mutS homolog 3 (MSH3) rs26279 G > A polymorphism with the risk of different types of cancers including colorectal cancer, breast cancer, prostate cancer, bladder cancer, thyroid cancer, ovarian cancer and oesophageal cancer. However, its association with cancer remains conflicting. We performed a comprehensive meta-analysis to derive a more precise estimation of the relationship between MSH3 rs26279 G > A polymorphism and cancer susceptibility. Systematically searching the PubMed and EMBASE databases yielded 11 publications with 12 studies of 3282 cases and 6476 controls. The strength of the association was determined by crude odds ratios (OR) and 95% confidence intervals (CI). Overall, pooled risk estimates demonstrated that MSH3 rs26279 G > A was significantly associated with an increased overall cancer risk under all the genetic models (GG vs. AA: OR = 1.27, 95% CI = 1.09-1.48, P = 0.002; AG vs. AA: OR = 1.10, 95% CI = 1.00-1.21, P = 0.045; GG vs. AG + AA: OR = 1.23, 95% CI = 1.06-1.42, P = 0.005; AG + GG vs. AA: OR = 1.13, 95% CI = 1.04-1.24, P = 0.006; G vs. A: OR = 1.13, 95% CI = 1.05-1.20, P = 0.001). The association was more evident for colorectal cancer and breast cancer. Moreover, the significant association was also observed in the following subgroups: Europeans, Asians, population-based studies, hospital-based studies, and studies comprising relatively large sample size (≥ 200). Our meta-analysis results demonstrated that MSH3 rs26279 G > A polymorphism is associated with an increased risk of overall cancer, especially for the colorectal cancer and breast cancer. PMID:26617824

MSH3 rs26279 polymorphism increases cancer risk: a meta-analysis.

PubMed

Miao, Hui-Kai; Chen, Li-Ping; Cai, Dong-Ping; Kong, Wei-Ju; Xiao, Li; Lin, Jie

2015-01-01

Previous studies have investigated the association of mutS homolog 3 (MSH3) rs26279 G > A polymorphism with the risk of different types of cancers including colorectal cancer, breast cancer, prostate cancer, bladder cancer, thyroid cancer, ovarian cancer and oesophageal cancer. However, its association with cancer remains conflicting. We performed a comprehensive meta-analysis to derive a more precise estimation of the relationship between MSH3 rs26279 G > A polymorphism and cancer susceptibility. Systematically searching the PubMed and EMBASE databases yielded 11 publications with 12 studies of 3282 cases and 6476 controls. The strength of the association was determined by crude odds ratios (OR) and 95% confidence intervals (CI). Overall, pooled risk estimates demonstrated that MSH3 rs26279 G > A was significantly associated with an increased overall cancer risk under all the genetic models (GG vs. AA: OR = 1.27, 95% CI = 1.09-1.48, P = 0.002; AG vs. AA: OR = 1.10, 95% CI = 1.00-1.21, P = 0.045; GG vs. AG + AA: OR = 1.23, 95% CI = 1.06-1.42, P = 0.005; AG + GG vs. AA: OR = 1.13, 95% CI = 1.04-1.24, P = 0.006; G vs. A: OR = 1.13, 95% CI = 1.05-1.20, P = 0.001). The association was more evident for colorectal cancer and breast cancer. Moreover, the significant association was also observed in the following subgroups: Europeans, Asians, population-based studies, hospital-based studies, and studies comprising relatively large sample size (≥ 200). Our meta-analysis results demonstrated that MSH3 rs26279 G > A polymorphism is associated with an increased risk of overall cancer, especially for the colorectal cancer and breast cancer.

Risk characterization of hospitalizations for mental illness and/or behavioral disorders with concurrent heat-related illness

PubMed Central

2017-01-01

Background Many studies have found significant associations between high ambient temperatures and increases in heat-related morbidity and mortality. Several studies have demonstrated that increases in heat-related hospitalizations are elevated among individuals with diagnosed mental illnesses and/or behavioral disorders (MBD). However, there are a limited number of studies regarding risk factors associated with specific mental illnesses that contribute, at least in part, to heat-related illnesses (HRI) in the United States. Objective To identify and characterize individual and environmental risk factors associated with MBD hospitalizations with a concurrent HRI diagnosis. Methods This study uses hospitalization data from the Nationwide Inpatient Sample (2001–2010). Descriptive analyses of primary and secondary diagnoses of MBDs with an HRI were examined. Risk ratios (RR) were calculated from multivariable models to identify risk factors for hospitalizations among patients with mental illnesses and/or behavioral disorders and HRI. Results Nondependent alcohol/drug abuse, dementia, and schizophrenia were among the disorders that were associated with increased frequency of HRI hospitalizations among MBD patients. Increased risk of MBD hospitalizations with HRI was observed for Males (RR, 3.06), African Americans (RR, 1.16), Native Americans (RR, 1.70), uninsured (RR, 1.92), and those 40 years and older, compared to MBD hospitalizations alone. Conclusions Previous studies outside the U.S. have found that dementia and schizophrenia are significant risk factors for HRI hospitalizations. Our results suggest that hospitalizations among substance abusers may also be an important risk factor associated with heat morbidity. Improved understanding of these relative risks could help inform future public health strategies. PMID:29036206

Hanging Out With the Right Crowd: Peer Influence on Risk-Taking Behavior in Adolescence.

PubMed

Van Hoorn, Jorien; Crone, Eveline A; Van Leijenhorst, Linda

2017-03-01

Peer influence plays a key role in the increase of risk-taking behavior during adolescence. However, its underlying processes are not fully understood. This study examined the effects of social norms, conveyed through peer advice, on risk-taking behavior in 15- to 17-year-old adolescents (N = 76). Participants played a card-guessing task alone and with online peer advice. Results showed that risk-taking increased in the presence of peers. The results further showed that adolescents took into account the uncertainty associated with gambles, as well as the social norms conveyed by peers. Our findings suggest that peers are most influential in uncertain situations and demonstrate the value of a social norms approach in examining the processes underlying peer effects. © 2016 The Authors. Journal of Research on Adolescence © 2016 Society for Research on Adolescence.

Thrombosis in Philadelphia negative classical myeloproliferative neoplasms: a narrative review on epidemiology, risk assessment, and pathophysiologic mechanisms.

PubMed

Ball, Somedeb; Thein, Kyaw Zin; Maiti, Abhishek; Nugent, Kenneth

2018-05-01

Thrombosis is common in cancer patients and is associated with increased morbidity and mortality. Myeloproliferative neoplasms (MPN) are common malignancies in elderly individuals and are known for a high incidence of thrombotic complications. Different risk factors have been identified in studies, and risk models have been developed to identify patients with MPN at higher risk for thrombosis. Several pathophysiological mechanisms help explain the increased likelihood of thrombosis in these patients. Factors, such as leukocyte and platelet activation leading to the formation of leukocyte-platelet aggregates, activation of the coagulation cascade by microparticles, high levels of inflammatory cytokines, and endothelial dysfunction have a crucial role in thrombosis in MPN patients. Recent studies have demonstrated a significant association between the allele burden of specific genetic mutations (mainly JAK2V617F) associated with MPN and the incidence of thrombotic events, thus suggesting a possible role for these mutations in thrombogenesis.

Anthropometric measurements of general and central obesity and the prediction of cardiovascular disease risk in women: a cross-sectional study

PubMed Central

Goh, Louise G H; Dhaliwal, Satvinder S; Welborn, Timothy A; Lee, Andy H; Della, Phillip R

2014-01-01

Objectives It is important to ascertain which anthropometric measurements of obesity, general or central, are better predictors of cardiovascular disease (CVD) risk in women. 10-year CVD risk was calculated from the Framingham risk score model, SCORE risk chart for high-risk regions, general CVD and simplified general CVD risk score models. Increase in CVD risk associated with 1 SD increment in each anthropometric measurement above the mean was calculated, and the diagnostic utility of obesity measures in identifying participants with increased likelihood of being above the treatment threshold was assessed. Design Cross-sectional data from the National Heart Foundation Risk Factor Prevalence Study. Setting Population-based survey in Australia. Participants 4487 women aged 20–69 years without heart disease, diabetes or stroke. Outcome measures Anthropometric obesity measures that demonstrated the greatest increase in CVD risk as a result of incremental change, 1 SD above the mean, and obesity measures that had the greatest diagnostic utility in identifying participants above the respective treatment thresholds of various risk score models. Results Waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-stature ratio had larger effects on increased CVD risk compared with body mass index (BMI). These central obesity measures also had higher sensitivity and specificity in identifying women above and below the 20% treatment threshold than BMI. Central obesity measures also recorded better correlations with CVD risk compared with general obesity measures. WC and WHR were found to be significant and independent predictors of CVD risk, as indicated by the high area under the receiver operating characteristic curves (>0.76), after controlling for BMI in the simplified general CVD risk score model. Conclusions Central obesity measures are better predictors of CVD risk compared with general obesity measures in women. It is equally important to maintain a healthy weight and to prevent central obesity concurrently. PMID:24503301

Anthropometric measurements of general and central obesity and the prediction of cardiovascular disease risk in women: a cross-sectional study.

PubMed

Goh, Louise G H; Dhaliwal, Satvinder S; Welborn, Timothy A; Lee, Andy H; Della, Phillip R

2014-02-06

It is important to ascertain which anthropometric measurements of obesity, general or central, are better predictors of cardiovascular disease (CVD) risk in women. 10-year CVD risk was calculated from the Framingham risk score model, SCORE risk chart for high-risk regions, general CVD and simplified general CVD risk score models. Increase in CVD risk associated with 1 SD increment in each anthropometric measurement above the mean was calculated, and the diagnostic utility of obesity measures in identifying participants with increased likelihood of being above the treatment threshold was assessed. Cross-sectional data from the National Heart Foundation Risk Factor Prevalence Study. Population-based survey in Australia. 4487 women aged 20-69 years without heart disease, diabetes or stroke. Anthropometric obesity measures that demonstrated the greatest increase in CVD risk as a result of incremental change, 1 SD above the mean, and obesity measures that had the greatest diagnostic utility in identifying participants above the respective treatment thresholds of various risk score models. Waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-stature ratio had larger effects on increased CVD risk compared with body mass index (BMI). These central obesity measures also had higher sensitivity and specificity in identifying women above and below the 20% treatment threshold than BMI. Central obesity measures also recorded better correlations with CVD risk compared with general obesity measures. WC and WHR were found to be significant and independent predictors of CVD risk, as indicated by the high area under the receiver operating characteristic curves (>0.76), after controlling for BMI in the simplified general CVD risk score model. Central obesity measures are better predictors of CVD risk compared with general obesity measures in women. It is equally important to maintain a healthy weight and to prevent central obesity concurrently.

Evidence for a link between changes to gaze behaviour and risk of falling in older adults during adaptive locomotion.

PubMed

Chapman, G J; Hollands, M A

2006-11-01

There is increasing evidence that gaze stabilization with respect to footfall targets plays a crucial role in the control of visually guided stepping and that there are significant changes to gaze behaviour as we age. However, past research has not measured if age-related changes in gaze behaviour are associated with changes to stepping performance. This paper aims to identify differences in gaze behaviour between young (n=8) adults, older adults determined to be at a low-risk of falling (low-risk, n=4) and older adults prone to falling (high-risk, n=4) performing an adaptive locomotor task and attempts to relate observed differences in gaze behaviour to decline in stepping performance. Participants walked at a self-selected pace along a 9m pathway stepping into two footfall target locations en route. Gaze behaviour and lower limb kinematics were recorded using an ASL 500 gaze tracker interfaced with a Vicon motion analysis system. Results showed that older adults looked significantly sooner to targets, and fixated the targets for longer, than younger adults. There were also significant differences in these measures between high and low-risk older adults. On average, high-risk older adults looked away from targets significantly sooner and demonstrated less accurate and more variable foot placements than younger adults and low-risk older adults. These findings suggest that, as we age, we need more time to plan precise stepping movements and clearly demonstrate that there are differences between low-risk and high-risk older adults in both where and when they look at future stepping targets and the precision with which they subsequently step. We propose that high-risk older adults may prioritize the planning of future actions over the accurate execution of ongoing movements and that adoption of this strategy may contribute to an increased likelihood of falls. Copyright 2005 Elsevier B.V.

Assessment of Alzheimer's disease risk with functional magnetic resonance imaging: an arterial spin labeling study.

PubMed

Bangen, Katherine J; Restom, Khaled; Liu, Thomas T; Wierenga, Christina E; Jak, Amy J; Salmon, David P; Bondi, Mark W

2012-01-01

Functional magnetic resonance imaging (fMRI) of older adults at risk for Alzheimer's disease (AD) by virtue of their cognitive (i.e., mild cognitive impairment [MCI]) and/or genetic (i.e., apolipoprotein E [APOE] ε4 allele) status demonstrate divergent brain response patterns during memory encoding across studies. Using arterial spin labeling MRI, we examined the influence of AD risk on resting cerebral blood flow (CBF) as well as the CBF and blood oxygenation level dependent (BOLD) signal response to memory encoding in the medial temporal lobes (MTL) in 45 older adults (29 cognitively normal [14 APOE ε4 carriers and 15 noncarriers]; 16 MCI [8 APOE ε4 carriers, 8 noncarriers]). Risk groups were comparable in terms of mean age, years of education, gender distribution, and vascular risk burden. Individuals at genetic risk for AD by virtue of the APOE ε4 allele demonstrated increased MTL resting state CBF relative to ε4 noncarriers, whereas individuals characterized as MCI showed decreased MTL resting state CBF relative to their cognitively normal peers. For percent change CBF, there was a trend toward a cognitive status by genotype interaction. In the cognitively normal group, there was no difference in percent change CBF based on APOE genotype. In contrast, in the MCI group, APOE ε4 carriers demonstrated significantly greater percent change in CBF relative to ε4 noncarriers. No group differences were found for BOLD response. Findings suggest that abnormal resting state CBF and CBF response to memory encoding may be early indicators of brain dysfunction in individuals at risk for developing AD.

Platelets derived from the bone marrow of diabetic animals show dysregulated endoplasmic reticulum stress proteins that contribute to increased thrombosis.

PubMed

Hernández Vera, Rodrigo; Vilahur, Gemma; Ferrer-Lorente, Raquel; Peña, Esther; Badimon, Lina

2012-09-01

Patients with diabetes mellitus have an increased risk of suffering atherothrombotic syndromes and are prone to clustering cardiovascular risk factors. However, despite their dysregulated glucose metabolism, intensive glycemic control has proven insufficient to reduce thrombotic complications. Therefore, we aimed to elucidate the determinants of thrombosis in a model of type 2 diabetes mellitus with cardiovascular risk factors clustering. Intravital microscopy was used to analyze thrombosis in vivo in Zucker diabetic fatty rats (ZD) and lean normoglycemic controls. Bone marrow (BM) transplants were performed to test the contribution of each compartment (blood or vessel wall) to thrombogenicity. ZD showed significantly increased thrombosis compared with lean normoglycemic controls. BM transplants demonstrated the key contribution of the hematopoietic compartment to increased thrombogenicity. Indeed, lean normoglycemic controls transplanted with ZD-BM showed increased thrombosis with normal glucose levels, whereas ZD transplanted with lean normoglycemic controls-BM showed reduced thrombosis despite presenting hyperglycemia. Significant alterations in megakaryopoiesis and platelet-endoplasmic reticulum stress proteins, protein disulfide isomerase and 78-kDa glucose-regulated protein, were detected in ZD, and increased tissue factor procoagulant activity was detected in plasma and whole blood of ZD. Our results indicate that diabetes mellitus with cardiovascular risk factor clustering favors BM production of hyperreactive platelets with altered protein disulfide isomerase and 78-kDa glucose-regulated protein expression that can contribute to increase thrombotic risk independently of blood glucose levels.

Relation between age and carotid artery intima-medial thickness: a systematic review.

PubMed

van den Munckhof, Inge C L; Jones, Helen; Hopman, Maria T E; de Graaf, Jacqueline; Nyakayiru, Jean; van Dijk, Bart; Eijsvogels, Thijs M H; Thijssen, Dick H J

2018-05-12

Carotid artery intima-medial thickness (cIMT) represents a popular measure of atherosclerosis and is predictive of future cardiovascular and cerebrovascular events. Although older age is associated with a higher cIMT, little is known about whether this increase in cIMT follows a linear relationship with age or it is affected under influence of cardiovascular diseases (CVD) or CVD risk factors. We hypothesize that the relationship between cIMT and age is nonlinear and is affected by CVD or risk factors. A systematic review of studies that examined cIMT in the general population and human populations free from CVD/risk factors was undertaken. The literature search was conducted in PubMed, Scopus, and Web of Science. Seventeen studies with 32 unique study populations, involving 10,124 healthy individuals free from CVD risk factors, were included. Furthermore, 58 studies with 115 unique study populations were included, involving 65,774 individuals from the general population (with and without CVD risk factors). A strong positive association was evident between age and cIMT in the healthy population, demonstrating a gradual, linear increase in cIMT that did not differ between age decades (r = 0.91, P < 0.001). Although populations with individuals with CVD demonstrated a higher cIMT compared to populations free of CVD, a linear relation between age and cIMT was also present in this population. Our data suggest that cIMT is strongly and linearly related to age. This linear relationship was not affected by CVD or risk factors. © 2018 Wiley Periodicals, Inc.

The selective estrogen receptor modulators in breast cancer prevention.

PubMed

Li, Fangxuan; Dou, Jinli; Wei, Lijuan; Li, Shixia; Liu, Juntian

2016-05-01

Persistently increased blood levels of estrogens are associated with an increased risk of breast cancer. Selective estrogen receptor modulators (SERMs) are a class of compounds that act on the estrogen receptor (ER). Several clinical trials have demonstrated the effectiveness of its prophylactic administration. Incidence of invasive ER-positive breast cancer was reduced by SERMs treatment, especially for those women with high risk of developing breast cancer. In this study, we reviewed the clinical application of SERMs in breast cancer prevention. To date, four prospective randomized clinical trials had been performed to test the efficacy of tamoxifen for this purpose. Concerning on the benefit and cost of tamoxifen, various studies from different countries demonstrated that chemoprevention with tamoxifen seemed to be cost-effective for women with a high risk of invasive breast cancer. Based above, tamoxifen was approved for breast cancer prevention by the US Food and Drug Administration in 1998. Raloxifene was also approved for postmenopausal women in 2007 for breast cancer prevention which reduces the risk of invasive breast cancer with a lower risk of unwanted stimulation of endometrium. Thus, raloxifene is considered to have a better clinical possesses as prophylactic agent. Several other agents, such as arzoxifene and lasofoxifene, are currently being investigated in clinic. The American Society of Clinical Oncology and National Comprehensive Cancer Network had published guidelines on breast cancer chemoprevention by SERMs. However, use of tamoxifen and raloxifene for primary breast cancer prevention was still low. A broader educational effort is needed to alert women and primary care physicians that SERMs are available to reduce breast cancer risk.

Food Sources of Saturated Fat and the Association With Mortality: A Meta-Analysis

PubMed Central

O’Sullivan, Therese A.; Mitrou, Francis; Lawrence, David

2013-01-01

We summarized the data related to foods high in saturated fat and risk of mortality. We searched Cochrane Library, MEDLINE, EMBASE, and ProQuest for studies from January 1952 to May 2012. We identified 26 publications with individual dietary data and all-cause, total cancer, or cardiovascular mortality as endpoints. Pooled relative risk estimates demonstrated that high intakes of milk, cheese, yogurt, and butter were not associated with a significantly increased risk of mortality compared with low intakes. High intakes of meat and processed meat were significantly associated with an increased risk of mortality but were associated with a decreased risk in a subanalysis of Asian studies. The overall quality of studies was variable. Associations varied by food group and population. This may be because of factors outside saturated fat content of individual foods. There is an ongoing need for improvement in assessment tools and methods that investigate food sources of saturated fat and mortality to inform dietary guidelines. PMID:23865702

Academic-Community Partnership to Develop a Patient-Centered Breast Cancer Risk Reduction Program for Latina Primary Care Patients.

PubMed

Castañeda, Sheila F; Giacinto, Rebeca E; Medeiros, Elizabeth A; Brongiel, Ilana; Cardona, Olga; Perez, Patricia; Talavera, Gregory A

2016-06-01

This collaborative study sought to address Latina breast cancer (BC) disparities by increasing health literacy (HL) in a community health center situated on the US-Mexico border region of San Diego County. An academic-community partnership conducted formative research to develop a culturally tailored promotora-based intervention with 109 individuals. The Spanish language program, entitled Nuestra Cocina: Mesa Buena, Vida Sana (Our Kitchen: Good Table, Healthy Life), included six sessions targeting HL, women's health, BC risk reduction, and patient-provider communication; sessions include cooking demonstrations of recipes with cancer-risk-reducing ingredients. A pilot study with 47 community health center Latina patients was conducted to examine the program's acceptability, feasibility, and ability to impact knowledge and skills. Pre- and post-analyses demonstrated that participants improved their self-reported cancer screening, BC knowledge, daily fruit and vegetable intake, and ability to read a nutrition label (p < 0.05). Results of the pilot study demonstrate the importance of utilizing patient-centered culturally appropriate noninvasive means to educate and empower Latina patients.

Academic-Community Partnership to Develop a Patient-Centered Breast Cancer Risk Reduction Program for Latina Primary Care Patients

PubMed Central

Castañeda, Sheila F.; Giacinto, Rebeca E.; Medeiros, Elizabeth A.; Brongiel, Ilana; Cardona, Olga; Perez, Patricia; Talavera, Gregory A.

2015-01-01

This collaborative study sought to address Latina breast cancer (BC) disparities by increasing health literacy (HL) in a community health center situated on the US-Mexico border region of San Diego County. An academic-community partnership conducted formative research to develop a culturally tailored promotora-based intervention with 109 individuals. The Spanish language program, entitled Nuestra Cocina: Mesa Buena, Vida Sana (Our Kitchen: Good Table, Healthy Life), included six sessions targeting HL, women’s health, BC risk reduction, and patient-provider communication; sessions include cooking demonstrations of recipes with cancer-risk-reducing ingredients. A pilot study with 47 community health center Latina patients was conducted to examine the program’s acceptability, feasibility, and ability to impact knowledge and skills. Pre- and post-analyses demonstrated that participants improved their self-reported cancer screening, BC knowledge, daily fruit and vegetable intake, and ability to read a nutrition label (p<0.05). Results of the pilot study demonstrate the importance of utilizing patient-centered culturally appropriate noninvasive means to educate and empower Latina patients. PMID:27271058

Heightened activity in social reward networks is associated with adolescents' risky sexual behaviors.

PubMed

Eckstrand, Kristen L; Choukas-Bradley, Sophia; Mohanty, Arpita; Cross, Marissa; Allen, Nicholas B; Silk, Jennifer S; Jones, Neil P; Forbes, Erika E

2017-10-01

Adolescent sexual risk behavior can lead to serious health consequences, yet few investigations have addressed its neurodevelopmental mechanisms. Social neurocircuitry is postulated to underlie the development of risky sexual behavior, and response to social reward may be especially relevant. Typically developing adolescents (N=47; 18M, 29F; 16.3±1.4years; 42.5% sexual intercourse experience) completed a social reward fMRI task and reported their sexual risk behaviors (e.g., lifetime sexual partners) on the Youth Risk Behavior Survey (YRBS). Neural response and functional connectivity to social reward were compared for adolescents with higher- and lower-risk sexual behavior. Adolescents with higher-risk sexual behaviors demonstrated increased activation in the right precuneus and the right temporoparietal junction during receipt of social reward. Adolescents with higher-risk sexual behaviors also demonstrated greater functional connectivity between the precuneus and the temporoparietal junction bilaterally, dorsal medial prefrontal cortex, and left anterior insula/ventrolateral prefrontal cortex. The greater activation and functional connectivity in self-referential, social reward, and affective processing regions among higher sexual risk adolescents underscores the importance of social influence underlying sexual risk behaviors. Furthermore, results suggest an orientation towards and sensitivity to social rewards among youth engaging in higher-risk sexual behavior, perhaps as a consequence of or vulnerability to such behavior. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Methods for analyzing matched designs with double controls: excess risk is easily estimated and misinterpreted when evaluating traffic deaths.

PubMed

Redelmeier, Donald A; Tibshirani, Robert J

2018-06-01

To demonstrate analytic approaches for matched studies where two controls are linked to each case and events are accumulating counts rather than binary outcomes. A secondary intent is to clarify the distinction between total risk and excess risk (unmatched vs. matched perspectives). We review past research testing whether elections can lead to increased traffic risks. The results are reinterpreted by analyzing both the total count of individuals in fatal crashes and the excess count of individuals in fatal crashes, each time accounting for the matched double controls. Overall, 1,546 individuals were in fatal crashes on the 10 election days (average = 155/d), and 2,593 individuals were in fatal crashes on the 20 control days (average = 130/d). Poisson regression of total counts yielded a relative risk of 1.19 (95% confidence interval: 1.12-1.27). Poisson regression of excess counts yielded a relative risk of 3.22 (95% confidence interval: 2.72-3.80). The discrepancy between analyses of total counts and excess counts replicated with alternative statistical models and was visualized in graphical displays. Available approaches provide methods for analyzing count data in matched designs with double controls and help clarify the distinction between increases in total risk and increases in excess risk. Copyright © 2018 Elsevier Inc. All rights reserved.

E057: Renal Stone Risk Assessment During Space Flight: Assessment and Countermeasure Validation

NASA Technical Reports Server (NTRS)

Whitson, Peggy A.; Pietrzyk, Robert A.; Jones, Jeffrey A.; Sams, Clarence F.

2001-01-01

Exposure to the microgravity environment results in many metabolic and physiological changes to humans. Body fluid volumes, electrolyte levels, and bone and muscle undergo changes as the human body adapts to the weightless environment. Changes in the urinary biochemistry occur as early as flight day 3-4 in the short duration Shuttle crewmembers. Significant decreases were observed both in fluid intake and urinary output. Other significant changes were observed in the urinary pH, calcium, potassium and uric acid levels. During Shuttle missions, the risk of calcium oxalate stone formation increased early in the flight, continued at elevated levels throughout the flight and remained in the increased risk range on landing day. The calcium phosphate risk was significantly increased early in-flight and remained significantly elevated throughout the remainder of the mission. Results from the long duration Shuttle-Mir missions followed a similar trend. Most long duration crewmembers demonstrated increased urinary calcium levels despite lower dietary calcium intake. Fluid intake and urine volumes were significantly lower during the flight than during the preflight. The calcium oxalate risk was increased relative to the preflight levels during the early in-flight period and continued in the elevated risk range for the remainder of the space flight and through two weeks postflight. Calcium phosphate risk for these long duration crewmembers increased during flight and remained in the increased risk range throughout the flight and following landing. The complexity, expense and visibility of the human space program require that every effort be made to protect the health of the crewmembers and ensure the success of the mission. Results from our early investigations clearly indicate that exposure to the microgravity environment of space significantly increases the risk of renal stone formation. The early studies have indicated specific avenues for development of countermeasures for the increased renal stone risk observed during and following space flight. Increased hydration and implementation of pharmacological countermeasures are being tested for their efficacy in mitigating the in-flight risk of renal stones. Maintaining the health and well-being of crewmembers during space flight requires a means of minimizing potential detrimental health effects of microgravity. The formation of a renal stone during flight obviously has severe consequences for the affected crewmember as well as the success of the mission.

The rise of global warming skepticism: exploring affective image associations in the United States over time.

PubMed

Smith, Nicholas; Leiserowitz, Anthony

2012-06-01

This article explores how affective image associations to global warming have changed over time. Four nationally representative surveys of the American public were conducted between 2002 and 2010 to assess public global warming risk perceptions, policy preferences, and behavior. Affective images (positive or negative feelings and cognitive representations) were collected and content analyzed. The results demonstrate a large increase in "naysayer" associations, indicating extreme skepticism about the issue of climate change. Multiple regression analyses found that holistic affect and "naysayer" associations were more significant predictors of global warming risk perceptions than cultural worldviews or sociodemographic variables, including political party and ideology. The results demonstrate the important role affective imagery plays in judgment and decision-making processes, how these variables change over time, and how global warming is currently perceived by the American public. © 2012 Society for Risk Analysis.

Reversal of Alcohol-Induced Dysregulation in Dopamine Network Dynamics May Rescue Maladaptive Decision-making

PubMed Central

Schindler, Abigail G.; Soden, Marta E.; Zweifel, Larry S.

2016-01-01

Alcohol is the most commonly abused substance among adolescents, promoting the development of substance use disorders and compromised decision-making in adulthood. We have previously demonstrated, with a preclinical model in rodents, that adolescent alcohol use results in adult risk-taking behavior that positively correlates with phasic dopamine transmission in response to risky options, but the underlying mechanisms remain unknown. Here, we show that adolescent alcohol use may produce maladaptive decision-making through a disruption in dopamine network dynamics via increased GABAergic transmission within the ventral tegmental area (VTA). Indeed, we find that increased phasic dopamine signaling after adolescent alcohol use is attributable to a midbrain circuit, including the input from the pedunculopontine tegmentum to the VTA. Moreover, we demonstrate that VTA dopamine neurons from adult rats exhibit enhanced IPSCs after adolescent alcohol exposure corresponding to decreased basal dopamine levels in adulthood that negatively correlate with risk-taking. Building on these findings, we develop a model where increased inhibitory tone on dopamine neurons leads to a persistent decrease in tonic dopamine levels and results in a potentiation of stimulus-evoked phasic dopamine release that may drive risky choice behavior. Based on this model, we take a pharmacological approach to the reversal of risk-taking behavior through normalization of this pattern in dopamine transmission. These results isolate the underlying circuitry involved in alcohol-induced maladaptive decision-making and identify a novel therapeutic target. SIGNIFICANCE STATEMENT One of the primary problems resulting from chronic alcohol use is persistent, maladaptive decision-making that is associated with ongoing addiction vulnerability and relapse. Indeed, studies with the Iowa Gambling Task, a standard measure of risk-based decision-making, have reliably shown that alcohol-dependent individuals make riskier, more maladaptive choices than nondependent individuals, even after periods of prolonged abstinence. Using a preclinical model, in the current work, we identify a selective disruption in dopamine network dynamics that may promote maladaptive decision-making after chronic adolescent alcohol use and demonstrate its pharmacological reversal in adulthood. Together, these results highlight a novel neural mechanism underlying heightened risk-taking behavior in alcohol-dependent individuals and provide a potential therapeutic target for further investigation. PMID:27030756

Workplace Digital Health Is Associated with Improved Cardiovascular Risk Factors in a Frequency-Dependent Fashion: A Large Prospective Observational Cohort Study.

PubMed

Widmer, R Jay; Allison, Thomas G; Keane, Brendie; Dallas, Anthony; Bailey, Kent R; Lerman, Lilach O; Lerman, Amir

2016-01-01

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the US. Emerging employer-sponsored work health programs (WHP) and Digital Health Intervention (DHI) provide monitoring and guidance based on participants' health risk assessments, but with uncertain success. DHI--mobile technology including online and smartphone interventions--has previously been found to be beneficial in reducing CVD outcomes and risk factors, however its use and efficacy in a large, multisite, primary prevention cohort has not been described to date. We analyzed usage of DHI and change in intermediate markers of CVD over the course of one year in 30,974 participants of a WHP across 81 organizations in 42 states between 2011 and 2014, stratified by participation log-ins categorized as no (n = 14,173), very low (<12/yr, n = 12,260), monthly (n = 3,360), weekly (n = 651), or semi-weekly (at least twice per week). We assessed changes in weight, waist circumference, body mass index (BMI), blood pressure, lipids, and glucose at one year, as a function of participation level. We utilized a Poisson regression model to analyze variables associated with increased participation. Those with the highest level of participation were slightly, but significantly (p<0.0001), older (48.3±11.2 yrs) than non-participants (47.7±12.2 yr) and more likely to be females (63.7% vs 37.3% p<0.0001). Significant improvements in weight loss were demonstrated with every increasing level of DHI usage with the largest being in the semi-weekly group (-3.39±1.06 lbs; p = 0.0013 for difference from weekly). Regression analyses demonstrated that greater participation in the DHI (measured by log-ins) was significantly associated with older age (p<0.001), female sex (p<0.001), and Hispanic ethnicity (p<0.001). The current study demonstrates the success of DHI in a large, community cohort to modestly reduce CVD risk factors in individuals with high participation rate. Furthermore, participants previously underrepresented in WHPs (females and Hispanics) and those with an increased number of CVD risk factors including age and elevated BMI show increased adherence to DHI, supporting the use of this low-cost intervention to improve CVD health.

Positive association between hypertension and urinary bladder cancer: epidemiologic evidence involving 79,236 propensity score-matched individuals.

PubMed

Kok, Victor C; Zhang, Han-Wei; Lin, Chin-Teng; Huang, Shih-Chung; Wu, Ming-Feng

2018-06-18

We hypothesized that hypertensive patients harbor a higher risk of urinary bladder (UB) cancer. We performed a population-based cohort study on adults using a National Health Insurance Research Database (NHIRD) dataset. Hypertension and comparison non-hypertensive (COMP) groups comprising 39,618 patients each were propensity score-matched by age, sex, index date, and medical comorbidities. The outcome was incident UB cancer validated using procedure codes. We constructed multivariable Cox models to derive adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs). Cumulative incidence was compared using a log-rank test. During a total follow-up duration of 380,525 and 372,020 person-years in the hypertension and COMP groups, 248 and 186 patients developed UB cancer, respectively, representing a 32% increase in the risk (aHR, 1.32; 95% CI, 1.09-1.60). Hypertensive women harbored a significantly increased risk of UB cancer (aHR, 1.55; 95% CI, 1.12-2.13) compared with non-hypertensive women, whereas men with hypertension had a statistically non-significant increased risk (aHR, 1.22; 95% CI, 0.96-1.55). The sensitivity analysis demonstrated that the increased risk was sustained throughout different follow-up durations for the entire cohort; a statistical increase in the risk was also noted among hypertensive men. This nationwide population-based propensity score-matched cohort study supports a positive association between hypertension and subsequent UB cancer development.

Sugar-sweetened and artificially-sweetened beverages in relation to obesity risk.

PubMed

Pereira, Mark A

2014-11-01

The goal of this review was to critically evaluate the scientific evidence in humans on the potential effect of sweetened beverages on weight gain and risk of obesity in youth and adults. Two categories of these beverages were reviewed. Sugar-sweetened beverages (SSBs) include soft drinks, colas, other sweetened carbonated beverages, and fruit drinks with added sugar. Artificially sweetened beverages (ASBs), also referred to as non-nutritive sweetened beverages, are marketed and used as a replacement for SSBs for those who want to reduce sugar and caloric intake. The totality of evidence to date demonstrates a pattern across observational and experimental studies of an increased risk of weight gain and obesity with higher intake of SSBs. However, it remains difficult to establish the strength of the association and the independence from other potentially confounding factors. The primary reason for unclear conclusions regarding the robustness of any effect of SSBs is due to the heterogeneity and methodologic limitations of both observational and experimental studies on this topic. Although some observational studies have suggested that ASBs may cause increased risk of obesity and cardiometabolic diseases, there is no clear mechanism for this pathway, and the epidemiologic studies are highly inconsistent. An important issue with the observational studies on ASBs and obesity or disease risk is reverse causality bias, with higher-quality studies demonstrating this possibility. The field needs higher-quality experimental studies in humans, with relevant direct comparisons between sweetened beverages and their sweetened solid-food alternatives. © 2014 American Society for Nutrition.

Timing of Pregnancy After Kidney Transplantation and Risk of Allograft Failure.

PubMed

Rose, C; Gill, J; Zalunardo, N; Johnston, O; Mehrotra, A; Gill, J S

2016-08-01

The optimal timing of pregnancy after kidney transplantation remains uncertain. We determined the risk of allograft failure among women who became pregnant within the first 3 posttransplant years. Among 21 814 women aged 15-45 years who received a first kidney-only transplant between 1990 and 2010 captured in the United States Renal Data System, n = 729 pregnancies were identified using Medicare claims. The probability of allograft failure from any cause including death (ACGL) at 1, 3, and 5 years after pregnancy was 9.6%, 25.9%, and 36.6%. In multivariate analyses, pregnancy in the first posttransplant year was associated with an increased risk of ACGL (hazard ratio [HR]: 1.18; 95% confidence interval [CI] 1.00, 1.40) and death censored graft loss (DCGL) (HR:1.25; 95% CI 1.04, 1.50), while pregnancy in the second posttransplant year was associated with an increased risk of DCGL (HR: 1.26; 95% CI 1.06, 1.50). Pregnancy in the third posttransplant year was not associated with an increased risk of ACGL or DCGL. These findings demonstrate a higher incidence of allograft failure after pregnancy than previously reported and that the increased risk of allograft failure extends to pregnancies in the second posttransplant year. © Copyright 2016 The American Society of Transplantation and the American Society of Transplant Surgeons.

Gut microbiota and graft-versus-host disease: broad-spectrum antibiotic use increases post-allogeneic hematopoietic stem cell transplant graft-versus-host disease-related mortality.

PubMed

Shono, Yusuke

2017-01-01

Intestinal bacteria can modulate the risk of infection and graft-versus-host disease (GVHD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Allo-HSCT recipients often develop neutropenic fever, which is treated with antibiotics that may target anaerobic bacteria in the gut. We retrospectively examined 857 allo-HSCT recipients and found that treatment using broad-spectrum antibiotics was associated with increased GVHD-related mortality at 5 years. Analysis of stool specimens from allo-HSCT recipients showed that broad-spectrum antibiotic administration was associated with perturbation of gut microbial composition. Studies in mice also demonstrated aggravated GVHD mortality with broad-spectrum antibiotics use. Broad-spectrum antibiotics treatment of mice with GVHD led to a loss of the protective mucus lining of the colon, compromised intestinal barrier function, as well as increased a commensal bacterium with mucus-degrading capabilities, raising the possibility that mucus degradation may contribute to murine GVHD. We demonstrate an underappreciated risk of antibiotics in allo-HSCT recipients that may exacerbate GVHD in the colon.

Potential Lunar In-Situ Resource Utilization Experiments and Mission Scenarios

NASA Technical Reports Server (NTRS)

Sanders, Gerald B.

2010-01-01

The extraction and use of resources on the Moon, known as In-Situ Resource Utilization (ISRU), can potentially reduce the cost and risk of human lunar exploration while also increasing science achieved. By not having to bring all of the shielding and mission consumables from Earth and being able to make products on the Moon, missions may require less mass to accomplish the same objectives, carry more science equipment, go to more sites of exploration, and/or provide options to recover from failures not possible with delivery of spares and consumables from Earth alone. While lunar ISRU has significant potential for mass, cost, and risk reduction for human lunar missions, it has never been demonstrated before in space. To demonstrate that ISRU can meet mission needs and to increase confidence in incorporating ISRU capabilities into mission architectures, terrestrial laboratory and analog field testing along with robotic precursor missions are required. A stepwise approach with international collaboration is recommended. This paper will outline the role of ISRU in future lunar missions, and define the approach and possible experiments to increase confidence in ISRU applications for future human lunar exploration

Vulnerable Populations Perceive Their Health as at Risk from Climate Change.

PubMed

Akerlof, Karen L; Delamater, Paul L; Boules, Caroline R; Upperman, Crystal R; Mitchell, Clifford S

2015-12-04

Climate change is already taking a toll on human health, a toll that is likely to increase in coming decades. The relationship between risk perceptions and vulnerability to climate change's health threats has received little attention, even though an understanding of the dynamics of adaptation among particularly susceptible populations is becoming increasingly important. We demonstrate that some people whose health will suffer the greatest harms from climate change-due to social vulnerability, health susceptibility, and exposure to hazards-already feel they are at risk. In a 2013 survey we measured Maryland residents' climate beliefs, health risk perceptions, and household social vulnerability characteristics, including medical conditions (n = 2126). We paired survey responses with secondary data sources for residence in a floodplain and/or urban heat island to predict perceptions of personal and household climate health risk. General health risk perceptions, political ideology, and climate beliefs are the strongest predictors. Yet, people in households with the following characteristics also see themselves at higher risk: members with one or more medical conditions or disabilities; low income; racial/ethnic minorities; and residence in a floodplain. In light of these results, climate health communication among vulnerable populations should emphasize protective actions instead of risk messages.

Vulnerable Populations Perceive Their Health as at Risk from Climate Change

PubMed Central

Akerlof, Karen L.; Delamater, Paul L.; Boules, Caroline R.; Upperman, Crystal R.; Mitchell, Clifford S.

2015-01-01

Climate change is already taking a toll on human health, a toll that is likely to increase in coming decades. The relationship between risk perceptions and vulnerability to climate change’s health threats has received little attention, even though an understanding of the dynamics of adaptation among particularly susceptible populations is becoming increasingly important. We demonstrate that some people whose health will suffer the greatest harms from climate change—due to social vulnerability, health susceptibility, and exposure to hazards—already feel they are at risk. In a 2013 survey we measured Maryland residents’ climate beliefs, health risk perceptions, and household social vulnerability characteristics, including medical conditions (n = 2126). We paired survey responses with secondary data sources for residence in a floodplain and/or urban heat island to predict perceptions of personal and household climate health risk. General health risk perceptions, political ideology, and climate beliefs are the strongest predictors. Yet, people in households with the following characteristics also see themselves at higher risk: members with one or more medical conditions or disabilities; low income; racial/ethnic minorities; and residence in a floodplain. In light of these results, climate health communication among vulnerable populations should emphasize protective actions instead of risk messages. PMID:26690184

Novel daidzein analogs enhance osteogenic activity of bone marrow-derived mesenchymal stem cells and adipose-derived stromal/stem cells through estrogen receptor dependent and independent mechanisms

USDA-ARS?s Scientific Manuscript database

Osteoporosis is a disease characterized by low bone mineral density (BMD) and increased risk of fractures. Studies have demonstrated the use of phytoestrogens, or plant-derived estrogens, such as genistein anddaidzein, to effectively increase osteogenic activity of bone marrow-derived mesenchymal s...

Genetic risk of major depressive disorder: the moderating and mediating effects of neuroticism and psychological resilience on clinical and self-reported depression.

PubMed

Navrady, L B; Adams, M J; Chan, S W Y; Ritchie, S J; McIntosh, A M

2017-11-29

Polygenic risk scores (PRS) for depression correlate with depression status and chronicity, and provide causal anchors to identify depressive mechanisms. Neuroticism is phenotypically and genetically positively associated with depression, whereas psychological resilience demonstrates negative phenotypic associations. Whether increased neuroticism and reduced resilience are downstream mediators of genetic risk for depression, and whether they contribute independently to risk remains unknown. Moderating and mediating relationships between depression PRS, neuroticism, resilience and both clinical and self-reported depression were examined in a large, population-based cohort, Generation Scotland: Scottish Family Health Study (N = 4166), using linear regression and structural equation modelling. Neuroticism and resilience were measured by the Eysenck Personality Scale Short Form Revised and the Brief Resilience Scale, respectively. PRS for depression was associated with increased likelihood of self-reported and clinical depression. No interaction was found between PRS and neuroticism, or between PRS and resilience. Neuroticism was associated with increased likelihood of self-reported and clinical depression, whereas resilience was associated with reduced risk. Structural equation modelling suggested the association between PRS and self-reported and clinical depression was mediated by neuroticism (43-57%), while resilience mediated the association in the opposite direction (37-40%). For both self-reported and clinical diagnoses, the genetic risk for depression was independently mediated by neuroticism and resilience. Findings suggest polygenic risk for depression increases vulnerability for self-reported and clinical depression through independent effects on increased neuroticism and reduced psychological resilience. In addition, two partially independent mechanisms - neuroticism and resilience - may form part of the pathway of vulnerability to depression.

A multivariate test of disease risk reveals conditions leading to disease amplification.

PubMed

Halliday, Fletcher W; Heckman, Robert W; Wilfahrt, Peter A; Mitchell, Charles E

2017-10-25

Theory predicts that increasing biodiversity will dilute the risk of infectious diseases under certain conditions and will amplify disease risk under others. Yet, few empirical studies demonstrate amplification. This contrast may occur because few studies have considered the multivariate nature of disease risk, which includes richness and abundance of parasites with different transmission modes. By combining a multivariate statistical model developed for biodiversity-ecosystem-multifunctionality with an extensive field manipulation of host (plant) richness, composition and resource supply to hosts, we reveal that (i) host richness alone could not explain most changes in disease risk, and (ii) shifting host composition allowed disease amplification, depending on parasite transmission mode. Specifically, as predicted from theory, the effect of host diversity on parasite abundance differed for microbes (more density-dependent transmission) and insects (more frequency-dependent transmission). Host diversity did not influence microbial parasite abundance, but nearly doubled insect parasite abundance, and this amplification effect was attributable to variation in host composition. Parasite richness was reduced by resource addition, but only in species-rich host communities. Overall, this study demonstrates that multiple drivers, related to both host community and parasite characteristics, can influence disease risk. Furthermore, it provides a framework for evaluating multivariate disease risk in other systems. © 2017 The Author(s).

Radiation as a Risk Factor for Cardiovascular Disease

PubMed Central

Moulder, John E.; Hopewell, John W.

2011-01-01

Abstract Humans are continually exposed to ionizing radiation from terrestrial sources. The two major contributors to radiation exposure of the U.S. population are ubiquitous background radiation and medical exposure of patients. From the early 1980s to 2006, the average dose per individual in the United States for all sources of radiation increased by a factor of 1.7–6.2 mSv, with this increase due to the growth of medical imaging procedures. Radiation can place individuals at an increased risk of developing cardiovascular disease. Excess risk of cardiovascular disease occurs a long time after exposure to lower doses of radiation as demonstrated in Japanese atomic bomb survivors. This review examines sources of radiation (atomic bombs, radiation accidents, radiological terrorism, cancer treatment, space exploration, radiosurgery for cardiac arrhythmia, and computed tomography) and the risk for developing cardiovascular disease. The evidence presented suggests an association between cardiovascular disease and exposure to low-to-moderate levels of radiation, as well as the well-known association at high doses. Studies are needed to define the extent that diagnostic and therapeutic radiation results in increased risk factors for cardiovascular disease, to understand the mechanisms involved, and to develop strategies to mitigate or treat radiation-induced cardiovascular disease. Antioxid. Redox Signal. 15, 1945–1956. PMID:21091078

Psoriasis increases risk of new-onset atrial fibrillation: a systematic review and meta-analysis of prospective observational studies.

PubMed

Upala, Sikarin; Shahnawaz, Afeefa; Sanguankeo, Anawin

2017-08-01

Psoriasis is a common chronic immune-mediated dermatological disease that increases the risk of cardiovascular disease. We conducted a systematic review and meta-analysis to evaluate the association between psoriasis and atrial fibrillation from prospective observational studies. A comprehensive search of the databases of the MEDLINE and EMBASE was performed from inception through November 2015. The inclusion criterion was the prospective observational study that assessed the risk of new-onset atrial fibrillation in adults with psoriasis. Outcome was the adjusted hazard ratio (HR) of atrial fibrillation comparison between patients with psoriasis and controls. Pooled HR and 95% confidence intervals (CI) were calculated using a random-effects model. The initial search yielded 176 articles. Fifteen articles underwent full-length review and data were extracted from 4 observational studies. Incidence of atrial fibrillation was ascertained by cardiologist-reviewed electrocardiograms. There was a significant increased risk of new-onset atrial fibrillation in patients with psoriasis compared to controls with a pooled HR 1.42 (95%CI 1.22-1.65). Our meta-analysis of prospective studies demonstrated that patients with psoriasis have increased risk of new-onset atrial fibrillation. Future interventional studies addressing the impact of psoriasis treatment and prevention of atrial fibrillation should be performed.

The Effects of Silicone Hydrogel Lens Wear on the Corneal Epithelium and Risk for Microbial Keratitis

PubMed Central

Robertson, Danielle M.

2012-01-01

Previous studies using animal models and human clinical trials have demonstrated that the use of low oxygen transmissible contact lens materials produce corneal epithelial surface damage resulting in increased Pseudomonas aeruginosa (PA) adhesion and raft-mediated internalization into surface corneal epithelial cells. These findings led to the testable clinical predictions that: (1) microbial keratitis (MK) risk is expected to be greatest during the first 6 months of wear; (2) there is no difference between 6 and 30 night extended wear; and (3) that wear of hyper-oxygen transmissible lenses would reduce the reported incidence of infection. Subsequent epidemiological studies have confirmed the first two predictions; however, increased oxygen transmissibility with silicone hydrogel (SiHy) lens wear has not altered the overall incidence of MK. In this review, more recent clinical and basic studies that investigate epithelial alterations and bacterial adhesion to corneal epithelial cells following wear of SiHy lenses with and without concomitant exposure to chemically preserved multipurpose solutions (MPS) will be examined. The collective results of these studies demonstrate that even in the absence of lens-related hypoxia, MPS induce ocular surface changes during SiHy lens wear which are associated with a pathophysiological increase in PA adherence and internalization in the corneal epithelium, and therefore, predict an increased risk for PA-MK. In addition, new data supporting an interactive role for inflammation in facilitating PA adherence and internalization in the corneal epithelium will also be discussed. PMID:23266590

A General Model of Distant Hybridization Reveals the Conditions for Extinction in Atlantic Salmon and Brown Trout

PubMed Central

Quilodrán, Claudio S.; Currat, Mathias; Montoya-Burgos, Juan I.

2014-01-01

Interspecific hybridization is common in nature but can be increased in frequency or even originated by human actions, such as species introduction or habitat modification, which may threaten species persistence. When hybridization occurs between distantly related species, referred to as “distant hybridization,” the resulting hybrids are generally infertile or fertile but do not undergo chromosomal recombination during gametogenesis. Here, we present a model describing this frequent but poorly studied interspecific hybridization to assess its consequences on parental species and to anticipate the conditions under which they can reach extinction. Our general model fully incorporates three important processes: density-dependent competition, dominance/recessivity inheritance of traits and assortative mating. We demonstrate its use and flexibility by assessing population extinction risk between Atlantic salmon and brown trout in Norway, whose interbreeding has recently increased due to farmed fish releases into the wild. We identified the set of conditions under which hybridization may threaten salmonid species. Thanks to the flexibility of our model, we evaluated the effect of an additional risk factor, a parasitic disease, and showed that the cumulative effects dramatically increase the extinction risk. The consequences of distant hybridization are not genetically, but demographically mediated. Our general model is useful to better comprehend the evolution of such hybrid systems and we demonstrated its importance in the field of conservation biology to set up management recommendations when this increasingly frequent type of hybridization is in action. PMID:25003336

A general model of distant hybridization reveals the conditions for extinction in Atlantic salmon and brown trout.

PubMed

Quilodrán, Claudio S; Currat, Mathias; Montoya-Burgos, Juan I

2014-01-01

Interspecific hybridization is common in nature but can be increased in frequency or even originated by human actions, such as species introduction or habitat modification, which may threaten species persistence. When hybridization occurs between distantly related species, referred to as "distant hybridization," the resulting hybrids are generally infertile or fertile but do not undergo chromosomal recombination during gametogenesis. Here, we present a model describing this frequent but poorly studied interspecific hybridization to assess its consequences on parental species and to anticipate the conditions under which they can reach extinction. Our general model fully incorporates three important processes: density-dependent competition, dominance/recessivity inheritance of traits and assortative mating. We demonstrate its use and flexibility by assessing population extinction risk between Atlantic salmon and brown trout in Norway, whose interbreeding has recently increased due to farmed fish releases into the wild. We identified the set of conditions under which hybridization may threaten salmonid species. Thanks to the flexibility of our model, we evaluated the effect of an additional risk factor, a parasitic disease, and showed that the cumulative effects dramatically increase the extinction risk. The consequences of distant hybridization are not genetically, but demographically mediated. Our general model is useful to better comprehend the evolution of such hybrid systems and we demonstrated its importance in the field of conservation biology to set up management recommendations when this increasingly frequent type of hybridization is in action.

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

PubMed

Heaton, Timothy J; Chico, Victoria

2016-01-01

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

Validation of a modified FRAX® tool for improving outpatient efficiency--part of the "Catch Before a Fall" initiative.

PubMed

Parker, Simon; Ciaccio, Maria; Cook, Erica; Davenport, Graham; Cooper, Alun; Grange, Simon; Smitham, Peter

2015-01-01

We have validated our touch-screen-modified FRAX® tool against the traditional healthcare professional-led questionnaire, demonstrating strong concordance between doctor- and patient-derived results. We will use this in outpatient clinics and general practice to increase our capture rate of at-risk patients, making valuable use of otherwise wasted patient waiting times. Outpatient clinics offer an opportunity to collect valuable health information from a captive population. We have previously developed a modified fracture risk assessment (FRAX®) tool, enabling patients to self-assess their osteoporotic fracture risk in a touch-screen computer format and demonstrated its acceptability with patients. We aim to validate the accuracy of our tool against the traditional questionnaire. Fifty patients over 50 years of age within the fracture clinic independently completed a paper equivalent of our touch-screen-modified FRAX® questionnaire. Responses were analysed against the traditional healthcare professional (HCP)-led questionnaire which was carried out afterwards. Correlation was assessed by sensitivity, specificity, Cohen's kappa statistic and Fisher's exact test for each potential FRAX® outcome of "treat", "measure BMD" and "lifestyle advice". Age range was 51-98 years. The FRAX® tool was completed by 88 % of patients; six patients lacked confidence in estimating either their height or weight. Following question adjustment according to patient response and feedback, our tool achieved >95 % sensitivity and specificity for the "treat" and "lifestyle advice" groups, and 79 % sensitivity and 100 % specificity in the "measure BMD" group. Cohen's kappa value ranged from 0.823 to 0.995 across all groups, demonstrating "very good" agreement for all. Fisher's exact test demonstrated significant concordance between doctor and patient decisions. Our modified tool provides a simple, accurate and reliable method for patients to self-report their own FRAX® score outside the clinical contact period, thus releasing the HCP from the time required to complete the questionnaire and potentially increasing our capture rate of at-risk patients.

Medication use and associated risk of falling in a geriatric outpatient population.

PubMed

Freeland, Kathryn N; Thompson, Amy N; Zhao, Yumin; Leal, Julie E; Mauldin, Patrick D; Moran, William P

2012-09-01

Studies have shown that approximately one third of community-dwelling people aged 65 years and older will experience a fall each year. Many studies indicate that use of multiple medications may put patients at an increased risk of falling, but few studies have been conducted to correlate the number of medications with the risk of falls. To determine the medications most frequently used in patients aged 65 years or older who have experienced a fall within the past year, with particular attention to type or number of medications most commonly associated with multiple falls or a fall with injury. We conducted a chart review in an outpatient internal medicine clinic over a 13-month period. A total of 118 patients 65 years of age or older who were taking 4 or more medications and had experienced at least 1 fall in the previous 12 months were included. Data relating to sex, age, race, diagnoses, medications, and number and type of falls were obtained during the chart review. The primary end point of the study was number and type of medications most commonly used in patients experiencing a fall. A total of 116 patients were examined for trends in fall risk. A logistic regression model and receiver operating characteristic curve demonstrated significant fall risk with the addition of medications, with patients experiencing a 14% increase in fall risk with the addition of each medication beyond a 4-medication regimen (OR 1.14; 95% CI 1.02 to 1.27; p = 0.027). The addition of medications is associated with a significant increase in risk of falls in elderly patients, regardless of drug class. Further studies are needed to assess the possible increased risk of falls with increasing number of medications.

Association Between Serum 25-Hydroxy Vitamin D Levels and Blood Pressure Among Adolescents in Two Resource-Limited Settings in Peru

PubMed Central

Tomaino, Katherine; Romero, Karina M.; Robinson, Colin L.; Baumann, Lauren M.; Hansel, Nadia N.; Pollard, Suzanne L.; Gilman, Robert H.; Mougey, Edward; Lima, John J.

2015-01-01

INTRODUCTION Serum 25-hydroxyvitamin D (25OHD) deficiency (<50 nmol/l or 20ng/ml) has been associated with increased blood pressure (BP) in observational studies. A paucity of data on this relationship is available in Latin American or child populations. This study investigates the association between 25OHD levels and BP in adolescents at risk for vitamin D deficiency in 2 Peruvian settings. METHODS In a population-based study of 1,441 Peruvian adolescents aged 13–15 years, 1,074 (75%) provided a serum blood sample for 25OHD analysis and BP measurements. Relationships between 25OHD and BP metrics were assessed using multiple linear regressions, adjusted for anthropometrics and sociodemographic factors. RESULTS 25OHD deficiency was associated with an elevated diastolic BP (DBP) (1.09mm Hg increase, 95% confidence interval: 0.04 to 2.14; P = 0.04) compared to nondeficient adolescents. Systolic BP (SBP) trended to increase with vitamin D deficiency (1.30mm Hg increase, 95% confidence interval: −0.13 to 2.72; P = 0.08). Mean arterial pressure (MAP) was also greater in adolescents with 25OHD (1.16mm Hg increase, 95% confidence interval: 0.10 to 2.22; P = 0.03). SBP was found to demonstrate a U-shaped relationship with 25OHD, while DBP and MAP demonstrated inverse J-shaped relationships with serum 25OHD status. The association between 25OHD deficiency and BP was not different across study sites (all P ≥ 0.19). DISCUSSION Adolescents deficient in 25OHD demonstrated increased DBP and MAP and a trend toward increased SBP, when compared to nondeficient subjects. 25OHD deficiency early in life was associated with elevated BP metrics, which may predispose risk of hypertension later in adulthood. PMID:25600222

When Low Self-Esteem Encourages Behaviors that Risk Rejection to Increase Interdependence: The Role of Relational Self-Control

PubMed Central

Baker, Levi R.; McNulty, James K.

2013-01-01

Increasing interdependence in an intimate relationship requires engaging in behaviors that risk rejection, such as expressing affection and asking for support. Who takes such risks and who avoids them? Although several theoretical perspectives suggest that self-esteem plays a crucial role in shaping such behaviors, they can be used to make competing predictions regarding the direction of this effect. Six studies reconcile these contrasting predictions by demonstrating that the effects of self-esteem on behaviors that risk rejection to increase interdependence depend on relational self-construal— i.e., the extent to which people define themselves by their close relationships. In Studies 1 and 2, participants were given the opportunity to disclose negative personal information (Study 1) and feelings of intimacy (Study 2) to their dating partners. In Study 3, married couples reported the extent to which they confided in one another. In Study 4, we manipulated self-esteem and relational self-construal and participants reported their willingness to engage in behaviors that increase interdependence. In Studies 5 and 6, we manipulated the salience of interpersonal risk and participants reported their willingness to engage in behaviors that risk rejection to increase interdependence. In all six studies, self-esteem was positively associated with behaviors that can increase interdependence among people low in relational self-construal but negatively associated with those behaviors among people high in relational self-construal. Accordingly, theoretical descriptions of the role of self-esteem in relationships will be most complete to the extent that they consider the degree to which people define themselves by their close relationships. PMID:23586411

Risk factors for the development of Clostridium difficile infection in hospitalized children.

PubMed

Samady, Waheeda; Pong, Alice; Fisher, Erin

2014-10-01

This article defines the risk factors for Clostridium difficile infection (CDI) in hospitalized children in light of recent studies demonstrating a change in the epidemiology of these infections in both adults and children. Antibiotic exposure within the past 4-12 weeks was noted in a majority of published cases of pediatric CDI, and that remains a key risk factor for infection. Past and/or prolonged hospitalization increase a child's risk for CDI as they increase potential contact with C. difficile spores. Of all CDI, hospital-acquired infection remains more common. Many comorbid conditions have been linked with CDI, with the strongest association existing in children with cancer and inflammatory bowel disease. Severe infections occur infrequently in pediatric patients. Markers established in adults for severe CDI resulting in colectomy or transfer to ICU have not been shown to correlate in pediatric patients. Recent antibiotic exposure and hospitalization remain key risk factors for CDI in the hospitalized pediatric patient. Patients with comorbid conditions such as malignancy and inflammatory bowel disease are at higher risk for CDI. Resistant infections and severe outcomes are not common in the pediatric population.

HIV, STD, and hepatitis risk to primary female partners of men being released from prison.

PubMed

Grinstead, Olga A; Faigeles, Bonnie; Comfort, Megan; Seal, David; Nealey-Moore, Jill; Belcher, Lisa; Morrow, Kathleen

2005-01-01

Incarcerated men in the US are at increased risk for HIV, STDs and hepatitis, and many men leaving prison have unprotected sex with a primary female partner immediately following release from prison. This paper addresses risk to the primary female partners of men being released from prison (N = 106) by examining the prevalence of men's concurrent unprotected sex with other partners or needle sharing prior to and following release from prison (concurrent risk). Rates of concurrent risk were 46% prior to incarceration, 18% one month post release, and 24% three months post release. Multivariate analysis showed concurrent risk was significantly associated with having a female partner who had one or more HIV/STD risk factors and having a history of injection drug use. Findings demonstrate need for prevention programs for incarcerated men and their female partners.

The Association between Body Mass Index and Hot Flash in Midlife Women: A Meta-analysis.

PubMed

Shobeiri, Fatemeh; Jenabi, Ensiyeh; Poorolajal, Jalal; Hazavehei, Seyyed Mohammad Mahdi

2016-04-01

The association between body mass index (BMI) and hot flash risk has not been specifically clarifies yet. This meta-analysis was, therefore, conducted to estimate the association between overweight and obesity and hot flash risk. We searched PubMed, Web of Science, and Scopus for observational studies addressing the association between BMI and hot flash until August 2015. Data were independently extracted and analyzed using 95% odds ratio (OR), and confidence intervals (CI) based on the random-effects models. We identified 2,244 references and conducted seven studies with 4,219 participants. The association between hot flash and overweight was estimated 1.13 (95% CI: 0.97-1.32) and that of obesity was estimated 1.79 (95% CI: 1.52-2.11). No evidence of heterogeneity and publication bias was observed. This meta-analysis demonstrated that, though not to a great extent, obesity does increase the risk of hot flash. The findings from this meta-analysis indicated that obesity is associated with an increased risk of hot flash. Further large prospective cohort studies are required to provide convincing evidence as to whether or not BMI is associated with an increased risk of hot flashes.

How important is donor age in liver transplantation?

PubMed

Lué, Alberto; Solanas, Estela; Baptista, Pedro; Lorente, Sara; Araiz, Juan J; Garcia-Gil, Agustin; Serrano, M Trinidad

2016-06-07

The age of liver donors has been increasing in the past several years because of a donor shortage. In the United States, 33% of donors are age 50 years or older, as are more than 50% in some European countries. The impact of donor age on liver transplantation (LT) has been analyzed in several studies with contradictory conclusions. Nevertheless, recent analyses of the largest databases demonstrate that having an older donor is a risk factor for graft failure. Donor age is included as a risk factor in the more relevant graft survival scores, such as the Donor Risk Index, donor age and Model for End-stage Liver Disease, Survival Outcomes Following Liver Transplantation, and the Balance of Risk. The use of old donors is related to an increased rate of biliary complications and hepatitis C virus-related graft failure. Although liver function does not seem to be significantly affected by age, the incidence of several liver diseases increases with age, and the capacity of the liver to manage or overcome liver diseases or external injuries decreases. In this paper, the importance of age in LT outcomes, the role of donor age as a risk factor, and the influence of aging on liver regeneration are reviewed.

How important is donor age in liver transplantation?

PubMed Central

Lué, Alberto; Solanas, Estela; Baptista, Pedro; Lorente, Sara; Araiz, Juan J; Garcia-Gil, Agustin; Serrano, M Trinidad

2016-01-01

The age of liver donors has been increasing in the past several years because of a donor shortage. In the United States, 33% of donors are age 50 years or older, as are more than 50% in some European countries. The impact of donor age on liver transplantation (LT) has been analyzed in several studies with contradictory conclusions. Nevertheless, recent analyses of the largest databases demonstrate that having an older donor is a risk factor for graft failure. Donor age is included as a risk factor in the more relevant graft survival scores, such as the Donor Risk Index, donor age and Model for End-stage Liver Disease, Survival Outcomes Following Liver Transplantation, and the Balance of Risk. The use of old donors is related to an increased rate of biliary complications and hepatitis C virus-related graft failure. Although liver function does not seem to be significantly affected by age, the incidence of several liver diseases increases with age, and the capacity of the liver to manage or overcome liver diseases or external injuries decreases. In this paper, the importance of age in LT outcomes, the role of donor age as a risk factor, and the influence of aging on liver regeneration are reviewed. PMID:27275089

A Risk Score for Predicting Multiple Sclerosis.

PubMed

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

2016-01-01

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

Making hypertensive smokers motivated in quitting: developing 'blood pressure equivalence of smoking'.

PubMed

Wen, Chi Pang; Tsai, Min Kuang; Chan, Hui Ting; Tsai, Shan Pou; Cheng, Ting Yuan David; Chiang, Po Huang

2008-04-01

To express the increased risk from smoking in terms of 'blood pressure' so that hypertensive smokers are motivated into quitting. Mortality risks of smokers were compared with nonsmokers in a large worker cohort in Taiwan (n = 23755 with a 17-year follow-up) for all-cause and for cardiovascular diseases. The blood pressure equivalence of smoking was then identified by the difference in mortality risks between smokers and nonsmokers. Some interaction between hypertension and smoking was found to be synergistic. When hypertension and smoking co-existed, the all-cause mortality outcome [relative risk (RR) = 4.25] was larger than the sum or product of each individual risk for hypertension (RR = 2.16) or for smoking (RR = 1.97). The excess mortality risks of smoking for smokers were converted into a 'blood pressure equivalence'. The results demonstrate that the addition of smoking was similar to an increase of mortality risk approximately equivalent to an increase in blood pressure of 40 mmHg. Smoking cessation in hypertensive patients could provide a reduction of mortality risks similar to a permanent reduction of 40 mmHg in blood pressure, over and above any antihypertensive medications. Appreciating this relationship enables physicians to bridge the clinical disconnection and motivates hypertensive smokers to seek smoking cessation. The use of a 'blood pressure equivalence of smoking' can link the two separate risk factors and may lead to a paradigm shift in overcoming an existing clinical challenge.

Arsenic in Drinking Water and Lung Cancer Mortality in the United States: An Analysis Based on US Counties and 30 Years of Observation (1950–1979)

PubMed Central

Afari-Dwamena, Nana Ama; Li, Ji; Chen, Rusan; Feinleib, Manning; Lamm, Steven H.

2016-01-01

Background. To examine whether the US EPA (2010) lung cancer risk estimate derived from the high arsenic exposures (10–934 µg/L) in southwest Taiwan accurately predicts the US experience from low arsenic exposures (3–59 µg/L). Methods. Analyses have been limited to US counties solely dependent on underground sources for their drinking water supply with median arsenic levels of ≥3 µg/L. Results. Cancer risks (slopes) were found to be indistinguishable from zero for males and females. The addition of arsenic level did not significantly increase the explanatory power of the models. Stratified, or categorical, analysis yielded relative risks that hover about 1.00. The unit risk estimates were nonpositive and not significantly different from zero, and the maximum (95% UCL) unit risk estimates for lung cancer were lower than those in US EPA (2010). Conclusions. These data do not demonstrate an increased risk of lung cancer associated with median drinking water arsenic levels in the range of 3–59 µg/L. The upper-bound estimates of the risks are lower than the risks predicted from the SW Taiwan data and do not support those predictions. These results are consistent with a recent metaregression that indicated no increased lung cancer risk for arsenic exposures below 100–150 µg/L. PMID:27382373

Zoonotic disease risk perceptions in the British veterinary profession.

PubMed

Robin, Charlotte; Bettridge, Judy; McMaster, Fiona

2017-01-01

In human and veterinary medicine, reducing the risk of occupationally-acquired infections relies on effective infection prevention and control practices (IPCs). In veterinary medicine, zoonoses present a risk to practitioners, yet little is known about how these risks are understood and how this translates into health protective behaviour. This study aimed to explore risk perceptions within the British veterinary profession and identify motivators and barriers to compliance with IPCs. A cross-sectional study was conducted using veterinary practices registered with the Royal College of Veterinary Surgeons. Here we demonstrate that compliance with IPCs is influenced by more than just knowledge and experience, and understanding of risk is complex and multifactorial. Out of 252 respondents, the majority were not concerned about the risk of zoonoses (57.5%); however, a considerable proportion (34.9%) was. Overall, 44.0% of respondents reported contracting a confirmed or suspected zoonoses, most frequently dermatophytosis (58.6%). In veterinary professionals who had previous experience of managing zoonotic cases, time or financial constraints and a concern for adverse animal reactions were not perceived as barriers to use of personal protective equipment (PPE). For those working in large animal practice, the most significant motivator for using PPE was concerns over liability. When assessing responses to a range of different "infection control attitudes", veterinary nurses tended to have a more positive perspective, compared with veterinary surgeons. Our results demonstrate that IPCs are not always adhered to, and factors influencing motivators and barriers to compliance are not simply based on knowledge and experience. Educating veterinary professionals may help improve compliance to a certain extent, however increased knowledge does not necessarily equate to an increase in risk-mitigating behaviour. This highlights that the construction of risk is complex and circumstance-specific and to get a real grasp on compliance with IPCs, this construction needs to be explored in more depth. Copyright © 2016. Published by Elsevier B.V.

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

NASA Astrophysics Data System (ADS)

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

2013-03-01

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

Proton pump inhibitors and potential interactions with clopidogrel: an update.

PubMed

Gerson, Lauren B

2013-06-01

Clopidogrel, an antiplatelet agent, is increasingly prescribed for patients with recent stroke, myocardial infarction, acute coronary syndrome, and/or patients post-coronary stent insertion to prevent recurrent cardiovascular events. Since clopidogrel can increase the risk of gastrointestinal hemorrhage, co-administration of proton pump inhibitors (PPIs) has been recommended, particularly in patients at high risk. In 2009, the FDA issued warnings about potential interactions between clopidogrel and PPIs, given the fact that both drugs are metabolized via the cytochrome P450 pathway. Prior studies have demonstrated significant reduction in platelet inhibition when PPI therapy is administered to subjects on clopidogrel therapy. Two meta-analyses were published in 2010 and 2011, the first suggesting association of PPIs with adverse cardiovascular events when observational studies were examined, but noting that the results were limited by the presence of significant heterogeneity. The second meta-analysis did not find a significant increase in the risk of adverse primary events (which included all cause mortality, cardiovascular death, myocardial infarction, or stroke), and concluded that analysis of the data from two randomized controlled trials yielded a risk difference of zero. An updated literature search was performed to assess clinical studies describing interactions between PPIs and clopidogrel published from 2011-2012. The majority of these studies did not show significant interactions when primary cardiac outcomes were considered. More importantly, the newer data demonstrated that PPI usage independently was a risk factor for adverse CV outcomes, since most PPI users were older patients who were more likely to have concomitant co-morbid conditions. Two updated reviews also concluded that the presence of confounding factors likely explained differences in results between studies, and that there were no significant differences in effects on clopidogrel between individual proton pump inhibitors. Overall, clinicians can assure their patients that combination therapy is safe when indicated in a patient at high risk of GI bleeding, but they should also stop PPI therapy if it is not clinically indicated.

[Uterine leiomyomas during pregnancy and its impact on obstetric outcome].

PubMed

Morgan Ortiz, Fred; Piña Romero, Brizna; Elorriaga García, Enrique; Báez Barraza, Josefina; Quevedo Castro, Everardo; Peraza Garay, Felipe de Jesús

2011-08-01

The association of uterine leiomyoma and pregnancy is increasing due to the tendency of couples to delay first pregnancy after age 30. The risk of uterine fibroids is greater with advancing age of the woman. To evaluate the impact of fibroids on the incidence of complications during pregnancy, labor and delivery. We observed 65 pregnant patients with uterine fibroids and 165 pregnant patients without fibroids. Follow-up ultrasound was performed at weeks 20 to 24, 30 to 32 and 36 to 40. We analyzed the following variables: threatened abortion, pregnancy loss, preterm birth, premature rupture of membranes, abnormal fetal presentation, mode of termination of pregnancy, uterine atony, postpartum hemorrhage and perinatal outcome. The frequency of threatened abortion, risk of pregnancy loss in the second trimester, preterm births, premature rupture of membranes and abnormal fetal presentation was significantly higher in patients with uterine fibroids compared to patients without fibroids. It was not demonstrated that fibroids grow during follow-up even, there was a trend toward reduction in size as pregnancy progressed and until its completion. No significant differences in the frequency of cesarean section between groups (52.3 vs. 47.9%, RR 1.09; 95% CI 0.82-1.45, p = 0.646). Uterine atony was more frequent in patients with fibroids than in patients without fibroids (12.3 vs 4.2%, RR = 2.9, 95% CI 1.2-7.6, p = 0.036). There were no differences in perinatal outcomes between the groups. Uterine fibroids increase the risk of complications during pregnancy and childbirth. Could not be demonstrated an increased risk of caesarean section.

Acute myeloid and chronic lymphoid leukaemias and exposure to low-level benzene among petroleum workers

PubMed Central

Rushton, L; Schnatter, A R; Tang, G; Glass, D C

2014-01-01

Background: High benzene exposure causes acute myeloid leukaemia (AML). Three petroleum case–control studies identified 60 cases (241 matched controls) for AML and 80 cases (345 matched controls) for chronic lymphoid leukaemia (CLL). Methods: Cases were classified and scored regarding uncertainty by two haematologists using available diagnostic information. Blinded quantitative benzene exposure assessment used work histories and exposure measurements adjusted for era-specific circumstances. Statistical analyses included conditional logistic regression and penalised smoothing splines. Results: Benzene exposures were much lower than previous studies. Categorical analyses showed increased ORs for AML with several exposure metrics, although patterns were unclear; neither continuous exposure metrics nor spline analyses gave increased risks. ORs were highest in terminal workers, particularly for Tanker Drivers. No relationship was found between benzene exposure and risk of CLL, although the Australian study showed increased risks in refinery workers. Conclusion: Overall, this study does not persuasively demonstrate a risk between benzene and AML. A previously reported strong relationship between myelodysplastic syndrome (MDS) (potentially previously reported as AML) at our study's low benzene levels suggests that MDS may be the more relevant health risk for lower exposure. Higher CLL risks in refinery workers may be due to more diverse exposures than benzene alone. PMID:24357793

Traditional marijuana, high-potency cannabis and synthetic cannabinoids: increasing risk for psychosis.

PubMed

Murray, Robin M; Quigley, Harriet; Quattrone, Diego; Englund, Amir; Di Forti, Marta

2016-10-01

Epidemiological evidence demonstrates that cannabis use is associated with an increased risk of psychotic outcomes, and confirms a dose-response relationship between the level of use and the risk of later psychosis. High-potency cannabis and synthetic cannabinoids carry the greatest risk. Experimental administration of tetrahydrocannabinol, the active ingredient of cannabis, induces transient psychosis in normal subjects, but this effect can be ameliorated by co-administration of cannabidiol. This latter is a constituent of traditional hashish, but is largely absent from modern high-potency forms of cannabis. Argument continues over the extent to which genetic predisposition is correlated to, or interacts with, cannabis use, and what proportion of psychosis could be prevented by minimizing heavy use. As yet, there is not convincing evidence that cannabis use increases risk of other psychiatric disorders, but there are no such doubts concerning its detrimental effect on cognitive function. All of the negative aspects are magnified if use starts in early adolescence. Irrespective of whether use of cannabis is decriminalized or legalized, the evidence that it is a component cause of psychosis is now sufficient for public health messages outlining the risk, especially of regular use of high-potency cannabis and synthetic cannabinoids. © 2016 World Psychiatric Association.

Humans Have Already Increased the Risk of Basin-wide Disruptions to Pacific Rainfall, and the Risk Increases Even If Global Warming is Restricted to the 2oC Paris Target

NASA Astrophysics Data System (ADS)

Power, S.; Delage, F.; Chung, C.; Ye, H.; Murphy, B.

2017-12-01

The El Nino-Southern Oscillation causes major, intermittent disruptions to rainfall patterns and intensity over the Pacific Ocean lasting up to approximately one year. These disruptions have major impacts on severe weather, agricultural production, ecosystems, streamflow, and disease within and adjacent to the Pacific, and in many countries beyond. The frequency with which major disruptions to Pacific rainfall occur has been projected to increase over the 21st century, in response to global warming caused by large 21st century greenhouse gas emissions. Here we use the latest generation of climate models to show that the risk of disruption has already increased, and that humans may have contributed to the severity of the 1982/83 and 1997/98 events. We also demonstrate - for the first time - that although marked and sustained reductions in 21st century anthropogenic greenhouse gas emissions can greatly moderate the likelihood of major disruption, elevated risk of occurrence appears locked in now, and for at least the remainder of the 21st century. DOI: 10.1038/ncomms14368

Pentagastrin-induced hemoconcentration in healthy volunteers and patients with panic disorder: effect of pretreatment with ethinyl estradiol.

PubMed

Le Melledo, Jean Michel; Perez-Parada, Jorge; Morrow, Jarret; Bellavance, Francois; Lara, Nathalie; Jahandar, Farideh; Granger, Robert; Tait, Glendon; McManus, Karen

2011-01-01

Panic disorder has been associated with both an increased risk of coronary events as well as an increased risk of stroke. Hemoconcentration, with both a decrease in plasma volume and an increase in plasma viscosity, is a possible contributor to the risk of acute ischemic events. Our objectives were to demonstrate the process of hemoconcentration in response to induced panic symptoms and to assess the effect of pretreatment with ethinyl estradiol on panic-induced hemoconcentration. Fifteen male patients with panic disorder and 10 male healthy volunteers were included in a double-blind cross-over placebo-controlled design consisting of two injections of pentagastrin following randomized pretreatment with placebo and ethinyl estradiol. Plasma levels of hematocrit and hemoglobin were assessed at baseline and post-injections, and used to calculate an indirect estimation of the change in plasma volume. Pentagastrin-induced panic symptoms were associated with a mean decrease in plasma volume of 4.8% in the placebo pretreatment condition. Pretreatment with ethinyl estradiol attenuated this effect. The acute hemoconcentration observed in relation to pentagastrin-induced panic symptoms may be relevant to the increased risk of stroke and acute coronary events found in patients with panic disorder.

Ovarian response markers lead to appropriate and effective use of corifollitropin alpha in assisted reproduction.

PubMed

La Marca, Antonio; D'Ippolito, Giovanni

2014-02-01

Corifollitropin alpha is a highly effective gonadotrophin, which maintains multifollicular growth for a week. The advantages of its administration include ease of use of the drug, making the treatment more patient friendly, resulting in a lower level of distress for the patient. At the same time, the pregnancy rate resulting from its use in IVF/intracytoplasmic sperm injection cycles is similar to that found when daily recombinant FSH is administered. The ovarian response to corifollitropin alpha is dependent on clinically established predictors such as baseline FSH, antral follicle count (AFC) and age. There is a general trend towards a higher ovarian response with an increasing AFC and the number of oocytes per attempt decreased with increasing baseline FSH and age. Even if the risk of ovarian hyperstimulation syndrome following corifollitropin alpha is very similar to the rate reported in literature for young women undergoing IVF, the risk of overstimulation may be reduced by avoiding maximal ovarian stimulation in women anticipated to be hyperresponders. High basal anti-Müllerian hormone and/or AFC can identify women with enhanced functional ovarian reserve at risk of overstimulation, and the risk is even higher if maximally stimulated with corifollitropin alpha or high dose of daily recombinant FSH. Corifollitropin alpha is a highly effective gonadotrophin which maintains multifollicular growth for a week. The ovarian response to corifollitropin was demonstrated to be dependent on clinically established predictors such as baseline FSH, antral follicle count (AFC) and age. There was a general trend toward a higher ovarian response with an increasing AFC and the mean number of oocytes per attempt decreased with increasing baseline FSH and age. Even if the risk of ovarian hyperstimulation syndrome (OHSS) following corifollitropin alpha is very similar to the rate of OHSS reported in literature for young women undergoing IVF, the risk of overstimulation may be reduced by avoiding maximal ovarian stimulation in women anticipated to be hyperresponders. Increasing evidence demonstrates that anti-Müllerian hormone and AFC exhibit a very good diagnostic performance in the prediction of hyperresponse. High basal anti-Müllerian hormone and/or AFC can identify women with enhanced functional ovarian reserve who are at risk of overstimulation if stimulated in IVF cycles and the risk is even higher if maximally stimulated with corifollitropin alpha or high dose of daily recombinant FSH. Copyright © 2013 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

The impact of serum lipids on risk for microangiopathy in patients with type 2 diabetes mellitus

PubMed Central

2012-01-01

Background Few large-scale, real-world studies have assessed the relative associations of lipid fractions with diabetic microvascular events. The main objective of this study was to evaluate the association of the lipid profile components, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), triglycerides (TG), and non-high density lipoprotein cholesterol (non-HDL-C) with microvascular complications (MVCs) in type 2 diabetes mellitus (T2DM) patients. Methods This observational cohort study queried the HealthCore Integrated Research Database (HIRDSM) for newly-diagnosed (Index Date) 18-64-year-old patients with diabetes mellitus between 01/01/2005-06/30/2010. Inclusion required ≥12 months pre-index continuous health plan eligibility and ≥1 pre-index lipid profile result. Patients with polycystic ovary syndrome and prior MVCs were excluded. Incident complications were defined as the earliest occurrence of diabetic retinopathy, peripheral neuropathy, and/or nephropathy post-index. Cox proportional models and Kaplan-Meier (KM) curves were used to evaluate associations among variables. Results Of the patients (N = 72,267), 50.05 % achieved HDL-C, 64.28 % LDL-C, 59.82 % TG, and 56.79 % non-HDL-C American Diabetes Association goals at baseline. During follow-up (mean, 21.74 months), there were 5.21 microvascular events per 1,000 patient-months. A 1-mg/dL increase in HDL-C was associated with 1 % decrease in any MVC risk (P < .0001), but for LDL-C, TG, and non-HDL-C, 1-mg/dL increase resulted in increases of 0.2 % (P < .0001), 0.1 % (P < 0.001) and 0.3 % (P < 0.001) in MVC risk. Patients achieving HDL-C goals had a 11 % lower risk of MVC versus non-achievers (RR 0.895, [95 % CI, 0.852-0.941], P < .0001). Similarly, TG goal attainment was associated with a lowered risk for any MVC (RR 0.849, [95 % CI, 0.808-0.892], P < .0001). Evaluation of KM survival curves demonstrated no significant difference in the risk of MVCs between patients achieving vs. not achieving LDL-C goals, but did demonstrate a difference in MVC risk between patients achieving vs. not achieving non-HDL-C goals. Conclusion This study demonstrates significant independent associations among lipid fractions and risk for microangiopathy. These findings suggest that attaining established ADA goals for HDL-C, TG, and non-HDL-C may reduce risk for microvascular events among patients with diabetes. PMID:22978715

Risk Assessment in Underground Coalmines Using Fuzzy Logic in the Presence of Uncertainty

NASA Astrophysics Data System (ADS)

Tripathy, Debi Prasad; Ala, Charan Kumar

2018-04-01

Fatal accidents are occurring every year as regular events in Indian coal mining industry. To increase the safety conditions, it has become a prerequisite to performing a risk assessment of various operations in mines. However, due to uncertain accident data, it is hard to conduct a risk assessment in mines. The object of this study is to present a method to assess safety risks in underground coalmines. The assessment of safety risks is based on the fuzzy reasoning approach. Mamdani fuzzy logic model is developed in the fuzzy logic toolbox of MATLAB. A case study is used to demonstrate the applicability of the developed model. The summary of risk evaluation in case study mine indicated that mine fire has the highest risk level among all the hazard factors. This study could help the mine management to prepare safety measures based on the risk rankings obtained.

Association Between Cardiovascular Disease Risk Factors and Rotator Cuff Tendinopathy: A Cross-Sectional Study.

PubMed

Applegate, Kara Arnold; Thiese, Matthew S; Merryweather, Andrew S; Kapellusch, Jay; Drury, David L; Wood, Eric; Kendall, Richard; Foster, James; Garg, Arun; Hegmann, Kurt T

2017-02-01

Recent evidence has found potential associations between cardiovascular disease (CVD) risk factors and common musculoskeletal disorders. We evaluated possible associations between risk factors and both glenohumeral joint pain and rotator cuff tendinopathy. Data from WISTAH hand study participants (n = 1226) were assessed for associations between Framingham Heart Study CVD risk factors and both health outcomes. A strong association was observed between CVD risk scores and both glenohumeral joint pain and rotator cuff tendinopathy. Peak odds ratios (ORs) of the adjusted models were 4.55 [95% confidence interval (95% CI) 1.97 to 10.31] and 5.97 (95% CI 2.12 to 16.83), respectively. The results show a dose-response trend of increasing risk. Individual risk factors were associated with both outcomes. Combined, CVD risk factors demonstrated a strong correlation with glenohumeral joint pain and an even stronger correlation with rotator cuff tendinopathy. Results suggest a potentially modifiable disease mechanism.

Increasing URM Undergraduate Student Success through Assessment-Driven Interventions: A Multiyear Study Using Freshman-Level General Biology as a Model System

PubMed Central

Carmichael, Mary C.; St. Clair, Candace; Edwards, Andrea M.; Barrett, Peter; McFerrin, Harris; Davenport, Ian; Awad, Mohamed; Kundu, Anup; Ireland, Shubha Kale

2016-01-01

Xavier University of Louisiana leads the nation in awarding BS degrees in the biological sciences to African-American students. In this multiyear study with ∼5500 participants, data-driven interventions were adopted to improve student academic performance in a freshman-level general biology course. The three hour-long exams were common and administered concurrently to all students. New exam questions were developed using Bloom’s taxonomy, and exam results were analyzed statistically with validated assessment tools. All but the comprehensive final exam were returned to students for self-evaluation and remediation. Among other approaches, course rigor was monitored by using an identical set of 60 questions on the final exam across 10 semesters. Analysis of the identical sets of 60 final exam questions revealed that overall averages increased from 72.9% (2010) to 83.5% (2015). Regression analysis demonstrated a statistically significant correlation between high-risk students and their averages on the 60 questions. Additional analysis demonstrated statistically significant improvements for at least one letter grade from midterm to final and a 20% increase in the course pass rates over time, also for the high-risk population. These results support the hypothesis that our data-driven interventions and assessment techniques are successful in improving student retention, particularly for our academically at-risk students. PMID:27543637

Resistance to Aerobic Exercise Training Causes Metabolic Dysfunction and Reveals Novel Exercise-Regulated Signaling Networks

PubMed Central

Lessard, Sarah J.; Rivas, Donato A.; Alves-Wagner, Ana B.; Hirshman, Michael F.; Gallagher, Iain J.; Constantin-Teodosiu, Dumitru; Atkins, Ryan; Greenhaff, Paul L.; Qi, Nathan R.; Gustafsson, Thomas; Fielding, Roger A.; Timmons, James A.; Britton, Steven L.; Koch, Lauren G.; Goodyear, Laurie J.

2013-01-01

Low aerobic exercise capacity is a risk factor for diabetes and a strong predictor of mortality, yet some individuals are “exercise-resistant” and unable to improve exercise capacity through exercise training. To test the hypothesis that resistance to aerobic exercise training underlies metabolic disease risk, we used selective breeding for 15 generations to develop rat models of low and high aerobic response to training. Before exercise training, rats selected as low and high responders had similar exercise capacities. However, after 8 weeks of treadmill training, low responders failed to improve their exercise capacity, whereas high responders improved by 54%. Remarkably, low responders to aerobic training exhibited pronounced metabolic dysfunction characterized by insulin resistance and increased adiposity, demonstrating that the exercise-resistant phenotype segregates with disease risk. Low responders had impaired exercise-induced angiogenesis in muscle; however, mitochondrial capacity was intact and increased normally with exercise training, demonstrating that mitochondria are not limiting for aerobic adaptation or responsible for metabolic dysfunction in low responders. Low responders had increased stress/inflammatory signaling and altered transforming growth factor-β signaling, characterized by hyperphosphorylation of a novel exercise-regulated phosphorylation site on SMAD2. Using this powerful biological model system, we have discovered key pathways for low exercise training response that may represent novel targets for the treatment of metabolic disease. PMID:23610057

Preoperative proteinuria is associated with long-term progression to chronic dialysis and mortality after coronary artery bypass grafting surgery.

PubMed

Wu, Vin-Cent; Huang, Tao-Min; Wu, Pei-Chen; Wang, Wei-Jie; Chao, Chia-Ter; Yang, Shao-Yu; Shiao, Chih-Chung; Hu, Fu-Chang; Lai, Chun-Fu; Lin, Yu-Feng; Han, Yin-Yi; Chen, Yih-Sharng; Hsu, Ron-Bin; Young, Guang-Huar; Wang, Shoei-Shen; Tsai, Pi-Ru; Chen, Yung-Ming; Chao, Ting-Ting; Ko, Wen-Je; Wu, Kwan-Dun

2012-01-01

Preoperative proteinuria is associated with post-operative acute kidney injury (AKI), but whether it is also associated with increased long-term mortality and end-stage renal disease (ESRD) is unknown. We studied 925 consecutive patients undergoing CABG. Demographic and clinical data were collected prospectively, and patients were followed for a median of 4.71 years after surgery. Proteinuria, according to dipstick tests, was defined as mild (trace to 1+) or heavy (2+ to 4+) according to the results of the dipstick test. A total of 276 (29.8%) patients had mild proteinuria before surgery and 119 (12.9%) patients had heavy proteinuria. During the follow-up, the Cox proportional hazards model demonstrated that heavy proteinuria (hazard ratio [HR], 27.17) was an independent predictor of long-term ESRD. There was a progressive increased risk for mild proteinuria ([HR], 1.88) and heavy proteinuria ([HR], 2.28) to predict all-cause mortality compared to no proteinuria. Mild ([HR], 2.57) and heavy proteinuria ([HR], 2.70) exhibited a stepwise increased ratio compared to patients without proteinuria for long-term composite catastrophic outcomes (mortality and ESRD), which were independent of the baseline GFR and postoperative acute kidney injury (AKI). Our study demonstrated that proteinuria is a powerful independent risk factor of long-term all-cause mortality and ESRD after CABG in addition to preoperative GFR and postoperative AKI. Our study demonstrated that proteinuria should be integrated into clinical risk prediction models for long-term outcomes after CABG. These results provide a high priority for future renal protective strategies and methods for post-operative CABG patients.

Modeling individual movement decisions of brown hare (Lepus europaeus) as a key concept for realistic spatial behavior and exposure: A population model for landscape-level risk assessment.

PubMed

Kleinmann, Joachim U; Wang, Magnus

2017-09-01

Spatial behavior is of crucial importance for the risk assessment of pesticides and for the assessment of effects of agricultural practice or multiple stressors, because it determines field use, exposition, and recovery. Recently, population models have increasingly been used to understand the mechanisms driving risk and recovery or to conduct landscape-level risk assessments. To include spatial behavior appropriately in population models for use in risk assessments, a new method, "probabilistic walk," was developed, which simulates the detailed daily movement of individuals by taking into account food resources, vegetation cover, and the presence of conspecifics. At each movement step, animals decide where to move next based on probabilities being determined from this information. The model was parameterized to simulate populations of brown hares (Lepus europaeus). A detailed validation of the model demonstrated that it can realistically reproduce various natural patterns of brown hare ecology and behavior. Simulated proportions of time animals spent in fields (PT values) were also comparable to field observations. It is shown that these important parameters for the risk assessment may, however, vary in different landscapes. The results demonstrate the value of using population models to reduce uncertainties in risk assessment and to better understand which factors determine risk in a landscape context. Environ Toxicol Chem 2017;36:2299-2307. © 2017 SETAC. © 2017 SETAC.

Thyroid cancer following scalp irradiation. [X radiation

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

Modan, B.; Ron, E.; Werner, A.

1977-05-25

A sixfold increase in the risk of thyroid cancer was observed among 10,902 persons irradiated for scalp tinea in childhood as compared to two matched control groups. The dosimetry studies demonstrated that the original mean dose given to the thyroid was less than 9 rads, yielding a risk of 6.3/10/sup 6//year. This carcinogenic effect of low-level radiation must be considered in the planning of safety measures against potential public health hazards.

Proximity to Pollution Sources and Risk of Amphibian Limb Malformation

PubMed Central

Taylor, Brynn; Skelly, David; Demarchis, Livia K.; Slade, Martin D.; Galusha, Deron; Rabinowitz, Peter M.

2005-01-01

The cause of limb deformities in wild amphibian populations remains unclear, even though the apparent increase in prevalence of this condition may have implications for human health. Few studies have simultaneously assessed the effect of multiple exposures on the risk of limb deformities. In a cross-sectional survey of 5,264 hylid and ranid metamorphs in 42 Vermont wetlands, we assessed independent risk factors for nontraumatic limb malformation. The rate of nontraumatic limb malformation varied by location from 0 to 10.2%. Analysis of a subsample did not demonstrate any evidence of infection with the parasite Ribeiroia. We used geographic information system (GIS) land-use/land-cover data to validate field observations of land use in the proximity of study wetlands. In a multiple logistic regression model that included land use as well as developmental stage, genus, and water-quality measures, proximity to agricultural land use was associated with an increased risk of limb malformation (odds ratio = 2.26; 95% confidence interval, 1.42–3.58; p < 0.001). The overall discriminant power of the statistical model was high (C = 0.79). These findings from one of the largest systematic surveys to date provide support for the role of chemical toxicants in the development of amphibian limb malformation and demonstrate the value of an epidemiologic approach to this problem. PMID:16263502

Factors associated with falls in older patients with diffuse polyneuropathy.

PubMed

Richardson, James K

2002-11-01

To identify clinical factors associated with falls by older persons with polyneuropathy (PN). A cross-sectional study of 82 subjects aged 50 to 85 with clinical and electrodiagnostic evidence of PN. Electrodiagnostic and biomechanical research laboratories. Patients referred to the electrodiagnostic laboratory. History and physical examination, including semiquantitative methods of peripheral nerve function, and clinical balance testing. Falls were defined by retrospective self-report over a 2-year period. Forty (48.8%), 28 (34.1%), and 18 (22.0%) subjects reported a history of at least one fall, multiple falls, and injurious falls, respectively. Factors associated with single and multiple falls were similar, so only results for multiple and injurious falls are reported. Bivariate analysis showed that an increased body mass index (BMI) and more severe PN (as determined by the Michigan Diabetes Neuropathy Score) were associated with both fall categories. Men reporting falls also demonstrated a decreased unipedal stance time. Age, sex, nerve conduction study parameters, Romberg testing, medications, and comorbidities were not consistently associated with either fall category. Logistic regression demonstrated that multiple and injurious falls were associated with an increased BMI and more severe PN, controlling for age, sex, medications, and comorbidities (pseudo R2 = 0.458 and 0.484, respectively). Although previous work has demonstrated that all older persons with PN are at increased risk for falls, patients with increased BMI and more severe PN are at particularly high risk and should be targeted for intervention.

Increased mortality associated with extreme-heat exposure in King County, Washington, 1980-2010

NASA Astrophysics Data System (ADS)

Isaksen, Tania Busch; Fenske, Richard A.; Hom, Elizabeth K.; Ren, You; Lyons, Hilary; Yost, Michael G.

2016-01-01

Extreme heat has been associated with increased mortality, particularly in temperate climates. Few epidemiologic studies have considered the Pacific Northwest region in their analyses. This study quantified the historical (May to September, 1980-2010) heat-mortality relationship in the most populous Pacific Northwest County, King County, Washington. A relative risk (RR) analysis was used to explore the relationship between heat and all-cause mortality on 99th percentile heat days, while a time series analysis, using a piece-wise linear model fit, was used to estimate the effect of heat intensity on mortality, adjusted for temporal trends. For all ages, all causes, we found a 10 % (1.10 (95 % confidence interval (CI), 1.06, 1.14)) increase in the risk of death on a heat day versus non-heat day. When considering the intensity effect of heat on all-cause mortality, we found a 1.69 % (95 % CI, 0.69, 2.70) increase in the risk of death per unit of humidex above 36.0 °C. Mortality stratified by cause and age produced statistically significant results using both types of analyses for: all-cause, non-traumatic, circulatory, cardiovascular, cerebrovascular, and diabetes causes of death. All-cause mortality was statistically significantly modified by the type of synoptic weather type. These results demonstrate that heat, expressed as humidex, is associated with increased mortality on heat days, and that risk increases with heat's intensity. While age was the only individual-level characteristic found to modify mortality risks, statistically significant increases in diabetes-related mortality for the 45-64 age group suggests that underlying health status may contribute to these risks.

[Increased risk of type II diabetes mellitus and cardiovascular disease after gestational diabetes mellitus: a systematic review].

PubMed

Hopmans, Tara-Eileen J P; van Houten, Chantal B; Kasius, Annemieke; Kouznetsova, Ouliana I; Nguyen, Ly A; Rooijmans, Sanne V; Voormolen, Daphne N; van Vliet, Elvira O G; Franx, Arie; Koster, M P H Wendy

2015-01-01

To determine the long-term risk of developing type II diabetes (T2D) and cardiovascular disease (CVD) for women with a history of gestational diabetes mellitus. Systematic review and meta-analysis. Two search strategies were used in PubMed and Embase to determine the long-term risks of developing T2D and CVD after a pregnancy complicated by gestational diabetes mellitus. After critical appraisal of the papers found, 11 papers were included, involving a total of 328,423 patients. Absolute and relative risks (RRs) were calculated. Eight studies (n=276,829) reported on the long-term risk of T2D and 4 (n=141,048) on the long-term risk of CVD. Follow-up ranged from 3.5 to 11.5 years for T2D and from 1.2 to 74.0 years for CVD. Women with gestational diabetes had a risk of T2D varying between 9.5% and 37.0% and a risk of CVD of between 0.28% and 15.5%. Women with gestational diabetes were at increased risk of T2D (weighted RR: 13.2; 95% CI: 8.5-20.7) and CVD (weighted RR: 2.0; 95% CI: 1.1-3.7) compared to women without gestational diabetes. Women with prior gestational diabetes mellitus have a significantly increased risk of developing T2D and CVD. It is very important that gestational diabetes is recognised as a cardiovascular risk factor in daily practice. It would be desirable to screen this group of women for the presence of hyperglycaemia and other cardiovascular risk factors. Further research is required to be able to specify the long-term risk of T2D and CVD and to demonstrate whether such screening is cost-effective.

High weight gain during pregnancy increases the risk for emergency caesarean section - Population-based data from the Swedish Maternal Health Care Register 2011-2012.

PubMed

Nilses, Carin; Persson, Margareta; Lindkvist, Marie; Petersson, Kerstin; Mogren, Ingrid

2017-03-01

The aim was to investigate maternal background factors' significance in relation to risk of elective and emergency caesarean sections (CS) in Sweden. Population-based, retrospective, cross-sectional study. The Swedish Maternal Health Care Register (MHCR) is a national quality register that collects data on pregnancy, delivery and postpartum period. All women registered in MHCR 2011 to 2012 were included in the study sample (N = 178,716). The risk of elective and emergency caesarean section in relation to age, parity, education, country of origin, weight in early pregnancy and weight gain during pregnancy was calculated in logistic regression models. Multiparous women demonstrated a doubled risk of elective CS compared to primiparous women, but their risk for emergency CS was halved. Overweight and obesity at enrolment in antenatal care increased the risk for emergency CS, irrespective of parity. Weight gain above recommended international levels (Institute of Medicine, IOM) during pregnancy increased the risk for emergency CS for women with normal weight, overweight or obesity. There is a need of national guidelines on recommended weight gain during pregnancy in Sweden. We suggest that the usefulness of the IOM guidelines for weight gain during pregnancy should be evaluated in the Swedish context. Copyright © 2016 Elsevier B.V. All rights reserved.

Blood glucose concentration and risk of liver cancer: systematic review and meta-analysis of prospective studies.

PubMed

Han, Hedong; Zhang, Tianyi; Jin, Zhichao; Guo, Honglei; Wei, Xin; Liu, Yuzhou; Chen, Qi; He, Jia

2017-07-25

The question of whether elevated blood glucose is a risk factor for liver cancer has been intensively studied, yet with inconsistent results. To explore the relationship between blood glucose concentration and risk of liver cancer, we conduct a meta-analysis of prospective studies. Literature search was comprehensively performed using database of PubMed, EMBASE and the Cochrane Library through October 2016. Random-effect models were used to combine the effect estimations. Eight articles containing ten studies with a total of 1975 liver cancer cases were included. The pooled RRs demonstrated that elevated fasting blood glucose was associated with increased risk of liver cancer (combined RRs: 1.77; 95% CI: 1.46, 2.13) with mild heterogeneity (I2 = 30.40%, P = 0.17). In sensitivity analysis, the pooled result remained significant (combined RRs: 1.33; 95% CI: 1.12, 1.59; I2 = 33.90%, P = 0.16) when we restricted blood glucose categories in the range of nondiabetic subjects. We also detected a J-shaped non-linear dose-response relationship between blood glucose concentration and risk of liver cancer. There is evidence that elevated blood glucose increases risk of liver cancer across the range of prediabetes and diabetes. Considering the rapidly increasing prevalence of prediabetes and diabetes, controlling blood glucose may lower the risk of liver cancer.

Predictors of patterns of pain, fatigue and insomnia during the first year following a cancer diagnosis in the elderly

PubMed Central

Bandeen-Roche, Karen

2008-01-01

Pain, fatigue and insomnia (PFI) are among the most prevalent, distressing, and under managed symptoms experienced by cancer patients. Research has demonstrated that PFI co-occur; what remains unclear are the patterning and stability of PFI patterns, and the patient, disease and treatment characteristics that predict PFI patterns over time. This secondary analysis used a dataset comprised of 867 elders (46% female) who were newly diagnosed with breast, colorectal, lung or prostate cancer and followed at four points during the year following diagnosis. The university's IRB approved this study. Descriptive statistics and multi-state transition models using multinomial logistic regression were employed. The typical participant was 72.6 years, reported 7.9 symptoms and 2.7 comorbidities. Prior PFI pattern was consistently associated with significantly increased risks for subsequent PFI pattern. At observations 1-3, lung cancer, treatment, higher comorbidity with breast cancer, and late stage colorectal cancer were significantly associated with increased risks for PFI patterns. Advancing age was not significantly associated with increased risks for PFI patterns. PFI co-occurrence declined over time, but was associated with significantly increased risks for death or loss to follow-up and increased reports of other symptoms. PFI co-occurrence is associated with adverse outcomes and should be proactively targeted for intervention. PMID:18772657

Air pollution and health risks due to vehicle traffic.

PubMed

Zhang, Kai; Batterman, Stuart

2013-04-15

Traffic congestion increases vehicle emissions and degrades ambient air quality, and recent studies have shown excess morbidity and mortality for drivers, commuters and individuals living near major roadways. Presently, our understanding of the air pollution impacts from congestion on roads is very limited. This study demonstrates an approach to characterize risks of traffic for on- and near-road populations. Simulation modeling was used to estimate on- and near-road NO2 concentrations and health risks for freeway and arterial scenarios attributable to traffic for different traffic volumes during rush hour periods. The modeling used emission factors from two different models (Comprehensive Modal Emissions Model and Motor Vehicle Emissions Factor Model version 6.2), an empirical traffic speed-volume relationship, the California Line Source Dispersion Model, an empirical NO2-NOx relationship, estimated travel time changes during congestion, and concentration-response relationships from the literature, which give emergency doctor visits, hospital admissions and mortality attributed to NO2 exposure. An incremental analysis, which expresses the change in health risks for small increases in traffic volume, showed non-linear effects. For a freeway, "U" shaped trends of incremental risks were predicted for on-road populations, and incremental risks are flat at low traffic volumes for near-road populations. For an arterial road, incremental risks increased sharply for both on- and near-road populations as traffic increased. These patterns result from changes in emission factors, the NO2-NOx relationship, the travel delay for the on-road population, and the extended duration of rush hour for the near-road population. This study suggests that health risks from congestion are potentially significant, and that additional traffic can significantly increase risks, depending on the type of road and other factors. Further, evaluations of risk associated with congestion must consider travel time, the duration of rush-hour, congestion-specific emission estimates, and uncertainties. Copyright © 2013 Elsevier B.V. All rights reserved.

Air pollution and health risks due to vehicle traffic

PubMed Central

Zhang, Kai; Batterman, Stuart

2014-01-01

Traffic congestion increases vehicle emissions and degrades ambient air quality, and recent studies have shown excess morbidity and mortality for drivers, commuters and individuals living near major roadways. Presently, our understanding of the air pollution impacts from congestion on roads is very limited. This study demonstrates an approach to characterize risks of traffic for on- and near-road populations. Simulation modeling was used to estimate on- and near-road NO2 concentrations and health risks for freeway and arterial scenarios attributable to traffic for different traffic volumes during rush hour periods. The modeling used emission factors from two different models (Comprehensive Modal Emissions Model and Motor Vehicle Emissions Factor Model version 6.2), an empirical traffic speed–volume relationship, the California Line Source Dispersion Model, an empirical NO2–NOx relationship, estimated travel time changes during congestion, and concentration–response relationships from the literature, which give emergency doctor visits, hospital admissions and mortality attributed to NO2 exposure. An incremental analysis, which expresses the change in health risks for small increases in traffic volume, showed non-linear effects. For a freeway, “U” shaped trends of incremental risks were predicted for on-road populations, and incremental risks are flat at low traffic volumes for near-road populations. For an arterial road, incremental risks increased sharply for both on- and near-road populations as traffic increased. These patterns result from changes in emission factors, the NO2–NOx relationship, the travel delay for the on-road population, and the extended duration of rush hour for the near-road population. This study suggests that health risks from congestion are potentially significant, and that additional traffic can significantly increase risks, depending on the type of road and other factors. Further, evaluations of risk associated with congestion must consider travel time, the duration of rush-hour, congestion-specific emission estimates, and uncertainties. PMID:23500830

Risk factors for severe hemorrhagic transformation in ischemic stroke patients treated with recombinant tissue plasminogen activator: a secondary analysis of the European-Australasian Acute Stroke Study (ECASS II).

PubMed

Larrue, V; von Kummer R, R; Müller, A; Bluhmki, E

2001-02-01

Intravenous thrombolysis with recombinant tissue plasminogen activator (rtPA) improves the outcome for ischemic stroke patients who can be treated within 3 hours of symptom onset. The efficacy of thrombolysis has been demonstrated despite an increased risk of severe hemorrhagic transformation (HT) in patients treated with rtPA. We performed an analysis of risk factors for severe HT in the second European-Australasian Acute Stroke Study (ECASS II). HTs were classified by using clinical and radiological criteria as follows: hemorrhagic infarction (HI), parenchymal hemorrhage (PH), and symptomatic intracranial hemorrhage (SICH). Potential risk factors for HT were tested by stepwise logistic regression analysis, including rtPA-by-variable interactions. In addition, the distribution of bad outcome (modified Rankin score 5 to 6) at day 90 was stratified according to each category of HT. PH and SICH but not HI were associated with rtPA. Also, PH and SICH but not HI were more severe in rtPA-treated patients than in those receiving placebo. Risk factors for PH were rtPA, extent of parenchymal hypoattenuation on baseline CT, congestive heart failure, increasing age, and baseline systolic blood pressure. The risk of PH on rtPA was increased in older patients and in those who were treated with aspirin before thrombolysis. Risk factors for SICH were rtPA, congestive heart failure, extent of parenchymal hypoattenuation, and increasing age. The risk of SICH on rtPA was increased in patients who were treated with aspirin before thrombolysis. This secondary analysis of ECASS II has confirmed the importance of the extent of hypoattenuation as a risk factor for severe HT. The findings also suggest that older patients and those who have used aspirin before stroke are at higher risk of a severe HT on rtPA.

Flood Risk and Global Change: Future Prospects

NASA Astrophysics Data System (ADS)

Serra-Llobet, A.

2014-12-01

Global flood risk is increasing in response to population growth in flood-prone areas, human encroachment into natural flood paths (exacerbating flooding in areas formerly out of harm's way), and climate change (which alters variables driving floods). How will societies respond to and manage flood risk in coming decades? Analysis of flood policy evolution in the EU and US demonstrates that changes occurred in steps, in direct response to disasters. After the flood produced by the collapse of Tous Dam in 1982, Spain initiated a systematic assessment of areas of greatest flood risk and civil protection response. The devastating floods on the Elbe and elsewhere in central Europe in 2002 motivated adoption of the EU Floods Directive (2007), which requires member states to develop systematic flood risk maps (now due) and flood risk management plans (due in 2015). The flooding of New Orleans by Hurricane Katrina in 2005 resulted in a nationwide levee-safety assessment and improvements in communicating risk, but overall less fundamental change in US flood management than manifest in the EU since 2007. In the developing world, large (and increasing) concentrations of populations in low-lying floodplains, deltas, and coasts are increasingly vulnerable, and governments mostly ill-equipped to implement fundamental changes in land use to prevent future increases in exposure, nor to develop responses to the current threats. Even in the developed world, there is surprisingly little research on how well residents of flood-prone lands understand their true risk, especially when they are 'protected' by '100-year' levees. Looking ahead, researchers and decision makers should prioritize improvements in flood risk perception, river-basin-scale assessment of flood runoff processes (under current and future climate and land-use conditions) and flood management alternatives, and bridging the disconnect between national and international floodplain management policies and local land-use decisions.

Failure to Redose Antibiotic Prophylaxis in Long Surgery Increases Risk of Surgical Site Infection.

PubMed

Kasatpibal, Nongyao; Whitney, Joanne D; Dellinger, E Patchen; Nair, Bala G; Pike, Kenneth C

Antibiotic prophylaxis is a key component of the prevention of surgical site infection (SSI). Failure to manage antibiotic prophylaxis effectively may increase the risk of SSI. This study aimed to examine the effects of antibiotic prophylaxis on SSI risk. A retrospective cohort study was conducted among patients having general surgery between May 2012 and June 2015 at the University of Washington Medical Center. Peri-operative data extracted from hospital databases included patient and operation characteristics, intra-operative medication and fluid administration, and survival outcome. The effects of antibiotic prophylaxis and potential factors on SSI risk were estimated using multiple logistic regression and were expressed as risk ratios (RRs). A total of 4,078 patients were eligible for analysis. Of these, 180 had an SSI. Mortality rates within and after 30 days were 0.8% and 0.3%, respectively. Improper antibiotic redosing increased the risk of SSI (RR 4.61; 95% confidence interval [CI] 1.33-15.91). Other risk factors were in-patient status (RR 4.05; 95% CI 1.69-9.66), smoking (RR 1.63; 95% CI 1.03-2.55), emergency surgery (RR 1.97; 95% CI 1.26-3.08), colectomy (RR 3.31; 95% CI 1.19-9.23), pancreatectomy (RR 4.52; 95% CI 1.53-13.39), proctectomy (RR 5.02; 95% CI 1.72-14.67), small bowel surgery (RR 6.16; 95% CI 2.13-17.79), intra-operative blood transfusion >500 mL (RR 2.76; 95% CI 1.45-5.26), and multiple procedures (RR 1.40; 95% CI 1.01-1.95). These data demonstrate that failure to redose prophylactic antibiotic during long operations increases the risk of SSI. Strengthening a collaborative surgical quality improvement program may help to eradicate this risk.

Relation between risk of falling and postural sway complexity in diabetes.

PubMed

Morrison, S; Colberg, S R; Parson, H K; Vinik, A I

2012-04-01

For older individuals with diabetes, any decline in balance control can be especially problematic since it is often a precursor to an increased risk of falling. This study was designed to evaluate differences in postural motion dynamics and falls risk for older individuals with type 2 diabetes (T2DM) classified as fallers/non-fallers and, to assess what impact exercise has on balance and falls risk. The results demonstrated that the risk of falling is greater for those older individuals with multiple risk factors including diabetes and a previous falls history. The postural motion features of the high-risk individuals (T2DM-fallers) were also different, being characterized by increased variability and complexity, increased AP-ML coupling, less overall COP motion and increased velocity. One suggestion is that these individuals evoked a stiffening strategy during the more challenging postural tasks. Following training, a decline in falls risk was observed for all groups, with this effect being most pronounced for the T2DM-fallers. Interestingly, the COP motion of this group became more similar to controls, exhibiting decreased complexity and variability, and decreased velocity. The reciprocal changes in COP complexity support the broader view that age/disease-related changes in physiological complexity are bi-directional. Overall, these results show that, even for older T2DM individuals at greater risk of falling, targeted interventions can positively enhance their postural dynamics. Further, the finding that the pattern of postural motion variability and complexity was altered highlights that a decline in physiological complexity may not always be negatively associated with aging and/or disease. Copyright © 2011 Elsevier B.V. All rights reserved.

Characterizing the Intersection of Co-Occurring Risk Factors for Illicit Drug Abuse and Dependence in a U.S. Nationally Representative Sample

PubMed Central

Kurti, Allison N.; Keith, Diana R.; Noble, Alyssa; Priest, Jeff S.; Sprague, Brian; Higgins, Stephen T.

2016-01-01

Few studies have attempted to characterize how co-occurring risk factors for substance use disorders intersect. A recent study examined this question regarding cigarette smoking and demonstrated that co-occurring risk factors generally act independently. The present study examines whether that same pattern of independent intersection of risk factors extends to illicit drug abuse/dependence using a U.S. nationally representative sample (National Survey on Drug Use and Health, 2011–2013). Logistic regression and classification and regression tree (CART) modeling were used to examine risk of past-year drug abuse/dependence associated with a well-established set of risk factors for substance use (age, gender, race/ethnicity, education, poverty, smoking status, alcohol abuse/dependence, mental illness). Each of these risk factors was associated with significant increases in the odds of drug abuse/dependence in univariate logistic regressions. Each remained significant in a multivariate model examining all eight risk factors simultaneously. CART modeling of these 8 risk factors identified subpopulation risk profiles wherein drug abuse/dependence prevalence varied from < 1% to > 80% corresponding to differing combinations of risk factors present. Alcohol abuse/dependence and cigarette smoking had the strongest associations with drug abuse/dependence risk. These results demonstrate that co-occurring risk factors for illicit drug/abuse dependence generally intersect in the same independent manner as risk factors for cigarette smoking, underscoring further fundamental commonalities across these different types of substance use disorders. These results also underscore the fundamental importance of differences in the presence of co-occurring risk factors when considering the often strikingly different prevalence rates of illicit drug abuse/dependence in U.S. population subgroups. PMID:27687534

RISK ASSESSMENT FOR THE EFFECTS OF SOLAR RADIATION ON AMPHIBIANS

EPA Science Inventory

Recent studies have demonstrated that exposure to solar ultraviolet radiation (UVR) can cause mortality and increase the occurrence of eye and limb malformation in some species of amphibians. Based on these reports and various field observations, it has been hypothesized that UV...

Cultural protective factors for community risks and substance use among rural African American adolescents.

PubMed

Nasim, Aashir; Fernander, Anita; Townsend, Tiffany G; Corona, Rosalie; Belgrave, Faye Z

2011-01-01

Relatively little attention has been afforded to protective factors for community-level risks among non-urban populations. This study examined the extent to which traditional cultural attitudes and behaviors of 137 African American adolescents (ages 12-17) from a rural community moderated the relationship between perceived community disorganization and substance use behaviors. Results from hierarchical linear regression revealed that traditional cultural attitudes and behaviors were differentially related to community disorganization and adolescent substance use. In terms of protective influences, religious beliefs and practices and traditional family practices moderated the effect of community disorganization on substance use. Specifically, religious beliefs and practices demonstrated a protective-stabilizing effect as community disorganization increased; traditional family practices demonstrated a protective but reactive effect. Attitudes of cultural mistrust increased youth's susceptibility to substance use as community disorganization worsened--vulnerable and reactive. The findings underscore the importance of examining the link between cultural and contextual factors in an attempt to understand the etiology of substance use among rural African American adolescents.

4G/5G polymorphism modulates PAI-1 circulating levels in obese women.

PubMed

Fernandes, Karla S; Sandrim, Valéria C

2012-05-01

The increase in plasminogen activator inhibitor type 1 (PAI-1) has been described as a risk factor to thrombosis-related diseases. In addition, it has been demonstrated that the variant 4G of polymorphism 4G/5G located in promoter region of PAI-1 gene is associated with higher PAI-1 levels. We investigate the role of this polymorphism on circulating PAI-1 concentration in a population of 57 obese women (23%, 4G/4G; 49%, 4G/5G and 28%, 5G/5G genotypes). Our results demonstrate a genotype-specific modulation on PAI-1 levels in obese women, thus 5G/5G genotype presented significantly lower levels of plasma PAI-1 when compared to 4G/4G group (46 ± 19 ng/mL vs. 63 ± 13 ng/mL, respectively). Our findings indicate that obese carriers of 4G/4G genotype may have increased risk to develop thrombotic diseases.

An Analysis of the Effects of Smartphone Push Notifications on Task Performance with regard to Smartphone Overuse Using ERP

PubMed Central

Kim, Seul-Kee; Kim, So-Yeong; Kang, Hang-Bong

2016-01-01

Smartphones are used ubiquitously worldwide and are essential tools in modern society. However, smartphone overuse is an emerging social issue, and limited studies have objectively assessed this matter. The majority of previous studies have included surveys or behavioral observation studies. Since a previous study demonstrated an association between increased push notifications and smartphone overuse, we investigated the effects of push notifications on task performance. We detected changes in brainwaves generated by smartphone push notifications using the N200 and P300 components of event-related potential (ERP) to investigate both concentration and cognitive ability. ERP assessment indicated that, in both risk and nonrisk groups, the lowest N200 amplitude and the longest latency during task performance were found when push notifications were delivered. Compared to the nonrisk group, the risk group demonstrated lower P300 amplitudes and longer latencies. In addition, the risk group featured a higher rate of error in the Go-Nogo task, due to the negative influence of smartphone push notifications on performance in both risk and nonrisk groups. Furthermore, push notifications affected subsequent performance in the risk group. PMID:27366147

An Analysis of the Effects of Smartphone Push Notifications on Task Performance with regard to Smartphone Overuse Using ERP.

PubMed

Kim, Seul-Kee; Kim, So-Yeong; Kang, Hang-Bong

2016-01-01

Smartphones are used ubiquitously worldwide and are essential tools in modern society. However, smartphone overuse is an emerging social issue, and limited studies have objectively assessed this matter. The majority of previous studies have included surveys or behavioral observation studies. Since a previous study demonstrated an association between increased push notifications and smartphone overuse, we investigated the effects of push notifications on task performance. We detected changes in brainwaves generated by smartphone push notifications using the N200 and P300 components of event-related potential (ERP) to investigate both concentration and cognitive ability. ERP assessment indicated that, in both risk and nonrisk groups, the lowest N200 amplitude and the longest latency during task performance were found when push notifications were delivered. Compared to the nonrisk group, the risk group demonstrated lower P300 amplitudes and longer latencies. In addition, the risk group featured a higher rate of error in the Go-Nogo task, due to the negative influence of smartphone push notifications on performance in both risk and nonrisk groups. Furthermore, push notifications affected subsequent performance in the risk group.

Common polymorphisms of calpain-10 and the risk of Type 2 Diabetes in a Tunisian Arab population: a case-control study

PubMed Central

2010-01-01

Background Genetic variations in the calpain-10 gene (CAPN10), in particular the at-risk diplotype (112/121), were previously implicated with increased risk of type 2 diabetes (T2D). Methods We examined the association of CAPN10 UCSNP-43 (rs3792267), UCSNP-19 (rs3842570), and UCSNP-63 (rs5030952) SNPs with T2D in 917 Tunisian T2D patients and 748 non-diabetic controls. CAPN10 genotyping was done by PCR-RFLP. Results Enrichment of UCSNP-19 2R (minor) allele and 2R/2R genotype was found in T2D patients; the allele and genotype distribution of UCSNP-43 and UCSNP-63 alleles and genotypes were not significantly different between patient groups and non-diabetic control subjects. Regression analysis demonstrated progressive increases in T2D risk in 3R/2R [OR (95% CI) = 1.35 (1.08 - 1.68)] and 2R/2R [OR (95% CI) = 1.61 (1.20 - 2.18)] genotypes. Of the six haplotypes detected, enrichment of haplotype 111 (UCSNP-43/UCSNP-19/UCSNP-63) was seen in patients (Pc = 0.034); the distribution of the other haplotypes was comparable between patients and control subjects; neither haplotype 211 nor haplotype 212 was observed. Furthermore, the frequency of all CAPN10 diplotypes identified, including the "high-risk diplotype (112/121) reported for Mexican-Americans and Northern Europeans, were comparable between patients and controls. Conclusions CAPN10 UCSNP-19 variant, and the 111 haplotype contribute to the risk of T2D in Tunisian subjects; no significant associations between CAPN10 diplotypes and T2D were demonstrated for Tunisians. PMID:20470430

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.

A climate-based prediction model in the high-risk clusters of the Mekong Delta region, Vietnam: towards improving dengue prevention and control.

PubMed

Phung, Dung; Talukder, Mohammad Radwanur Rahman; Rutherford, Shannon; Chu, Cordia

2016-10-01

To develop a prediction score scheme useful for prevention practitioners and authorities to implement dengue preparedness and controls in the Mekong Delta region (MDR). We applied a spatial scan statistic to identify high-risk dengue clusters in the MDR and used generalised linear-distributed lag models to examine climate-dengue associations using dengue case records and meteorological data from 2003 to 2013. The significant predictors were collapsed into categorical scales, and the β-coefficients of predictors were converted to prediction scores. The score scheme was validated for predicting dengue outbreaks using ROC analysis. The north-eastern MDR was identified as the high-risk cluster. A 1 °C increase in temperature at lag 1-4 and 5-8 weeks increased the dengue risk 11% (95% CI, 9-13) and 7% (95% CI, 6-8), respectively. A 1% rise in humidity increased dengue risk 0.9% (95% CI, 0.2-1.4) at lag 1-4 and 0.8% (95% CI, 0.2-1.4) at lag 5-8 weeks. Similarly, a 1-mm increase in rainfall increased dengue risk 0.1% (95% CI, 0.05-0.16) at lag 1-4 and 0.11% (95% CI, 0.07-0.16) at lag 5-8 weeks. The predicted scores performed with high accuracy in diagnosing the dengue outbreaks (96.3%). This study demonstrates the potential usefulness of a dengue prediction score scheme derived from complex statistical models for high-risk dengue clusters. We recommend a further study to examine the possibility of incorporating such a score scheme into the dengue early warning system in similar climate settings. © 2016 John Wiley & Sons Ltd.

Screening for breast cancer in a high-risk series

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

Woodard, E.D.; Hempelmann, L.H.; Janus, J.

1982-01-01

A unique cohort of women at increased risk of breast cancer because of prior X-ray treatment of acute mastitis and their selected high-risk siblings were offered periodic breast cancer screening including physical examination of the breasts, mammography, and thermography. Twelve breast cancers were detected when fewer than four would have been expected based on age-specific breast cancer detection rates from the National Cancer institute/American Cancer Society Breast Cancer Demonstration Detection Projects. Mammograpy was positive in all cases but physical examination was positive in only three cases. Thermography was an unreliable indicator of disease. Given the concern over radiation-induced risk, usemore » of low-dose technique and of criteria for participation that select women at high risk of breast cancer will maximize the benefit/risk ratio for mammography screening.« less

Screening for breast cancer in a high-risk series

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

Woodard, E.D.; Hempelmann, L.H.; Janus, J.

1982-01-01

A unique cohort of women at increased risk of breast cancer because of prior X-ray treatment of acute mastitis and their selected high-risk siblings were offered periodic breast cancer screening including physical examination of the breasts, mammography, and thermography. Twelve breast cancers were detected when fewer than four would have been expected based on age-specific breast cancer detection rates from the National Cancer Institute/American Cancer Society Breast Cancer Demonstration Detection Projects. Mammography was positive in all cases but physical examination was positive in only three cases. Thermography was an unreliable indicator of disease. Given the concern over radiation-induced risk, usemore » of low-dose technique and of criteria for participation that select women at high risk of breast cancer will maximize the benefit/risk ratio for mammography screening.« less

Parenthood and Worrying About Climate Change: The Limitations of Previous Approaches.

PubMed

Ekholm, Sara; Olofsson, Anna

2017-02-01

The present study considers the correlation between parenthood and worry about the consequences of climate change. Two approaches to gauging people's perceptions of the risks of climate change are compared: the classic approach, which measures risk perception, and the emotion-based approach, which measures feelings toward a risk object. The empirical material is based on a questionnaire-based survey of 3,529 people in Sweden, of whom 1,376 answered, giving a response rate of 39%. The results show that the correlation of parenthood and climate risk is significant when the emotional aspect is raised, but not when respondents were asked to do cognitive estimates of risk. Parenthood proves significant in all three questions that measure feelings, demonstrating that it is a determinant that serves to increase worry about climate change. © 2016 Society for Risk Analysis.

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

PubMed

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

2016-08-01

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

Changes in Association between Previous Therapeutic Abortion and Preterm Birth in Scotland, 1980 to 2008: A Historical Cohort Study

PubMed Central

Oliver-Williams, Clare; Fleming, Michael; Monteath, Kirsten; Wood, Angela M.; Smith, Gordon C. S.

2013-01-01

Background Numerous studies have demonstrated that therapeutic termination of pregnancy (abortion) is associated with an increased risk of subsequent preterm birth. However, the literature is inconsistent, and methods of abortion have changed dramatically over the last 30 years. We hypothesized that the association between previous abortion and the risk of preterm first birth changed in Scotland between 1 January 1980 and 31 December 2008. Methods and Findings We studied linked Scottish national databases of births and perinatal deaths. We analysed the risk of preterm birth in relation to the number of previous abortions in 732,719 first births (≥24 wk), adjusting for maternal characteristics. The risk (adjusted odds ratio [95% CI]) of preterm birth was modelled using logistic regression, and associations were expressed for a one-unit increase in the number of previous abortions. Previous abortion was associated with an increased risk of preterm birth (1.12 [1.09–1.16]). When analysed by year of delivery, the association was strongest in 1980–1983 (1.32 [1.21–1.43]), progressively declined between 1984 and 1999, and was no longer apparent in 2000–2003 (0.98 [0.91–1.05]) or 2004–2008 (1.02 [0.95–1.09]). A statistical test for interaction between previous abortion and year was highly statistically significant (p<0.001). Analysis of data for abortions among nulliparous women in Scotland 1992–2008 demonstrated that the proportion that were surgical without use of cervical pre-treatment decreased from 31% to 0.4%, and that the proportion of medical abortions increased from 18% to 68%. Conclusions Previous abortion was a risk factor for spontaneous preterm birth in Scotland in the 1980s and 1990s, but the association progressively weakened and disappeared altogether by 2000. These changes were paralleled by increasing use of medical abortion and cervical pre-treatment prior to surgical abortion. Although it is plausible that the two trends were related, we could not test this directly as the data on the method of prior abortions were not linked to individuals in the cohort. However, we speculate that modernising abortion methods may be an effective long-term strategy to reduce global rates of preterm birth. Please see later in the article for the Editors' Summary PMID:23874161

Changes in association between previous therapeutic abortion and preterm birth in Scotland, 1980 to 2008: a historical cohort study.

PubMed

Oliver-Williams, Clare; Fleming, Michael; Monteath, Kirsten; Wood, Angela M; Smith, Gordon C S

2013-01-01

Numerous studies have demonstrated that therapeutic termination of pregnancy (abortion) is associated with an increased risk of subsequent preterm birth. However, the literature is inconsistent, and methods of abortion have changed dramatically over the last 30 years. We hypothesized that the association between previous abortion and the risk of preterm first birth changed in Scotland between 1 January 1980 and 31 December 2008. We studied linked Scottish national databases of births and perinatal deaths. We analysed the risk of preterm birth in relation to the number of previous abortions in 732,719 first births (≥24 wk), adjusting for maternal characteristics. The risk (adjusted odds ratio [95% CI]) of preterm birth was modelled using logistic regression, and associations were expressed for a one-unit increase in the number of previous abortions. Previous abortion was associated with an increased risk of preterm birth (1.12 [1.09-1.16]). When analysed by year of delivery, the association was strongest in 1980-1983 (1.32 [1.21-1.43]), progressively declined between 1984 and 1999, and was no longer apparent in 2000-2003 (0.98 [0.91-1.05]) or 2004-2008 (1.02 [0.95-1.09]). A statistical test for interaction between previous abortion and year was highly statistically significant (p<0.001). Analysis of data for abortions among nulliparous women in Scotland 1992-2008 demonstrated that the proportion that were surgical without use of cervical pre-treatment decreased from 31% to 0.4%, and that the proportion of medical abortions increased from 18% to 68%. Previous abortion was a risk factor for spontaneous preterm birth in Scotland in the 1980s and 1990s, but the association progressively weakened and disappeared altogether by 2000. These changes were paralleled by increasing use of medical abortion and cervical pre-treatment prior to surgical abortion. Although it is plausible that the two trends were related, we could not test this directly as the data on the method of prior abortions were not linked to individuals in the cohort. However, we speculate that modernising abortion methods may be an effective long-term strategy to reduce global rates of preterm birth.

Space Launch System NASA Research Announcement Advanced Booster Engineering Demonstration and/or Risk Reduction

NASA Technical Reports Server (NTRS)

Crumbly, Christopher M.; Craig, Kellie D.

2011-01-01

The intent of the Advanced Booster Engineering Demonstration and/or Risk Reduction (ABEDRR) effort is to: (1) Reduce risks leading to an affordable Advanced Booster that meets the evolved capabilities of SLS (2) Enable competition by mitigating targeted Advanced Booster risks to enhance SLS affordability. Key Concepts (1) Offerors must propose an Advanced Booster concept that meets SLS Program requirements (2) Engineering Demonstration and/or Risk Reduction must relate to the Offeror s Advanced Booster concept (3) NASA Research Announcement (NRA) will not be prescriptive in defining Engineering Demonstration and/or Risk Reduction

Online Gambling Advertising Regulations in Spain. A Study on the Protection of Minors.

PubMed

Buil, Pilar; Solé Moratilla, Maria José; García Ruiz, Pablo

2015-09-15

This article examines the online gambling advertising regulations in Spain currently in effect to assess the actual protection of underage youth. In recent years, online gambling among youth has increased. Through advertising, online gambling companies incite and encourage an involvement that can be harmful for vulnerable audiences. Some studies have demonstrated that advertising influences youths' assessment of gambling by increasing its appeal. We demonstrate that the shortcomings of the legal framework in force results in effective vulnerability of minors. We claim that society should seek to implement a regulatory framework to protect children from the risk of developing an addiction.

Consumption of beer and colorectal cancer incidence: a meta-analysis of observational studies.

PubMed

Zhang, Cheng; Zhong, Min

2015-04-01

Several meta-analyses and reports from the World Cancer Research Fund supported a risk association between alcohol consumption and colorectal cancer (CRC). However, the association for beer consumption, the common type of alcoholic beverage, remains unclear. We identified studies by a literature search of PUBMED and EMBASE through 30 June 2014. Summary relative risks (SRRs) with their 95% CIs were calculated with a fixed or random effects model. Twelve case-control and nine cohort studies were included. Compared with non-alcohol drinkers or non-beer drinkers, any beer drinkers were associated with an increased risk of CRC (SRR = 1.20, 95% CI, 1.06-1.37; p(heterogeneity) <0.001, I(2) = 73.3%), which was stronger in the rectum than in the colon. The categorical meta-analysis indicated that heavy (≥ 2 drinks/day) beer drinking was related to increased risk of CRC (SRR = 1.37, 95% CI 1.26-1.49), while light or moderate beer drinking was not. The dose-response analysis demonstrated that an increase of one drink per day in beer consumption was related to an increased risk of CRC (SRR = 1.13, 95% CI, 1.06-1.21). There was evidence of a potential nonlinear association between beer intake and CRC incidence (p = 0.002 for nonlinearity). The results from this meta-analysis suggest that heavy (≥ 2 drinks/day) beer drinking may be associated with increased CRC risk. More researches with improved control of confounding and actual measurement of beer consumption are needed to confirm these findings.

Divergence and Convergence of Risky Decision Making Across Prospective Gains and Losses: Preferences and Strategies

PubMed Central

Kurnianingsih, Yoanna A.; Mullette-Gillman, O'Dhaniel A.

2015-01-01

People choose differently when facing potential gains than when facing potential losses. Clear gross differences in decision making between gains and losses have been empirically demonstrated in numerous studies (e.g., framing effect, risk preference, loss aversion). However, theories maintain that there are strong underlying connections (e.g., reflection effect). We investigated the relationship between gains and losses decision making, examining risk preferences, and choice strategies (the reliance on option information) using a monetary gamble task with interleaved trials. For risk preferences, participants were on average risk averse in the gains domain and risk neutral/seeking in the losses domain. We specifically tested for a theoretically hypothesized correlation between individual risk preferences across the gains and losses domains (the reflection effect), but found no significant relationship in the predicted direction. Interestingly, despite the lack of reflected risk preferences, cross-domain risk preferences were still informative of individual choice behavior. For choice strategies, in both domains participants relied more heavily on the maximizing strategy than the satisficing strategy, with increased reliance on the maximizing strategy in the losses domain. Additionally, while there is no mathematical reliance between the risk preference and strategy metrics, within both domains there were significant relationships between risk preferences and strategies—the more participants relied upon the maximizing strategy the more risk neutral they were (equating value and utility maximization). These results demonstrate the complexity of gains and losses decision making, indicating the apparent contradiction that their underlying cognitive/neural processes are both dissociable and overlapping. PMID:26733779

Divergence and Convergence of Risky Decision Making Across Prospective Gains and Losses: Preferences and Strategies.

PubMed

Kurnianingsih, Yoanna A; Mullette-Gillman, O'Dhaniel A

2015-01-01

People choose differently when facing potential gains than when facing potential losses. Clear gross differences in decision making between gains and losses have been empirically demonstrated in numerous studies (e.g., framing effect, risk preference, loss aversion). However, theories maintain that there are strong underlying connections (e.g., reflection effect). We investigated the relationship between gains and losses decision making, examining risk preferences, and choice strategies (the reliance on option information) using a monetary gamble task with interleaved trials. For risk preferences, participants were on average risk averse in the gains domain and risk neutral/seeking in the losses domain. We specifically tested for a theoretically hypothesized correlation between individual risk preferences across the gains and losses domains (the reflection effect), but found no significant relationship in the predicted direction. Interestingly, despite the lack of reflected risk preferences, cross-domain risk preferences were still informative of individual choice behavior. For choice strategies, in both domains participants relied more heavily on the maximizing strategy than the satisficing strategy, with increased reliance on the maximizing strategy in the losses domain. Additionally, while there is no mathematical reliance between the risk preference and strategy metrics, within both domains there were significant relationships between risk preferences and strategies-the more participants relied upon the maximizing strategy the more risk neutral they were (equating value and utility maximization). These results demonstrate the complexity of gains and losses decision making, indicating the apparent contradiction that their underlying cognitive/neural processes are both dissociable and overlapping.

Relationship of phosphodiesterase 4D (PDE4D) gene polymorphisms with risk of ischemic stroke: a hospital based case-control study.

PubMed

Kumar, Amit; Misra, Shubham; Kumar, Pradeep; Sagar, Ram; Gulati, Arti; Prasad, Kameshwar

2017-08-01

Stroke remains a leading cause of death and disability worldwide. Ischemic stroke (IS) accounts for around 80-85% of total stroke and is a complex polygenic multi-factorial disorder which is affected by a complex combination of vascular, environmental, and genetic factors. The study was conducted with an aim to examine the relationship of single nucleotide polymorphisms (SNPs) of PDE4D (T83C, C87T, and C45T) gene with increasing risk of IS in patients in North Indian population. In this hospital-based case-control study, 250 IS subjects and 250 age-and sex-matched control subjects were enrolled from the Neurosciences Centre, A.I.I.M.S., New Delhi, India. Deoxyribonucleic acids (DNAs) were extracted using the conventional Phenol-Chloroform isolation method. Different genotypes were determined by Polymerase chain reaction- Restriction fragment length polymorphism method. Odds ratio (OR) and 95% Confidence Interval (CI) of relationship of polymorphisms with risk of IS were calculated by conditional multivariable regression analysis. High blood pressure, low socioeconomic status, dyslipidemia, diabetes, and family history of stroke were observed to be statistically significant risk factors for IS. Multivariable adjusted analysis demonstrated a statistically significant relationship between SNP 83 of PDE4D gene polymorphism and increasing odds of IS under the dominant model of inheritance (OR, 1.59; 95% CI, 1.02 to 2.50; p value = 0.04) after adjustment of potential confounding variables. Stratified analysis on the basis of TOAST classification demonstrated a statistically significant association for increasing 2.73 times odds for developing large vessel disease stroke as compared to controls (OR, 2.73; 95% CI, 1.16 to 0.02; p value = 0.02). We did not find any significant association of SNPs (C87T and C45T) of the PDE4D gene with the risk of IS. SNP 83 of PDE4D gene may increase the risk for developing IS whereas SNP 87 and SNP45 of PDE4D may not be associated with the risk of IS in the North Indian population. Prospective cohort studies are required to corroborate these findings.

The Space Shuttle in perspective

NASA Technical Reports Server (NTRS)

Hosenball, S. N.

1981-01-01

Commercial aspects of the Space Shuttle are examined, with attention given to charges to users, schedule of launches and reimbursement, kinds of payload and their selection, NASA authority, space allocation, and risk, liability, and insurance. It is concluded that insurance to reduce the risk, incentives that NASA is willing to make available to U.S. industry, and the demonstrated willingness of industry and the financial community to invest their funds in space ventures indicate that the new Shuttle capabilities will exponentially increase commercial activities in space during the 1980s.

The Value of Continued Followup in a Preventive Medicine Program

NASA Technical Reports Server (NTRS)

Villafana, C.; Mockbee, J.

1970-01-01

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

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.

National Quality Improvement Center on Early Childhood

ERIC Educational Resources Information Center

Browne, Charlyn Harper

2014-01-01

The national Quality Improvement Center on early Childhood (QIC-eC) funded four research and demonstration projects that tested child maltreatment prevention approaches. The projects were guided by several key perspectives: the importance of increasing protective factors in addition to decreasing risk factors in child maltreatment prevention…

Networks Analysis of a Regional Ecosystem of Afterschool Programs

ERIC Educational Resources Information Center

Russell, Martha G.; Smith, Marc A.

2011-01-01

Case studies have documented the impact of family-school-community collaboration in afterschool programs on increasing awareness about the problems of at-risk youth, initiating dialogue among leaders and community representatives, developing rich school-based information systems, and demonstrating how to build strong relationships between public…

A Novel Hypoxia Challenge Test Demonstrates Cardiovascular and Pulmonary Susceptibility to Acrolein Gas in Hypertensive Rats.

EPA Science Inventory

High levels of air pollution increase the risk of cardiovascular morbidity and mortality, especially in susceptible populations including those with hypertension. Stress tests are useful for manifesting latent effects of exposure, particularly at low concentrations, often when no...

Predator odor exposure increases food-carrying behavior in rats.

PubMed

Wernecke, Kerstin E A; Brüggemann, Judith; Fendt, Markus

2016-02-01

To cover their energy demands, prey animals are forced to search for food. However, during foraging they also expose themselves to the risk of becoming the prey of predators. Consequently, in order to increase their fitness foraging animals have to trade-off efficiency of foraging against the avoidance of predation risk. For example, the decision on whether a found food piece should be eaten at the food source or whether it should be carried to a protective site such as the nest (food-carrying behavior), is strongly dependent on different incentive factors (e.g., hunger level, food size, distance to the nest). It has been shown that food-carrying behavior increases the more risky the foraging situation becomes. Since predator odors are clearly fear-inducing in rats, we ask here whether the detection of predator odors in close proximity to the food source modulates food-carrying behavior. In the present study, the food-carrying behavior of rats for six different food pellet sizes was measured in a "low risk" and a "high risk" testing condition by presenting water or a fox urine sample, respectively, next to the food source. For both testing conditions, food-carrying behavior of rats increased with increasing food pellet weight. Importantly, the proportion of food-carrying rats was significantly higher during exposure to fox urine ("high risk") than when rats were tested with the water control ("low risk"). Taken together, these results demonstrate that food-carrying behavior of rats is increased by the detection of a predator odor. Our data also support the idea that such food-carrying behavior can be considered as a pre-encounter defensive response. Copyright © 2015 Elsevier Inc. All rights reserved.

Increased Risk of Restless Legs Syndrome in Patients With Migraine

PubMed Central

Yang, Fu-Chi; Lin, Te-Yu; Chen, Hsuan-Ju; Lee, Jiunn-Tay; Lin, Chun-Chieh; Huang, Wen-Yen; Chen, Hsin-Hung; Kao, Chia-Hung

2016-01-01

Abstract Previous studies suggest that an association between restless legs syndrome (RLS) and migraine exists. However, population-based data are unavailable in Asian cohorts. Our study thus aims to evaluate the association between migraine and RLS in a nationwide, population-based cohort in Taiwan and to examine the effects of age, sex, migraine subtype, and comorbidities on RLS development. Data from the Taiwan National Health Insurance Research Database were used. Patients aged 20 years or older with newly diagnosed migraine from 2000 to 2008 were included; 23,641 patients with newly diagnosed migraine and 94,564 subjects without migraine were randomly selected and followed until RLS development, withdrawal from the National Health Insurance, or until the end of 2011. A multivariate Cox proportional hazards regression model was used to explore the risk of RLS in patients with migraine after adjustment for demographic characteristics and comorbidities. Both cohorts were followed for a mean of 7.38 years. After adjustment for covariates, the risk of RLS was 1.42-fold higher (95% confidence interval = 1.13–1.79) in the migraine cohort than in the nonmigraine cohort (7.19 versus 3.42 years per 10,000 person-years). The increased risk was more prominent in males in the migraine cohort (1.87-fold increased risk, 95% confidence interval 1.22–2.85). Neither comorbidity status nor migraine subtype influenced the RLS risk. This population-based study demonstrated that migraine is associated with an increased risk of RLS compared with those without migraine, particularly in male patients with migraine and regardless of the comorbidity status. PMID:26844484

Randomized community-level HIV prevention intervention trial for men who drink in South African alcohol-serving venues.

PubMed

Kalichman, Seth C; Simbayi, Leickness C; Cain, Demetria; Carey, Kate B; Carey, Michael P; Eaton, Lisa; Harel, Ofer; Mehlomakhulu, Vuyelwa; Mwaba, Kelvin

2014-10-01

South African alcohol-serving establishments (i.e., shebeens) offer unique opportunities to reduce HIV risks among men who drink. To test an individual- and a social structural-level HIV prevention intervention for men who drink in shebeens. Twelve matched pairs of township neighbourhoods were randomized to receive either (i) an HIV prevention intervention (guided by Social Action Theory) to reduce sexual risk and increase risk reduction communication in social networks, or (ii) an attention-matched control intervention that focused on the prevention of relationship violence. At the individual level, the interventions delivered skills building workshops focused on sexual risk reduction. At the social structural level, the intervention aimed to increase conversations about safer sex among men in the shebeens, distributed small media and implemented community educational events. Individual-level outcomes were assessed by following the workshop cohorts for 1 year (N = 984), and community-level outcomes were examined through cross-sectional community surveys conducted for 1 year in the shebeens (N = 9,678). Men in the HIV prevention workshops demonstrated greater condom use, more HIV prevention-oriented conversations and greater perceptions of safer sex norms than men in the comparison workshops. Changes at the community level demonstrated significant differences in condom use, although the pattern was not consistent over time. Multi-level interventions that target men who drink in South African shebeens may help reduce risks for HIV and other sexually transmitted infections. © The Author 2013. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

The impact of workplace screening on the occurrence of cumulative trauma disorders and workers' compensation claims.

PubMed

Melhorn, J M

1999-02-01

Work-related musculoskeletal pain, commonly referred to more specifically as musculoskeletal disorders or cumulative trauma disorders, has continued to occur despite efforts by employers, employees, health care providers, and the government to eradicate it. The National Institute for Occupational Safety and Health has encouraged employers to establish ergonomic prevention programs; however, many employers are concerned that screening, education, and focused attention on workplace pain will cause an increase in the number of OSHA 200 events and the incidence of workers' compensation claims. This prospective cohort study demonstrated that there was no increase in the number of OSHA 200 events and no increase in the incidence of workers' compensation claims after completion of an individual risk screening program that included education and employee awareness about work-related musculoskeletal pain. Incidence of cumulative trauma disorders has been most effectively reduced by use of individual risk-screening programs. Therefore, employers should be encouraged to develop and implement prevention programs that include individual risk screening.

Diabetes mellitus prevention.

PubMed

Allende-Vigo, Myriam Zaydee

2015-01-01

The aim of this study was to review lifestyle modification interventions and pharmacological clinical studies designed to prevent diabetes and provide evidence-based recommendations for the prevention of Diabetes Mellitus. A review of relevant literature compiled via a literature search (PUBMED) of English-language publications between 1997 and 2010 was conducted. It is found that people at increased risk of developing type 2 diabetes mellitus can halt the development of the disease. Lifestyle modification intervention with reduction of 5%-10% of excess body weight and increase in moderate physical activity by 150 min/wk has consistently proven to reduce the appearance of diabetes in different at-risk populations. Pharmacologic interventions have also demonstrated the prevention of the appearance of diabetes in persons at risk. Bariatric surgery has decreased the appearance of diabetes patients in a select group of individuals. The progression from prediabetes to diabetes mellitus can be prevented. Lifestyle modification intervention changes with weight loss and increased physical activity are currently recommended for the prevention of diabetes.

Prevalence of circumcision among men and boys aged 14 to 59 years in the United States, National Health and Nutrition Examination Surveys 2005-2010.

PubMed

Introcaso, Camille E; Xu, Fujie; Kilmarx, Peter H; Zaidi, Akbar; Markowitz, Lauri E

2013-07-01

In 2009, an estimated 3590 new heterosexually acquired HIV infections occurred in males in the United States. Three randomized controlled trials demonstrated that male circumcision decreased a man's risk for HIV acquisition through heterosexual sex. We describe circumcision prevalence in US males and determine circumcision prevalence among males potentially at increased risk for heterosexually acquired HIV infection. We estimated circumcision prevalence among men and boys aged 14 to 59 years using data from the National Health and Nutrition Examination Surveys 2005-2010. We defined men and boys with 2 or more female partners in the last year as potentially at increased risk for heterosexually acquired HIV infection. Estimated circumcision prevalence was 80.5%. Prevalence varied significantly by year of birth, race/ethnicity, health insurance type, and family income. Circumcision prevalence among men and boys reporting 2 or more female partners in the last year was 80.4%, which corresponded to an estimated 3.5 million uncircumcised men and boys potentially at increased risk for heterosexually acquired HIV infection. Of these men and boys, 48.3% lacked health insurance. Circumcision prevalence in the United States differs by demographic group, and half of uncircumcised men and boys potentially at increased risk for heterosexually acquired HIV are uninsured. These data could inform recommendations and cost analyses concerning circumcision in the United States.

Serum uric acid level and cardiovascular risks in hemodialysis patients: an Algerian cohort study.

PubMed

Gouri, Adel; Dekaken, Aoulia; Bentorki, Ahmed Aimen; Touaref, Amel; Yakhlef, Amina; Kouicem, Nabila

2014-01-01

Elevated serum uric acid (SUA) was usually associated with an increased risk of cardiovascular events and mortality in the general population. However, there are few reports concerning the clinical impact and the pathogenic role of uric acid (UA) in hemodialysis (HD) patients. The aim of the study was to investigate the relationship between SUA and various cardiovascular (CV) risk factors in HD patients. This retrospective, observational cohort study includes 45 HD patients with a mean age of 51.26 +/- 15.21 years. The differences of the CV risk factors between the patients according to their SUA levels were investigated. Age, cardiovascular diseases (CVD), increased creatinine, fasting blood glucose (FBG), corrected calcium (cCa), phosphate (P), cCa x P product, and LDL cholesterol levels were associated with lower SUA levels, whereas a higher SUA level was associated with diabetes mellitus (DM), hypertension, and increased triglycerides level (p < 0.01). In multiple regression analysis, history of diabetes (beta = 0.360, p < 0.05), reduced corrected serum calcium (cCa) (beta = -1.456, p < 0.01), and phosphate (P) levels (beta = -1.752, p < 0.01) were predictive of an increased SUA concentration. Despite what has been demonstrated in the general population and DM patients, a lower SUA level in HD patients was associated with higher cardiovascular risk factors and high co-morbidity burden. Moreover, higher SUA concentrations may be cardioprotective in dialysis patients.

Serum uric acid level and cardiovascular risks in hemodialysis patients: an Algerian cohort study.

PubMed

Gouri, Adel; Dekaken, Aoulia; Bentorki, Ahmed Aimen; Touaref, Amel; Yekhlef, Amina; Sekkache, Fouzia; Kouicem, Nabila

2013-09-01

Elevated Serum Uric Acid (SUA) was usually associated with an increased risk of cardiovascular events and mortality in general population. However, there are few reports concerning the clinical impact and the pathogenic role of Uric Acid (UA) in Hemodialysis (HD) patients. The aim of the study was to investigate the relationship between SUA and various Cardiovascular (CV) risk factors in HD patients. This retrospective; observational cohort study includes 45 HD patients with a mean age of 51.26+/-15.21 years. The differences of the CV risk factors between the patients according to their SUA levels were investigated. Age, Cardiovascular Diseases (CVD), increased creatinine, Fasting Blood Glucose (FBG), Corrected Calcium (cCa), Phosphate (P), cCa x P product and LDL cholesterol levels were associated with lower SUA levels, whereas higher SUA level was associated with Diabetes Mellitus (DM), hypertension and increased triglycerides level (p<0.01). In multiple regression analysis, history of diabetes (beta= 0.360, p<0.05), reduced corrected serum calcium (cCa) (beta = -1.456, p<0.01) and Phosphate (P) levels (beta= -1.752, p<0.01) were predictive of an increased SUA concentration. Despite from what has been demonstrated in the general population and DM patients, a lower SUA level in HD patients was associated with higher cardiovascular risk factors and high co-morbidity burden. Moreover, higher SUA concentrations may be cardioprotective in dialysis patients.

Use of fall risk increasing drugs in residents of retirement villages: a pilot study of long term care and retirement home residents in Ontario, Canada.

PubMed

Rojas-Fernandez, Carlos; Dadfar, Farzan; Wong, Andrea; Brown, Susan G

2015-10-14

Falls continue to be a problem for older people in long-term care (LTC) and retirement home (RH) settings and are associated with significant morbidity and health care use. Fall-risk increasing drugs (FRIDs) are known to increase fall risk and represent modifiable risk factors. There are limited data regarding the use of FRIDs in contemporary LTC and RH settings, and it has not been well documented to what extent medication regimens are reviewed and modified for those who have sustained falls. The objective of this study is to characterize medication related fall risk factors in LTC and RH residents and on-going use of medications known to increase fall risk. Retrospective chart review of residents aged >65 who sustained one or more falls living in LTC or RH settings. 105 residents who fell one or more times during 2009-2010 were identified with a mean age of 89 years, a mean of nine scheduled medications and seven diagnoses, and 83% were women. Residents in LTC were ostensibly at higher risk for falls relative to those in RH settings as suggested by higher proportion of residents with multiple falls, multiple comorbidities, comorbidities that increase fall risk and visual impairment. Post fall injuries were sustained by 42% of residents, and residents in RH sustained more injuries relative to LTC residents (47 vs 34%). Use of FRIDs such as benzodiazepines, antipsychotic, antidepressant and various antihypertensive drugs was common in the present sample. No medication regimen changes were noted in the 6-month post fall period. The present study documented common use FRIDs by LTC and RH residents with multiple falls. These potentially modifiable falls risk factors are not being adequately addressed in contemporary practice, demonstrating that there is much room for improvement with regards to the safe and appropriate use of medications in LTC and RH residents.

The Gap Between Clinical Research and Standard of Care: A Review of Frailty Assessment Scales in Perioperative Surgical Settings.

PubMed

Stoicea, Nicoleta; Baddigam, Ramya; Wajahn, Jennifer; Sipes, Angela C; Arias-Morales, Carlos E; Gastaldo, Nicholas; Bergese, Sergio D

2016-01-01

The elderly population in the United States is increasing exponentially in tandem with risk for frailty. Frailty is described by a clinically significant state where a patient is at risk for developing complications requiring increased assistance in daily activities. Frailty syndrome studied in geriatric patients is responsible for an increased risk for falls, and increased mortality. In efforts to prepare for and to intervene in perioperative complications and general frailty, a universal scale to measure frailty is necessary. Many methods for determining frailty have been developed, yet there remains a need to define clinical frailty and, therefore, the most effective way to measure it. This article reviews six popular scales for measuring frailty and evaluates their clinical effectiveness demonstrated in previous studies. By identifying the most time-efficient, criteria comprehensive, and clinically effective scale, a universal scale can be implemented into standard of care and reduce complications from frailty in both non-surgical and surgical settings, especially applied to the perioperative surgical home model. We suggest further evaluation of the Edmonton Frailty Scale for inclusion in patient care.

The Gap Between Clinical Research and Standard of Care: A Review of Frailty Assessment Scales in Perioperative Surgical Settings

PubMed Central

Stoicea, Nicoleta; Baddigam, Ramya; Wajahn, Jennifer; Sipes, Angela C.; Arias-Morales, Carlos E.; Gastaldo, Nicholas; Bergese, Sergio D.

2016-01-01

The elderly population in the United States is increasing exponentially in tandem with risk for frailty. Frailty is described by a clinically significant state where a patient is at risk for developing complications requiring increased assistance in daily activities. Frailty syndrome studied in geriatric patients is responsible for an increased risk for falls, and increased mortality. In efforts to prepare for and to intervene in perioperative complications and general frailty, a universal scale to measure frailty is necessary. Many methods for determining frailty have been developed, yet there remains a need to define clinical frailty and, therefore, the most effective way to measure it. This article reviews six popular scales for measuring frailty and evaluates their clinical effectiveness demonstrated in previous studies. By identifying the most time-efficient, criteria comprehensive, and clinically effective scale, a universal scale can be implemented into standard of care and reduce complications from frailty in both non-surgical and surgical settings, especially applied to the perioperative surgical home model. We suggest further evaluation of the Edmonton Frailty Scale for inclusion in patient care. PMID:27493935

Psychological factors and mortality in the Japan Collaborative Cohort Study for Evaluation of Cancer (JACC).

PubMed

Tanno, Kozo; Sakata, Kiyomi

2007-01-01

Psychological factors may have an influence on disease processes and therefore they were investigated in the Japan Collaborative Cohort Study. Overall there were very few consistent associations with cancer death. Persons with 'ikigai', defined as 'that which most makes one's life seem worth living', demonstrated decreased risk of mortality from all causes, ischemic heart disease (IHD) and cerebrovascular disease (CVD).There was no consistent link with being quick to judge, although those answering no to quick judgement were at increased risk of all cause, IHD and CVD mortality. psychological stress was related to a slightly elevated risk of all cause death, IHD in men and CVD in women. However, a sense of hurry was linked to a slightly reduced risk for mortality from all causes and CVD. Persons who were likely to be angry had an increased risk for mortality from all causes. In women not likely to be angry there were also positive links to death from cancers like breast. Joyfulness was associated with decreased mortality, especially from CVD. A feeling of being trusted was also protective, again particularly for CVD.

Risk Associated with Pulse Pressure on Out-of-Office Blood Pressure Measurement

PubMed Central

Gu, Yu-Mei; Aparicio, Lucas S.; Liu, Yan-Ping; Asayama, Kei; Hansen, Tine W.; Niiranen, Teemu J.; Boggia, José; Thijs, Lutgarde; Staessen, Jan A.

2014-01-01

Background Longitudinal studies have demonstrated that the risk of cardiovascular disease increases with pulse pressure (PP). However, PP remains an elusive cardiovascular risk factor with findings being inconsistent between studies. The 2013 ESH/ESC guideline proposed that PP is useful in stratification and suggested a threshold of 60 mm Hg, which is 10 mm Hg higher compared to that in the 2007 guideline; however, no justification for this increase was provided. Methodology Published thresholds of PP are based on office blood pressure measurement and often on arbitrary categorical analyses. In the International Database on Ambulatory blood pressure in relation to Cardiovascular Outcomes (IDACO) and the International Database on HOme blood pressure in relation to Cardiovascular Outcome (IDHOCO), we determined outcome-driven thresholds for PP based on ambulatory or home blood pressure measurement, respectively. Results The main findings were that for people aged <60 years, PP did not refine risk stratification, whereas in older people the thresholds were 64 and 76 mm Hg for the ambulatory and home PP, respectively. However, PP provided little added predictive value over and beyond classical risk factors. PMID:26587443

Multiple environmental chemical exposures to lead, mercury and polychlorinated biphenyls among childbearing-aged women (NHANES 1999-2004): Body burden and risk factors.

PubMed

Thompson, Marcella Remer; Boekelheide, Kim

2013-02-01

Lead, mercury and polychlorinated biphenyls (PCBs) are neurotoxicants with intergenerational health consequences from maternal body burden and gestational exposures. Little is known about multiple chemical exposures among childbearing-aged women. To determine the percentage of women aged 16-49 of diverse races and ethnicities whose body burdens for all three xenobiotics were at or above the median; to identify mixed exposures; and to describe those women disproportionately burdened by two or more of these chemicals based on susceptibility- and exposure-related attributes, socioeconomic factors and race-ethnicity. Secondary data analysis of National Health and Nutrition Examination Survey (1999-2004). The best-fit logistic regression model without interactions contained 12 variables. Four risk factors associated with body burden were notable (P≤0.05). An exponential relationship was demonstrated with increasing age. Any fish consumption in past 30 days more than doubled the odds. Heavy alcohol consumption increased the relative risk. History of breastfeeding reduced this risk. These women were more likely to have two xenobiotics at or above the median than one. More than one-fifth of these childbearing-aged women had three xenobiotic levels at or above the median. These findings are among the first description of US childbearing-aged women's body burden and risk factors for multiple chemical exposures. This study supports increasing age, any fish consumption and heavy alcohol consumption as significant risk factors for body burden. History of breastfeeding lowered the body burden. Limited evidence was found of increased risk among minority women independent of other risk factors. Copyright © 2012 Elsevier Inc. All rights reserved.

Examination of HFE associations with childhood leukemia risk and extension to other iron regulatory genes.

PubMed

Kennedy, Amy E; Kamdar, Kala Y; Lupo, Philip J; Okcu, M Fatih; Scheurer, Michael E; Baum, Marianna K; Dorak, M Tevfik

2014-09-01

Hereditary hemochromatosis (HFE) variants correlating with body iron levels have shown associations with cancer risk, including childhood acute lymphoblastic leukemia (ALL). Using a multi-ethnic sample of cases and controls from Houston, TX, we examined two HFE variants (rs1800562 and rs1799945), one transferrin receptor gene (TFRC) variant (rs3817672) and three additional iron regulatory gene (IRG) variants (SLC11A2 rs422982; TMPRSS6 rs855791 and rs733655) for their associations with childhood ALL. Being positive for either of the HFE variants yielded a modestly elevated odds ratio (OR) for childhood ALL risk in males (1.40, 95% CI=0.83-2.35), which increased to 2.96 (95% CI=1.29-6.80) in the presence of a particular TFRC genotype for rs3817672 (P interaction=0.04). The TFRC genotype also showed an ethnicity-specific association, with increased risk observed in non-Hispanic Whites (OR=2.54, 95% CI=1.05-6.12; P interaction with ethnicity=0.02). The three additional IRG SNPs all showed individual risk associations with childhood ALL in males (OR=1.52-2.60). A polygenic model based on the number of variant alleles in five IRG SNPs revealed a linear increase in risk among males with the increasing number of variants possessed (OR=2.0 per incremental change, 95% CI=1.29-3.12; P=0.002). Our results replicated previous HFE risk associations with childhood ALL in a US population and demonstrated novel associations for IRG SNPs, thereby strengthening the hypothesis that iron excess mediated by genetic variants contributes to childhood ALL risk. Copyright © 2014 Elsevier Ltd. All rights reserved.

Preeclampsia and Future Cardiovascular Health: A Systematic Review and Meta-Analysis.

PubMed

Wu, Pensée; Haththotuwa, Randula; Kwok, Chun Shing; Babu, Aswin; Kotronias, Rafail A; Rushton, Claire; Zaman, Azfar; Fryer, Anthony A; Kadam, Umesh; Chew-Graham, Carolyn A; Mamas, Mamas A

2017-02-01

Preeclampsia is a pregnancy-specific disorder resulting in hypertension and multiorgan dysfunction. There is growing evidence that these effects persist after pregnancy. We aimed to systematically evaluate and quantify the evidence on the relationship between preeclampsia and the future risk of cardiovascular diseases. We studied the future risk of heart failure, coronary heart disease, composite cardiovascular disease, death because of coronary heart or cardiovascular disease, stroke, and stroke death after preeclampsia. A systematic search of MEDLINE and EMBASE was performed to identify relevant studies. We used random-effects meta-analysis to determine the risk. Twenty-two studies were identified with >6.4 million women including >258 000 women with preeclampsia. Meta-analysis of studies that adjusted for potential confounders demonstrated that preeclampsia was independently associated with an increased risk of future heart failure (risk ratio [RR], 4.19; 95% confidence interval [CI], 2.09-8.38), coronary heart disease (RR, 2.50; 95% CI, 1.43-4.37), cardiovascular disease death (RR, 2.21; 95% CI, 1.83-2.66), and stroke (RR, 1.81; 95% CI, 1.29-2.55). Sensitivity analyses showed that preeclampsia continued to be associated with an increased risk of future coronary heart disease, heart failure, and stroke after adjusting for age (RR, 3.89; 95% CI, 1.83-8.26), body mass index (RR, 3.16; 95% CI, 1.41-7.07), and diabetes mellitus (RR, 4.19; 95% CI, 2.09-8.38). Preeclampsia is associated with a 4-fold increase in future incident heart failure and a 2-fold increased risk in coronary heart disease, stroke, and death because of coronary heart or cardiovascular disease. Our study highlights the importance of lifelong monitoring of cardiovascular risk factors in women with a history of preeclampsia. © 2017 American Heart Association, Inc.

Applying geologic sensitivity analysis to environmental risk management: The financial implications

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

Rogers, D.T.

The financial risks associated with environmental contamination can be staggering and are often difficult to identify and accurately assess. Geologic sensitivity analysis is gaining recognition as a significant and useful tool that can empower the user with crucial information concerning environmental risk management and brownfield redevelopment. It is particularly useful when (1) evaluating the potential risks associated with redevelopment of historical industrial facilities (brownfields) and (2) planning for future development, especially in areas of rapid development because the number of potential contaminating sources often increases with an increase in economic development. An examination of the financial implications relating to geologicmore » sensitivity analysis in southeastern Michigan from numerous case studies indicate that the environmental cost of contamination may be 100 to 1,000 times greater at a geologically sensitive location compared to the least sensitive location. Geologic sensitivity analysis has demonstrated that near-surface geology may influence the environmental impact of a contaminated site to a greater extent than the amount and type of industrial development.« less

Differential Effects of Antiepileptic Drugs on Neonatal Outcomes

PubMed Central

Pennell, P.B.; Klein, A.M.; Browning, N.; Baker, G.A.; Clayton-Smith, J.; Kalayjian, L.A.; Liporace, J.D.; Privitera, M.; Crawford, T.; Loring, D.W.; Meador, K.J.

2012-01-01

Offspring of women with epilepsy (WWE) on AEDs are at increased risks for major congenital malformations and reduced cognition. They may be at risk for other adverse neonatal outcomes. WWE on carbamazepine (CBZ), lamotrigine (LTG), phenytoin (PHT), or valproate (VPA) monotherapy were enrolled in a prospective, observational, multicenter study of the neurodevelopmental effects of AEDs. The odds ratio for small for gestational age (SGA) was higher for VPA vs. PHT, VPA vs. LTG, and CBZ vs. PHT. Microcephaly rates were elevated to 12% for all newborns and 12-months-old, but normalized by age 24-months. Reduced Apgar scores occurred more frequently in the VPA and PHT groups at 1 minute, but scores were near normal in all groups at 5 minutes. This study demonstrates increased risks for being born SGA in the VPA and CBZ groups, and transiently reduced Apgar scores in the VPA and PHT groups. Differential risks amongst the AEDs can help inform decisions about AED selection for women during childbearing years. PMID:22749607

Correlation between fertility drugs use and malignant melanoma incidence: the state of the art.

PubMed

Tomao, Federica; Papa, Anselmo; Lo Russo, Giuseppe; Zuber, Sara; Spinelli, Gian Paolo; Rossi, Luigi; Caruso, Davide; Prinzi, Natalie; Stati, Valeria; Benedetti Panici, Pierluigi; Tomao, Silverio

2014-09-01

The relationship between fertility, reproductive hormones, and risk of malignant melanoma has acquired much interest in recent years. Melanocytes are hormonally responsive cells, and some in vitro studies demonstrated that estrogen hormones stimulate the growth of melanocytes. Moreover, estrogen receptors have been identified in melanoma cells, as well as in melanocytic nevi and in normal skin. Some evidences suggest a possible link between fertility treatments and the increased risk of malignant melanoma. This article addresses this association through a scrupulous search of the literature published thus far. The aim of this review is to determine the incidence of malignant melanoma in women treated with fertility drugs and to examine if the exposure to fertility treatments really increases the risk of malignant melanoma. In particular, our analysis focused on the different types of drugs and different treatment schedules used. Finally, this study provides additional insights regarding the long-term relationships between fertility drugs and the risk of malignant melanoma.

Climate change and sugarcane expansion increase Hantavirus infection risk.

PubMed

Prist, Paula Ribeiro; Uriarte, María; Fernandes, Katia; Metzger, Jean Paul

2017-07-01

Hantavirus Cardiopulmonary Syndrome (HCPS) is a disease caused by Hantavirus, which is highly virulent for humans. High temperatures and conversion of native vegetation to agriculture, particularly sugarcane cultivation can alter abundance of rodent generalist species that serve as the principal reservoir host for HCPS, but our understanding of the compound effects of land use and climate on HCPS incidence remains limited, particularly in tropical regions. Here we rely on a Bayesian model to fill this research gap and to predict the effects of sugarcane expansion and expected changes in temperature on Hantavirus infection risk in the state of São Paulo, Brazil. The sugarcane expansion scenario was based on historical data between 2000 and 2010 combined with an agro-environment zoning guideline for the sugar and ethanol industry. Future evolution of temperature anomalies was derived using 32 general circulation models from scenarios RCP4.5 and RCP8.5 (Representative greenhouse gases Concentration Pathways adopted by IPCC). Currently, the state of São Paulo has an average Hantavirus risk of 1.3%, with 6% of the 645 municipalities of the state being classified as high risk (HCPS risk ≥ 5%). Our results indicate that sugarcane expansion alone will increase average HCPS risk to 1.5%, placing 20% more people at HCPS risk. Temperature anomalies alone increase HCPS risk even more (1.6% for RCP4.5 and 1.7%, for RCP8.5), and place 31% and 34% more people at risk. Combined sugarcane and temperature increases led to the same predictions as scenarios that only included temperature. Our results demonstrate that climate change effects are likely to be more severe than those from sugarcane expansion. Forecasting disease is critical for the timely and efficient planning of operational control programs that can address the expected effects of sugarcane expansion and climate change on HCPS infection risk. The predicted spatial location of HCPS infection risks obtained here can be used to prioritize management actions and develop educational campaigns.

Climate change and sugarcane expansion increase Hantavirus infection risk

PubMed Central

Uriarte, María; Fernandes, Katia; Metzger, Jean Paul

2017-01-01

Hantavirus Cardiopulmonary Syndrome (HCPS) is a disease caused by Hantavirus, which is highly virulent for humans. High temperatures and conversion of native vegetation to agriculture, particularly sugarcane cultivation can alter abundance of rodent generalist species that serve as the principal reservoir host for HCPS, but our understanding of the compound effects of land use and climate on HCPS incidence remains limited, particularly in tropical regions. Here we rely on a Bayesian model to fill this research gap and to predict the effects of sugarcane expansion and expected changes in temperature on Hantavirus infection risk in the state of São Paulo, Brazil. The sugarcane expansion scenario was based on historical data between 2000 and 2010 combined with an agro-environment zoning guideline for the sugar and ethanol industry. Future evolution of temperature anomalies was derived using 32 general circulation models from scenarios RCP4.5 and RCP8.5 (Representative greenhouse gases Concentration Pathways adopted by IPCC). Currently, the state of São Paulo has an average Hantavirus risk of 1.3%, with 6% of the 645 municipalities of the state being classified as high risk (HCPS risk ≥ 5%). Our results indicate that sugarcane expansion alone will increase average HCPS risk to 1.5%, placing 20% more people at HCPS risk. Temperature anomalies alone increase HCPS risk even more (1.6% for RCP4.5 and 1.7%, for RCP8.5), and place 31% and 34% more people at risk. Combined sugarcane and temperature increases led to the same predictions as scenarios that only included temperature. Our results demonstrate that climate change effects are likely to be more severe than those from sugarcane expansion. Forecasting disease is critical for the timely and efficient planning of operational control programs that can address the expected effects of sugarcane expansion and climate change on HCPS infection risk. The predicted spatial location of HCPS infection risks obtained here can be used to prioritize management actions and develop educational campaigns. PMID:28727744

Mobile Device Management in the DOD Enterprise Network: Factors for Risk Management, Integration, and It Acquisition

DTIC Science & Technology

2013-03-01

Business Engineering, Liu et al. (2010) presented research demonstrating that businesses are increasingly over tasked to manage the growing equipment...Android, and Research in Motion’s BlackBerry ). Monitoring mission-critical applications for updates and compatibility is crucial to ensure...private sector has seen the CIO’s role increase into C- level leadership, growing from initial responsibilities of overseeing data processing, then 31

Family nurture intervention in preterm infants increases early development of cortical activity and independence of regional power trajectories.

PubMed

Welch, Martha G; Stark, Raymond I; Grieve, Philip G; Ludwig, Robert J; Isler, Joseph R; Barone, Joseph L; Myers, Michael M

2017-12-01

Premature delivery and maternal separation during hospitalisation increase infant neurodevelopmental risk. Previously, a randomised controlled trial of Family Nurture Intervention (FNI) in the neonatal intensive care unit demonstrated improvement across multiple mother and infant domains including increased electroencephalographic (EEG) power in the frontal polar region at term age. New aims were to quantify developmental changes in EEG power in all brain regions and frequencies and correlate developmental changes in EEG power among regions. EEG (128 electrodes) was obtained at 34-44 weeks postmenstrual age from preterm infants born 26-34 weeks. Forty-four infants were treated with Standard Care and 53 with FNI. EEG power was computed in 10 frequency bands (1-48 Hz) in 10 brain regions and in active and quiet sleep. Percent change/week in EEG power was increased in FNI in 132/200 tests (p < 0.05), 117 tests passed a 5% False Discovery Rate threshold. In addition, FNI demonstrated greater regional independence in those developmental rates of change. This study strengthens the conclusion that FNI promotes cerebral cortical development of preterm infants. The findings indicate that developmental changes in EEG may provide biomarkers for risk in preterm infants as well as proximal markers of effects of FNI. ©2017 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

Evaluating the effects of a peer-support model: reducing negative body esteem and disordered eating attitudes and behaviours in grade eight girls.

PubMed

Thompson, Carmen; Russell-Mayhew, Shelly; Saraceni, Reana

2012-01-01

During adolescence girls become increasingly preoccupied with unrealistic ideals about body weight, often leading to dieting and unhealthy compensatory behaviours. These practices have been linked to adverse psychological, social, and health consequences. Peer-support groups offer promise in addressing risk factors for disordered eating. This study explored the effects of peer-support on measures of body satisfaction, weight loss/weight gain behaviour, internalization of media ideals, weight based teasing, and communication, for a cohort of grade 8 girls. High-risk participants demonstrated trends toward decreased internalization of media ideals and increased body satisfaction at post-test. Implications and future research direction are discussed.

The High Stability Engine Control (HISTEC) Program: Flight Demonstration Phase

NASA Technical Reports Server (NTRS)

DeLaat, John C.; Southwick, Robert D.; Gallops, George W.; Orme, John S.

1998-01-01

Future aircraft turbine engines, both commercial and military, must be able to accommodate expected increased levels of steady-state and dynamic engine-face distortion. The current approach of incorporating sufficient design stall margin to tolerate these increased levels of distortion would significantly reduce performance. The objective of the High Stability Engine Control (HISTEC) program is to design, develop, and flight-demonstrate an advanced, integrated engine control system that uses measurement-based estimates of distortion to enhance engine stability. The resulting distortion tolerant control reduces the required design stall margin, with a corresponding increase in performance and decrease in fuel burn. The HISTEC concept has been developed and was successfully flight demonstrated on the F-15 ACTIVE aircraft during the summer of 1997. The flight demonstration was planned and carried out in two phases, the first to show distortion estimation, and the second to show distortion accommodation. Post-flight analysis shows that the HISTEC technologies are able to successfully estimate and accommodate distortion, transiently setting the stall margin requirement on-line and in real-time. This allows the design stall margin requirement to be reduced, which in turn can be traded for significantly increased performance and/or decreased weight. Flight demonstration of the HISTEC technologies has significantly reduced the risk of transitioning the technology to tactical and commercial engines.

Patient reactions to a web-based cardiovascular risk calculator in type 2 diabetes: a qualitative study in primary care.

PubMed

Nolan, Tom; Dack, Charlotte; Pal, Kingshuk; Ross, Jamie; Stevenson, Fiona A; Peacock, Richard; Pearson, Mike; Spiegelhalter, David; Sweeting, Michael; Murray, Elizabeth

2015-03-01

Use of risk calculators for specific diseases is increasing, with an underlying assumption that they promote risk reduction as users become better informed and motivated to take preventive action. Empirical data to support this are, however, sparse and contradictory. To explore user reactions to a cardiovascular risk calculator for people with type 2 diabetes. Objectives were to identify cognitive and emotional reactions to the presentation of risk, with a view to understanding whether and how such a calculator could help motivate users to adopt healthier behaviours and/or improve adherence to medication. Qualitative study combining data from focus groups and individual user experience. Adults with type 2 diabetes were recruited through website advertisements and posters displayed at local GP practices and diabetes groups. Participants used a risk calculator that provided individualised estimates of cardiovascular risk. Estimates were based on UK Prospective Diabetes Study (UKPDS) data, supplemented with data from trials and systematic reviews. Risk information was presented using natural frequencies, visual displays, and a range of formats. Data were recorded and transcribed, then analysed by a multidisciplinary group. Thirty-six participants contributed data. Users demonstrated a range of complex cognitive and emotional responses, which might explain the lack of change in health behaviours demonstrated in the literature. Cardiovascular risk calculators for people with diabetes may best be used in conjunction with health professionals who can guide the user through the calculator and help them use the resulting risk information as a source of motivation and encouragement. © British Journal of General Practice 2015.

Risk factors for father-daughter incest: data from an anonymous computerized survey.

PubMed

Stroebel, Sandra S; Kuo, Shih-Ya; O'Keefe, Stephen L; Beard, Keith W; Swindell, Sam; Kommor, Martin J

2013-12-01

Retrospective data from 2,034 female participants, provided anonymously using a computer-assisted self-interview, were used to identify risk factors for father-daughter incest (FDI). A total of 51 participants had reported having experienced FDI. The risk factors identified within the nuclear family by the multiple logistic regression analysis included the following: (a) Having parents whose relationship included verbal or physical fighting or brutality increased the likelihood of FDI by approximately 5 times; (b) families accepting father-daughter nudity as measured by a scale with values ranging from 0 to 4 increased the likelihood of FDI by approximately 2 times for each unit value increase of 1 above 0; (c) demonstrating maternal affection protected against FDI. The likelihood of being a victim of FDI was highest if the participant's mother never kissed or hugged her; it decreased by 0.44 for a 1-unit increase in affection and by 0.19 times for a 2-unit increase; and (d) being in homes headed by single-parent mothers or where divorce or death of the father had resulted in a man other than the biological father living in the home increased the risk of FDI by approximately 3.2 times. The results were consistent with the idea that FDI in many families was the cumulative result of a circular pattern of interactions, a finding that has implications for treatment of the perpetrator, the victim, and the families. The data also suggested it may be possible to design an information program for parents that will result in reducing the risk of FDI in families implementing the program's recommendations.

Quantitative Assessment of the Safety Benefits Associated with Increasing Clinical Peanut Thresholds Through Immunotherapy.

PubMed

Baumert, Joseph L; Taylor, Steve L; Koppelman, Stef J

Peanut immunotherapy studies are conducted with the aim to decrease the sensitivity of patients to peanut exposure with the outcome evaluated by testing the threshold for allergic response in a double-blind placebo-controlled food challenge. The clinical relevance of increasing this threshold is not well characterized. We aimed to quantify the clinical benefit of an increased threshold for peanut-allergic patients. Quantitative risk assessment was performed by matching modeled exposure to peanut protein with individual threshold levels. Exposure was modeled by pairing US consumption data for various food product categories with potential contamination levels of peanut that have been demonstrated to be present on occasion in such food products. Cookies, ice cream, doughnuts/snack cakes, and snack chip mixes were considered in the risk assessment. Increasing the baseline threshold before immunotherapy from 100 mg or less peanut protein to 300 mg peanut protein postimmunotherapy reduces the risk of experiencing an allergic reaction by more than 95% for all 4 food product categories that may contain trace levels of peanut residue. Further increase in the threshold to 1000 mg of peanut protein had an additional quantitative benefit in risk reduction for all patients reacting to 300 mg or less at baseline. We conclude that achieving thresholds of 300 mg and 1000 mg of peanut protein by peanut immunotherapy is clinically relevant, and that the risk for peanut-allergic patients who have achieved this increased threshold to experience an allergic reaction is reduced in a clinically meaningful way. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Reciprocal Risk of Acute Kidney Injury and Acute Respiratory Distress Syndrome in Critically Ill Burn Patients.

PubMed

Clemens, Michael S; Stewart, Ian J; Sosnov, Jonathan A; Howard, Jeffrey T; Belenkiy, Slava M; Sine, Christy R; Henderson, Jonathan L; Buel, Allison R; Batchinsky, Andriy I; Cancio, Leopoldo C; Chung, Kevin K

2016-10-01

To evaluate the association between acute respiratory distress syndrome and acute kidney injury with respect to their contributions to mortality in critically ill patients. Retrospective analysis of consecutive adult burn patients requiring mechanical ventilation. A 16-bed burn ICU at tertiary military teaching hospital. Adult patients more than 18 years old requiring mechanical ventilation during their initial admission to our burn ICU from January 1, 2003, to December 31, 2011. None. A total 830 patients were included, of whom 48.2% had acute kidney injury (n = 400). These patients had a 73% increased risk of developing acute respiratory distress syndrome after controlling for age, gender, total body surface area burned, and inhalation injury (hazard ratio, 1.73; 95% CI, 1.18-2.54; p = 0.005). In a reciprocal multivariate analysis, acute respiratory distress syndrome (n = 299; 36%) demonstrated a strong trend toward developing acute kidney injury (hazard ratio, 1.39; 95% CI, 0.99-1.95; p = 0.05). There was a 24% overall in-hospital mortality (n = 198). After adjusting for the aforementioned confounders, both acute kidney injury (hazard ratio, 3.73; 95% CI, 2.39-5.82; p < 0.001) and acute respiratory distress syndrome (hazard ratio, 2.16; 95% CI, 1.58-2.94; p < 0.001) significantly contributed to mortality. Age, total body surface area burned, and inhalation injury were also significantly associated with increased mortality. Acute kidney injury increases the risk of acute respiratory distress syndrome in mechanically ventilated burn patients, whereas acute respiratory distress syndrome similarly demonstrates a strong trend toward the development of acute kidney injury. Acute kidney injury and acute respiratory distress syndrome are both independent risks for subsequent death. Future research should look at this interplay for possible early interventions.

Prime Time Sister Circles: evaluating a gender-specific, culturally relevant health intervention to decrease major risk factors in mid-life African-American women.

PubMed Central

Gaston, Marilyn Hughes; Porter, Gayle K.; Thomas, Veronica G.

2007-01-01

PURPOSE: To evaluate the effectiveness of Prime Time Sister Circles (PTSC), a curriculum-based, culture- and gender-specific health intervention, in assisting mid-life African-American women to decrease the major risk factors of physical inactivity, poor nutrition and stress. METHODS: One-hundred-thirty-four African-American women were involved in 11 sites across the country in PTSC and comparison groups. PTSC uses a cognitive behavioral modality based on three theoretical approaches to reduce risk factors and promote positive health changes. Pretest and posttest (10 weeks, and six and 12 months) data were collected on various indicators. RESULTS: t test analyses demonstrated a statistically significant increase in the women's involvement in physical activity at 10 weeks, and six and 12 months. A significant 10-week difference was found in the women's diet, with them reporting eating more nutritious foods, t(77) = 3.32, p < 0.001. The women also indicated from pretest to 10 weeks, and six and 12 months that they changed what they ate to prevent disease (40.4%, 62.8%, 97.5% and 100%, respectively). A majority of the women at 10 weeks (62.7%) and 12 months (65.9%) reported utilizing stress management strategies. There was also a 60% increase in yearly mammograms and a 54% increase in blood pressures checks. Finally, 83.7% of the women at 12 months felt that the positive changes could be maintained over their lifetime. CONCLUSIONS: This study demonstrates the effectiveness of PTSC in modifying health-related knowledge, attitudes and certain high-risk behaviors in mid-life African-American women. PMID:17444433

Plasma fatty acid ethanolamides are associated with postprandial triglycerides, ApoCIII and ApoE in humans consuming high fructose corn syrup-sweetened beverage.

PubMed

Allister Price, Candice; Argueta, Donovan A; Medici, Valentina; Bremer, Andrew A; Lee, Vivien; Nunez, Marinelle V; Chen, Guoxia X; Keim, Nancy L; Havel, Peter J; Stanhope, Kimber L; DiPatrizio, Nicholas V

2018-04-10

Epidemiological and clinical research studies have provided ample evidence demonstrating that consumption of sugar-sweetened beverages (SSB) increases risk factors involved in the development of obesity, type 2 diabetes (T2D), and cardiovascular disease (CVD). Our previous study demonstrated that when compared to aspartame (Asp), two weeks of high-fructose corn syrup (HFCS)-sweetened beverages provided at 25% of daily energy requirement (Ereq) was associated with increased body weight, postprandial (pp) triglycerides (TG), and fasting and pp CVD risk factors in young adults. The fatty acid ethanolamide, anandamide (AEA), and the monoacylglycerol, 2-arachidonoyl-sn-glycerol (2-AG), are two primary endocannabinoids (ECs) that play a role in regulating food intake, increasing adipose storage, and regulating lipid metabolism. Therefore, we measured plasma concentrations of ECs and their analogs, oleoylethanolamide (OEA), docosahexaenoyl ethanolamide (DHEA), and docosahexaenoyl glycerol (DHG), in participants from our previous study who consumed HFCS- or Asp-sweetened beverages to determine associations with weight gain and CVD risk factors. Two-week exposure to either HFCS- or Asp-sweetened beverages resulted in significant differences in the changes in fasting levels of OEA and DHEA between groups after the testing period. Subjects who consumed Asp, but not HFCS, displayed a reduction in AEA, OEA and DHEA after the testing period. In contrast, there were significant positive relationships between AEA, OEA, and DHEA versus ppTG, ppApoCIII and ppApoE in those consuming HFCS, but not in those consuming Asp. Our findings reveal previously unknown associations between circulating ECs and EC-related molecules with markers of lipid metabolism and CVD risk after HFCS-consumption.

Global Climate Teleconnections to Forecast Increased Risk of Vector-Borne Animal and Human Disease Transmission

USDA-ARS?s Scientific Manuscript database

We willexamine how climate teleconnect ions and variability impact vector biology and vector borne disease ecology, and demonstrate that global climate monitoring can be used to anticipate and forecast epidemics and epizootics. In this context we willexamine significant worldwide weather anomalies t...

Emotional Intelligence and Academic Achievement in 11th Grade At-Risk Students

ERIC Educational Resources Information Center

Nelson, Patricia Diane

2009-01-01

As the emphasis on measures of student academic achievement increases, educational researchers and practitioners are interested in identifying factors that demonstrate effectiveness in supporting student achievement. This quantitative, correlational study explored the influence of emotional intelligence on closing the achievement gap. A study of…

Weather and environmental factors associated with F+ coliphages and fecal indicator bacteria in beach sand at two recreational marine beaches

EPA Science Inventory

Studies have demonstrated that fecal indicator bacteria (FIB) and pathogens may be present in beach sand and suggest an increased risk of enteric illness among beachgoers contacting sand. During the 2007 National Epidemiological and Environmental Assessment of Recreational (NEEAR...

Child Health, Maternal Marital and Socioeconomic Factors, and Maternal Health

ERIC Educational Resources Information Center

Garbarski, Dana; Witt, Whitney P.

2013-01-01

Although maternal socioeconomic status and health predict in part children's future health and socioeconomic prospects, it is possible that the intergenerational association flows in the other direction such that child health affects maternal outcomes. Previous research demonstrates that poor child health increases the risk of adverse maternal…

Effective Dropout Prevention and College Attendance Programs for Latino Students.

ERIC Educational Resources Information Center

Fashola, Olatokunbo S.; Slavin, Robert E.

This paper reviews research related to effective secondary school programs aimed at dropout prevention and increasing college enrollment rates for at-risk Latino youth. The review identifies programs that have demonstrated a significant impact on dropout rates, college attendance, school performance, or related outcomes in rigorous evaluations;…

Assessing introduction risk using species’ rank-abundance distributions

PubMed Central

Chan, Farrah T.; Bradie, Johanna; Briski, Elizabeta; Bailey, Sarah A.; Simard, Nathalie; MacIsaac, Hugh J.

2015-01-01

Mixed-species assemblages are often unintentionally introduced into new ecosystems. Analysing how assemblage structure varies during transport may provide insights into how introduction risk changes before propagules are released. Characterization of introduction risk is typically based on assessments of colonization pressure (CP, the number of species transported) and total propagule pressure (total PP, the total abundance of propagules released) associated with an invasion vector. Generally, invasion potential following introduction increases with greater CP or total PP. Here, we extend these assessments using rank-abundance distributions to examine how CP : total PP relationships change temporally in ballast water of ocean-going ships. Rank-abundance distributions and CP : total PP patterns varied widely between trans-Atlantic and trans-Pacific voyages, with the latter appearing to pose a much lower risk than the former. Responses also differed by taxonomic group, with invertebrates experiencing losses mainly in total PP, while diatoms and dinoflagellates sustained losses mainly in CP. In certain cases, open-ocean ballast water exchange appeared to increase introduction risk by uptake of new species or supplementation of existing ones. Our study demonstrates that rank-abundance distributions provide new insights into the utility of CP and PP in characterizing introduction risk. PMID:25473007

Polycystic ovary syndrome and the risk of obstructive sleep apnea: a meta-analysis and review of the literature

PubMed Central

Helvaci, Nafiye; Karabulut, Erdem; Demir, Ahmet Ugur

2017-01-01

Background and Objective Polycystic ovary syndrome (PCOS) has been reported to be associated with the development of obstructive sleep apnea (OSA). The objective of this meta-analysis is to assess the relationship between PCOS and OSA. Methods A literature search was conducted to identify studies linking PCOS with the risk of OSA. Studies in which the presence of OSA was confirmed with overnight polysomnography were included. Random effects models were used to calculate pooled relative risks. Results Eight studies conducted in adults and five studies conducted in adolescents were identified. The pooled OSA prevalence was 0.22 (95% confidence interval (CI): 0.08–0.40) in PCOS patients. The pooled prevalence of OSA was higher in adults (0.32, 95% CI: 0.13–0.55) than adolescents (0.08, 95% CI: 0.00–0.30). Risk of OSA was significantly increased in adult patients with PCOS (odds ratio (OR) 9.74, 95% CI: 2.76–34.41). Risk of OSA was not significantly increased in adolescents (OR: 4.54, 95% CI:0.56–36.43). Conclusions These findings demonstrate a significant association between PCOS and OSA in adult patients. Considering the increased risk for long-term cardiometabolic disorders associated with both PCOS and OSA, it is important to diagnose and treat OSA in patients with PCOS. PMID:28739562

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

PubMed

Thekdi, Shital A; Lambert, James H

2012-07-01

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

Aeroallergen sensitization predicts acute chest syndrome in children with sickle cell anaemia.

PubMed

Willen, Shaina M; Rodeghier, Mark; Strunk, Robert C; Bacharier, Leonard B; Rosen, Carol L; Kirkham, Fenella J; DeBaun, Michael R; Cohen, Robyn T

2018-02-01

Asthma is associated with higher rates of acute chest syndrome (ACS) and vaso-occlusive pain episodes among children with sickle cell anaemia (SCA). Aeroallergen sensitization is a risk factor for asthma. We hypothesized that aeroallergen sensitization is associated with an increased incidence of hospitalizations for ACS and pain. Participants in a multicentre, longitudinal cohort study, aged 4-18 years with SCA, underwent skin prick testing to ten aeroallergens. ACS and pain episodes were collected from birth until the end of the follow-up period. The number of positive skin tests were tested for associations with prospective rates of ACS and pain. Multivariable models demonstrated additive effects of having positive skin tests on future rates of ACS (incidence rate ratio (IRR) for each positive test 1·23, 95% confidence interval [CI] 1·11-1·36, P < 0·001). Aeroallergen sensitization was not associated with future pain (IRR 1·14, 95%CI 0·97-1·33, P = 0·11). Our study demonstrated that children with SCA and aeroallergen sensitization are at increased risk for future ACS. Future research is needed to determine whether identification of specific sensitizations and allergen avoidance and treatment reduce the risk of ACS for children with SCA. © 2018 John Wiley & Sons Ltd.

Mitigation of indirect environmental effects of GM crops

PubMed Central

Pidgeon, J.D; May, M.J; Perry, J.N; Poppy, G.M

2007-01-01

Currently, the UK has no procedure for the approval of novel agricultural practices that is based on environmental risk management principles. Here, we make a first application of the ‘bow-tie’ risk management approach in agriculture, for assessment of land use changes, in a case study of the introduction of genetically modified herbicide tolerant (GMHT) sugar beet. There are agronomic and economic benefits, but indirect environmental harm from increased weed control is a hazard. The Farm Scale Evaluation (FSE) trials demonstrated reduced broad-leaved weed biomass and seed production at the field scale. The simplest mitigation measure is to leave a proportion of rows unsprayed in each GMHT crop field. Our calculations, based on FSE data, show that a maximum of 2% of field area left unsprayed is required to mitigate weed seed production and 4% to mitigate weed biomass production. Tilled margin effects could simply be mitigated by increasing the margin width from 0.5 to 1.5 m. Such changes are cheap and simple to implement in farming practices. This case study demonstrates the usefulness of the bow-tie risk management approach and the transparency with which hazards can be addressed. If adopted generally, it would help to enable agriculture to adopt new practices with due environmental precaution. PMID:17439853

Cross-sectional study of area-level disadvantage and glycaemic-related risk in community health service users in the Southern.IML Research (SIMLR) cohort.

PubMed

Cross, Roger; Bonney, Andrew; Mayne, Darren J; Weston, Kathryn M

2017-09-19

Objectives The aim of the present study was to determine the association between area-level socioeconomic disadvantage and glycaemic-related risk in health service users in the Illawarra-Shoalhaven region of New South Wales, Australia. Methods HbA1c values recorded between 2010 and 2012 for non-pregnant individuals aged ≥18 years were extracted from the Southern.IML Research (SIMLR) database. Individuals were assigned quintiles of the Socioeconomic Indices for Australia (SEIFA) Index of Relative Socioeconomic Disadvantage (IRSD) according to their Statistical Area 1 of residence. Glycaemic risk categories were defined as HbA1c 5.0-5.99% (lowest risk), 6.0-7.49% (intermediate risk) and ≥7.5% (highest risk). Logistic regression models were fit with glycaemic risk category as the outcome variable and IRSD as the study variable, adjusting for age and sex. Results Data from 29064 individuals were analysed. Higher disadvantage was associated with belonging to a higher glycaemic risk category in the fully adjusted model (most disadvantaged vs least disadvantaged quintile; odds ratio 1.74, 95% confidence interval 1.58, 1.93; P<0.001). Conclusion In this geocoded clinical dataset, area-level socioeconomic disadvantage was a significant correlate of increased glycaemic-related risk. Geocoded clinical data can inform more targeted use of health service resources, with the potential for improved health care equity and cost-effectiveness. What is known about the topic? The rapid increase in the prevalence of Type 2 diabetes (T2D), both globally and nationally within Australia, is a major concern for the community and public health agencies. Individual socioeconomic disadvantage is a known risk factor for abnormal glucose metabolism (AGM), including T2D. Although small-area-level socioeconomic disadvantage is a known correlate of AGM in Australia, less is known of the association of area-level disadvantage and glycaemic-related risk in individuals with AGM. What does this paper add? This study demonstrates a robust association between small-area-level socioeconomic disadvantage and glycaemic-related risk in regional New South Wales. The study demonstrates that it is feasible to use geocoded, routinely collected clinical data to identify communities at increased health risk. What are the implications for practitioners? The identification of at-risk populations is an essential step towards targeted public health policy and programs aimed at reducing the burden of AGM, its complications and the associated economic costs. Collaboration between primary care and public health in the collection and use of data described in the present study has the potential to enhance the effectiveness of both sectors.

Hormonal contraceptive use and women's risk of HIV acquisition: priorities emerging from recent data.

PubMed

Ralph, Lauren J; Gollub, Erica L; Jones, Heidi E

2015-12-01

Understanding whether hormonal contraception increases women's risk of HIV acquisition is a public health priority. This review summarizes recent epidemiologic and biologic data, and considers the implications of new evidence on research and programmatic efforts. Two secondary analyses of HIV prevention trials demonstrated increased HIV risk among depot medroxyprogesterone acetate (DMPA) users compared with nonhormonal/no method users and norethisterone enanthate (NET-EN) users. A study of women in serodiscordant partnerships found no significant association for DMPA or implants. Two meta-analyses found elevated risks of HIV among DMPA users compared with nonhormonal/no method users, with no association for NET-EN or combined oral contraceptive pills. In-vitro and animal model studies identified plausible biological mechanisms by which progestin exposure could increase risk of HIV, depending on the type and dose of progestin, but such mechanisms have not been definitively observed in humans. Recent epidemiologic and biologic evidence on hormonal contraception and HIV suggests a harmful profile for DMPA but not combined oral contraceptives. In limited data, NET-EN appears safer than DMPA. More research is needed on other progestin-based methods, especially implants and Sayana Press. Future priorities include updating modeling studies with new pooled estimates, continued basic science to understand biological mechanisms, expanding contraceptive choice, and identifying effective ways to promote dual method use.

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.

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

PubMed

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

2018-03-01

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

A case-control study estimating accident risk for alcohol, medicines and illegal drugs.

PubMed

Kuypers, Kim Paula Colette; Legrand, Sara-Ann; Ramaekers, Johannes Gerardus; Verstraete, Alain Gaston

2012-01-01

The aim of the present study was to assess the risk of having a traffic accident after using alcohol, single drugs, or a combination, and to determine the concentrations at which this risk is significantly increased. A population-based case-control study was carried out, collecting whole blood samples of both cases and controls, in which a number of drugs were detected. The risk of having an accident when under the influence of drugs was estimated using logistic regression adjusting for gender, age and time period of accident (cases)/sampling (controls). The main outcome measures were odds ratio (OR) for accident risk associated with single and multiple drug use. In total, 337 cases (negative: 176; positive: 161) and 2726 controls (negative: 2425; positive: 301) were included in the study. Main findings were that 1) alcohol in general (all the concentrations together) caused an elevated crash risk; 2) cannabis in general also caused an increase in accident risk; at a cut-off of 2 ng/mL THC the risk of having an accident was four times the risk associated with the lowest THC concentrations; 3) when ranking the adjusted OR from lowest to highest risk, alcohol alone or in combination with other drugs was related to a very elevated crash risk, with the highest risk for stimulants combined with sedatives. The study demonstrated a concentration-dependent crash risk for THC positive drivers. Alcohol and alcohol-drug combinations are by far the most prevalent substances in drivers and subsequently pose the largest risk in traffic, both in terms of risk and scope.

Interacting effects of wildlife loss and climate on ticks and tick-borne disease.

PubMed

Titcomb, Georgia; Allan, Brian F; Ainsworth, Tyler; Henson, Lauren; Hedlund, Tyler; Pringle, Robert M; Palmer, Todd M; Njoroge, Laban; Campana, Michael G; Fleischer, Robert C; Mantas, John Naisikie; Young, Hillary S

2017-09-13

Both large-wildlife loss and climatic changes can independently influence the prevalence and distribution of zoonotic disease. Given growing evidence that wildlife loss often has stronger community-level effects in low-productivity areas, we hypothesized that these perturbations would have interactive effects on disease risk. We experimentally tested this hypothesis by measuring tick abundance and the prevalence of tick-borne pathogens ( Coxiella burnetii and Rickettsia spp . ) within long-term, size-selective, large-herbivore exclosures replicated across a precipitation gradient in East Africa. Total wildlife exclusion increased total tick abundance by 130% (mesic sites) to 225% (dry, low-productivity sites), demonstrating a significant interaction of defaunation and aridity on tick abundance. When differing degrees of exclusion were tested for a subset of months, total tick abundance increased from 170% (only mega-herbivores excluded) to 360% (all large wildlife excluded). Wildlife exclusion differentially affected the abundance of the three dominant tick species, and this effect varied strongly over time, likely due to differences among species in their host associations, seasonality, and other ecological characteristics. Pathogen prevalence did not differ across wildlife exclusion treatments, rainfall levels, or tick species, suggesting that exposure risk will respond to defaunation and climate change in proportion to total tick abundance. These findings demonstrate interacting effects of defaunation and aridity that increase disease risk, and they highlight the need to incorporate ecological context when predicting effects of wildlife loss on zoonotic disease dynamics. © 2017 The Author(s).

The Breast-Thyroid Cancer Link: A Systematic Review and Meta-Analysis

PubMed Central

Nielsen, Sarah M.; White, Michael G.; Hong, Susan; Aschebrook-Kilfoy, Briseis; Kaplan, Edwin L.; Angelos, Peter; Kulkarni, Swati A.; Olopade, Olufunmilayo I.; Grogan, Raymon H.

2015-01-01

Rates of thyroid cancer in women with a history of breast cancer are higher than expected. Similarly, rates of breast cancer in those with a history of thyroid cancer are increased. Explanations for these associations include detection bias, shared hormonal risk factors, treatment effect, and genetic susceptibility. With increasing numbers of breast and thyroid cancer survivors clinicians should be particularly cognizant of this association. Here we perform a systematic review and meta-analysis of the literature utilizing PubMed and Scopus search engines to identify all publications studying the incidence of breast cancer as a secondary malignancy following a diagnosis of thyroid cancer or thyroid cancer following a diagnosis of breast cancer. This demonstrated an increased risk of thyroid cancer as a secondary malignancy following breast cancer (OR=1.55, 95% CI [1.44,1.67]) and an increased risk of breast cancer as a secondary malignancy following thyroid cancer (OR= 1.32, 95% CI [1.23,1.42]). There is a clear increase in the odds of developing either thyroid or breast cancer as a secondary malignancy after diagnosis with the other. Here we review this association and current hypothesis as to the cause of this correlation. PMID:26908594

Mortality in epilepsy.

PubMed

Hitiris, Nikolas; Mohanraj, Rajiv; Norrie, John; Brodie, Martin J

2007-05-01

All studies report an increased mortality risk for people with epilepsy compared with the general population. Population-based studies have demonstrated that the increased mortality is often related to the cause of the epilepsy. Common etiologies include neoplasia, cerebrovascular disease, and pneumonia. Deaths in selected cohorts, such as sudden unexpected death in epilepsy (SUDEP), status epilepticus (SE), suicides, and accidents are more frequently epilepsy-related. SUDEP is a particular cause for concern in younger people, and whether and when SUDEP should be discussed with patients with epilepsy remain problematic issues. Risk factors for SUDEP include generalized tonic-clonic seizures, increased seizure frequency, concomitant learning disability, and antiepileptic drug polypharmacy. The overall incidence of SE may be increasing, although case fatality rates remain constant. Mortality is frequently secondary to acute symptomatic disorders. Poor compliance with treatment in patients with epilepsy accounts for a small proportion of deaths from SE. The incidence of suicide is increased, particularly for individuals with epilepsy and comorbid psychiatric conditions. Late mortality figures in patients undergoing epilepsy surgery vary and are likely to reflect differences in case selection. Future studies of mortality should be prospective and follow agreed guidelines to better quantify risk and causation in individual populations.

High Stability Engine Control (HISTEC): Flight Demonstration Results

NASA Technical Reports Server (NTRS)

Delaat, John C.; Southwick, Robert D.; Gallops, George W.; Orme, John S.

1998-01-01

Future aircraft turbine engines, both commercial and military, must be able to accommodate expected increased levels of steady-state and dynamic engine-face distortion. The current approach of incorporating sufficient design stall margin to tolerate these increased levels of distortion would significantly reduce performance. The High Stability Engine Control (HISTEC) program has developed technologies for an advanced, integrated engine control system that uses measurement- based estimates of distortion to enhance engine stability. The resulting distortion tolerant control reduces the required design stall margin, with a corresponding increase in performance and/or decrease in fuel burn. The HISTEC concept was successfully flight demonstrated on the F-15 ACTIVE aircraft during the summer of 1997. The flight demonstration was planned and carried out in two parts, the first to show distortion estimation, and the second to show distortion accommodation. Post-flight analysis shows that the HISTEC technologies are able to successfully estimate and accommodate distortion, transiently setting the stall margin requirement on-line and in real-time. Flight demonstration of the HISTEC technologies has significantly reduced the risk of transitioning the technology to tactical and commercial engines.

Adverse Effects of the Common Treatments for Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis

PubMed Central

Domecq, Juan Pablo; Prutsky, Gabriela; Mullan, Rebecca J.; Sundaresh, Vishnu; Wang, Amy T.; Erwin, Patricia J.; Welt, Corrine; Ehrmann, David; Montori, Victor M.

2013-01-01

Context: Polycystic ovary syndrome (PCOS) is common among women of childbearing age and the available pharmacological therapies have different side-effect profiles. Objective: We summarized the evidence about the side effects of oral contraceptive pills, metformin, and anti-androgens in women with PCOS. Data Source: Sources included Ovid Medline, OVID EMBASE, OVID Cochrane Library, Web of Science, Scopus, PsycInfo, and CINAHL from inception through April 2011. Study Selection: We included comparative observational studies enrolling women with PCOS who received the agents of choice for at least 6 months and reported adverse effects. Data Extraction: Using a standardized, piloted, and Web-based data extraction form and working in duplicate, we abstracted data from each study and performed meta-analysis when possible. Data Synthesis: We found 22 eligible studies of which 20 were randomized. No study reported severe side effects (eg, lactic acidosis, thromboembolic episodes, liver toxicity, cancer incidence, or pregnancy loss). Meta-analysis demonstrated no significant change in weight in oral contraceptive pills or flutamide users. Indirect evidence from populations without PCOS demonstrated no increased risk of lactic acidosis with metformin, only case reports of liver toxicity with flutamide (no comparative evidence), and increased relative risk difference of venous thromboembolism with oral contraceptive pills but very low absolute risk. Evidence on mortality, cardiovascular mortality, and cancer was inconclusive. Conclusions: Drugs commonly used to treat PCOS appear to be associated with very low risk of severe adverse effects although data are extrapolated from other populations. PMID:24092830

Adverse effects of the common treatments for polycystic ovary syndrome: a systematic review and meta-analysis.

PubMed

Domecq, Juan Pablo; Prutsky, Gabriela; Mullan, Rebecca J; Sundaresh, Vishnu; Wang, Amy T; Erwin, Patricia J; Welt, Corrine; Ehrmann, David; Montori, Victor M; Murad, Mohammad Hassan

2013-12-01

Polycystic ovary syndrome (PCOS) is common among women of childbearing age and the available pharmacological therapies have different side-effect profiles. We summarized the evidence about the side effects of oral contraceptive pills, metformin, and anti-androgens in women with PCOS. Sources included Ovid Medline, OVID EMBASE, OVID Cochrane Library, Web of Science, Scopus, PsycInfo, and CINAHL from inception through April 2011. We included comparative observational studies enrolling women with PCOS who received the agents of choice for at least 6 months and reported adverse effects. Using a standardized, piloted, and Web-based data extraction form and working in duplicate, we abstracted data from each study and performed meta-analysis when possible. We found 22 eligible studies of which 20 were randomized. No study reported severe side effects (eg, lactic acidosis, thromboembolic episodes, liver toxicity, cancer incidence, or pregnancy loss). Meta-analysis demonstrated no significant change in weight in oral contraceptive pills or flutamide users. Indirect evidence from populations without PCOS demonstrated no increased risk of lactic acidosis with metformin, only case reports of liver toxicity with flutamide (no comparative evidence), and increased relative risk difference of venous thromboembolism with oral contraceptive pills but very low absolute risk. Evidence on mortality, cardiovascular mortality, and cancer was inconclusive. Drugs commonly used to treat PCOS appear to be associated with very low risk of severe adverse effects although data are extrapolated from other populations.

Renal Stone Risk During Space Flight

NASA Technical Reports Server (NTRS)

Whitson, Peggy A.; Pietrzyk, Robert A.; Sams, Clarence F.; Pak, Charles Y. C.; Jones, Jeffrey A.

1999-01-01

Space flight produces a number of metabolic and physiological changes in the crewmembers exposed to microgravity. Following launch, body fluid volumes, electrolyte levels, and bone and muscle undergo changes as the human body adapts to the weightless environment. Changes in the urinary chemical composition may lead to the potentially serious consequences of renal stone formation. Previous data collected immediately after space flight indicate changes in the urine chemistry favoring an increased risk of calcium oxalate and uric acid stone formation (n = 323). During short term Shuttle space flights, the changes observed include increased urinary calcium and decreased urine volume, pH and citrate resulting in a greater risk for calcium oxalate and brushite stone formation (n = 6). Results from long duration Shuttle/Mir missions (n = 9) followed a similar trend and demonstrated decreased fluid intake and urine volume and increased urinary calcium resulting in a urinary environment saturated with the calcium stone-forming salts. The increased risk occurs rapidly upon exposure to microgravity, continues throughout the space flight and following landing. Dietary factors, especially fluid intake, or pharmacologic intervention can significantly influence the urinary chemical composition. Increasing fluid intake to produce a daily urine output of 2 liters/day may allow the excess salts in the urine to remain in solution, crystals formation will not occur and a renal stone will not develop. Results from long duration crewmembers (n = 2) who had urine volumes greater than 2.5 L/day minimized their risk of renal stone formation. Also, comparisons of stone-forming risk in short duration crewmembers clearly identified greater risk in those who produced less than 2 liters of urine/day. However, hydration and increased urine output does not correct the underlying calcium excretion due to bone loss and only treats the symptoms and not the cause of the increased urinary salts. Dietary modification and promising pharmacologic treatments may also be used to reduce the potential risk for renal stone formation. Potassium citrate is being used clinically to increase the urinary inhibitor levels to minimize the development of crystals and the growth of renal stones. Bisphosphonates are a class of drugs recently shown to help in patients with osteoporosis by inhibiting the loss of bones in elderly patients. This drug could potentially prevent the bone loss observed in astronauts and thereby minimize the increase in urinary calcium and reduce the risk for renal stone development. Results of NASA's renal stone risk assessment program clearly indicate that exposure to microgravity changes the urinary chemical environment such that there is an increased risk for supersaturation of stone-forming salts, including calcium oxalaie and brushite. These studies have indicated specific avenues for development of countermeasures for the increased renal stone risk observed during and following space flight. Increased hydration and implementation of pharmacologic countermeasures should largely mitigate the in-flight risk of renal stones.

School burnout: increased sympathetic vasomotor tone and attenuated ambulatory diurnal blood pressure variability in young adult women.

PubMed

May, Ross W; Sanchez-Gonzalez, Marcos A; Fincham, Frank D

2015-01-01

Two studies examined autonomic and cardiovascular functioning that may link school burnout to cardiovascular risk factors in young healthy adult females. Study 1 (N = 136) investigated whether school burnout was related to resting values of blood pressure (BP) and blood pressure variability (BPV) through laboratory beat-to-beat BP assessment. Study 2 (N = 94) examined the link between school burnout and diurnal BPV through ambulatory BP monitoring. Controlling for anxiety and depressive symptomatology, school burnout demonstrated strong positive relationships with indices of cardiac sympathovagal tone, sympathetic vasomotor tone, inefficient myocardial oxygen consumption, increased 24-h ambulatory heart rate and BP, blunted BP diurnal variability, and increased arterial stiffness. These studies establish cardiovascular biomarkers of school burnout and suggest that even in a seemingly healthy sample school burnout may predispose females to increased cardiovascular risk. Several future lines of research are outlined.

Chronic consumption of a high-fat diet during pregnancy causes perturbations in the serotonergic system and increased anxiety-like behavior in nonhuman primate offspring.

PubMed

Sullivan, Elinor L; Grayson, Bernadette; Takahashi, Diana; Robertson, Nicola; Maier, Adriane; Bethea, Cynthia L; Smith, M Susan; Coleman, Kristine; Grove, Kevin L

2010-03-10

Childhood obesity is associated with increased risk of behavioral/psychological disorders including depression, anxiety, poor learning, and attention deficient disorder. As the majority of women of child-bearing age are overweight or obese and consume a diet high in dietary fat, it is critical to examine the consequences of maternal overnutrition on the development of brain circuitry that regulates offspring behavior. Using a nonhuman primate model of diet-induced obesity, we found that maternal high-fat diet (HFD) consumption caused perturbations in the central serotonergic system of fetal offspring. In addition, female infants from HFD-fed mothers exhibited increased anxiety in response to threatening novel objects. These findings have important clinical implications as they demonstrate that exposure to maternal HFD consumption during gestation, independent of obesity, increases the risk of developing behavioral disorders such as anxiety.

Chronic Consumption of a High Fat Diet During Pregnancy Causes Perturbations in the Serotonergic System and Increased Anxiety-like Behavior in Nonhuman Primate Offspring

PubMed Central

Sullivan, Elinor L.; Grayson, Bernadette; Takahashi, Diana; Robertson, Nicola; Maier, Adriane; Bethea, Cynthia L.; Smith, M. Susan; Coleman, Kristine; Grove, Kevin L.

2010-01-01

Childhood obesity is associated with increased risk of behavioral/psychological disorders including depression, anxiety, poor learning, and attention deficient disorder. As the majority of women of child-bearing age are overweight or obese and consume a diet high in dietary fat, it is critical to examine the consequences of maternal overnutrition on the development of brain circuitry that regulates offspring behavior. Using a nonhuman primate (NHP) model of diet-induced obesity, we found that maternal high-fat diet (HFD) consumption caused perturbations in the central serotonergic system of fetal offspring. In addition, female infants from HFD fed mothers exhibited increased anxiety in response to threatening novel objects. These findings have important clinical implications as they demonstrate that exposure to maternal HFD consumption during gestation, independent of obesity, increases the risk of developing behavioral disorders such as anxiety. PMID:20220017

Race/ethnicity, genetic ancestry, and breast cancer-related lymphedema in the Pathways Study.

PubMed

Kwan, Marilyn L; Yao, Song; Lee, Valerie S; Roh, Janise M; Zhu, Qianqian; Ergas, Isaac J; Liu, Qian; Zhang, Yali; Kutner, Susan E; Quesenberry, Charles P; Ambrosone, Christine B; Kushi, Lawrence H

2016-08-01

Breast cancer-related lymphedema (BCRL) is a serious chronic condition after breast cancer (BC) surgery and treatment. It is unclear if BCRL risk varies by race/ethnicity. In a multiethnic prospective cohort study of 2953 BC patients, we examined the association of self-reported BCRL status with self-reported race/ethnicity and estimated genetic ancestry. Hazard ratios (HR) and 95 % confidence intervals (CI) were calculated by multivariable Cox proportional hazards models, with follow-up starting 6 months post-BC diagnosis. Estimates were further stratified by body mass index (BMI). By 48 months of follow-up, 342 (11.6 %) women reported having BCRL. Younger age at BC diagnosis, higher BMI at baseline, and lower physical activity were associated with greater BCRL risk. African American (AA) women had a 2-fold increased risk of BCRL compared with White women (HR = 2.04; 95 % CI 1.35-3.08). African genetic ancestry was also associated with an increased risk (HR = 2.50; 95 % CI 1.43, 4.36). Both risks were attenuated but remained elevated after adjusting for known risk factors and became more pronounced when restricted to the nonobese women (adjusted HR = 2.31 for AA and HR = 3.70 for African ancestry, both p < 0.05). There was also evidence of increased BCRL risk with Hispanic ethnicity in the nonobese women. Nonobese AA women had a higher risk of BCRL than White women, which cannot be fully explained by known risk factors. This is the first large-scale, prospective study demonstrating differences in BCRL risk according to race/ethnicity as assessed by both self-report and genetic ancestry data, with a potential ancestry-obesity interaction.

Race/ethnicity, genetic ancestry, and breast cancer-related lymphedema in the Pathways Study

PubMed Central

Yao, Song; Lee, Valerie S.; Roh, Janise M.; Zhu, Qianqian; Ergas, Isaac J.; Liu, Qian; Zhang, Yali; Kutner, Susan E.; Quesenberry, Charles P.; Ambrosone, Christine B.; Kushi, Lawrence H.

2016-01-01

Breast cancer-related lymphedema (BCRL) is a serious chronic condition after breast cancer (BC) surgery and treatment. It is unclear if BCRL risk varies by race/ethnicity. In a multiethnic prospective cohort study of 2953 BC patients, we examined the association of self-reported BCRL status with self-reported race/ethnicity and estimated genetic ancestry. Hazard ratios (HR) and 95 % confidence intervals (CI) were calculated by multivariable Cox proportional hazards models, with follow-up starting 6 months post-BC diagnosis. Estimates were further stratified by body mass index (BMI). By 48 months of follow-up, 342 (11.6 %) women reported having BCRL. Younger age at BC diagnosis, higher BMI at baseline, and lower physical activity were associated with greater BCRL risk. African American (AA) women had a 2-fold increased risk of BCRL compared with White women (HR = 2.04; 95 % CI 1.35–3.08). African genetic ancestry was also associated with an increased risk (HR = 2.50; 95 % CI 1.43, 4.36). Both risks were attenuated but remained elevated after adjusting for known risk factors and became more pronounced when restricted to the nonobese women (adjusted HR = 2.31 for AA and HR = 3.70 for African ancestry, both p < 0.05). There was also evidence of increased BCRL risk with Hispanic ethnicity in the nonobese women. Nonobese AA women had a higher risk of BCRL than White women, which cannot be fully explained by known risk factors. This is the first large-scale, prospective study demonstrating differences in BCRL risk according to race/ethnicity as assessed by both self-report and genetic ancestry data, with a potential ancestry–obesity interaction. PMID:27449493

Predicting impacts of climate change on Fasciola hepatica risk.

PubMed

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

2011-01-10

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

Workplace exposure to passive smoking and risk of cardiovascular disease: summary of epidemiologic studies.

PubMed Central

Kawachi, I; Colditz, G A

1999-01-01

We reviewed the published epidemiologic studies addressing the relationship between workplace exposure to environmental tobacco smoke (ETS) and cardiovascular disease risk in three case-control studies and three cohort studies. Although the point estimates of risk for cardiovascular disease exceeded 1.0 in five of six studies, none of the relative risks was statistically significant because of the small number of cardiovascular end points occurring in individual studies. In common with most epidemiologic investigations of the health risks of ETS, none of the workplace studies included independent biochemical validation of ETS exposure. In contrast to the evidence on increased cardiovascular disease risk from exposure to spousal ETS, studies of ETS exposure in the workplace are still sparse and inconclusive. Conversely, there is no biologically plausible reason to believe that the hazards of ETS exposure that have been demonstrated in the home should not also apply to the workplace. PMID:10592141

Balance training reduces falls risk in older individuals with type 2 diabetes.

PubMed

Morrison, Steven; Colberg, Sheri R; Mariano, Mira; Parson, Henri K; Vinik, Arthur I

2010-04-01

This study assessed the effects of balance/strength training on falls risk and posture in older individuals with type 2 diabetes. Sixteen individuals with type 2 diabetes and 21 age-matched control subjects (aged 50-75 years) participated. Postural stability and falls risk was assessed before and after a 6-week exercise program. Diabetic individuals had significantly higher falls risk score compared with control subjects. The diabetic group also exhibited evidence of mild-to-moderate neuropathy, slower reaction times, and increased postural sway. Following exercise, the diabetic group showed significant improvements in leg strength, faster reaction times, decreased sway, and, consequently, reduced falls risk. Older individuals with diabetes had impaired balance, slower reactions, and consequently a higher falls risk than age-matched control subjects. However, all these variables improved after resistance/balance training. Together these results demonstrate that structured exercise has wide-spread positive effects on physiological function for older individuals with type 2 diabetes.

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

NASA Astrophysics Data System (ADS)

Whitley, Alison; Malloy, James; Chirouze, Manuel

2013-04-01

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

Alcohol consumption and risk of type 2 diabetes mellitus in Japanese: a systematic review.

PubMed

Seike, Nobuko; Noda, Mitsuhiko; Kadowaki, Takashi

2008-01-01

To evaluate the association between alcohol consumption and the risk for type 2 diabetes (DM) in Japanese. We searched the MEDLINE data base with the key words 'alcohol intake' (or 'alcohol consumption') and 'Japanese' cross-linked with 'diabetes mellitus' (or 'impaired glucose tolerance'). The reports we sought were restricted to prospective cohort studies, randomized controlled trials, meta-analyses and systematic reviews. Computerized and hand searches were conducted in June 2007. Seven prospective cohort studies were adopted. We previously reported that in lean Japanese men (BMI < or =22.0 kg/m2), moderate to heavy alcohol intake is a risk factor for diabetes. One study found heavy alcohol intake to be associated with an increased risk in low-BMI men while moderate alcohol intake was associated with a reduced risk in higher-BMI men. Another study suggested daily alcohol consumption to be a risk factor in low-BMI participants, while being protective in middle-BMI participants. Yet another study demonstrated a U-shaped association between alcohol consumption and the risk of diabetes in men. Three other studies, which did not divide the subjects in terms of BMI values, indicated alcohol intake to be an increased risk for diabetes, two being in men and one being in women, respectively. For a large number of Japanese men who have relatively low BMI, alcohol intake is an established risk factor for diabetes.

Cumulative Genetic Risk Predicts Platinum/Taxane-Induced Neurotoxicity

PubMed Central

McWhinney-Glass, Sarah; Winham, Stacey J.; Hertz, Daniel L.; Revollo, Jane Yen; Paul, Jim; He, Yijing; Brown, Robert; Motsinger-Reif, Alison A.; McLeod, Howard L.

2013-01-01

Purpose The combination of a platinum and taxane are standard of care for many cancers, but the utility is often limited due to debilitating neurotoxicity. We examined whether single nucleotide polymorphisms (SNPs) from annotated candidate genes will identify genetic risk for chemotherapy-induced neurotoxicity. Patients and Methods A candidate-gene association study was conducted to validate the relevance of 1261 SNPs within 60 candidate genes in 404 ovarian cancer patients receiving platinum/taxane chemotherapy on the SCOTROC1 trial. Statistically significant variants were then assessed for replication in a separate 404 patient replication cohort from SCOTROC1. Results Significant associations with chemotherapy-induced neurotoxicity were identified and replicated for four SNPs in SOX10, BCL2, OPRM1, and TRPV1. The Population Attributable Risk for each of the four SNPs ranged from 5–35%, with a cumulative risk of 62%. According to the multiplicative model, the odds of developing neurotoxicity increase by a factor of 1.64 for every risk genotype. Patients possessing 3 risk variants have an estimated odds ratio of 4.49 (2.36–8.54) compared to individuals with 0 risk variants. Neither the four SNPs nor the risk score were associated with progression free survival or overall survival. Conclusions This study demonstrates that SNPs in four genes have a significant cumulative association with increased risk for the development of chemotherapy-induced neurotoxicity, independent of patient survival. PMID:23963862

Understanding Genetic Breast Cancer Risk: Processing Loci of the BRCA Gist Intelligent Tutoring System

PubMed Central

Wolfe, Christopher R.; Reyna, Valerie F.; Widmer, Colin L.; Cedillos-Whynott, Elizabeth M.; Brust-Renck, Priscila G; Weil, Audrey M.; Hu, Xiangen

2016-01-01

The BRCA Gist Intelligent Tutoring System helps women understand and make decisions about genetic testing for breast cancer risk. BRCA Gist is guided by Fuzzy-Trace Theory, (FTT) and built using AutoTutor Lite. It responds differently to participants depending on what they say. Seven tutorial dialogues requiring explanation and argumentation are guided by three FTT concepts: forming gist explanations in one’s own words, emphasizing decision-relevant information, and deliberating the consequences of decision alternatives. Participants were randomly assigned to BRCA Gist, a control, or impoverished BRCA Gist conditions removing gist explanation dialogues, argumentation dialogues, or FTT images. All BRCA Gist conditions performed significantly better than controls on knowledge, comprehension, and risk assessment. Significant differences in knowledge, comprehension, and fine-grained dialogue analyses demonstrate the efficacy of gist explanation dialogues. FTT images significantly increased knowledge. Providing more elements in arguments against testing correlated with increased knowledge and comprehension. PMID:28008216

Understanding Genetic Breast Cancer Risk: Processing Loci of the BRCA Gist Intelligent Tutoring System.

PubMed

Wolfe, Christopher R; Reyna, Valerie F; Widmer, Colin L; Cedillos-Whynott, Elizabeth M; Brust-Renck, Priscila G; Weil, Audrey M; Hu, Xiangen

2016-07-01

The BRCA Gist Intelligent Tutoring System helps women understand and make decisions about genetic testing for breast cancer risk. BRCA Gist is guided by Fuzzy-Trace Theory, (FTT) and built using AutoTutor Lite. It responds differently to participants depending on what they say. Seven tutorial dialogues requiring explanation and argumentation are guided by three FTT concepts: forming gist explanations in one's own words, emphasizing decision-relevant information, and deliberating the consequences of decision alternatives. Participants were randomly assigned to BRCA Gist , a control, or impoverished BRCA Gist conditions removing gist explanation dialogues, argumentation dialogues, or FTT images. All BRCA Gist conditions performed significantly better than controls on knowledge, comprehension, and risk assessment. Significant differences in knowledge, comprehension, and fine-grained dialogue analyses demonstrate the efficacy of gist explanation dialogues. FTT images significantly increased knowledge. Providing more elements in arguments against testing correlated with increased knowledge and comprehension.

Hyperglycemia: a bad signature on the vascular system

PubMed Central

Costantino, Sarah; Paneni, Francesco

2015-01-01

Experimental work has clearly demonstrated that hyperglycemia is able to derail molecular pathways favouring oxidative stress, inflammation and endothelial dysfunction. Consistently, pooled analyses from prospective studies provide strong evidence that glycemic markers, namely glycated haemoglobin (HbA1c), predict cardiovascular risk, with an increase of about 18% in risk for each 1% absolute increase in HbA1c concentration, regardless of classical risk factors. Although the importance of hyperglycemic burden on cardiovascular phenotype, normalization of blood glucose levels in patients with long-standing hyperglycemia does not seem to reduce macrovascular complications. These data suggest that hyperglycemia may exert long-lasting detrimental effects on the cardiovascular system. This emerging phenomenon is defined metabolic or hyperglycemic memory to indicate a long-term persistence of hyperglycemic stress, even after blood glucose normalization. Here, we discuss clinical evidence and potential molecular mechanisms implicated in metabolic memory and, hence, diabetes-related cardiovascular complications. PMID:26543827

Post-traumatic Stress Disorder and Cardiovascular Disease.

PubMed

Burg, Matthew M; Soufer, Robert

2016-10-01

Post-traumatic stress disorder (PTSD) is a disabling condition that develops consequent to trauma exposure such as natural disasters, sexual assault, automobile accidents, and combat that independently increases risk for early incident cardiovascular disease (CVD) and cardiovascular (CV) mortality by over 50 % and incident hypertension risk by over 30 %. While the majority of research on PTSD and CVD has concerned initially healthy civilian and military veteran samples, emerging research is also demonstrating that PTSD consequent to the trauma of an acute cardiac event significantly increases risk for early recurrence and mortality and that patient experiences in the clinical pathway that are related to the emergency department environment may provide an opportunity to prevent PTSD onset and thus improve outcomes. Future directions for clinical and implementation science concern broad PTSD and trauma screening in the context of primary care medical environments and the testing of PTSD treatments with CVD-related surrogates and endpoints.

The variance of length of stay and the optimal DRG outlier payments.

PubMed

Felder, Stefan

2009-09-01

Prospective payment schemes in health care often include supply-side insurance for cost outliers. In hospital reimbursement, prospective payments for patient discharges, based on their classification into diagnosis related group (DRGs), are complemented by outlier payments for long stay patients. The outlier scheme fixes the length of stay (LOS) threshold, constraining the profit risk of the hospitals. In most DRG systems, this threshold increases with the standard deviation of the LOS distribution. The present paper addresses the adequacy of this DRG outlier threshold rule for risk-averse hospitals with preferences depending on the expected value and the variance of profits. It first shows that the optimal threshold solves the hospital's tradeoff between higher profit risk and lower premium loading payments. It then demonstrates for normally distributed truncated LOS that the optimal outlier threshold indeed decreases with an increase in the standard deviation.

Industrial Fungal Enzymes: An Occupational Allergen Perspective

PubMed Central

Green, Brett J.; Beezhold, Donald H.

2011-01-01

Occupational exposure to high-molecular-weight allergens is a risk factor for the development and pathogenesis of IgE-mediated respiratory disease. In some occupational environments, workers are at an increased risk of exposure to fungal enzymes used in industrial production. Fungal enzymes have been associated with adverse health effects in the work place, in particular in baking occupations. Exposure-response relationships have been demonstrated, and atopic workers directly handling fungal enzymes are at an increased risk for IgE-mediated disease and occupational asthma. The utilization of new and emerging fungal enzymes in industrial production will present new occupational exposures. The production of antibody-based immunoassays is necessary for the assessment of occupational exposure and the development of threshold limit values. Allergen avoidance strategies including personal protective equipment, engineering controls, protein encapsulation, and reduction of airborne enzyme concentrations are required to mitigate occupational exposure to fungal enzymes. PMID:21747869

Future prospects for contact factors as therapeutic targets

PubMed Central

Gailani, David

2015-01-01

Anticoagulants currently used in clinical practice to treat or prevent thromboembolic disease are effective, but place patients at increased risk for serious bleeding because they interfere with plasma enzymes (thrombin and factor Xa) that are essential for hemostasis. In the past 10 years, work with genetically altered mice and studies in baboons and rabbits have demonstrated that the plasma contact proteases factor XI, factor XII, and prekallikrein contribute to the formation of occlusive thrombi despite having limited roles in hemostasis. In the case of factor XI, epidemiologic data from human populations indicate that elevated levels of this protein increase risk for stroke and venous thromboembolism and may also influence risk for myocardial infarction. These findings suggest that inhibiting contact activation may produce an antithrombotic effect without significantly compromising hemostasis. This chapter reviews strategies that are being developed for therapeutic targeting of factor XI and factor XII and their performances in preclinical and early human trials. PMID:25696834

A variant in a cis-regulatory element enhances claudin-14 expression and is associated with pediatric-onset hypercalciuria and kidney stones.

PubMed

Ure, Megan E; Heydari, Emma; Pan, Wanling; Ramesh, Ajay; Rehman, Sabah; Morgan, Catherine; Pinsk, Maury; Erickson, Robin; Herrmann, Johannes M; Dimke, Henrik; Cordat, Emmanuelle; Lemaire, Mathieu; Walter, Michael; Alexander, R Todd

2017-06-01

The greatest risk factor for kidney stones is hypercalciuria, the etiology of which is largely unknown. A recent genome-wide association study (GWAS) linked hypercalciuria and kidney stones to a claudin-14 (CLDN14) risk haplotype. However, the underlying molecular mechanism was not delineated. Recently, renal CLDN14 expression was found to increase in response to increased plasma calcium, thereby inducing calciuria. We hypothesized therefore that some children with hypercalciuria and kidney stones harbor a CLDN14 variant that inappropriately increases gene expression. To test this hypothesis, we sequenced the CLDN14 risk haplotype in a cohort of children with idiopathic hypercalciuria and kidney stones. An intronic SNP was more frequent in affected children. Dual luciferase and cell-based assays demonstrated increased reporter or CLDN14 expression when this polymorphism was introduced. In silico studies predicted the SNP introduced a novel insulinoma-associated 1 (INSM1) transcription factor binding site. Consistent with this, repeating the dual luciferase assay in the presence of INSM1 further increased reporter expression. Our data suggest that children with the INSM1 binding site within the CLDN14 risk haplotype have a higher likelihood of hypercalciuria and kidney stones. Enhanced CLDN14 expression may play a role in the pathophysiology of their hypercalciuria. © 2017 Wiley Periodicals, Inc.

Loss of otolith function with age is associated with increased postural sway measures.

PubMed

Serrador, Jorge M; Lipsitz, Lewis A; Gopalakrishnan, Gosala S; Black, F Owen; Wood, Scott J

2009-11-06

Loss of balance and increased fall risk is a common problem associated with aging. Changes in vestibular function occur with aging but the contribution of reduced vestibular otolith function to fall risk remains unknown. We examined a population of 151 healthy individuals (aged 21-93) for both balance (sway measures) and ocular counter-rolling (OCR) function. We assessed balance function with eyes open and closed on a firm surface, eyes open and closed on a foam surface and OCR during +/-20 degree roll tilt at 0.005 Hz. Subjects demonstrated a significant age-related reduction in OCR and increase in postural sway. The effect of age on OCR was greater in females than males. The reduction in OCR was strongly correlated with the mediolateral measures of sway with eyes closed. This correlation was also present in the elderly group alone, suggesting that aging alone does not account for this effect. OCR decreased linearly with age and at a greater rate in females than males. This loss of vestibular otolith-ocular function is associated with increased mediolateral measures of sway which have been shown to be related to increased risk of falls. These data suggest a role for loss of otolith function in contributing to fall risk in the elderly. Further prospective, longitudinal studies are necessary to confirm these findings.

Quantifying Intracranial Aneurysm Wall Permeability for Risk Assessment Using Dynamic Contrast-Enhanced MRI: A Pilot Study.

PubMed

Vakil, P; Ansari, S A; Cantrell, C G; Eddleman, C S; Dehkordi, F H; Vranic, J; Hurley, M C; Batjer, H H; Bendok, B R; Carroll, T J

2015-05-01

Pathological changes in the intracranial aneurysm wall may lead to increases in its permeability; however the clinical significance of such changes has not been explored. The purpose of this pilot study was to quantify intracranial aneurysm wall permeability (K(trans), VL) to contrast agent as a measure of aneurysm rupture risk and compare these parameters against other established measures of rupture risk. We hypothesized K(trans) would be associated with intracranial aneurysm rupture risk as defined by various anatomic, imaging, and clinical risk factors. Twenty-seven unruptured intracranial aneurysms in 23 patients were imaged with dynamic contrast-enhanced MR imaging, and wall permeability parameters (K(trans), VL) were measured in regions adjacent to the aneurysm wall and along the paired control MCA by 2 blinded observers. K(trans) and VL were evaluated as markers of rupture risk by comparing them against established clinical (symptomatic lesions) and anatomic (size, location, morphology, multiplicity) risk metrics. Interobserver agreement was strong as shown in regression analysis (R(2) > 0.84) and intraclass correlation (intraclass correlation coefficient >0.92), indicating that the K(trans) can be reliably assessed clinically. All intracranial aneurysms had a pronounced increase in wall permeability compared with the paired healthy MCA (P < .001). Regression analysis demonstrated a significant trend toward an increased K(trans) with increasing aneurysm size (P < .001). Logistic regression showed that K(trans) also predicted risk in anatomic (P = .02) and combined anatomic/clinical (P = .03) groups independent of size. We report the first evidence of dynamic contrast-enhanced MR imaging-modeled contrast permeability in intracranial aneurysms. We found that contrast agent permeability across the aneurysm wall correlated significantly with both aneurysm size and size-independent anatomic risk factors. In addition, K(trans) was a significant and size-independent predictor of morphologically and clinically defined high-risk aneurysms. © 2015 by American Journal of Neuroradiology.

Dynamic balance control during stair negotiation for older adults and people with Parkinson disease.

PubMed

Conway, Zachary J; Blackmore, Tim; Silburn, Peter A; Cole, Michael H

2018-06-01

It is well understood that stability during ambulation is reliant upon appropriate control of the trunk segment, but research shows that the rhythmicity of this segment is significantly reduced for people with Parkinson's disease (PD). Given the increased risk associated with stair ambulation, this study investigated whether people with PD demonstrate poorer trunk control during stair ambulation compared with age-matched controls. Trunk accelerations were recorded for twelve PD patients and age-matched controls during stair ascent and descent. Accelerations were used to derive measures of harmonic ratios and root mean square (RMS) acceleration to provide insight into the rhythmicity and amplitude of segmental motion. Compared with what is typically seen during level-ground walking, gait rhythmicity during stair negotiation was markedly reduced for older adults and people with PD. Furthermore, both groups exhibited significantly poorer trunk movements during stair descent compared to stair ascent, suggesting that both populations may face a greater risk of falling during this task. As stair negotiation is a common activity of daily life, the increased risk associated with this task should be considered when working with populations that have an increased risk of falling. Copyright © 2018 Elsevier B.V. All rights reserved.

Sleep and youth suicidal behavior: a neglected field.

PubMed

Liu, Xianchen; Buysse, Daniel J

2006-05-01

Sleep undergoes substantial changes during adolescence and suicide risk begins to increase during this period as well. This review focuses on recent literature on the relationship between sleep and suicidal behavior and proposes directions for future research. Adolescent sleep is characterized by widespread sleep restriction, irregular sleep schedules, daytime sleepiness, and elevated risk for sleep disturbances. More research on adolescent sleep and psychosocial impairment, psychiatric disorders, and suicidal behavior has been conducted. Suicidal psychiatric patients had more sleep disturbances including insomnia, hypersomnia, or nightmares than nonsuicidal patients. Shorter rapid eye movement latency and increased rapid eye movement activity have been noted to be a marker of suicidality in psychiatric patients. Epidemiological studies have demonstrated that insomnia, nightmares, and sleep insufficiency are associated with elevated risk for suicide. Although the link between insomnia and suicidal behavior appears to be mediated by depression, existing data suggest an independent predictive role of nightmares in future suicidal behavior. Sleep loss or disturbances are likely to signal an increased risk of future suicidal action in adolescents. Large-scale prospective studies and neurobiological studies are needed for a better understanding of the complex relationship between sleep, psychopathology, and youth suicidal behavior.

Tailored community cancer education programs: Pawsox and prostates.

PubMed

Glicksman, Arvin S; Meyer, Andrea; Dipiero, Maureen

2010-06-01

To assess the prostate cancer screening practices in Rhode Island, we designed a questionnaire which was sent to 150 primary care physicians. A population-based survey was distributed to 194 men over 40 asking about screening history and risk factors. Eighty-five percent of primary care physicians reported performing annual prostate-specific antigen tests (PSAs) and digital rectal exams, 63% recognized family history as a risk factor, and 14% identified African Americans as a high-risk population. The survey found that 48% of men recognized family history as a risk factor and 6% understood that African Americans were at high risk. Each year, 200 men, primarily SED, are invited to a PawSox baseball game where physicians provide information on prostate cancer risk, treatment options, and outcomes. Free PSAs are provided. The questionnaire and survey demonstrate a need for more public education regarding prostate cancer in high-risk populations. Tailored community-based interventions, such as the Pawsox & Prostate program, can be effective professional and public education strategies to increase screening in high-risk populations.

Risk of Death for Veterans on Release From Prison

PubMed Central

Wortzel, Hal S.; Blatchford, Patrick; Conner, Latoya; Adler, Lawrence E.; Binswanger, Ingrid A.

2017-01-01

We sought to determine, among veterans released from Washington state prisons from 1999 through 2003, the risk of death from all causes, whether those veterans have faced a higher risk of death than have nonveterans, and whether having VA benefits decreased the risk of death. We linked data from a retrospective cohort study to data from the Veterans Benefit Administration. Mortality rates were compared between veteran and nonveteran former inmates. The crude rate of veteran mortality was 1,195 per 100,000 person-years, significantly higher than that of nonveterans (p < .001), but adjustment for demographic factors demonstrated no significant increased risk. VA benefits were associated with a reduced risk for all-cause deaths (hazard ratio, .376; 95% confidence interval, 0.18–0.79). Veterans share the heightened risk of death after release from prison faced by all released inmates and should be included in efforts to reduce the risks associated with transitioning from prison to the community. VA benefits appear to offer a protective effect, particularly against medical deaths. PMID:22960917

Longitudinal Study of Low Serum LDL and Depressive Symptom Onset in Postmenopause

PubMed Central

Persons, Jane E.; Robinson, Jennifer G.; Coryell, William H.; Payne, Martha E.; Fiedorowicz, Jess G.

2016-01-01

Objective The aim of this study was to characterize the relationship between serum low-density lipoprotein cholesterol (LDL-c) and subsequent depressive symptoms onset in postmenopausal women. We secondarily assessed serum high-density lipoprotein (HDL-c), total cholesterol, and triglycerides. Methods This population-based prospective cohort study utilizes data from 24,216 50-79 year old participants of the Women’s Health Initiative, which originally ran from 1993-2005 and has since incorporated two extension studies, with the most recent culminating in 2015. Fasting lipids were measured for all participants at baseline, and for a subset through six years of follow-up. Depressive symptoms were characterized using the Burnam eight-item scale for depressive disorders (Center for Epidemiologic Studies-Depression/Diagnostic Interview Schedule short form) at baseline and over follow-up, using a cutpoint of 0.06 to indicate presence of depressive symptoms. Results The lowest quintile of LDL-c was associated with an increased risk of subsequent depressive symptoms (HR=1.25, CI 1.05-1.49, p=0.01) and follow-up analyses demonstrated that the elevated risk appeared to be confined to the lowest decile (LDL-c <100 mg/dL). Further, this elevated risk was moderated by lipid-lowering drug treatment. Elevated risk was demonstrated among those who reported no lipid-lowering medication use (HR=1.23, CI 1.03-1.47, p=0.02), but not among those reporting use (HR=0.65, CI 0.18-2.29, p=0.50). Conclusion Among postmenopausal women, untreated serum LDL-c below 100 mg/dL was associated with an increased risk of developing depressive symptoms. No excess risk was observed in those attaining LDL-c <100 mg/dl with lipid-lowering therapy. These findings have important implications for risk assessment, treatment considerations, and mechanistic insight. PMID:26930520

Risk Assessment and Control through Countermeasure System Iplementation for Long-term Crew Exposure to Microgravity

NASA Technical Reports Server (NTRS)

Gernand, Jeremy M.

2004-01-01

Experience with the International Space Station (ISS) program demonstrates the degree to which engineering design and operational solutions must protect crewmembers from health risks due to long-term exposure to the microgravity environment. Risks to safety and health due to degradation in the microgravity environment include crew inability to complete emergency or nominal activities, increased risk of injury, and inability to complete safe return to the ground due to reduced strength or embrittled bones. These risks without controls slowly increase in probability for the length of the mission and become more significant for increasing mission durations. Countermeasures to microgravity include hardware systems that place a crewmember s body under elevated stress to produce an effect similar to daily exposure to gravity. The ISS countermeasure system is predominately composed of customized exercise machines. Historical treatment of microgravity countermeasure systems as medical research experiments unintentionally reduced the foreseen importance and therefore the capability of the systems to function in a long-term operational role. Long-term hazardous effects and steadily increasing operational risks due to non-functional countermeasure equipment require a more rigorous design approach and incorporation of redundancy into seemingly non- mission-critical hardware systems. Variations in the rate of health degradation and responsiveness to countermeasures among the crew population drastically increase the challenge for design requirements development and verification of the appropriate risk control strategy. The long-term nature of the hazards and severe limits on logistical re-supply mass, volume and frequency complicates assessment of hardware availability and verification of an adequate maintenance and sparing plan. Design achievement of medically defined performance requirements by microgravity countermeasure systems and incorporation of adequate failure tolerance significantly reduces these risks. Future implementation of on-site monitoring hardware for critical health parameters such as bone mineral density would allow greater responsiveness, efficiency, and optimized design of the countermeasures system.

Cancer Incidence in First- and Second-Degree Relatives of BRCA1 and BRCA2 Mutation Carriers.

PubMed

Streff, Haley; Profato, Jessica; Ye, Yuanqing; Nebgen, Denise; Peterson, Susan K; Singletary, Claire; Arun, Banu K; Litton, Jennifer K

2016-07-01

Mutations in the BRCA1 and BRCA2 genes are associated with increased risk of breast, ovarian, and several other cancers. The purpose of the present study was to evaluate the incidence of cancer in first- and second-degree relatives of BRCA mutation carriers compared with the general population. A total of 1,086 pedigrees of BRCA mutation carriers was obtained from a prospectively maintained, internal review board-approved study of persons referred for clinical genetic counseling at the University of Texas MD Anderson Cancer Center. We identified 9,032 first- and second-degree relatives from 784 pedigrees that had demonstrated a clear indication of parental origin of mutation. Standardized incidence ratios (SIRs) were used to compare the observed incidence of 20 primary cancer sites to the expected incidence of each cancer based on the calculated risk estimates according to each subject's age, sex, and ethnicity. BRCA1 families had increased SIRs for breast and ovarian cancer (p < .001) and decreased SIRs for kidney, lung, prostate, and thyroid cancer and non-Hodgkin's lymphoma (p < .001). BRCA2 families had increased SIRs for breast, ovarian, and pancreatic cancer (p < .001) and decreased SIRs for kidney, lung, thyroid, and uterine cancer and non-Hodgkin's lymphoma (p < .0025). Analysis of only first-degree relatives (n = 4,099) identified no decreased SIRs and agreed with the increased SIRs observed in the overall study population. We have confirmed previous reports of an association between breast, ovarian, and pancreatic cancers with BRCA mutations. Additional research to quantify the relative risks of these cancers for BRCA mutation carriers can help tailor recommendations for risk reduction and enhance genetic counseling. BRCA gene mutations have been well described to carry an increased risk of both breast and ovarian cancer. However, the implications and risks of other cancers continues to be investigated. Evaluating the risks for other cancers further is key in identifying and managing risk reduction strategies. ©AlphaMed Press.

Vulnerability Risk Index Profile for Elder Abuse in Community-Dwelling Population

PubMed Central

Dong, XinQi; Simon, Melissa A.

2013-01-01

Objectives Elder abuse is associated with increased morbidity and mortality. This study aims to develop a vulnerability index for elder abuse in a community-dwelling population. Design Population-based study Setting Geographically defined community in Chicago. Participants A population-based study was conducted in Chicago of community-dwelling older adults who participated in the Chicago Health and Aging Project (CHAP). Of the 8,157 participants in the CHAP study, 213 participants were reported to social services agency for suspected elder abuse. Measurements A vulnerability index for elder abuse was constructed from sociodemographic, health-related, and psychosocial factors. The outcomes of interest were reported and confirmed elder abuse. Logistic regression models were used to determine the accuracy of the index with respect to elder abuse outcomes. Results Out of the selected risk index for elder abuse, every one point increase in the 9 item vulnerability index items, there was a two fold increase in the risk for reported elder abuse (OR, 2.19 (2.00–2.40) and confirmed elder abuse (OR, 2.19 (1.94–2.47). Compared to the reference group, older adults with 3–4 vulnerability index items had increased risk for reported elder abuse (OR, 2.98 (1.98–4.49) and confirmed elder abuse (OR, 3.90, (2.07–7.36); and older adults with 5 or more risk index items, there was an 18 fold increase in risk for reported elder abuse (OR, 18.46 (12.15–28.04) and confirmed elder abuse (OR, 26.79 (14.18–50.61). Receiver Operating Characteristic (ROC) statistically derived curves for identifying reported elder abuse ranged between 0.77–0.84 and for predicting confirmed elder abuse ranged between 0.79–0.86. Conclusion The vulnerability risk index demonstrates value for identifying individuals at risk for elder abuse. Additional studies are needed to validate this index in other community dwelling populations. PMID:25180376

Assessing the potential adverse consequences of supplemental calcium on cardiovascular outcomes: should we change our approach to bone health?

PubMed

Rojas-Fernandez, Carlos H; Maclaughlin, Eric J; Dore, Naomi L; Ebsary, Sally

2012-05-01

To assess cardiovascular risks associated with supplemental calcium use to assist clinicians with evidence-based recommendations for patients who have, or who are at risk for, osteoporosis or osteopenia. Literature was accessed through December 2011 using MEDLINE, Cochrane Library, and International Pharmaceutical Abstracts using the terms calcium compounds and cardiovascular disease. In addition, reference citations from the publications identified were reviewed. All English-language articles were evaluated. Randomized controlled trials, observational studies, and meta-analyses were included. While supplemental calcium and vitamin D have been demonstrated to improve bone mineral density and decrease the risk of fractures, there have been recent reports that calcium supplements may increase the risk for cardiovascular events. Nine clinical trials and/or meta-analyses were reviewed; 3 documented increases in cardiovascular risk associated with calcium supplements, and 6 did not. No studies were designed to assess cardiovascular outcomes as primary end points. Balancing the evidence from these analyses with the results of randomized controlled trials assessing the effect of calcium on fracture prevention suggests that the benefits of calcium outweigh the cardiovascular risk. At this time, there is no cause to change routine practice surrounding supplemental calcium use in patients who have, or are at risk for, osteoporosis or osteopenia.

Is isomerism a risk factor for intestinal volvulus?

PubMed

Landisch, Rachel M; Loomba, Rohit S; Salazar, Jose H; Buelow, Matthew W; Frommelt, Michele; Anderson, Robert H; Wagner, Amy J

2018-03-06

Isomerism, or heterotaxy syndrome, affects many organ systems anatomically and functionally. Intestinal malrotation is common in patients with isomerism. Despite a low reported risk of volvulus, some physicians perform routine screening and prophylactic Ladd procedures on asymptomatic patients with isomerism who are found to have intestinal malrotation. The primary aim of this study was to determine if isomerism is an independent risk factor for volvulus. Kid's Inpatient Database data from 1997 to 2012 was utilized for this study. Characteristics of admissions with and without isomerism were compared with a particular focus on intestinal malrotation, volvulus, and Ladd procedure. A logistic regression was conducted to determine independent risk factors for volvulus with respect to isomerism. 15,962,403 inpatient admissions were included in the analysis, of which 7970 (0.05%) patients had isomerism, and 6 patients (0.1%) developed volvulus. Isomerism was associated with a 52-fold increase in the odds of intestinal malrotation by univariate analysis. Of 251 with isomerism and intestinal malrotation, only 2.4% experienced volvulus. Logistic regression demonstrated that isomerism was not an independent risk factor for volvulus. Isomerism is associated with an increased risk of intestinal malrotation but is not an independent risk factor for volvulus. Prognosis study. Level III. Copyright © 2018 Elsevier Inc. All rights reserved.

The influence of polygenic risk for bipolar disorder on neural activation assessed using fMRI

PubMed Central

Whalley, H C; Papmeyer, M; Sprooten, E; Romaniuk, L; Blackwood, D H; Glahn, D C; Hall, J; Lawrie, S M; Sussmann, Je; McIntosh, A M

2012-01-01

Genome-wide association studies (GWAS) have demonstrated a significant polygenic contribution to bipolar disorder (BD) where disease risk is determined by the summation of many alleles of small individual magnitude. Modelling polygenic risk scores may be a powerful way of identifying disrupted brain regions whose genetic architecture is related to that of BD. We determined the extent to which common genetic variation underlying risk to BD affected neural activation during an executive processing/language task in individuals at familial risk of BD and healthy controls. Polygenic risk scores were calculated for each individual based on GWAS data from the Psychiatric GWAS Consortium Bipolar Disorder Working Group (PGC-BD) of over 16 000 subjects. The familial group had a significantly higher polygene score than the control group (P=0.04). There were no significant group by polygene interaction effects in terms of association with brain activation. However, we did find that an increasing polygenic risk allele load for BD was associated with increased activation in limbic regions previously implicated in BD, including the anterior cingulate cortex and amygdala, across both groups. The findings suggest that this novel polygenic approach to examine brain-imaging data may be a useful means of identifying genetically mediated traits mechanistically linked to the aetiology of BD. PMID:22760554

Uptake of prenatal diagnostic testing and the effectiveness of prenatal screening for Down syndrome.

PubMed

Jaques, Alice M; Collins, Veronica R; Muggli, Evelyne E; Amor, David J; Francis, Ivan; Sheffield, Leslie J; Halliday, Jane L

2010-06-01

To map prenatal screening and diagnostic testing pathways in Victorian pregnant women during 2003 to 2004; measure the impact of prenatal diagnostic testing uptake on the effectiveness of prenatal screening for Down syndrome; and assess factors influencing uptake of diagnostic testing following screening. State-wide data collections of prenatal screening and diagnostic tests were linked to all Victorian births and pregnancy terminations for birth defects. Overall, 52% of women had a prenatal test (65 692/126 305); screening (44.9%), diagnostic testing (3.9%), or both (3.2%). Uptake of diagnostic testing was 71.4% (2390/3349) after an increased risk screen result, and 2.5% (1381/54 286) after a low risk result. Variation in uptake of diagnostic testing reduced the effectiveness of the screening program by 11.2%: from 87.4% (sensitivity - 125/143) to 76.2% (prenatal diagnoses of Down syndrome - 109/143). In both the increased and low risk groups, uptake was influenced by absolute numerical risk, as well as by the change in numerical risk from a priori risk. This comprehensive follow-up demonstrates clearly that numerical risk is being used to aid in decision making about confirmatory diagnostic testing. Collectively, these fundamental individual decisions will impact on the overall effectiveness of screening programmes for Down syndrome.

Cybervictimization of Young People With an Intellectual or Developmental Disability: Risks Specific to Sexual Solicitation.

PubMed

Normand, Claude L; Sallafranque-St-Louis, François

2016-03-01

Studies demonstrate that youth are vulnerable to online sexual solicitation. However, no study has estimated this risk for youth diagnosed with an intellectual or developmental disability (IDD). A literature review of the risk factors associated with online sexual solicitation in youths was done using electronic databases, such as PsychInFO, ERIC, MEDLINE and Scopus. Fifty-seven published papers were found relevant. However, only two pertained to the population with IDD. Sexual and physical abuse, social isolation, loneliness, depression, and chatting were found to increase the risk of being prey to sexual solicitation on the Internet. Many of these risk factors are even more prevalent in youth with IDD than in the general population. Recommendations are made for future research to help understand and prevent sexual cybersolicitation. © 2015 John Wiley & Sons Ltd.

The Effect on Melanoma Risk of Genes Previously Associated With Telomere Length

PubMed Central

Bishop, D. Timothy; Taylor, John C.; Hayward, Nicholas K.; Brossard, Myriam; Cust, Anne E.; Dunning, Alison M.; Lee, Jeffrey E.; Moses, Eric K.; Akslen, Lars A.; Andresen, Per A.; Avril, Marie-Françoise; Azizi, Esther; Scarrà, Giovanna Bianchi; Brown, Kevin M.; Dębniak, Tadeusz; Elder, David E.; Friedman, Eitan; Ghiorzo, Paola; Gillanders, Elizabeth M.; Goldstein, Alisa M.; Gruis, Nelleke A.; Hansson, Johan; Harland, Mark; Helsing, Per; Hočevar, Marko; Höiom, Veronica; Ingvar, Christian; Kanetsky, Peter A.; Landi, Maria Teresa; Lang, Julie; Lathrop, G. Mark; Lubiński, Jan; Mackie, Rona M.; Martin, Nicholas G.; Molven, Anders; Montgomery, Grant W.; Novaković, Srdjan; Olsson, Håkan; Puig, Susana; Puig-Butille, Joan Anton; Radford-Smith, Graham L.; Randerson-Moor, Juliette; van der Stoep, Nienke; van Doorn, Remco; Whiteman, David C.; MacGregor, Stuart; Pooley, Karen A.; Ward, Sarah V.; Mann, Graham J.; Amos, Christopher I.; Pharoah, Paul D. P.; Demenais, Florence; Law, Matthew H.; Newton Bishop, Julia A.; Barrett, Jennifer H.

2014-01-01

Telomere length has been associated with risk of many cancers, but results are inconsistent. Seven single nucleotide polymorphisms (SNPs) previously associated with mean leukocyte telomere length were either genotyped or well-imputed in 11108 case patients and 13933 control patients from Europe, Israel, the United States and Australia, four of the seven SNPs reached a P value under .05 (two-sided). A genetic score that predicts telomere length, derived from these seven SNPs, is strongly associated (P = 8.92x10-9, two-sided) with melanoma risk. This demonstrates that the previously observed association between longer telomere length and increased melanoma risk is not attributable to confounding via shared environmental effects (such as ultraviolet exposure) or reverse causality. We provide the first proof that multiple germline genetic determinants of telomere length influence cancer risk. PMID:25231748

Relationships among trust in messages, risk perception, and risk reduction preferences based upon avian influenza in Taiwan.

PubMed

Fang, David; Fang, Chen-Ling; Tsai, Bi-Kun; Lan, Li-Chi; Hsu, Wen-Shan

2012-08-01

Improvements in communications technology enable consumers to receive information through diverse channels. In the case of avian influenza, information repeated by the mass media socially amplifies the consumer awareness of risks. Facing indeterminate risks, consumers may feel anxious and increase their risk perception. When consumers trust the information published by the media, their uncertainty toward avian influenza may decrease. Consumers might take some actions to reduce risk. Therefore, this study focuses on relationships among trust in messages, risk perception and risk reduction preferences. This study administered 525 random samples and consumer survey questionnaires in different city of Taiwan in 2007. Through statistical analysis, the results demonstrate: (1) the higher the trust consumers have in messages about avian influenza, the lower their risk perceptions are; (2) the higher the consumers' risk perceptions are and, therefore, the higher their desired level of risk reductive, the more likely they are to accept risk reduction strategies; (3) consumer attributes such as age, education level, and marital status correlate with significant differences in risk perception and risk reduction preferences acceptance. Gender has significant differences only in risk reduction preferences and not in risk perception.

Relationships among Trust in Messages, Risk Perception, and Risk Reduction Preferences Based upon Avian Influenza in Taiwan

PubMed Central

Fang, David; Fang, Chen-Ling; Tsai, Bi-Kun; Lan, Li-Chi; Hsu, Wen-Shan

2012-01-01

Improvements in communications technology enable consumers to receive information through diverse channels. In the case of avian influenza, information repeated by the mass media socially amplifies the consumer awareness of risks. Facing indeterminate risks, consumers may feel anxious and increase their risk perception. When consumers trust the information published by the media, their uncertainty toward avian influenza may decrease. Consumers might take some actions to reduce risk. Therefore, this study focuses on relationships among trust in messages, risk perception and risk reduction preferences. This study administered 525 random samples and consumer survey questionnaires in different city of Taiwan in 2007. Through statistical analysis, the results demonstrate: (1) the higher the trust consumers have in messages about avian influenza, the lower their risk perceptions are; (2) the higher the consumers’ risk perceptions are and, therefore, the higher their desired level of risk reductive, the more likely they are to accept risk reduction strategies; (3) consumer attributes such as age, education level, and marital status correlate with significant differences in risk perception and risk reduction preferences acceptance. Gender has significant differences only in risk reduction preferences and not in risk perception. PMID:23066394

Castroviejo Lecture 2009: 40 years in search of the perfect contact lens.

PubMed

Cavanagh, H Dwight; Robertson, Danielle M; Petroll, W Matthew; Jester, James V

2010-10-01

To identify the pathophysiological changes produced by contact lens wear that predispose the cornea to infection and search for prospective modifiable risk factors that could reduce the incidence of this critical complication in millions of patients worldwide. Significant experimental and clinical publications are reviewed, and the results of ongoing studies are presented. Pseudomonas aeruginosa (PA) is the most common pathogen causing lens-related infectious keratitis over 3 decades. Contact lens wear can increase the risk of infection by increasing surface cell PA binding, thereby promoting invasion between broken tight junctions and initiating direct intracellular invasion mediated by lens-induced membrane lipid rafts. Prevention of upregulation of specific surface-binding receptors for PA with concomitant increase in infection risk is a zero damage game where independent interactions among lens type, mode of wear, oxygen transmissibility, polymer, and toxic effects of associated care solutions ideally should collectively produce no increased ability for PA to attach and/or to invade, thus minimizing the risk for lens-associated infections. The specific hypothesis tested is, "no increased epithelial surface damage... no increased PA binding or invasion... no increased risk for infection." Testing of this new paradigm has been performed in vitro and in animal and human clinical trials and correlated clinically with relative risk results from robust current epidemiological studies. Results to date clearly support the use of lens-related increases in PA binding (bench) as a noninvasive clinical predictor of risk for lens-related infection in subsequent large-scale population studies (bedside). Currently, results suggest that use of common commercial multipurpose lens care solutions with soft lenses may alone significantly increase infection risk by enhancing lens-related PA binding as compared with use of nonpreserved solutions (hydrogen peroxide). Clinical testing also shows that only peroxide solutions show significant disinfection capability against amoebic cysts. Further case-control studies to examine relative risk for infection by lens type and lens care solution are urgently needed. Millions of patients are dependent on contact lenses for vision worldwide; over 3 decades, lens use has increased, although risk for lens-related infection has remained stubbornly unchanged. Unfortunately, recent introduction of a new generation of hyper-oxygen transmissible lenses used with traditional multipurpose lens care solutions has not lowered overall risks for lens-related infections; however, similar lenses used with nonpreserved care solutions (peroxide) recently demonstrated no significant increases in PA binding in a 1-year clinical trial. Collectively, these findings along with the urgent need for amoebic cysticidal disinfection have led to a current recommendation to patients to use nonpreserved (hydrogen peroxide) care solutions in soft lens wear.

Challenges in risk estimation using routinely collected clinical data: The example of estimating cervical cancer risks from electronic health-records.

PubMed

Landy, Rebecca; Cheung, Li C; Schiffman, Mark; Gage, Julia C; Hyun, Noorie; Wentzensen, Nicolas; Kinney, Walter K; Castle, Philip E; Fetterman, Barbara; Poitras, Nancy E; Lorey, Thomas; Sasieni, Peter D; Katki, Hormuzd A

2018-06-01

Electronic health-records (EHR) are increasingly used by epidemiologists studying disease following surveillance testing to provide evidence for screening intervals and referral guidelines. Although cost-effective, undiagnosed prevalent disease and interval censoring (in which asymptomatic disease is only observed at the time of testing) raise substantial analytic issues when estimating risk that cannot be addressed using Kaplan-Meier methods. Based on our experience analysing EHR from cervical cancer screening, we previously proposed the logistic-Weibull model to address these issues. Here we demonstrate how the choice of statistical method can impact risk estimates. We use observed data on 41,067 women in the cervical cancer screening program at Kaiser Permanente Northern California, 2003-2013, as well as simulations to evaluate the ability of different methods (Kaplan-Meier, Turnbull, Weibull and logistic-Weibull) to accurately estimate risk within a screening program. Cumulative risk estimates from the statistical methods varied considerably, with the largest differences occurring for prevalent disease risk when baseline disease ascertainment was random but incomplete. Kaplan-Meier underestimated risk at earlier times and overestimated risk at later times in the presence of interval censoring or undiagnosed prevalent disease. Turnbull performed well, though was inefficient and not smooth. The logistic-Weibull model performed well, except when event times didn't follow a Weibull distribution. We have demonstrated that methods for right-censored data, such as Kaplan-Meier, result in biased estimates of disease risks when applied to interval-censored data, such as screening programs using EHR data. The logistic-Weibull model is attractive, but the model fit must be checked against Turnbull non-parametric risk estimates. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

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.

Effect of antiretroviral therapy use and adherence on the risk of hyperlipidemia among HIV-infected patients, in the highly active antiretroviral therapy era

PubMed Central

Tsai, Fuu-Jen; Cheng, Chi-Fung; Lai, Chih-Ho; Wu, Yang-Chang; Ho, Mao-Wang; Wang, Jen-Hsien; Tien, Ni; Liu, Xiang; Tsang, Hsinyi; Lin, Ting-Hsu; Liao, Chiu-Chu; Huang, Shao-Mei; Li, Ju-Pi; Lin, Jung-Chun; Lin, Chih-Chien; Chen, Jin-Hua; Liang, Wen-Miin; Lin, Ying-Ju

2017-01-01

HIV-infected patients exposed to antiretroviral therapy (ART) have an increased risk for hyperlipidemia and cardiovascular disease. We performed a longitudinal, comprehensive, and population-based study to investigate the cumulative effect of different types of ART regimens on hyperlipidemia risk in the Taiwanese HIV/ART cohort. A total of 13,370 HIV-infected patients (2,674 hyperlipidemia and 10,696 non-hyperlipidemia patients) were recruited after matching for age, gender, and the first diagnosis date of HIV infection by using the National Health Insurance Research Database in Taiwan. Hyperlipidemia risk associated with cumulative ART use, ART adherence, and their combination was assessed. The matched hyperlipidemia group had a larger number of patients using ART and a higher incidence of comorbidities, specifically, respiratory disease and diabetes. Patients with high ART dosage and dose-dependent manner adherence, respectively, demonstrated an increased risk of hyperlipidemia. For single ART regimens, patients receiving nucleoside reverse-transcriptase inhibitors (NRTI/NRTI)- containing regimen had the highest hyperlipidemia risk, followed by protease inhibitor (PI)- containing and non-NRTI- containing regimens. For combination ART regimens, patients receiving a NRTI/NRTI + PI regimen had the highest hyperlipidemia risk. An increased cumulative drug dose was observed in patients who received the PI, NRTI/NRTI, NRTI, and NNRTI regimens in the hyperlipidemia group, when compared to the non-hyperlipidemia group. In conclusion, ART cumulative use, adherence, and regimen may affect hyperlipidemia risk among HIV-infected patients in a dose-dependent manner. PMID:29290955

Drawing the line on the sand

NASA Astrophysics Data System (ADS)

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

2016-02-01

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

Dietary and stored iron as predictors of breast cancer risk: A nested case-control study in Shanghai.

PubMed

Moore, Amber B; Shannon, Jackilen; Chen, Chu; Lampe, Johanna W; Ray, Roberta M; Lewis, Sharon K; Lin, Minggang; Stalsberg, Helge; Thomas, David B

2009-09-01

Increases in risk of breast cancer in successive generations of migrants to the United States from China and rapid temporal changes in incidence rates in China following social and economic changes clearly implicate environmental factors in the etiology of this disease. Case-control and cohort studies have provided evidence that at least some of these factors may be dietary. Iron, an essential element necessary for cell function, has also been demonstrated to have potential carcinogenic and co-carcinogenic activities. Iron overload, which was previously uncommon, has become more common in the United States than iron deficiency and may be increasing in China concurrently with dramatic increases in meat consumption. A case-control study nested in a cohort of women in Shanghai, China, was conducted to evaluate possible associations between risk of proliferative and nonproliferative fibrocystic changes as well as breast cancer and dietary iron intake and plasma ferritin levels. Plasma ferritin levels and reported dietary iron intake were compared in 346 women with fibrocystic changes, 248 breast cancer cases and 1,040 controls. Increasing ferritin levels were significantly associated with increasing risk of nonproliferative fibrocystic changes (OR: 2.51, 95% CI: 1.16-5.45, p trend = 0.04). Similar, but weaker, trends were observed for proliferative changes and for breast cancer. Risk of breast cancer relative to the risk of fibrocystic changes was associated with dietary iron intake in women with nonproliferative fibrocystic changes (OR: 2.63, 95% CI: 1.04-6.68, p = 0.02). In conclusion, this study finds significant associations between iron (stored and dietary) and fibrocystic disease and breast cancer. 2009 UICC.

Risk of Adverse Health Effects Due to Host-Microorganism Interactions

NASA Technical Reports Server (NTRS)

Ott, C. Mark; Oubre, Cherie; Castro, Sarah; Mehta, Satish; Pierson, Duane

2015-01-01

While preventive measures limit the presence of many medically significant microorganisms during spaceflight missions, microbial infection of crewmembers cannot be completely prevented. Spaceflight experiments over the past 50 years have demonstrated a unique microbial response to spaceflight culture, although the mechanisms behind those responses and their operational relevance were unclear. In 2007, the operational importance of these microbial responses was emphasized as the results of an experiment aboard STS-115 demonstrated that the enteric pathogen Salmonella enterica serovar Typhimurium (S. Typhimurium) increased in virulence in a murine model of infection. The experiment was reproduced in 2008 aboard STS-123 confirming this finding. In response to these findings, the Institute of Medicine of the National Academies recommended that NASA investigate this risk and its potential impact on the health of the crew during spaceflight. NASA assigned this risk to the Human Research Program. To better understand this risk, evidence has been collected and reported from both spaceflight analog systems and actual spaceflight. Although the performance of virulence studies during spaceflight are challenging and often impractical, additional information has been and continues to be collected to better understand the risk to crew health. Still, the uncertainty concerning the extent and severity of these alterations in host-microorganism interactions is very large and requires more investigation.

Effects of the Communities That Care Model in Pennsylvania on Change in Adolescent Risk and Problem Behaviors

PubMed Central

Jones, Damon; Greenberg, Mark T.; Osgood, D. Wayne; Bontempo, Daniel

2015-01-01

Despite the public health burden of adolescent substance use, delinquency, and other problem behavior, few comprehensive models of disseminating evidence-based prevention programs to communities have demonstrated positive youth outcomes at a population level, capacity to maintain program fidelity, and sustainability. We examined whether the Communities That Care (CTC; Hawkins and Catalano 1992) model had a positive impact on risk/protective factors and academic and behavioral outcomes among adolescents in a quasi-experimental effectiveness study. We conducted a longitudinal study of CTC in Pennsylvania utilizing biannual surveillance data collected through anonymous in-school student surveys. We utilized multilevel models to examine CTC impact on change in risk/protective factors, grades, delinquency, and substance use over time. Youth in CTC communities demonstrated less growth in delinquency, but not substance use, than youth in non-CTC communities. Levels of risk factors increased more slowly, and protective factors and academic performance decreased more slowly, among CTC community grade-cohorts that were exposed to evidence-based, universal prevention programs than comparison grade cohorts. Community coalitions can affect adolescent risk and protective behaviors at a population level when evidence-based programs are utilized. CTC represents an effective model for disseminating such programs. PMID:20020209

Racial/Ethnic Inequities in Low Birth Weight and Preterm Birth: The Role of Multiple Forms of Stress.

PubMed

Almeida, Joanna; Bécares, Laia; Erbetta, Kristin; Bettegowda, Vani R; Ahluwalia, Indu B

2018-02-13

Introduction Racial/ethnic inequities in low birth weight (LBW) and preterm birth (PTB) persist in the United States. Research has identified numerous risk factors for adverse birth outcomes; however, they do not fully explain the occurrence of, or inequalities in PTB/LBW. Stress has been proposed as one explanation for differences in LBW and PTB by race/ethnicity. Methods Using the Pregnancy Risk Assessment Monitoring System (PRAMS) data from 2012 to 2013 for 21 states and one city (n = 15,915) we used Poisson regression to estimate the association between acute, financial and relationship stressors and LBW and PTB, and to examine the contribution of these stressors individually and simultaneously to racial/ethnic differences in LBW and PTB. Results Adjusting for age and race/ethnicity, acute (p < 0.001), financial (p < 0.001) and relationship (p < 0.05) stressors were associated with increased risk of LBW, but only acute (p < 0.05) and financial (p < 0.01) stress increased risk of PTB. Across all models, non-Hispanic blacks had higher risk of LBW and PTB relative to non-Hispanic whites (IRR 1.87, 95% CI 1.55, 2.27 and IRR 1.46, 95% CI 1.18, 1.79). Accounting for the effects of stressors attenuated the risk of LBW and PTB by 17 and 22% respectively, but did not fully explain the increased likelihood of LBW and PTB among non-Hispanic blacks. Discussion Results of this study demonstrate that stress may increase the risk of LBW and PTB. While stressors may contribute to racial/ethnic differences in LBW and PTB, they do not fully explain them. Mitigating stress during pregnancy may help promote healthier birth outcomes and reduce racial/ethnic inequities in LBW and PTB.

Association Between Allogeneic Blood Transfusion and Postoperative Infection in Major Spine Surgery.

PubMed

Fisahn, Christian; Jeyamohan, Shiveindra; Norvell, Daniel C; Tubbs, Richard S; Moisi, Marc; Chapman, Jens R; Page, Jeni; Oskouian, Rod J

2017-08-01

Retrospective cohort study. The objective of this study is to compare the incidence of infection in patients who do and do not receive blood transfusions in major deformity surgery (>8 levels). Postoperative infections increase morbidity and mortality rates in spine surgery and generate additional costs for the health care system. It has been proposed that blood transfusions increase the risk of wound infection, urinary tract infection, pneumonia, and sepsis. A total of 56 patients met the study criteria, receiving spine surgery involving the fusion of 8 levels or more. Patient-specific characteristics, starting and ending hematocrits, number of units transfused and infections including urinary tract infection, wound infection, pneumonia, and sepsis were documented. Differences in infection risk between those who did and did not undergo a transfusion and their 95% confidence intervals were calculated. Groups were similar with respect to baseline and surgical characteristics except for smoking status, operative time, estimated blood loss, and ending hematocrit. The overall infection rate was greater in patients who underwent transfusion than those who did not (36% vs. 10%; P=0.03). Wound infections (n=5) were only observed in those who underwent a transfusion. Smokers were more likely to receive a transfusion and more likely to experience infection. A stratified analysis demonstrated an increased risk of infection associated with transfusion; however, the risk was greater in smokers, suggesting the effect of transfusion on infection could be modified by smoking. Patients undergoing transfusion experienced a significantly longer hospital stay (P=0.01). Allogeneic red blood cell transfusion in major spine surgery could be a risk factor for postoperative infection. This increased risk seems to be magnified in those who smoke. Further studies are warranted, and risks of blood loss and transfusion-related complications in smokers also potentially merit exploration. Level 3.

Increased Small-World Network Topology Following Deployment-Acquired Traumatic Brain Injury Associated with the Development of Post-Traumatic Stress Disorder.

PubMed

Rowland, Jared A; Stapleton-Kotloski, Jennifer R; Dobbins, Dorothy L; Rogers, Emily; Godwin, Dwayne W; Taber, Katherine H

2018-05-01

Cross-sectional and longitudinal studies in active duty and veteran cohorts have both demonstrated that deployment-acquired traumatic brain injury (TBI) is an independent risk factor for developing post-traumatic stress disorder (PTSD), beyond confounds such as combat exposure, physical injury, predeployment TBI, and pre-deployment psychiatric symptoms. This study investigated how resting-state brain networks differ between individuals who developed PTSD and those who did not following deployment-acquired TBI. Participants included postdeployment veterans with deployment-acquired TBI history both with and without current PTSD diagnosis. Graph metrics, including small-worldness, clustering coefficient, and modularity, were calculated from individually constructed whole-brain networks based on 5-min eyes-open resting-state magnetoencephalography (MEG) recordings. Analyses were adjusted for age and premorbid IQ. Results demonstrated that participants with current PTSD displayed higher levels of small-worldness, F(1,12) = 5.364, p < 0.039, partial eta squared = 0.309, and Cohen's d = 0.972, and clustering coefficient, F(1, 12) = 12.204, p < 0.004, partial eta squared = 0.504, and Cohen's d = 0.905, than participants without current PTSD. There were no between-group differences in modularity or the number of modules present. These findings are consistent with a hyperconnectivity hypothesis of the effect of TBI history on functional networks rather than a disconnection hypothesis, demonstrating increased levels of clustering coefficient rather than a decrease as might be expected; however, these results do not account for potential changes in brain structure. These results demonstrate the potential pathological sequelae of changes in functional brain networks following deployment-acquired TBI and represent potential neurobiological changes associated with deployment-acquired TBI that may increase the risk of subsequently developing PTSD.

Joint Effects of Exposure to Prenatal Infection and Peripubertal Psychological Trauma in Schizophrenia

PubMed Central

Debost, Jean-Christophe P. G.; Larsen, Janne Tidselbak; Munk-Olsen, Trine; Mortensen, Preben Bo; Meyer, Urs; Petersen, Liselotte

2017-01-01

Context: Prenatal infection and traumatizing experiences have both been linked with schizophrenia, but none of these factors seem sufficient to cause the disorder. However, recent evidence suggests that these environmental insults act in synergy to increase schizophrenia risk. Objective: To estimate the independent and joint effects of exposure to prenatal infection and peripubertal psychological trauma on the risk of schizophrenia. Design: Danish nationwide registers were linked in this prospective cohort study. We used survival analysis to report incidence rate ratios (IRRs) and corresponding 95% confidence intervals (95% CIs). Analyses were adjusted for age and calendar period and stratified by sex. Participants: A total of 979701 persons born between 1980 and 1998 were followed up from January 1, 1995 through December 31, 2013, with 9656 having a hospital contact for schizophrenia. Results: Females exposed to prenatal infection had a significantly increased risk of schizophrenia (IRR: 1.61, 95% CI: 1.30–2.00), but not males (IRR: 0.99, 95% CI: 0.77–1.28). Peripubertal trauma was associated with increased risk in both sexes. Males, however, had a significantly higher risk of schizophrenia after exposure to both prenatal infection and peripubertal psychological trauma (IRR: 2.85, 95% CI: 2.32–3.51), with significant interaction between infection and peripubertal trauma on the multiplicative scale (P = .007). Conclusions: Our study demonstrated for the first time that prenatal infection and psychological trauma in peripubertal life can act in synergy to increase the risk of schizophrenia, with a potentially stronger susceptibility in males. PMID:27343007

Safety in Numbers: Are Major Cities the Safest Places in the United States?

PubMed Central

Myers, Sage R.; Branas, Charles C.; French, Benjamin C.; Nance, Michael L.; Kallan, Michael J.; Wiebe, Douglas J.; Carr, Brendan G.

2014-01-01

Study objectives Many US cities have experienced population reductions, often blamed on crime and interpersonal injury. Yet the overall injury risk in urban areas compared with suburban and rural areas has not been fully described. We begin to investigate this evidence gap by looking specifically at injury-related mortality risk, determining the risk of all injury death across the rural-urban continuum. Methods A cross-sectional time-series analysis of US injury deaths from 1999 to 2006 in counties classified according to the rural-urban continuum was conducted. Negative binomial generalized estimating equations and tests for trend were completed. Total injury deaths were the primary comparator, whereas differences by mechanism and age were also explored. Results A total of 1,295,919 injury deaths in 3,141 US counties were analyzed. Injury mortality increased with increasing rurality. Urban counties demonstrated the lowest death rates, significantly less than rural counties (mean difference=24.0 per 100,000; 95% confidence interval 16.4 to 31.6 per 100,000). After adjustment, the risk of injury death was 1.22 times higher in the most rural counties compared with the most urban (95% confidence interval 1.07 to 1.39). Conclusion Using total injury death rate as an overall safety metric, US urban counties were safer than their rural counterparts, and injury death risk increased steadily as counties became more rural. Greater emphasis on elevated injury-related mortality risk outside of large cities, attention to locality-specific injury prevention priorities, and an increased focus on matching emergency care needs to emergency care resources are in order. PMID:23886781

PACER SHARE Productivity and Personnel Management Demonstration: Third-Year Evaluation

DTIC Science & Technology

1993-01-01

12 Productivity Gainsharing . . . . . . . . . . . . . . . . . . . . . . . 13 Risks of the Demonstration...SHARE’s cor- porate focus. Payments to DS employees are made in equal dollar shares rather than being based on a percentage of salary. RISKS OF THE...DEMONSTRATION Despite the goals of PACER SHARE and the expected benefits of the interventions, there may be risks in the demonstration. Or

TCDD and cancer: A critical review of epidemiologic studies

PubMed Central

Boffetta, Paolo; Mundt, Kenneth A; Adami, Hans-Olov; Cole, Philip; Mandel, Jack S

2011-01-01

The authors reviewed the epidemiologic studies on exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) and cancer risk, published since the last full-scale review made by the International Agency for Research on Cancer Monographs program in 1997. The update of a cohort of US herbicide producers generated negative results overall; the internal analysis provided evidence of an increased “all-cancer” risk in the highest exposure category, with a statistically significant exposure-response association in some of the many analyses performed.The update of a similar Dutch cohort did not confirm the previously observed association with TCDD exposure. The updated surveillance of the Seveso population provided evidence of increased all-cancer mortality 15-20 years after exposure among those living in the most contaminated area but might also reflect random variation, as overall excesses in the most recent follow-up were not observed. Corresponding data on cancer incidence offer little support to the mortality results. Updated results from cohort studies of Vietnam veterans potentially exposed to TCDD did not consistently suggest an increased risk of cancer. Results of additional, smaller studies of other occupational groups potentially exposed to TCDD, and of community-based case-control studies, did not provide consistent evidence of an increased cancer risk. In conclusion, recent epidemiological evidence falls far short of conclusively demonstrating a causal link between TCDD exposure and cancer risk in humans. The emphasis on results for overall cancer risk—rather than risk for specific neoplasms—is notjustified on epidemiologic grounds and is nota reason for ignoring the weaknesses of the available evidence. PMID:21718216

Fluorosis increases the risk of postmenopausal osteoporosis by stimulating interferon γ.

PubMed

Lv, Yun-Gang; Kang, Li; Wu, Guangyao

2016-10-14

Estrogen deficiency in postmenopausal women frequently activates osteoclasts (OC), accelerates bone resorption, and leads to osteoporosis (OP). Previous studies have demonstrated that interferon γ (IFNγ) could increase bone resorption and may be involved in postmenopausal OP. Fluorosis also increased the risk of fractures and dental fluorosis, and fluoride may enhance osteoclast formation and induce osteoclastic bone destruction in postmenopausal women, but the underlying mechanisms are as yet unknown. Here, we show that serum fluoride and IFNγ levels are negatively correlated with bone mineral density (BMD) in postmenopausal women residing in a fluorotic area. Estrogen suppresses IFNγ, which is elevated by fluoride, playing a pivotal role in triggering bone loss in estrogen-deficient conditions. In vitro, IFNγ is inhibited by estrogen treatment and increased by fluoride in Raw264.7 cell, an osteoclast progenitor cell line. In ovariectomized (Ovx) mice, estrogen loss and IFNγ promote OC activation and subsequent bone loss in vivo. However, IFNγ deficiency prevents bone loss in Ovx mice even in fluoride conditions. Interestingly, fluoride fails to increase IFNγ expression in estrogen receptor α (ERα)-deficient conditions, but not in ERβ-deficient conditions. These findings demonstrate that fluorosis increases the bone loss in postmenopausal OP through an IFNγ-dependent mechanism. IFNγ signaling activates OC and aggravates estrogen deficiency inducing OP. Thus, stimulation of IFNγ production is a pivotal ''upstream'' mechanism by which fluoride promotes bone loss. Suppression of IFNγ levels may constitute a therapeutic approach for preventing bone loss. Copyright © 2016 Elsevier Inc. All rights reserved.

Association of resting heart rate and cardiovascular disease mortality in hypertensive and normotensive rural Chinese.

PubMed

Zhang, Ming; Han, Chengyi; Wang, Chongjian; Wang, Jinjin; Li, Linlin; Zhang, Lu; Wang, Bingyuan; Ren, Yongcheng; Zhang, Hongyan; Yang, Xiangyu; Zhao, Yang; Zhou, Junmei; Pang, Chao; Yin, Lei; Feng, Tianping; Zhao, Jingzhi; Luo, Xinping; Hu, Dongsheng

2017-05-01

Studies have demonstrated an increased risk of cardiovascular disease (CVD)-associated death (CVD death) with increased resting heart rate (RHR); however, whether the association is consistent in rural Chinese with hypertension and normotension is unknown. We examined the association of RHR and CVD death by hypertension and normotension status in rural Chinese people. Baseline data for 20,069 participants ≥18 years old were collected during July to August of 2007 and July to August of 2008; 17,151 (85.5%) participants were followed up in July to August of 2013 and July to October of 2014. The association of RHR and CVD death was determined by Cox proportional hazards regression. During a mean of 5.88 years (100,889 person-years) of follow-up, we recorded 479 CVD deaths (309 in hypertensive participants). CVD death increased significantly with increasing RHR, beginning from 80 beats per minute (bpm), for hypertensive and normotensive participants. After adjusting for pulse pressure and other covariates, for hypertensive participants, risk of CVD death was increased with RHR 80-89 and ≥90bpm. However, for normotensive participants, risk of CVD death was increased with only RHR≥90bpm. Risk of CVD death was associated with elevated RHR for both hypertensive and normotensive rural Chinese, and for hypertensive participants, even slightly elevated RHR was associated with CVD death. Copyright © 2016 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

Transgender HIV prevention: implementation and evaluation of a workshop.

PubMed

Bockting, W O; Rosser, B R; Scheltema, K

1999-04-01

Virtually no HIV prevention education has specifically targeted the transgender community. To fill this void, a transgender HIV prevention workshop was developed, implemented and evaluated. A 4 h workshop, grounded in the Health Belief Model and the Eroticizing Safer Sex approach, combined lectures, videos, a panel, discussion, roleplay and exercises. Evaluation using a pre-, post- and follow-up test design showed an increase in knowledge and an initial increase in positive attitudes that diminished over time. Due to the small sample size (N = 59) and limited frequency of risk behavior, a significant decrease in unsafe sexual or needle practices could not be demonstrated. However, findings suggested an increase in safer sexual behaviors such as (mutual) masturbation. Peer support improved significantly. Future prevention education should make special efforts to target the more difficult-to-reach, high-risk subgroups of the transgender population.

Ophthalmologic screening in 25 consecutive geriatric psychiatric inpatient admissions.

PubMed

Billick, Stephen B; Garakani, Amir

2014-03-01

In the aging process, people are at increasing risk of visual abnormalities such as cataracts, glaucoma, age-related macular degeneration, and other retinal defects. This holds true for geriatric psychiatric patients as well. These ophthalmic problems may increase risk of falls or increase the comorbidity from dementing processes and depression. Geriatric patients presenting for psychiatric treatment may also be misdiagnosed or under-diagnosed as a result of these visual problems. This quality assurance review of 25 consecutive geriatric psychiatric inpatients demonstrated discrepancies between chart documentation and actual ophthalmologic pathology present in the patients. Doing a simple but complete ophthalmologic screening as part of the general physical examination on admission to an inpatient psychiatric unit can identify those patients who will need more in depth examination of their eyes and promote more accurate differential diagnoses for the patients.

Association Between Serum 25-Hydroxy Vitamin D Levels and Blood Pressure Among Adolescents in Two Resource-Limited Settings in Peru.

PubMed

Tomaino, Katherine; Romero, Karina M; Robinson, Colin L; Baumann, Lauren M; Hansel, Nadia N; Pollard, Suzanne L; Gilman, Robert H; Mougey, Edward; Lima, John J; Checkley, William

2015-08-01

Serum 25-hydroxyvitamin D (25OHD) deficiency (<50 nmol/l or 20 ng/ml) has been associated with increased blood pressure (BP) in observational studies. A paucity of data on this relationship is available in Latin American or child populations. This study investigates the association between 25OHD levels and BP in adolescents at risk for vitamin D deficiency in 2 Peruvian settings. In a population-based study of 1,441 Peruvian adolescents aged 13-15 years, 1,074 (75%) provided a serum blood sample for 25OHD analysis and BP measurements. Relationships between 25OHD and BP metrics were assessed using multiple linear regressions, adjusted for anthropometrics and sociodemographic factors. 25OHD deficiency was associated with an elevated diastolic BP (DBP) (1.09 mm Hg increase, 95% confidence interval: 0.04 to 2.14; P = 0.04) compared to nondeficient adolescents. Systolic BP (SBP) trended to increase with vitamin D deficiency (1.30 mm Hg increase, 95% confidence interval: -0.13 to 2.72; P = 0.08). Mean arterial pressure (MAP) was also greater in adolescents with 25OHD (1.16 mm Hg increase, 95% confidence interval: 0.10 to 2.22; P = 0.03). SBP was found to demonstrate a U-shaped relationship with 25OHD, while DBP and MAP demonstrated inverse J-shaped relationships with serum 25OHD status. The association between 25OHD deficiency and BP was not different across study sites (all P ≥ 0.19). Adolescents deficient in 25OHD demonstrated increased DBP and MAP and a trend toward increased SBP, when compared to nondeficient subjects. 25OHD deficiency early in life was associated with elevated BP metrics, which may predispose risk of hypertension later in adulthood. © American Journal of Hypertension, Ltd 2015. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Biomarkers of exposure, sensitivity and disease

NASA Technical Reports Server (NTRS)

Brooks, A. L.

1999-01-01

PURPOSE: This review is to evaluate the use of biomarkers as an indication of past exposure to radiation or other environmental insults, individual sensitivity and risk for the development of late occurring disease. OVERVIEW: Biomarkers can be subdivided depending on their applications. Markers of exposure and dose can be used to reconstruct and predict past accidental or occupational exposures when limited or no physical measurements were available. Markers of risk or susceptibility can help identify sensitivity individuals that are at increased risk for development of spontaneous disease and may help predict the increased risk in sensitive individuals associated with environmental or therapeutic radiation exposures. Markers of disease represent the initial cellular or molecular changes that occur during disease development. Each of these types of biomarkers serves a unique purpose. OUTLINE: This paper concentrates on biomarkers of dose and exposure and provides a brief review of biomarkers of sensitivity and disease. The review of biomarkers of dose and exposure will demonstrate the usefulness of biomarkers in evaluation of physical factors associated with radiation exposure, such as LET, doserate and dose distribution. It will also evaluate the use of biomarkers to establish relationships that exist between exposure parameters such as energy deposition, environmental concentration of radioactive materials, alpha traversals and dose. In addition, the importance of biological factors on the magnitude of the biomarker response will be reviewed. Some of the factors evaluated will be the influence of species, tissue, cell types and genetic background. The review will demonstrate that markers of sensitivity and disease often have little usefulness in dose-reconstruction and, by the same token, many markers of dose or exposure may not be applicable for prediction of sensitivity or risk.

Understanding and treating hypertension in diabetic populations.

PubMed

Volpe, Massimo; Battistoni, Allegra; Savoia, Carmine; Tocci, Giuliano

2015-10-01

Hypertension and diabetes frequently occurs in the same individuals in clinical practice. Moreover, the presence of hypertension does increase the risk of new-onset diabetes, as well as diabetes does promote development of hypertension. Whatever the case, the concomitant presence of these conditions confers a high risk of major cardiovascular complications and promotes the use integrated pharmacological interventions, aimed at achieving the recommended therapeutic targets. While the benefits of lowering abnormal fasting glucose levels in patients with hypertension and diabetes have been consistently demonstrated, the blood pressure (BP) targets to be achieved to get a benefit in patients with diabetes have been recently reconsidered. In the past, randomized clinical trials have, indeed, demonstrated that lowering BP levels to less than 140/90 mmHg was associated to a substantial reduction of the risk of developing macrovascular and microvascular complications in hypertensive patients with diabetes. In addition, epidemiological and clinical reports suggested that "the lower, the better" for BP in diabetes, so that levels of BP even lower than 130/80 mmHg have been recommended. Recent randomized clinical trials, however, designed to evaluate the potential benefits obtained with an intensive antihypertensive therapy, aimed at achieving a target systolic BP level below 120 mmHg as compared to those obtained with less stringent therapy, have challenged the previous recommendations from international guidelines. In fact, detailed analyses of these trials showed a paradoxically increased risk of coronary events, mostly myocardial infarction, in those patients who achieved the lowest BP levels, particularly in the high-risk subsets of hypertensive populations with diabetes. In the light of these considerations, the present article will briefly review the common pathophysiological mechanisms, the potential sites of therapeutic interactions and the currently recommended BP targets to be achieved under pharmacological treatment in hypertension and diabetes.

Awareness of Risk Factors for Breast, Lung and Cervical Cancer in a UK Student Population.

PubMed

Sherman, Susan M; Lane, Emily L

2015-12-01

The objective of this study is to identify levels of risk awareness for breast, lung and cervical cancer, in a UK student population. A sample of male (N=62) and female (N=58) university students, mean age 21.62 years completed a questionnaire identifying which risk factors they knew for each cancer. Analysis of variance was used to compare differences in risk awareness across gender and cancer types. Risk factor awareness was highest for lung cancer (0.78), mid-range for breast cancer (0.61) and lowest for cervical cancer (0.47). Women had greater risk factor awareness (0.67) than males (0.57) across all three cancers. There is also significant belief in mythic risk factors such as stress (from 14 to 40% across the three cancers). Previous research has demonstrated that risk factor awareness increases with educational status, yet even in a university student population, in which the majority of females would have been offered the HPV vaccination, risk factor awareness for cancers is variable. More health education is needed particularly around the risk factors for cervical cancer.

Momentary changes in craving predict smoking lapse behavior: a laboratory study.

PubMed

Motschman, Courtney A; Germeroth, Lisa J; Tiffany, Stephen T

2018-04-27

Current research on factors that predict smoking lapse behavior is limited in its ability to fully characterize the critical moments leading up to decisions to smoke. We used a validated and widely used experimental analogue for smoking lapse to assess how moment-to-moment dynamics of craving relate to decisions to smoke. Heavy smokers (N = 128, M age = 35.9) participated in a 50-min laboratory delay to smoking task on 2 consecutive days, earning money for each 5 min they remained abstinent or ending the task by choosing to smoke. Participants rated craving and negative affect levels immediately prior to each choice. Participants were randomized to smoking as usual (n = 50) or overnight abstinence (n = 50 successfully abstained, n = 22 failed abstaining) prior to session 2. Discrete-time hazard models were used to examine craving and negative affect as time-varying predictors of smoking. Higher craving levels prior to smoking opportunities predicted increased risk of smoking. When controlling for craving levels, incremental increases in craving predicted increased smoking risk. Increases in negative affect incrementally predicted increased smoking risk at session 2 only. Smokers who failed to abstain were at a higher risk of smoking than those who successfully abstained, whereas abstinent and non-abstinent smokers did not differ in smoking risk. Findings demonstrate an extension of the smoking lapse paradigm that can be utilized to capture momentary changes in craving that predict smoking behavior. Evaluations of nuanced craving experiences may inform clinical and pharmacological research on preventing smoking lapse and relapse.

Promoting Statistical Thinking in Schools with Road Injury Data

ERIC Educational Resources Information Center

Woltman, Marie

2017-01-01

Road injury is an immediately relevant topic for 9-19 year olds. Current availability of Open Data makes it increasingly possible to find locally relevant data. Statistical lessons developed from these data can mutually reinforce life lessons about minimizing risk on the road. Devon County Council demonstrate how a wide array of statistical…

ASSESSMENT OF THE RISK OF SOLAR ULTRAVIOLET RADIATION TO AMPHIBIANS. II: IN SITU CHARACTERIZATION OF SOLAR ULTRAVIOLET RADIATION IN AMPHIBIAN HABITATS

EPA Science Inventory

Ultraviolet B (UVB) radiation has been hypothesized as a potential cause of amphibian population declines and increased incidences of malformations. Realistic studies documenting UV irradiance or dose have rarely been conducted in wetlands used by amphibians. We demonstrate that ...

It's in the Cards: A Classwide Management System to Promote Student Success

ERIC Educational Resources Information Center

Murphy, Sashaa A.; Korinek, Lori

2009-01-01

Increasing numbers of students with disabilities and those at risk for school failure are participating in general education classes. They are expected to master the content, to take primary responsibility for their success, and to manage their own progress. Unfortunately, many students do not consistently demonstrate the nonacademic skills that…

Anxiety Sensitivity and Panic Attacks: A 1-Year Longitudinal Study

ERIC Educational Resources Information Center

Li, Wen; Zinbarg, Richard E.

2007-01-01

The hypothesis that anxiety sensitivity (AS) is a risk factor for panic genesis has obtained compelling support, but the clinical/practical importance of AS in panic genesis has been questioned. In addition, the association between panic experience and AS increase has not been clearly demonstrated. Through this 1-year longitudinal study among…

Developing a heme iron database for meats according to meat type, cooking method and doneness level

USDA-ARS?s Scientific Manuscript database

Background: Animal studies have demonstrated that iron may be related to carcinogenesis, and human studies found that heme iron can increase the formation of N-nitroso compounds, which are known carcinogens. Objectives: One of the postulated mechanisms linking red meat intake to cancer risk involves...

The Invisible Injury: Supporting the Recovery of Dancers with Concussions

ERIC Educational Resources Information Center

Kish, Robin L.; Koutures, Chris G.

2016-01-01

Dancers are "artistic athletes." They must possess the strength, agility, power and flexibility of any athlete and perform with perfect musicality and emotion, demonstrating the artistry of the dance. As an art form dance continues to push the physical boundaries of the human body, increasing the inherent risks to the dancers. Most…

Cost effectiveness of the LIFE physical activity intervention for older adults at increased risk for mobility disability

USDA-ARS?s Scientific Manuscript database

BACKGROUND: Losing the ability to walk safely and independently is a major concern for many older adults. The Lifestyle Interventions and Independence for Elders study recently demonstrated that a physical activity (PA) intervention can delay the onset of major mobility disability. Our objective is ...

Cellular Radio Telecommunication for Health Care: Benefits and Risks

PubMed Central

Sneiderman, Charles A.; Ackerman, Michael J.

2004-01-01

Cellular radio telecommunication has increased exponentially with many applications to health care reported. The authors attempt to summarize published applications with demonstrated effect on health care, review briefly the rapid evolution of hardware and software standards, explain current limitations and future potential of data quality and security, and discuss issues of safety. PMID:15298996

Lung cancer among coal miners, ore miners and quarrymen: smoking-adjusted risk estimates from the synergy pooled analysis of case-control studies.

PubMed

Taeger, Dirk; Pesch, Beate; Kendzia, Benjamin; Behrens, Thomas; Jöckel, Karl-Heinz; Dahmann, Dirk; Siemiatycki, Jack; Kromhout, Hans; Vermeulen, Roel; Peters, Susan; Olsson, Ann; Brüske, Irene; Wichmann, Heinz-Erich; Stücker, Isabelle; Guida, Florence; Tardón, Adonina; Merletti, Franco; Mirabelli, Dario; Richiardi, Lorenzo; Pohlabeln, Hermann; Ahrens, Wolfgang; Landi, Maria Teresa; Caporaso, Neil; Pesatori, Angela Cecilia; Mukeriya, Anush; Szeszenia-Dabrowska, Neonila; Lissowska, Jolanta; Gustavsson, Per; Field, John; Marcus, Michael W; Fabianova, Eleonora; 't Mannetje, Andrea; Pearce, Neil; Rudnai, Peter; Bencko, Vladimir; Janout, Vladimir; Dumitru, Rodica Stanescu; Foretova, Lenka; Forastiere, Francesco; McLaughlin, John; Paul Demers, Paul Demers; Bueno-de-Mesquita, Bas; Schüz, Joachim; Straif, Kurt; Brüning, Thomas

2015-09-01

Working in mines and quarries has been associated with an elevated lung cancer risk but with inconsistent results for coal miners. This study aimed to estimate the smoking-adjusted lung cancer risk among coal miners and compare the risk pattern with lung cancer risks among ore miners and quarrymen. We estimated lung cancer risks of coal and ore miners and quarrymen among 14 251 lung cancer cases and 17 267 controls from the SYNERGY pooled case-control study, controlling for smoking and employment in other at-risk occupations. Ever working as miner or quarryman (690 cases, 436 controls) was associated with an elevated odds ratio (OR) of 1.55 [95% confidence interval (95% CI) 1.34-1.79] for lung cancer. Ore miners (53 cases, 24 controls) had a higher OR (2.34, 95% CI 1.36-4.03) than quarrymen (67 cases, 39 controls; OR 1.92, 95% CI 1.21-3.05) and coal miners (442 cases, 297 controls; OR 1.40, 95% CI 1.18-1.67), but CI overlapped. We did not observe trends by duration of exposure or time since last exposure. This pooled analysis of population-based studies demonstrated an excess lung cancer risk among miners and quarrymen that remained increased after adjustment for detailed smoking history and working in other at-risk occupations. The increase in risk among coal miners were less pronounced than for ore miners or quarrymen.

Development and calibration of a load sensing cervical distractor capable of withstanding autoclave sterilization.

PubMed

Demetropoulos, C K; Truumees, E; Herkowitz, H N; Yang, K H

2005-05-01

In surgery of the cervical spine, a Caspar pin distractor is often used to apply a tensile load to the spine in order to open up the disc space. This is often done in order to place a graft or other interbody fusion device in the spine. Ideally a tight interference fit is achieved. If the spine is over distracted, allowing for a large graft, there is an increased risk of subsidence into the endplate. If there is too little distraction, there is an increased risk of graft dislodgement or pseudoarthrosis. Generally, graft height is selected from preoperative measurements and observed distraction without knowing the intraoperative compressive load. This device was designed to give the surgeon an assessment of this applied load. Instrumentation of the device involved the application of strain gauges and the selection of materials that would survive standard autoclave sterilization. The device was calibrated, sterilized and once again calibrated to demonstrate its suitability for surgical use. Results demonstrate excellent linearity in the calibration, and no difference was detected in the pre- and post-sterilization calibrations.

Surrogate modeling of joint flood risk across coastal watersheds

NASA Astrophysics Data System (ADS)

Bass, Benjamin; Bedient, Philip

2018-03-01

This study discusses the development and performance of a rapid prediction system capable of representing the joint rainfall-runoff and storm surge flood response of tropical cyclones (TCs) for probabilistic risk analysis. Due to the computational demand required for accurately representing storm surge with the high-fidelity ADvanced CIRCulation (ADCIRC) hydrodynamic model and its coupling with additional numerical models to represent rainfall-runoff, a surrogate or statistical model was trained to represent the relationship between hurricane wind- and pressure-field characteristics and their peak joint flood response typically determined from physics based numerical models. This builds upon past studies that have only evaluated surrogate models for predicting peak surge, and provides the first system capable of probabilistically representing joint flood levels from TCs. The utility of this joint flood prediction system is then demonstrated by improving upon probabilistic TC flood risk products, which currently account for storm surge but do not take into account TC associated rainfall-runoff. Results demonstrate the source apportionment of rainfall-runoff versus storm surge and highlight that slight increases in flood risk levels may occur due to the interaction between rainfall-runoff and storm surge as compared to the Federal Emergency Management Association's (FEMAs) current practices.

The association of two productivity measures with health risks and medical conditions in an Australian employee population.

PubMed

Musich, Shirley; Hook, Dan; Baaner, Stephanie; Edington, Dee W

2006-01-01

To investigate the impact of health on job performance using two measures of productivity loss: (1) a self-reported measure of health-related presenteeism and (2) an objective measure of absenteeism. A cross-sectional survey using a Health Risk Appraisal (HRA) to evaluate self-reported presenteeism and the prevalence of 12 health risks and eight medical conditions. Employees (n=224) of a private insurance provider in Australia. A Health Risk Appraisal (HRA) questionnaire was used to evaluate self-reported presenteeism on different aspects of job demands and to assess the prevalence of 12 health risks and eight medical conditions. Illness absent hours were obtained from company administrative records. Increased presenteeism was significantly associated with high stress, life dissatisfaction, and back pain, while increased illness absenteeism was significantly associated with overweight, poor perception of health, and diabetes. Excess presenteeism associated with excess health risks (productivity loss among those with medium- or high-risk status compared to those with low-risk status) was independently calculated at 19.0% for presenteeism and 12.8% for illness absenteeism. This study demonstrates an association between health metrics and self-reported work impairment (presenteeism) and measured absenteeism. The study provides a first indication of the potential benefits of health promotion programming to Australian employees in improving health and to the corporation in minimizing health-related productivity loss.

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.

A spatially-dynamic preliminary risk assessment of the American peregrine falcon at the Los Alamos National Laboratory (version 1)

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

Gallegos, A.F.; Gonzales, G.J.; Bennett, K.D.

1997-06-01

The Endangered Species Act and the Record of Decision on the Dual Axis Radiographic Hydrodynamic Test Facility at the Los Alamos National Laboratory require protection of the American peregrine falcon. A preliminary risk assessment of the peregrine was performed using a custom FORTRAN model and a geographical information system. Estimated doses to the falcon were compared against toxicity reference values to generate hazard indices. Hazard index results indicated no unacceptable risk to the falcon from the soil ingestion pathway, including a measure of cumulative effects from multiple contaminants that assumes a linear additive toxicity type. Scaling home ranges on themore » basis of maximizing falcon height for viewing prey decreased estimated risk by 69% in a canyons-based home range and increased estimated risk by 40% in a river-based home range. Improving model realism by weighting simulated falcon foraging based on distance from potential nest sites decreased risk by 93% in one exposure unit and by 82% in a second exposure unit. It was demonstrated that choice of toxicity reference values can have a substantial impact on risk estimates. Adding bioaccumulation factors for several organics increased partial hazard quotients by a factor of 110, but increased the mean hazard index by only 0.02 units. Adding a food consumption exposure pathway in the form of biomagnification factors for 15 contaminants of potential ecological concern increased the mean hazard index to 1.16 ({+-} 1.0), which is above the level of acceptability (1.0). Aroclor-1254, dichlorodiphenyltrichlorethane (DDT) and dichlorodiphenylethelyne (DDE) accounted for 81% of the estimated risk that includes soil ingestion and food consumption Contaminant pathways and a biomagnification component. Information on risk by specific geographical location was generated, which can be used to manage contaminated areas, falcon habitat, facility siting, and/or facility operations. 123 refs., 10 figs., 2 tabs.« less

The Effect of XPD Polymorphisms on Digestive Tract Cancers Risk: A Meta-Analysis

PubMed Central

Zhang, Qian; Chen, Zhipeng; Lu, Kai; Shu, Yongqian; Chen, Tao; Zhu, Lingjun

2014-01-01

Background The Xeroderma pigmento-sum group D gene (XPD) plays a key role in nucleotide excision repair. Single nucleotide polymorphisms (SNP) located in its functional region may alter DNA repair capacity phenotype and cancer risk. Many studies have demonstrated that XPD polymorphisms are significantly associated with digestive tract cancers risk, but the results are inconsistent. We conducted a comprehensive meta-analysis to assess the association between XPD Lys751Gln polymorphism and digestive tract cancers risk. The digestive tract cancers that our study referred to, includes oral cancer, esophageal cancer, gastric cancer and colorectal cancer. Methods We searched PubMed and EmBase up to December 31, 2012 to identify eligible studies. A total of 37 case-control studies including 9027 cases and 16072 controls were involved in this meta-analysis. Statistical analyses were performed with Stata software (version 11.0, USA). Odds ratios (ORs) with 95% confidence intervals (CIs) were used to assess the strength of the association. Results The results showed that XPD Lys751Gln polymorphism was associated with the increased risk of digestive tract cancers (homozygote comparison (GlnGln vs. LysLys): OR = 1.12, 95% CI = 1.01–1.24, P = 0.029, P heterogeneity = 0.133). We found no statistical evidence for a significantly increased digestive tract cancers risk in the other genetic models. In the subgroup analysis, we also found the homozygote comparison increased the susceptibility of Asian population (OR = 1.28, 95% CI = 1.01–1.63, P = 0.045, P heterogeneity = 0.287). Stratified by cancer type and source of control, no significantly increased cancer risk was found in these subgroups. Additionally, risk estimates from hospital-based studies and esophageal studies were heterogeneous. Conclusions Our meta-analysis suggested that the XPD 751Gln/Gln genotype was a low-penetrate risk factor for developing digestive tract cancers, especially in Asian populations. PMID:24787743

The effect of XPD polymorphisms on digestive tract cancers risk: a meta-analysis.

PubMed

Du, Haina; Guo, Nannan; Shi, Bin; Zhang, Qian; Chen, Zhipeng; Lu, Kai; Shu, Yongqian; Chen, Tao; Zhu, Lingjun

2014-01-01

The Xeroderma pigmento-sum group D gene (XPD) plays a key role in nucleotide excision repair. Single nucleotide polymorphisms (SNP) located in its functional region may alter DNA repair capacity phenotype and cancer risk. Many studies have demonstrated that XPD polymorphisms are significantly associated with digestive tract cancers risk, but the results are inconsistent. We conducted a comprehensive meta-analysis to assess the association between XPD Lys751Gln polymorphism and digestive tract cancers risk. The digestive tract cancers that our study referred to, includes oral cancer, esophageal cancer, gastric cancer and colorectal cancer. We searched PubMed and EmBase up to December 31, 2012 to identify eligible studies. A total of 37 case-control studies including 9027 cases and 16072 controls were involved in this meta-analysis. Statistical analyses were performed with Stata software (version 11.0, USA). Odds ratios (ORs) with 95% confidence intervals (CIs) were used to assess the strength of the association. The results showed that XPD Lys751Gln polymorphism was associated with the increased risk of digestive tract cancers (homozygote comparison (GlnGln vs. LysLys): OR = 1.12, 95% CI = 1.01-1.24, P = 0.029, P heterogeneity = 0.133). We found no statistical evidence for a significantly increased digestive tract cancers risk in the other genetic models. In the subgroup analysis, we also found the homozygote comparison increased the susceptibility of Asian population (OR = 1.28, 95% CI = 1.01-1.63, P = 0.045, P heterogeneity = 0.287). Stratified by cancer type and source of control, no significantly increased cancer risk was found in these subgroups. Additionally, risk estimates from hospital-based studies and esophageal studies were heterogeneous. Our meta-analysis suggested that the XPD 751Gln/Gln genotype was a low-penetrate risk factor for developing digestive tract cancers, especially in Asian populations.

Alternative tobacco use among college students: who is at highest risk?

PubMed

Enofe, Nosayaba; Berg, Carla J; Nehl, Eric J

2014-03-01

To examines smoking status, substance use, sociodemographics, and psychosocial characteristics in relation to alternative tobacco use among college students. Current tobacco use (cigarettes, cigar-like products, hookah, chew, snus) and correlates (sociodemographics, sensation-seeking, attitudes toward tobacco and smokers, social factors) were assessed among students aged 18-25 at 6 Southeastern US colleges using an online survey. Those who were younger, male, black, cigarette and marijuana users, and demonstrating at-risk psychosocial factors were at increased risk of alternative tobacco product use (p < .001). Among current smokers, never daily nondaily smokers were 3 times as likely as former daily non-daily smokers and daily smokers to use alternative tobacco products (p < .001). Important risk factors for alternative tobacco use included important sociodemographic and psychosocial characteristics.

Reward Processing And Risk For Depression Across Development

PubMed Central

Luking, Katherine R; Pagliaccio, David; Luby, Joan L; Barch, Deanna M

2016-01-01

Striatal response to reward has been of great interest in the typical development and psychopathology literatures. These parallel lines of inquiry demonstrate that while typically developing adolescents show robust striatal response to reward, adolescents with major depressive disorder (MDD) or those at high-risk for MDD show blunted response to reward. Understanding how these findings intersect is critical for the development and application of early preventative interventions in at-risk children, ideally before the sharp increase in the rate of MDD onset that occurs in adolescence. Robust findings relating blunted striatal response to reward and MDD-risk are reviewed and situated within a normative developmental context. We highlight the need for future studies investigating longitudinal development, specificity to MDD, and roles of potential moderators and mediators. PMID:27131776

[The evaluation of color vision and its diagnostic value in predicting the risk of diabetic retinopathy in patients with glucose metabolism disorders].

PubMed

Jończyk-Skórka, Katarzyna; Kowalski, Jan

2017-07-21

The aim of the study was to evaluate color vision and its diagnostic value in predicting the risk of diabetic retinopathy in patients with glucose metabolism disorders. The study involved 197 people, 92 women and 105 men aged 63.21 ± 8.74 years. In order to assess glucose metabolism disorders, patients were divided into three groups. The first group (DM) consisted of 60 people (16 women and 44 men aged 61.92 ± 8.46 years). These were people with type 2 diabetes. Second group (IFG IGT) consisted of 67 people (35 women and 32 men aged 65 ± 8.5 years). These were people who were diagnosed with impaired fasting glucose or impaired glucose tolerance. The third group, the control one (K) consisted of 70 people (41 women and 29 men aged 62.6 ± 9.06 years). They were healthy individuals. In order to assess diabetic retinopathy study population was divided into two groups. The first group (BZ) consisted of 177 patients (84 women and 93 men aged 62.9 ± 8.78 years) without diabetic retinopathy. The second group (NPDR) consisted of 20 patients (8 women and 12 men aged 65.95 ± 8.17 years) with diabetic retinopathy. Glucose metabolism disorders were diagnosed with glucose tolerance test (OGTT). Evaluation of retinopathy was based on eye examination. All patients underwent binocular Farnsworth-Munsell 100 Hue color vision test (test result is a Total Error Score - TES). In the healthy control group (K) there were less patients with diabetic retinopathy (p = 0,0101), and less patients with abnormal color vision test (p = 0,0001) than in other groups. Majority of patients in K group had generalized abnormalities of color vision while other groups demonstrated tritanomalią (p = 0,0018). It was discovered that sTES value adequately distinguishes group K from group IFG, IGT, DM (AUC = 0,673), group K from group DM (AUC = 0,701), and group K from group IFG IGT (AUC = 0,648) sTES does not differentiate groups IGT, IFG and DM (AUC = 0,563). It was shown that in IGT, IFG group sTES was an independent risk factor that increased the risk of prediabetes almost six times (OR 5,924, 95% CI [1,169- 30,036], p = 0,032). In DM group sTES was an independent risk factor, which increased the risk of diabetes more than thirteen times (OR 13,408, 95% CI [2,324-77,345], p = 0,004). Higher values of sTES occurred in patients with retinopathy (NPDR) (p <0,001) and multivariate analyzes demonstrated that sTES ≥1.04 was an independent risk factor that increased the risk of retinopathy over twenty times (OR 21,380, 95% CI [1,101 -89,241], p <0,001). sTES is an independent risk factor for glucose metabolism disorders that increases the risk of prediabetes almost six times and the risk of diabetes more than thirteen times. sTES ≥1,04 is an independent risk factor for diabetic retinopathy. sTES ≥1,04 increases the risk of diabetic retinopathy over twenty times. The color vision 100 Hue test can be useful in detecting glucose metabolism disorders even before the ophthalmoscopic manifestation of retinopathy. Early detection rises the possibility to prevent or delay the development of diabetes through lifestyle changes and implementation of healthy behaviors.

Personalizing lung cancer risk prediction and imaging follow-up recommendations using the National Lung Screening Trial dataset.

PubMed

Hostetter, Jason M; Morrison, James J; Morris, Michael; Jeudy, Jean; Wang, Kenneth C; Siegel, Eliot

2017-11-01

To demonstrate a data-driven method for personalizing lung cancer risk prediction using a large clinical dataset. An algorithm was used to categorize nodules found in the first screening year of the National Lung Screening Trial as malignant or nonmalignant. Risk of malignancy for nodules was calculated based on size criteria according to the Fleischner Society recommendations from 2005, along with the additional discriminators of pack-years smoking history, sex, and nodule location. Imaging follow-up recommendations were assigned according to Fleischner size category malignancy risk. Nodule size correlated with malignancy risk as predicted by the Fleischner Society recommendations. With the additional discriminators of smoking history, sex, and nodule location, significant risk stratification was observed. For example, men with ≥60 pack-years smoking history and upper lobe nodules measuring >4 and ≤6 mm demonstrated significantly increased risk of malignancy at 12.4% compared to the mean of 3.81% for similarly sized nodules (P < .0001). Based on personalized malignancy risk, 54% of nodules >4 and ≤6 mm were reclassified to longer-term follow-up than recommended by Fleischner. Twenty-seven percent of nodules ≤4 mm were reclassified to shorter-term follow-up. Using available clinical datasets such as the National Lung Screening Trial in conjunction with locally collected datasets can help clinicians provide more personalized malignancy risk predictions and follow-up recommendations. By incorporating 3 demographic data points, the risk of lung nodule malignancy within the Fleischner categories can be considerably stratified and more personalized follow-up recommendations can be made. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Kidney Transplant Outcomes in the Super Obese: A National Study From the UNOS Dataset.

PubMed

Kanthawar, Pooja; Mei, Xiaonan; Daily, Michael F; Chandarana, Jyotin; Shah, Malay; Berger, Jonathan; Castellanos, Ana Lia; Marti, Francesc; Gedaly, Roberto

2016-11-01

We evaluated outcomes of super-obese patients (BMI > 50) undergoing kidney transplantation in the US. We performed a review of 190 super-obese patients undergoing kidney transplantation from 1988 through 2013 using the UNOS dataset. Super-obese patients had a mean age of 45.7 years (21-75 years) and 111 (58.4 %) were female. The mean BMI of the super-obese group was 56 (range 50.0-74.2). A subgroup analysis demonstrated that patients with BMI > 50 had worse survival compared to any other BMI class. The 30-day perioperative mortality and length of stay was 3.7 % and 10.09 days compared to 0.8 % and 7.34 days in nonsuper-obese group. On multivariable analysis, BMI > 50 was an independent predictor of 30-day mortality, with a 4.6-fold increased risk of perioperative death. BMI > 50 increased the risk of delayed graft function and the length of stay by twofold. The multivariable analysis of survival showed a 78 % increased risk of death in this group. Overall patient survival for super-obese transplant recipients at 1, 3, and 5 years was 88, 82, and 76 %, compared to 96, 91, 86 % on patients transplanted with BMI < 50. A propensity score adjusted analysis further demonstrates significant worse survival rates in super-obese patients undergoing kidney transplantation. Super-obese patients had prolonged LOS and worse DGF rates. Perioperative mortality was increased 4.6-fold compared to patients with BMI < 50. In a subgroup analysis, super-obese patients who underwent kidney transplantation had significantly worse graft and patient survival compared to underweight, normal weight, and obesity class I, II, and III (BMI 40-50) patients.

Multiscale alterations in bone matrix quality increased fragility in steroid induced osteoporosis

PubMed Central

Karunaratne, A.; Xi, L.; Bentley, L.; Sykes, D.; Boyde, A.; Esapa, C.T.; Terrill, N.J.; Brown, S.D.M.; Cox, R.D.; Thakker, R.V.; Gupta, H.S.

2016-01-01

A serious adverse clinical effect of glucocorticoid steroid treatment is secondary osteoporosis, enhancing fracture risk in bone. This rapid increase in bone fracture risk is largely independent of bone loss (quantity), and must therefore arise from degradation of the quality of the bone matrix at the micro- and nanoscale. However, we lack an understanding of both the specific alterations in bone quality n steroid-induced osteoporosis as well as the mechanistic effects of these changes. Here we demonstrate alterations in the nanostructural parameters of the mineralized fibrillar collagen matrix, which affect bone quality, and develop a model linking these to increased fracture risk in glucocorticoid induced osteoporosis. Using a mouse model with an N-ethyl-N-nitrosourea (ENU)-induced corticotrophin releasing hormone promoter mutation (Crh− 120/+) that developed hypercorticosteronaemia and osteoporosis, we utilized in situ mechanical testing with small angle X-ray diffraction, synchrotron micro-computed tomography and quantitative backscattered electron imaging to link altered nano- and microscale deformation mechanisms in the bone matrix to abnormal macroscopic mechanics. We measure the deformation of the mineralized collagen fibrils, and the nano-mechanical parameters including effective fibril modulus and fibril to tissue strain ratio. A significant reduction (51%) of fibril modulus was found in Crh− 120/+ mice. We also find a much larger fibril strain/tissue strain ratio in Crh− 120/+ mice (~ 1.5) compared to the wild-type mice (~ 0.5), indicative of a lowered mechanical competence at the nanoscale. Synchrotron microCT show a disruption of intracortical architecture, possibly linked to osteocytic osteolysis. These findings provide a clear quantitative demonstration of how bone quality changes increase macroscopic fragility in secondary osteoporosis. PMID:26657825

A longitudinal study investigating neural processing of speech envelope modulation rates in children with (a family risk for) dyslexia.

PubMed

De Vos, Astrid; Vanvooren, Sophie; Vanderauwera, Jolijn; Ghesquière, Pol; Wouters, Jan

2017-08-01

Recent evidence suggests that a fundamental deficit in the synchronization of neural oscillations to temporal information in speech may underlie phonological processing problems in dyslexia. Since previous studies were performed cross-sectionally in school-aged children or adults, developmental aspects of neural auditory processing in relation to reading acquisition and dyslexia remain to be investigated. The present longitudinal study followed 68 children during development from pre-reader (5 years old) to beginning reader (7 years old) and more advanced reader (9 years old). Thirty-six children had a family risk for dyslexia and 14 children eventually developed dyslexia. EEG recordings of auditory steady-state responses to 4 and 20 Hz modulations, corresponding to syllable and phoneme rates, were collected at each point in time. Our results demonstrate an increase in neural synchronization to phoneme-rate modulations around the onset of reading acquisition. This effect was negatively correlated with later reading and phonological skills, indicating that children who exhibit the largest increase in neural synchronization to phoneme rates, develop the poorest reading and phonological skills. Accordingly, neural synchronization to phoneme-rate modulations was found to be significantly higher in beginning and more advanced readers with dyslexia. We found no developmental effects regarding neural synchronization to syllable rates, nor any effects of a family risk for dyslexia. Altogether, our findings suggest that the onset of reading instruction coincides with an increase in neural responsiveness to phoneme-rate modulations, and that the extent of this increase is related to (the outcome of) reading development. Hereby, dyslexic children persistently demonstrate atypically high neural synchronization to phoneme rates from the beginning of reading acquisition onwards. Copyright © 2017 Elsevier Ltd. All rights reserved.

The Cumulative Burden of Mental, Substance Use, and General Medical Disorders and Rehospitalization and Mortality After an Injury.

PubMed

Zatzick, Douglas F; Rowhani-Rahbar, Ali; Wang, Jin; Russo, Joan; Darnell, Doyanne; Ingraham, Leah; Whiteside, Lauren K; Guiney, Roxanne; Hedrick, Margot Kelly; Rivara, Frederick P

2017-06-01

Each year in the United States, 1.5-2.5 million individuals require hospitalization for an injury. Multiple mental, substance use, and chronic general medical disorders are endemic among injury survivors with and without traumatic brain injury (TBI), yet few studies have assessed the association between the cumulative burden of these conditions and health care outcomes. This study of patients hospitalized for an injury assessed associations between comorbid mental, substance use, and general medical disorders, TBI, and violent events or suicide attempts and the postinjury outcomes of recurrent hospitalization and death. Recurrent hospitalization and all-cause mortality were examined in this population-based retrospective cohort study. A total of 76,942 patients hospitalized for an injury in Washington State during 2006-2007 were followed for five years. ICD-9-CM codes identified conditions prior to or at the index injury admission. Index admissions related to injuries from firearms, assaultive violence, suicide attempts, and overdoses were identified through E-codes. Adjusted regression analyses demonstrated a significant, dose-response relationship between an increasing cumulative burden of disorders and an increasing risk of recurrent hospitalization (four or more conditions, relative risk=3.89, 95% confidence interval [CI]=3.66-4.14). Adjusted Cox proportional hazard regression demonstrated a similar relationship between increasing cumulative burden of disorders and all-cause mortality (four or more conditions, hazard ratio=5.33, CI=4.71-6.04). Increasing cumulative burden of disorders was associated with greater postinjury risk of recurrent hospitalization and death. Orchestrated investigative and policy efforts could introduce screening and intervention procedures that target this spectrum of comorbidity.

Obstructive Sleep Apnea Syndrome: An Emerging Risk Factor for Dementia.

PubMed

Buratti, Laura; Luzzi, Simona; Petrelli, Cristina; Baldinelli, Sara; Viticchi, Giovanna; Provinciali, Leandro; Altamura, Claudia; Vernieri, Fabrizio; Silvestrini, Mauro

2016-01-01

Epidemiological studies have suggested that obstructive sleep apnea syndrome (OSAS) may increase the risk of developing cognitive impairment. In patients with Alzheimer's disease (AD), the prevalence of OSAS is much higher than that expected in cognitively healthy subjects. A deeper knowledge of the pathophysiological link between OSAS and AD and the demonstration that OSAS may directly influence the development of cognitive alterations, would increase prevention and treatment strategies for AD patients. In this article, we discuss the evidence of the association between OSAS and dementia. Moreover, we present data about the functional and anatomic cerebral changes induced by OSAS and the possible effects on cognitive activities and on AD pathogenesis. The possibility to positively influence cognitive impairment by OSAS treatment will be also discussed.

[Current recommendations for deceleration of myopia progression].

PubMed

Lagrèze, W A; Joachimsen, L; Schaeffel, F

2017-01-01

Epidemiologic data demonstrate a rise in myopia prevalence. Therefore interventions to reduce the risk of myopia and its progression are needed and increasingly often asked for. Systematic literature search via PubMed in MEDLINE. Myopia progression can be reduced by the following means which are listed according to their efficacy: (1) Atropine eye drops low dosed to avoid clinically relevant side effects, (2) optical means aiming at the correction of peripheral hyperopic defocus, e. g., multifocal contact lenses, and (3) increased daylight exposure. Daylight exposure reduces the risk of incident myopia. Children should be advised to spend sufficient time outdoors, especially before and in primary school. Myopia progression can be effectively attenuated by low-dose topical atropine and multifocal contact lenses.

Should visceral fat be reduced to increase longevity?

PubMed

Finelli, Carmine; Sommella, Luigi; Gioia, Saverio; La Sala, Nicolina; Tarantino, Giovanni

2013-09-01

Several epidemiologic studies have implicated visceral fat as a major risk factor for insulin resistance, type 2 diabetes mellitus, cardiovascular disease, stroke, metabolic syndrome and death. Utilizing novel models of visceral obesity, numerous studies have demonstrated that the relationship between visceral fat and longevity is causal while the accrual of subcutaneous fat does not appear to play an important role in the etiology of disease risk. Specific recommended intake levels vary based on a number of factors, including current weight, activity levels, and weight loss goals. It is discussed the need of reducing the visceral fat as a potential treatment strategy to prevent or delay age-related diseases and to increase longevity. Copyright © 2013 Elsevier B.V. All rights reserved.

Marbling and Its Nutritional Impact on Risk Factors for Cardiovascular Disease

PubMed Central

2016-01-01

This review addresses the role of fat in beef palatability and healthfulness. Particular emphasis is placed on the content of oleic acid in beef, and how this increases with time when cattle are fed a grain-based diet. Oleic acid decreases the melting point of lipids from beef, increasing the perception of juiciness and improving beef flavor. Clinical trials have demonstrated that ground beef containing elevated oleic acid increases, or at the least has no negative effects on the concentration of HDL cholesterol. The amount of fat in published ground beef intervention trials greatly exceeds the amount of fat in equivalent portions of beef from U.S. domestic or Korean Hanwoo cattle. Thus, we conclude 1) Beef cattle should be raised under production conditions that increase the concentration of oleic acid in their edible tissues (i.e., by grain feeding over extended periods of time); and 2) The amount of fat consumed in a typical portion of beef will not increase risk factors for cardiovascular disease. PMID:27621682

Psychological Factors and Cardiac Risk And Impact of Exercise Training Programs—A Review of Ochsner Studies

PubMed Central

Lavie, Carl J.; Milani, Richard V.; Artham, Surya M.; Gilliland, Yvonne

2007-01-01

Although under-emphasized, substantial evidence indicates that psychological distress, especially depression, hostility, and anxiety, are risk factors for coronary heart disease (CHD) and affect recovery following major coronary heart disease events. We review several major studies from Ochsner Medical Center demonstrating the high prevalence of psychological distress in CHD patients and the marked benefits that occur following formal cardiac rehabilitation and exercise training programs. These benefits include reductions in psychological stress, improvements in CHD risk factors that accompany high stress, and reduced all-cause mortality. These data support the benefits of exercise training and increased levels of fitness to improve psychological stress and subsequent prognosis. PMID:21603539

Mobile phone radiation and the risk of cancer; a review.

PubMed

Abdus-salam, A; Elumelu, T; Adenipekun, A

2008-06-01

With the licensing of mobile phone operators about 7 years ago, Nigeria joined many countries where worries about the health risks (including carcinogenesis) of mobile phones have become common. Opinions have also been expressed by many, some of which were inaccurate in the light of scientific evidence. This article reviewed the current scientific evidence of the role of mobile phones as possible cancer risk. The preponderance of published research works over several decades including some with over ten years of follow up have not demonstrated any significant increase in cancer among mobile phone users. However, the need for caution is emphasized as it may take up to four decades for carcinogenesis to become fully apparent.

Effectiveness of a School- and Community-based Academic Asthma Health Education Program on Use of Effective Asthma Self-care Behaviors in Older School-age Students

PubMed Central

Kintner, Eileen K.; Cook, Gwendolyn; Marti, C. Nathan; Allen, April; Stoddard, Debbie; Harmon, Phyllis; Gomes, Melissa; Meeder, Linda; Van Egeren, Laurie A.

2014-01-01

Purpose The purpose was to evaluate the effectiveness of SHARP, an academic asthma health education and counseling program, on fostering use of effective asthma self-care behaviors. Design and Methods This was a phase III, two-group, cluster randomized, single-blinded, longitudinal design guided the study. Caregivers of 205 fourth- and fifth-grade students completed the asthma health behaviors survey at pre-intervention and 1, 12, and 24 months post-intervention. Analysis involved multilevel modeling. Results All students demonstrated improvement in episode management, risk-reduction/prevention, and health promotion behaviors; SHARP students demonstrated increased improvement in episode management and risk-reduction/prevention behaviors. Practice Implications Working with schoolteachers, nurses can improve use of effective asthma self-care behaviors. PMID:25443867

Impact of Obesity on Heart and Lung Transplantation: Does Pre-Transplant Obesity Affect Outcomes?

PubMed

Bozso, S J; Nagendran, Je; Gill, R S; Freed, D H; Nagendran, Ja

2017-03-01

Increasing prevalence of obesity has led to a rise in the number of prospective obese heart and lung transplant recipients. The optimal management strategy of obese patients with end-stage heart and lung failure remains controversial. This review article discusses and provides a summary of the literature surrounding the impact of obesity on outcomes in heart and lung transplantation. Studies on transplant obesity demonstrate controversy in terms of morbidity and mortality outcomes and obesity pre-transplantation. However, the impact of obesity on outcomes seems to be more consistently demonstrated in lung rather than heart transplantation. The ultimate goal in heart and lung transplantation in the obese patient is to identify those at highest risk of complication that may warrant therapies to mitigate risk by addressing comorbid conditions. Copyright © 2016 Elsevier Inc. All rights reserved.

Model Checking for Verification of Interactive Health IT Systems

PubMed Central

Butler, Keith A.; Mercer, Eric; Bahrami, Ali; Tao, Cui

2015-01-01

Rigorous methods for design and verification of health IT systems have lagged far behind their proliferation. The inherent technical complexity of healthcare, combined with the added complexity of health information technology makes their resulting behavior unpredictable and introduces serious risk. We propose to mitigate this risk by formalizing the relationship between HIT and the conceptual work that increasingly typifies modern care. We introduce new techniques for modeling clinical workflows and the conceptual products within them that allow established, powerful modeling checking technology to be applied to interactive health IT systems. The new capability can evaluate the workflows of a new HIT system performed by clinicians and computers to improve safety and reliability. We demonstrate the method on a patient contact system to demonstrate model checking is effective for interactive systems and that much of it can be automated. PMID:26958166

Assessing secondary soil salinization risk based on the PSR sustainability framework.

PubMed

Zhou, De; Lin, Zhulu; Liu, Liming; Zimmermann, David

2013-10-15

Risk assessment of secondary soil salinization, which is caused in part by the way people manage the land, is an essential challenge to agricultural sustainability. The objective of our study was to develop a soil salinity risk assessment methodology by selecting a consistent set of risk factors based on the conceptual Pressure-State-Response (PSR) sustainability framework and incorporating the grey relational analysis and the Analytic Hierarchy Process methods. The proposed salinity risk assessment methodology was demonstrated through a case study of developing composite risk index maps for the Yinchuan Plain, a major irrigation agriculture district in northwest China. Fourteen risk factors were selected in terms of the three PSR criteria: pressure, state, and response. The results showed that the salinity risk in the Yinchuan Plain was strongly influenced by the subsoil and groundwater salinity, land use, distance to irrigation canals, and depth to groundwater. To maintain agricultural sustainability in the Yinchuan Plain, a suite of remedial and preventative actions were proposed to manage soil salinity risk in the regions that are affected by salinity at different levels and by different salinization processes. The weight sensitivity analysis results also showed that the overall salinity risk of the Yinchuan Plain would increase or decrease as the weights for pressure or response risk factors increased, signifying the importance of human activities on secondary soil salinization. Ideally, the proposed methodology will help us develop more consistent management tools for risk assessment and management and for control of secondary soil salinization. Copyright © 2013 Elsevier Ltd. All rights reserved.

A Case-Control Study Estimating Accident Risk for Alcohol, Medicines and Illegal Drugs

PubMed Central

Kuypers, Kim Paula Colette; Legrand, Sara-Ann; Ramaekers, Johannes Gerardus; Verstraete, Alain Gaston

2012-01-01

Background The aim of the present study was to assess the risk of having a traffic accident after using alcohol, single drugs, or a combination, and to determine the concentrations at which this risk is significantly increased. Methods A population-based case-control study was carried out, collecting whole blood samples of both cases and controls, in which a number of drugs were detected. The risk of having an accident when under the influence of drugs was estimated using logistic regression adjusting for gender, age and time period of accident (cases)/sampling (controls). The main outcome measures were odds ratio (OR) for accident risk associated with single and multiple drug use. In total, 337 cases (negative: 176; positive: 161) and 2726 controls (negative: 2425; positive: 301) were included in the study. Results Main findings were that 1) alcohol in general (all the concentrations together) caused an elevated crash risk; 2) cannabis in general also caused an increase in accident risk; at a cut-off of 2 ng/mL THC the risk of having an accident was four times the risk associated with the lowest THC concentrations; 3) when ranking the adjusted OR from lowest to highest risk, alcohol alone or in combination with other drugs was related to a very elevated crash risk, with the highest risk for stimulants combined with sedatives. Conclusion The study demonstrated a concentration-dependent crash risk for THC positive drivers. Alcohol and alcohol-drug combinations are by far the most prevalent substances in drivers and subsequently pose the largest risk in traffic, both in terms of risk and scope. PMID:22952694

Risk Analysis of Prostate Cancer in PRACTICAL, a Multinational Consortium, Using 25 Known Prostate Cancer Susceptibility Loci.

PubMed

Amin Al Olama, Ali; Benlloch, Sara; Antoniou, Antonis C; Giles, Graham G; Severi, Gianluca; Neal, David E; Hamdy, Freddie C; Donovan, Jenny L; Muir, Kenneth; Schleutker, Johanna; Henderson, Brian E; Haiman, Christopher A; Schumacher, Fredrick R; Pashayan, Nora; Pharoah, Paul D P; Ostrander, Elaine A; Stanford, Janet L; Batra, Jyotsna; Clements, Judith A; Chambers, Suzanne K; Weischer, Maren; Nordestgaard, Børge G; Ingles, Sue A; Sorensen, Karina D; Orntoft, Torben F; Park, Jong Y; Cybulski, Cezary; Maier, Christiane; Doerk, Thilo; Dickinson, Joanne L; Cannon-Albright, Lisa; Brenner, Hermann; Rebbeck, Timothy R; Zeigler-Johnson, Charnita; Habuchi, Tomonori; Thibodeau, Stephen N; Cooney, Kathleen A; Chappuis, Pierre O; Hutter, Pierre; Kaneva, Radka P; Foulkes, William D; Zeegers, Maurice P; Lu, Yong-Jie; Zhang, Hong-Wei; Stephenson, Robert; Cox, Angela; Southey, Melissa C; Spurdle, Amanda B; FitzGerald, Liesel; Leongamornlert, Daniel; Saunders, Edward; Tymrakiewicz, Malgorzata; Guy, Michelle; Dadaev, Tokhir; Little, Sarah J; Govindasami, Koveela; Sawyer, Emma; Wilkinson, Rosemary; Herkommer, Kathleen; Hopper, John L; Lophatonanon, Aritaya; Rinckleb, Antje E; Kote-Jarai, Zsofia; Eeles, Rosalind A; Easton, Douglas F

2015-07-01

Genome-wide association studies have identified multiple genetic variants associated with prostate cancer risk which explain a substantial proportion of familial relative risk. These variants can be used to stratify individuals by their risk of prostate cancer. We genotyped 25 prostate cancer susceptibility loci in 40,414 individuals and derived a polygenic risk score (PRS). We estimated empirical odds ratios (OR) for prostate cancer associated with different risk strata defined by PRS and derived age-specific absolute risks of developing prostate cancer by PRS stratum and family history. The prostate cancer risk for men in the top 1% of the PRS distribution was 30.6 (95% CI, 16.4-57.3) fold compared with men in the bottom 1%, and 4.2 (95% CI, 3.2-5.5) fold compared with the median risk. The absolute risk of prostate cancer by age of 85 years was 65.8% for a man with family history in the top 1% of the PRS distribution, compared with 3.7% for a man in the bottom 1%. The PRS was only weakly correlated with serum PSA level (correlation = 0.09). Risk profiling can identify men at substantially increased or reduced risk of prostate cancer. The effect size, measured by OR per unit PRS, was higher in men at younger ages and in men with family history of prostate cancer. Incorporating additional newly identified loci into a PRS should improve the predictive value of risk profiles. We demonstrate that the risk profiling based on SNPs can identify men at substantially increased or reduced risk that could have useful implications for targeted prevention and screening programs. ©2015 American Association for Cancer Research.

Risk Analysis of Prostate Cancer in PRACTICAL, a Multinational Consortium, Using 25 Known Prostate Cancer Susceptibility Loci

PubMed Central

Amin Al Olama, Ali; Benlloch, Sara; Antoniou, Antonis C.; Zeigler-Johnson, Charnita; Stephenson, Robert; Cox, Angela; Southey, Melissa C.; Spurdle, Amanda B.; FitzGerald, Liesel; Leongamornlert, Daniel; Saunders, Edward; Tymrakiewicz, Malgorzata; Guy, Michelle; Dadaev, Tokhir; Little, Sarah J.; Govindasami, Koveela; Sawyer, Emma; Wilkinson, Rosemary; Herkommer, Kathleen; Hopper, John L.; Lophatonanon, Aritaya; Rinckleb, Antje E.; Kote-Jarai, Zsofia; Eeles, Rosalind A.; Easton, Douglas F.

2015-01-01

Background Genome-wide association studies have identified multiple genetic variants associated with prostate cancer (PrCa) risk which explain a substantial proportion of familial relative risk. These variants can be used to stratify individuals by their risk of PrCa. Methods We genotyped 25 PrCa susceptibility loci in 40,414 individuals and derived a polygenic risk score (PRS). We estimated empirical Odds Ratios for PrCa associated with different risk strata defined by PRS and derived age-specific absolute risks of developing PrCa by PRS stratum and family history. Results The PrCa risk for men in the top 1% of the PRS distribution was 30.6 (95% CI 16.4-57.3) fold compared with men in the bottom 1%, and 4.2 (95% CI 3.2-5.5) fold compared with the median risk. The absolute risk of PrCa by age 85 was 65.8% for a man with family history in the top 1% of the PRS distribution, compared with 3.7% for a man in the bottom 1%. The PRS was only weakly correlated with serum PSA level (correlation=0.09). Conclusions Risk profiling can identify men at substantially increased or reduced risk of PrCa. The effect size, measured by OR per unit PRS, was higher in men at younger ages and in men with family history of PrCa. Incorporating additional newly identified loci into a PRS should improve the predictive value of risk profiles. Impact We demonstrate that the risk profiling based on SNPs can identify men at substantially increased or reduced risk that could have useful implications for targeted prevention and screening programs. PMID:25837820

Germline Genetic Variants Disturbing the Let-7/LIN28 Double-Negative Feedback Loop Alter Breast Cancer Susceptibility

PubMed Central

Fan, Lei; Li, Ji-Yu; Yang, Chen; Huang, A-Ji; Shao, Zhi-Ming

2011-01-01

Previous studies have shown that let-7 can repress the post-transcriptional translation of LIN28, and LIN28 in turn could block the maturation of let-7, forming a double-negative feedback loop. In this study, we investigated the effect of germline genetic variants on regulation of the homeostasis of the let-7/LIN28 loop and breast cancer risk. We initially demonstrated that the T/C variants of rs3811463, a single nucleotide polymorphism (SNP) located near the let-7 binding site in LIN28, could lead to differential regulation of LIN28 by let-7. Specifically, the C allele of rs3811463 weakened let-7–induced repression of LIN28 mRNA, resulting in increased production of LIN28 protein, which could in turn down-regulate the level of mature let-7. This effect was then validated at the tissue level in that the normal breast tissue of individuals with the rs3811463-TC genotype expressed significantly lower levels of let-7 and higher levels of LIN28 protein than those individuals with the rs3811463-TT genotype. Because previous in vitro and ex vivo experiments have consistently suggested that LIN28 could promote cellular transformation, we then systematically evaluated the relationship between rs3811463 as well as other common LIN28 SNPs and the risk of breast cancer in a stepwise manner. The first hospital-based association study (n = 2,300) demonstrated that two SNPs were significantly associated with breast cancer risk, one of which was rs3811463, while the other was rs6697410. The C allele of the rs3811463 SNP corresponded to an increased risk of breast cancer with an odds ratio (OR) of 1.25 (P = 0.0091), which was successfully replicated in a second independent study (n = 1,156) with community-based controls. The combined P-value of the two studies was 8.0×10−5. Taken together, our study demonstrates that host genetic variants could disturb the regulation of the let-7/LIN28 double-negative feedback loop and alter breast cancer risk. PMID:21912531

Demonstration of the feasibility of emergency department immunization against influenza and pneumococcus.

PubMed

Slobodkin, D; Zielske, P G; Kitlas, J L; McDermott, M F; Miller, S; Rydman, R

1998-11-01

To demonstrate the feasibility of systematic immunization against influenza and pneumococcus in a public emergency department. This was a demonstration project conducted from October 21, 1996, through December 2, 1996, at Cook County Hospital, an inner-city hospital with a 1996 adult ED census of 120,449. Seventy-eight percent of patients are uninsured; 92% are people of color; 73% deny having a primary physician. Only 15% have emergency complaints. Nurses received standing orders that all nonemergency adult patients meeting Centers for Disease Control and Prevention criteria for high risk should be offered immunization against influenza and pneumococcus at triage. Cash prizes were offered to nurses appropriately immunizing the most patients. The date of immunization was entered into the computerized patient registration system, available to all providers within the county system. From November 4 through November 18, an extra nurse was assigned to triage to test for improvement in immunization rates. A time-motion study determined the time required per immunization on the basis of a convenience sample of 8 nurses drawn from all 3 shifts. Only 3% of identified high-risk patients reported previous pneumococcal immunization. Despite extreme variation in nurse performance, 2,631 patients (24% of patients triaged) were screened, and 716 high-risk patients were identified (27% of patients screened). A total of 1234 patients were immunized against influenza, and 241 patients were appropriately immunized against pneumococcus. Sixty-one percent of high-risk patients with no contraindication to influenza immunization were immunized against influenza. Thirty-five percent of high-risk patients not previously immunized against pneumococcus were immunized against pneumococcus. Immunizations per shift per triage nurse varied from 0 to 24. Median time for all activities related to immunization was 4 minutes (range, 2 to 10 minutes). There was no increase in immunization rates with the addition of an extra nurse at triage (95% confidence interval for odds ratio, .929 to 1.153). Systematic immunization against influenza and pneumococcus is both needed and feasible in a public ED. "Buy-in" by nurses is variable. Increased staffing alone does not improve immunization rates.

Classification of suicide attempters in schizophrenia using sociocultural and clinical features: A machine learning approach.

PubMed

Hettige, Nuwan C; Nguyen, Thai Binh; Yuan, Chen; Rajakulendran, Thanara; Baddour, Jermeen; Bhagwat, Nikhil; Bani-Fatemi, Ali; Voineskos, Aristotle N; Mallar Chakravarty, M; De Luca, Vincenzo

2017-07-01

Suicide is a major concern for those afflicted by schizophrenia. Identifying patients at the highest risk for future suicide attempts remains a complex problem for psychiatric interventions. Machine learning models allow for the integration of many risk factors in order to build an algorithm that predicts which patients are likely to attempt suicide. Currently it is unclear how to integrate previously identified risk factors into a clinically relevant predictive tool to estimate the probability of a patient with schizophrenia for attempting suicide. We conducted a cross-sectional assessment on a sample of 345 participants diagnosed with schizophrenia spectrum disorders. Suicide attempters and non-attempters were clearly identified using the Columbia Suicide Severity Rating Scale (C-SSRS) and the Beck Suicide Ideation Scale (BSS). We developed four classification algorithms using a regularized regression, random forest, elastic net and support vector machine models with sociocultural and clinical variables as features to train the models. All classification models performed similarly in identifying suicide attempters and non-attempters. Our regularized logistic regression model demonstrated an accuracy of 67% and an area under the curve (AUC) of 0.71, while the random forest model demonstrated 66% accuracy and an AUC of 0.67. Support vector classifier (SVC) model demonstrated an accuracy of 67% and an AUC of 0.70, and the elastic net model demonstrated and accuracy of 65% and an AUC of 0.71. Machine learning algorithms offer a relatively successful method for incorporating many clinical features to predict individuals at risk for future suicide attempts. Increased performance of these models using clinically relevant variables offers the potential to facilitate early treatment and intervention to prevent future suicide attempts. Copyright © 2017 Elsevier Inc. All rights reserved.

Warming reinforces nonconsumptive predator effects on prey growth, physiology, and body stoichiometry.

PubMed

Janssens, Lizanne; Van Dievel, Marie; Stoks, Robby

2015-12-01

While nonconsumptive effects of predators may strongly affect prey populations, little is known how future warming will modulate these effects. Such information would be especially relevant with regard to prey physiology and resulting changes in prey stoichiometry. We investigated in Enallagma cyathigerum damselfly larvae the effects of a 4°C warming (20°C vs. 24°C) and predation risk on growth rate, physiology and body stoichiometry, for the first time including all key mechanisms suggested by the general stress paradigm (GSP) on how stressors shape changes in body stoichiometry. Growth rate and energy storage were higher at 24°C. Based on thermodynamic principles and the growth rate hypothesis, we could demonstrate predictable reductions in body C:P under warming and link these to the increase in P-rich RNA; the associated warming-induced decrease in C:N may be explained by the increased synthesis of N-rich proteins. Yet, under predation risk, growth rate instead decreased with warming and the warming-induced decreases in C:N and C:P disappeared. As predicted by the GSP, larvae increased body C:N and C:P at 24°C under predation risk. Notably, we did not detect the assumed GSP-mechanisms driving these changes: despite an increased metabolic rate there was neither an increase of C-rich biomolecules (instead fat and sugar contents decreased under predation risk), nor a decrease of N-rich proteins. We hypothesize that the higher C:N and N:P under predation risk are caused by a higher investment in morphological defense. This may also explain the stronger predator-induced increase in C:N under warming. The expected higher C:P under predation risk was only present under warming and matched the observed growth reduction and associated reduction in P-rich RNA. Our integrated mechanistic approach unraveled novel pathways of how warming and predation risk shape body stoichiometry. Key findings that (1) warming effects on elemental stoichiometry were predictable and only present in the absence of predation risk and that (2) warming reinforced the predator-induced effects on C:N:P, are pivotal in understanding how nonconsumptive predator effects under global warming will shape prey populations.

Risk of selected structural abnormalities in infants after increased nuchal translucency measurement.

PubMed

Baer, Rebecca J; Norton, Mary E; Shaw, Gary M; Flessel, Monica C; Goldman, Sara; Currier, Robert J; Jelliffe-Pawlowski, Laura L

2014-12-01

We sought to examine the association between increased first-trimester fetal nuchal translucency (NT) measurement and major noncardiac structural birth defects in euploid infants. Included were 75,899 singleton infants without aneuploidy or critical congenital heart defects born in California in 2009 through 2010 with NT measured between 11-14 weeks of gestation. Logistic binomial regression was employed to estimate relative risks (RRs) and 95% confidence intervals (CIs) for occurrence of birth defects in infants with an increased NT measurement (by percentile at crown-rump length [CRL] and by ≥3.5 mm compared to those with measurements <90th percentile for CRL). When considered by CRL adjusted percentile and by measurement ≥3.5 mm, infants with a NT ≥95th percentile were at risk of having ≥1 major structural birth defects (any defect, RR, 1.6; 95% CI, 1.3-1.9; multiple defects, RR, 2.1; 95% CI, 1.3-3.4). Infants with a NT measurement ≥95th percentile were at particularly high risk for pulmonary, gastrointestinal, genitourinary, and musculoskeletal anomalies (RR, 1.6-2.7; 95% CI, 1.1-5.4). Our findings demonstrate that risks of major pulmonary, gastrointestinal, genitourinary, and musculoskeletal structural birth defects exist for NT measurements ≥95th percentile. The ≥3-fold risks were observed for congenital hydrocephalus; agenesis, hypoplasia, and dysplasia of the lung; atresia and stenosis of the small intestine; osteodystrophies; and diaphragm anomalies. Copyright © 2014 Elsevier Inc. All rights reserved.

Elevated Bathing-Associated Disease Risks Despite Certified Water Quality: A Cohort Study

PubMed Central

Papastergiou, Panagiotis; Mouchtouri, Varvara; Pinaka, Ourania; Katsiaflaka, Anna; Rachiotis, George; Hadjichristodoulou, Christos

2012-01-01

Bacteriological water quality criteria have been recommended to ensure bathers’ health. However, this risk-assessment approach is based mainly on routine measurements of fecal pollution indicator bacteria in seawater, and may not be adequate to protect bathers effectively. The aim of this study was to assess the risks of symptoms related to infectious diseases among bathers after exposure to seawater which was of excellent quality according to EU guidelines. This study is a cohort study recruiting bathers and non-bathers. Water samples were collected for estimating bacterial indicators. Univariable and multivariable analysis was performed to compare the risks of developing symptoms/diseases between bathers and non-bathers. A total of 3805 bathers and 572 non-bathers were included in the study. Water analysis results demonstrated excellent quality of bathing water. Significantly increased risks of symptoms related to gastrointestinal infections (OR = 3.60, 95% CI 1.28–10.13), respiratory infections (OR = 1.92, 95% CI 1.00–3.67), eye infections (OR = 2.43, 95% CI 1.27–4.63) and ear infections (OR = 17.21, 95% CI 2.42–122.34) were observed among bathers compared with non-bathers. Increased rates of medical consultation and medication use were also observed among bathers. There was evidence that bathers experienced increased morbidity compared with non-bathers though the bathing waters met bacteriological water quality criteria. These results suggest that risk assessments of recreational seawaters should not only focus on bacteriological water quality criteria. PMID:22754456

Assessment of the incidence of squamous cell papilloma of the esophagus and the presence of high-risk human papilloma virus.

PubMed

Pantham, Ganesh; Ganesan, Santhi; Einstadter, Douglas; Jin, Ge; Weinberg, Aaron; Fass, Ronnie

2017-01-01

There has been a recent increase in the incidence of oropharyngeal cancer (OPC) associated with high-risk human papilloma virus (HPV) infection. We investigated the incidence of esophageal papilloma and the presence of high-risk HPV infection. This is a cross-sectional study conducted at a County teaching hospital. Patients with esophageal papilloma between January 2000 and December 2013 were identified. Patients with sufficient specimens were tested for the HPV virus. Sixty patients with esophageal papilloma lesions were identified from 2000 to 2013. (31 males, age 51 ± 13 years). The incidence was 0.13% in 2000 and increased to 0.57% in 2013 (P < 0.0001). Twenty-nine patients (48.3%) had a papilloma that was more than 5 mm in size, and 20% had multiple lesions. The papilloma was located in the distal esophagus in 35 (58.3%) patients, mid esophagus in 17 (28.3%) patients, and proximal in 8 (13.3%) patients. Three (5%) patients had associated OPC, and 9 (47.4%) of the 19 patients tested were positive for high-risk HPV serotype 16. The incidence of esophageal papilloma has increased by fourfolds over the past 14 years. About half of the tested patients demonstrated high risk HPV. This may suggest a potential growing risk for esophageal squamous cell cancer in the future. © 2016 International Society for Diseases of the Esophagus.

Preoperative radiation and free flap outcomes for head and neck reconstruction: a systematic review and meta-analysis.

PubMed

Herle, Pradyumna; Shukla, Lipi; Morrison, Wayne A; Shayan, Ramin

2015-03-01

There is a general consensus among reconstructive surgeons that preoperative radiotherapy is associated with a higher risk of flap failure and complications in head and neck surgery. Opinion is also divided regarding the effects of radiation dose on free flap outcomes and timing of preoperative radiation to minimize adverse outcomes. Our meta-analysis will attempt to address these issues. A systematic review of the literature was conducted in concordance to PRISMA protocol. Data were combined using STATA 12 and Open Meta-Analyst software programmes. Twenty-four studies were included comparing 2842 flaps performed in irradiated fields and 3491 flaps performed in non-irradiated fields. Meta-analysis yielded statistically significant risk ratios for flap failure (RR 1.48, P = 0.004), complications (RR 1.84, P < 0.001), reoperation (RR 2.06, P < 0.001) and fistula (RR 2.05, P < 0.001). Mean radiation dose demonstrated a trend towards increased risk of flap failure, but this was not statistically significant. On subgroup analysis, flaps with >60 Gy radiation had a non-statistically significant higher risk of flap failure (RR 1.61, P = 0.145). Preoperative radiation is associated with a statistically significant increased risk of flap complications, failure and fistula. Preoperative radiation in excess of 60 Gy after radiotherapy represents a potential risk factor for increased flap loss and should be avoided where possible. © 2014 Royal Australasian College of Surgeons.

Risk assessment of brine contamination to aquatic resources from energy development in glacial drift deposits: Williston Basin, USA

USGS Publications Warehouse

Preston, Todd M.; Chesley-Preston, Tara

2015-01-01

Our goal was to improve the Sheridan County assessment (SCA) and evaluate the use of this new Williston Basin assessment (WBA) across 31 counties mantled by glacial drift in the Williston Basin. To determine if the WBA model improved the SCA model, results from both assessments were compared to CI values from 37 surface and groundwater samples collected to evaluate the SCA. The WBA (R2 = 0.65) outperformed the SCA (R2 = 0.52) indicating improved model performance. Applicability across the Williston Basin was evaluated by comparing WBA results to CI values from 123 surface water samples collected from 97 sections. Based on the WBA, the majority (83.5%) of sections lacked an oil well and had minimal risk. Sections with one or more oil wells comprised low (8.4%), moderate (6.5%), or high (1.7%) risk areas. The percentage of contaminated water samples, percentage of sections with at least one contaminated sample, and the average CI value of contaminated samples increased from low to high risk indicating applicability across the Williston Basin. Furthermore, the WBA performed better compared to only the contaminated samples (R2 = 0.62) versus all samples (R2 = 0.38). This demonstrates that the WBA was successful at identifying sections, but not individual aquatic resources, with an increased risk of contamination; therefore, WBA results can prioritize future sampling within areas of increased risk.

Multi-temporal analysis of forest fire risk driven by environmental and socio-economic change in the Republic of Korea

NASA Astrophysics Data System (ADS)

Kim, S. J.; Lim, C. H.; Kim, G. S.; Lee, W. K.

2017-12-01

Analysis of forest fire risk is important in disaster risk reduction (DRR) since it provides a way to manage forest fires. Climate and socio-economic factors are important in the cause of forest fires, and the role of the socio-economic factors in prevention and preparedness of forest fires is increasing. As most of the forest fires in the Republic of Korea are highly related to human activities, both environmental factors and socio-economic factors were considered into the analysis of forest fire risk. In this study, the Maximum Entropy (MaxEnt) model was used to predict the potential geographical distribution and probability of forest fire occurrence spatially and temporally from 1980s to the 2010s in the Republic of Korea by multi-temporal analysis and analyze the relationship between forest fires and the factors. As a result of the risk analysis, there was an overall increasing trend in forest fire risk from the 1980s to the 2000s, and socio-economic factors were highly correlated with the occurrence of forest fires. The study demonstrates that the socio-economic factors considered as human activities can increase the occurrence of forest fires. The result implies that managing human activities are significant to prevent forest fire occurrence. In addition, timely forest fire prevention and control is necessary as drought index such as Standardized Precipitation Index (SPI) also affected forest fires.

Risks and responses to universal drinking water security.

PubMed

Hope, Robert; Rouse, Michael

2013-11-13

Risks to universal drinking water security are accelerating due to rapid demographic, climate and economic change. Policy responses are slow, uneven and largely inadequate to address the nature and scale of the global challenges. The challenges relate both to maintaining water security in increasingly fragile supply systems and to accelerating reliable access to the hundreds of millions who remain water-insecure. A conceptual framework illustrates the relationship between institutional, operational and financial risks and drinking water security outcomes. We apply the framework to nine case studies from rural and urban contexts in South Asia and sub-Saharan Africa. Case studies are purposively selected based on established and emerging examples of political, technological or institutional reforms that address water security risks. We find broad evidence that improved information flows reduce institutional costs and promote stronger and more transparent operational performance to increase financial sustainability. However, political barriers need to be overcome in all cases through internal or external interventions that require often decadal time frames and catalytic investments. No single model exists, though there is sufficient evidence to demonstrate that risks to drinking water security can be reduced even in the most difficult and challenging contexts.

Interaction between Helicobacter pylori infection, nonsteroidal anti-inflammatory drugs and/or low-dose aspirin use: Old question new insights

PubMed Central

Sostres, Carlos; Gargallo, Carla Jerusalen; Lanas, Angel

2014-01-01

Previous reports clearly demonstrated that Helicobacter pylori (H. pylori) infection, nonsteroidal anti-inflammatory drugs (NSAID) or low dose aspirin (ASA) use significantly and independently increased the risk for the development of peptic ulcer disease. Today, the presence of H. pylori infection associated with low dose ASA and/or NSAID use in the same patient is becoming more frequent and therefore the potential interaction between these factors and the consequences of it has important implications. Whether NSAID intake in the presence of H. pylori infection may further increase the risk of peptic ulcer carried by the presence of only one risk factor is still a matter of debate. Studies on the interaction between the two risk factors yielded conflicting data and no consensus has been reached in the last years. In addition, the interaction between H. pylori infection and low-dose ASA remains even more controversial. In real clinical practice, we can find different clinical scenarios involving these three factors associated with the presence of different gastrointestinal and cardiovascular risk factors. These huge variety of possible combinations greatly hinder the decision making process of physicians. PMID:25071338

Using Risk Assessment and Habitat Suitability Models to Prioritise Invasive Species for Management in a Changing Climate.

PubMed

Chai, Shauna-Lee; Zhang, Jian; Nixon, Amy; Nielsen, Scott

2016-01-01

Accounting for climate change in invasive species risk assessments improves our understanding of potential future impacts and enhances our preparedness for the arrival of new non-native species. We combined traditional risk assessment for invasive species with habitat suitability modeling to assess risk to biodiversity based on climate change. We demonstrate our method by assessing the risk for 15 potentially new invasive plant species to Alberta, Canada, an area where climate change is expected to facilitate the poleward expansion of invasive species ranges. Of the 15 species assessed, the three terrestrial invasive plant species that could pose the greatest threat to Alberta's biodiversity are giant knotweed (Fallopia sachalinensis), tamarisk (Tamarix chinensis), and alkali swainsonpea (Sphaerophysa salsula). We characterise giant knotweed as 'extremely invasive', with 21 times the suitable habitat between baseline and future projected climate. Tamarisk is 'extremely invasive' with a 64% increase in suitable habitat, and alkali swainsonpea is 'highly invasive' with a 21% increase in suitable habitat. Our methodology can be used to predict and prioritise potentially new invasive species for their impact on biodiversity in the context of climate change.

Using Risk Assessment and Habitat Suitability Models to Prioritise Invasive Species for Management in a Changing Climate

PubMed Central

Chai, Shauna-Lee; Zhang, Jian; Nixon, Amy; Nielsen, Scott

2016-01-01

Accounting for climate change in invasive species risk assessments improves our understanding of potential future impacts and enhances our preparedness for the arrival of new non-native species. We combined traditional risk assessment for invasive species with habitat suitability modeling to assess risk to biodiversity based on climate change. We demonstrate our method by assessing the risk for 15 potentially new invasive plant species to Alberta, Canada, an area where climate change is expected to facilitate the poleward expansion of invasive species ranges. Of the 15 species assessed, the three terrestrial invasive plant species that could pose the greatest threat to Alberta’s biodiversity are giant knotweed (Fallopia sachalinensis), tamarisk (Tamarix chinensis), and alkali swainsonpea (Sphaerophysa salsula). We characterise giant knotweed as ‘extremely invasive’, with 21 times the suitable habitat between baseline and future projected climate. Tamarisk is ‘extremely invasive’ with a 64% increase in suitable habitat, and alkali swainsonpea is ‘highly invasive’ with a 21% increase in suitable habitat. Our methodology can be used to predict and prioritise potentially new invasive species for their impact on biodiversity in the context of climate change. PMID:27768758

Quantifying lead-time bias in risk factor studies of cancer through simulation.

PubMed

Jansen, Rick J; Alexander, Bruce H; Anderson, Kristin E; Church, Timothy R

2013-11-01

Lead-time is inherent in early detection and creates bias in observational studies of screening efficacy, but its potential to bias effect estimates in risk factor studies is not always recognized. We describe a form of this bias that conventional analyses cannot address and develop a model to quantify it. Surveillance Epidemiology and End Results (SEER) data form the basis for estimates of age-specific preclinical incidence, and log-normal distributions describe the preclinical duration distribution. Simulations assume a joint null hypothesis of no effect of either the risk factor or screening on the preclinical incidence of cancer, and then quantify the bias as the risk-factor odds ratio (OR) from this null study. This bias can be used as a factor to adjust observed OR in the actual study. For this particular study design, as average preclinical duration increased, the bias in the total-physical activity OR monotonically increased from 1% to 22% above the null, but the smoking OR monotonically decreased from 1% above the null to 5% below the null. The finding of nontrivial bias in fixed risk-factor effect estimates demonstrates the importance of quantitatively evaluating it in susceptible studies. Copyright © 2013 Elsevier Inc. All rights reserved.

Metabolite Profiles of Diabetes Incidence and Intervention Response in the Diabetes Prevention Program

PubMed Central

Ma, Yong; Clish, Clary; Florez, Jose C.; Wang, Thomas J.; Gerszten, Robert E.

2016-01-01

Identifying novel biomarkers of type 2 diabetes risk may improve prediction and prevention among individuals at high risk of the disease and elucidate new biological pathways relevant to diabetes development. We performed plasma metabolite profiling in the Diabetes Prevention Program (DPP), a completed trial that randomized high-risk individuals to lifestyle, metformin, or placebo interventions. Previously reported markers, branched-chain and aromatic amino acids and glutamine/glutamate, were associated with incident diabetes (P < 0.05 for all), but these associations were attenuated upon adjustment for clinical and biochemical measures. By contrast, baseline levels of betaine, also known as glycine betaine (hazard ratio 0.84 per SD log metabolite level, P = 0.02), and three other metabolites were associated with incident diabetes even after adjustment. Moreover, betaine was increased by the lifestyle intervention, which was the most effective approach to preventing diabetes, and increases in betaine at 2 years were also associated with lower diabetes incidence (P = 0.01). Our findings indicate betaine is a marker of diabetes risk among high-risk individuals both at baseline and during preventive interventions and they complement animal models demonstrating a direct role for betaine in modulating metabolic health. PMID:26861782

Patient- and cohort-specific dose and risk estimation for abdominopelvic CT: a study based on 100 patients

NASA Astrophysics Data System (ADS)

Tian, Xiaoyu; Li, Xiang; Segars, W. Paul; Frush, Donald P.; Samei, Ehsan

2012-03-01

The purpose of this work was twofold: (a) to estimate patient- and cohort-specific radiation dose and cancer risk index for abdominopelvic computer tomography (CT) scans; (b) to evaluate the effects of patient anatomical characteristics (size, age, and gender) and CT scanner model on dose and risk conversion coefficients. The study included 100 patient models (42 pediatric models, 58 adult models) and multi-detector array CT scanners from two commercial manufacturers (LightSpeed VCT, GE Healthcare; SOMATOM Definition Flash, Siemens Healthcare). A previously-validated Monte Carlo program was used to simulate organ dose for each patient model and each scanner, from which DLP-normalized-effective dose (k factor) and DLP-normalized-risk index values (q factor) were derived. The k factor showed exponential decrease with increasing patient size. For a given gender, q factor showed exponential decrease with both increasing patient size and patient age. The discrepancies in k and q factors across scanners were on average 8% and 15%, respectively. This study demonstrates the feasibility of estimating patient-specific organ dose and cohort-specific effective dose and risk index in abdominopelvic CT requiring only the knowledge of patient size, gender, and age.

Static knee alignment and its association with radiographic knee osteoarthritis.

PubMed

Teichtahl, A J; Cicuttini, F M; Janakiramanan, N; Davis, S R; Wluka, A E

2006-09-01

Although knee alignment is associated with the progression of knee osteoarthritis (OA), it is unclear which features that characterize radiographic OA are related to alignment. The aim of this study was to examine the relationship between static knee joint alignment (measured as a continuous variable) and the radiographic features of knee OA (joint space narrowing and osteophytes). One hundred and twenty one adults with symptomatic knee OA were recruited using a combined strategy including referral from specialist centres, arthritis support groups and media advertising. X-rays were performed to classify the severity of disease and to determine static knee alignment. Increasing varus knee alignment was associated with increasing risk of medial compartment joint space narrowing (P < 0.001) and osteophytes (P = 0.005). Increasing valgus knee alignment was associated with an increased risk for lateral compartment joint space narrowing (P < 0.001) and osteophytes (P = 0.002). This study has demonstrated that the static knee angle, measured as a continuous variable, is an important determinant of the compartment-specific features of radiographic knee OA. Further work is required to determine whether interventions aimed at correcting these relatively minor levels of varus and valgus angulation will have an effect on the risk of tibiofemoral OA.

A low-frequency inactivating AKT2 variant enriched in the Finnish population is associated with fasting insulin levels and type 2 diabetes risk

PubMed Central

Grarup, Niels; Rivas, Manuel A; Mahajan, Anubha; Locke, Adam E; Cingolani, Pablo; Pers, Tune H; Viñuela, Ana; Brown, Andrew A; Wu, Ying; Flannick, Jason; Fuchsberger, Christian; Gamazon, Eric R; Gaulton, Kyle J; Im, Hae Kyung; Teslovich, Tanya M; Blackwell, Thomas W; Bork-Jensen, Jette; Burtt, Noël P; Chen, Yuhui; Green, Todd; Hartl, Christopher; Kang, Hyun Min; Kumar, Ashish; Ladenvall, Claes; Ma, Clement; Moutsianas, Loukas; Pearson, Richard D; Perry, John R B; Rayner, N William; Robertson, Neil R; Scott, Laura J; van de Bunt, Martijn; Eriksson, Johan G; Jula, Antti; Koskinen, Seppo; Lehtimäki, Terho; Palotie, Aarno; Raitakari, Olli T; Jacobs, Suzanne BR; Wessel, Jennifer; Chu, Audrey Y; Scott, Robert A; Goodarzi, Mark O; Blancher, Christine; Buck, Gemma; Buck, David; Chines, Peter S; Gabriel, Stacey; Gjesing, Anette P; Groves, Christopher J; Hollensted, Mette; Huyghe, Jeroen R; Jackson, Anne U; Jun, Goo; Justesen, Johanne Marie; Mangino, Massimo; Murphy, Jacquelyn; Neville, Matt; Onofrio, Robert; Small, Kerrin S; Stringham, Heather M; Trakalo, Joseph; Banks, Eric; Carey, Jason; Carneiro, Mauricio O; DePristo, Mark; Farjoun, Yossi; Fennell, Timothy; Goldstein, Jacqueline I; Grant, George; de Angelis, Martin Hrabé; Maguire, Jared; Neale, Benjamin M; Poplin, Ryan; Purcell, Shaun; Schwarzmayr, Thomas; Shakir, Khalid; Smith, Joshua D; Strom, Tim M; Wieland, Thomas; Lindstrom, Jaana; Brandslund, Ivan; Christensen, Cramer; Surdulescu, Gabriela L; Lakka, Timo A; Doney, Alex S F; Nilsson, Peter; Wareham, Nicholas J; Langenberg, Claudia; Varga, Tibor V; Franks, Paul W; Rolandsson, Olov; Rosengren, Anders H; Farook, Vidya S; Thameem, Farook; Puppala, Sobha; Kumar, Satish; Lehman, Donna M; Jenkinson, Christopher P; Curran, Joanne E; Hale, Daniel Esten; Fowler, Sharon P; Arya, Rector; DeFronzo, Ralph A; Abboud, Hanna E; Syvänen, Ann-Christine; Hicks, Pamela J; Palmer, Nicholette D; Ng, Maggie C Y; Bowden, Donald W; Freedman, Barry I; Esko, Tõnu; Mägi, Reedik; Milani, Lili; Mihailov, Evelin; Metspalu, Andres; Narisu, Narisu; Kinnunen, Leena; Bonnycastle, Lori L; Swift, Amy; Pasko, Dorota; Wood, Andrew R; Fadista, João; Pollin, Toni I; Barzilai, Nir; Atzmon, Gil; Glaser, Benjamin; Thorand, Barbara; Strauch, Konstantin; Peters, Annette; Roden, Michael; Müller-Nurasyid, Martina; Liang, Liming; Kriebel, Jennifer; Illig, Thomas; Grallert, Harald; Gieger, Christian; Meisinger, Christa; Lannfelt, Lars; Musani, Solomon K; Griswold, Michael; Taylor, Herman A; Wilson, Gregory; Correa, Adolfo; Oksa, Heikki; Scott, William R; Afzal, Uzma; Tan, Sian-Tsung; Loh, Marie; Chambers, John C; Sehmi, Jobanpreet; Kooner, Jaspal Singh; Lehne, Benjamin; Cho, Yoon Shin; Lee, Jong-Young; Han, Bok-Ghee; Käräjämäki, Annemari; Qi, Qibin; Qi, Lu; Huang, Jinyan; Hu, Frank B; Melander, Olle; Orho-Melander, Marju; Below, Jennifer E; Aguilar, David; Wong, Tien Yin; Liu, Jianjun; Khor, Chiea-Chuen; Chia, Kee Seng; Lim, Wei Yen; Cheng, Ching-Yu; Chan, Edmund; Tai, E Shyong; Aung, Tin; Linneberg, Allan; Isomaa, Bo; Meitinger, Thomas; Tuomi, Tiinamaija; Hakaste, Liisa; Kravic, Jasmina; Jørgensen, Marit E; Lauritzen, Torsten; Deloukas, Panos; Stirrups, Kathleen E; Owen, Katharine R; Farmer, Andrew J; Frayling, Timothy M; O'Rahilly, Stephen P; Walker, Mark; Levy, Jonathan C; Hodgkiss, Dylan; Hattersley, Andrew T; Kuulasmaa, Teemu; Stančáková, Alena; Barroso, Inês; Bharadwaj, Dwaipayan; Chan, Juliana; Chandak, Giriraj R; Daly, Mark J; Donnelly, Peter J; Ebrahim, Shah B; Elliott, Paul; Fingerlin, Tasha; Froguel, Philippe; Hu, Cheng; Jia, Weiping; Ma, Ronald C W; McVean, Gilean; Park, Taesung; Prabhakaran, Dorairaj; Sandhu, Manjinder; Scott, James; Sladek, Rob; Tandon, Nikhil; Teo, Yik Ying; Zeggini, Eleftheria; Watanabe, Richard M; Koistinen, Heikki A; Kesaniemi, Y Antero; Uusitupa, Matti; Spector, Timothy D; Salomaa, Veikko; Rauramaa, Rainer; Palmer, Colin N A; Prokopenko, Inga; Morris, Andrew D; Bergman, Richard N; Collins, Francis S; Lind, Lars; Ingelsson, Erik; Tuomilehto, Jaakko; Karpe, Fredrik; Groop, Leif; Jørgensen, Torben; Hansen, Torben; Pedersen, Oluf; Kuusisto, Johanna; Abecasis, Gonçalo; Bell, Graeme I; Blangero, John; Cox, Nancy J; Duggirala, Ravindranath; Seielstad, Mark; Wilson, James G; Dupuis, Josee; Ripatti, Samuli; Hanis, Craig L; Florez, Jose C; Mohlke, Karen L; Meigs, James B; Laakso, Markku; Morris, Andrew P; Boehnke, Michael; Altshuler, David; McCarthy, Mark I; Gloyn, Anna L; Lindgren, Cecilia M

2017-01-01

To identify novel coding association signals and facilitate characterization of mechanisms influencing glycemic traits and type 2 diabetes risk, we analyzed 109,215 variants derived from exome array genotyping together with an additional 390,225 variants from exome sequence in up to 39,339 normoglycemic individuals from five ancestry groups. We identified a novel association between the coding variant (p.Pro50Thr) in AKT2 and fasting insulin, a gene in which rare fully penetrant mutations are causal for monogenic glycemic disorders. The low-frequency allele is associated with a 12% increase in fasting plasma insulin (FI) levels. This variant is present at 1.1% frequency in Finns but virtually absent in individuals from other ancestries. Carriers of the FI-increasing allele had increased 2-hour insulin values, decreased insulin sensitivity, and increased risk of type 2 diabetes (odds ratio=1.05). In cellular studies, the AKT2-Thr50 protein exhibited a partial loss of function. We extend the allelic spectrum for coding variants in AKT2 associated with disorders of glucose homeostasis and demonstrate bidirectional effects of variants within the pleckstrin homology domain of AKT2. PMID:28341696

Accelerated epigenetic aging in Down syndrome

PubMed Central

Horvath, Steve; Garagnani, Paolo; Bacalini, Maria Giulia; Pirazzini, Chiara; Salvioli, Stefano; Gentilini, Davide; Di Blasio, Anna Maria; Giuliani, Cristina; Tung, Spencer; Vinters, Harry V; Franceschi, Claudio

2015-01-01

Down Syndrome (DS) entails an increased risk of many chronic diseases that are typically associated with older age. The clinical manifestations of accelerated aging suggest that trisomy 21 increases the biological age of tissues, but molecular evidence for this hypothesis has been sparse. Here, we utilize a quantitative molecular marker of aging (known as the epigenetic clock) to demonstrate that trisomy 21 significantly increases the age of blood and brain tissue (on average by 6.6 years, P = 7.0 × 10−14). PMID:25678027

Inflammation and Cardiovascular Disease Risk: A Case Study of HIV and Inflammatory Joint Disease.

PubMed

Rahman, Faisal; Martin, Seth S; Whelton, Seamus P; Mody, Freny V; Vaishnav, Joban; McEvoy, John William

2018-04-01

The epidemiologic data associating infection and inflammation with increased risk of cardiovascular disease is well established. Patients with chronically upregulated inflammatory pathways, such as those with HIV and inflammatory joint diseases, often have a risk of future cardiovascular risk that is similar to or higher than patients with diabetes. Thus, it is of heightened importance for clinicians to consider the cardiovascular risk of patients with these conditions. HIV and inflammatory joint diseases are archetypal examples of how inflammatory disorders contribute to vascular disease and provide illustrative lessons that can be leveraged in the prevention of cardiovascular disease. Managing chronic inflammatory diseases calls for a multifaceted approach to evaluation and treatment of suboptimal lifestyle habits, accurate estimation of cardiovascular disease risk with potential upwards recalibration due to chronic inflammation, and more intensive treatment of risk factors because current tools often underestimate the risk in this population. This approach is further supported by the recently published CANTOS trial demonstrating that reducing inflammation can serve as a therapeutic target among persons with residual inflammatory risk for cardiovascular disease. Copyright © 2018 Elsevier Inc. All rights reserved.

Electric vehicle (EV) storage supply chain risk and the energy market: A micro and macroeconomic risk management approach

NASA Astrophysics Data System (ADS)

Aguilar, Susanna D.

As a cost effective storage technology for renewable energy sources, Electric Vehicles can be integrated into energy grids. Integration must be optimized to ascertain that renewable energy is available through storage when demand exists so that cost of electricity is minimized. Optimization models can address economic risks associated with the EV supply chain- particularly the volatility in availability and cost of critical materials used in the manufacturing of EV motors and batteries. Supply chain risk can reflect itself in a shortage of storage, which can increase the price of electricity. We propose a micro-and macroeconomic framework for managing supply chain risk through utilization of a cost optimization model in combination with risk management strategies at the microeconomic and macroeconomic level. The study demonstrates how risk from the EVs vehicle critical material supply chain affects manufacturers, smart grid performance, and energy markets qualitatively and quantitatively. Our results illustrate how risk in the EV supply chain affects EV availability and the cost of ancillary services, and how EV critical material supply chain risk can be mitigated through managerial strategies and policy.

Obesity, Inflammation, and Cancer.

PubMed

Deng, Tuo; Lyon, Christopher J; Bergin, Stephen; Caligiuri, Michael A; Hsueh, Willa A

2016-05-23

Obesity, a worldwide epidemic, confers increased risk for multiple serious conditions, including cancer, and is increasingly recognized as a growing cause of preventable cancer risk. Chronic inflammation, a well-known mediator of cancer, is a central characteristic of obesity, leading to many of its complications, and obesity-induced inflammation confers additional cancer risk beyond obesity itself. Multiple mechanisms facilitate this strong association between cancer and obesity. Adipose tissue is an important endocrine organ, secreting several hormones, including leptin and adiponectin, and chemokines that can regulate tumor behavior, inflammation, and the tumor microenvironment. Excessive adipose expansion during obesity causes adipose dysfunction and inflammation to increase systemic levels of proinflammatory factors. Cells from adipose tissue, such as cancer-associated adipocytes and adipose-derived stem cells, enter the cancer microenvironment to enhance protumoral effects. Dysregulated metabolism that stems from obesity, including insulin resistance, hyperglycemia, and dyslipidemia, can further impact tumor growth and development. This review describes how adipose tissue becomes inflamed in obesity, summarizes ways these mechanisms impact cancer development, and discusses their role in four adipose-associated cancers that demonstrate elevated incidence or mortality in obesity.

Loneliness, Social Isolation, and Cardiovascular Health.

PubMed

Xia, Ning; Li, Huige

2018-03-20

Social and demographic changes have led to an increased prevalence of loneliness and social isolation in modern society. Recent Advances: Population-based studies have demonstrated that both objective social isolation and the perception of social isolation (loneliness) are correlated with a higher risk of mortality and that both are clearly risk factors for cardiovascular disease (CVD). Lonely individuals have increased peripheral vascular resistance and elevated blood pressure. Socially isolated animals develop more atherosclerosis than those housed in groups. Molecular mechanisms responsible for the increased cardiovascular risk are poorly understood. In recent reports, loneliness and social stress were associated with activation of the hypothalamic-pituitary-adrenocortical axis and the sympathetic nervous system. Repeated and chronic social stress leads to glucocorticoid resistance, enhanced myelopoiesis, upregulated proinflammatory gene expression, and oxidative stress. However, the causal role of these mechanisms in the development of loneliness-associated CVD remains unclear. Elucidation of the molecular mechanisms of how CVD is induced by loneliness and social isolation requires additional studies. Understanding of the pathomechanisms is essential for the development of therapeutic strategies to prevent the detrimental effects of social stress on health. Antioxid. Redox Signal. 28, 837-851.