Early introduction and cumulative consumption of sugar-sweetened beverages during the pre-school period and risk of obesity at 8-14 years of age.

PubMed

Cantoral, A; Téllez-Rojo, M M; Ettinger, A S; Hu, H; Hernández-Ávila, M; Peterson, K

2016-02-01

Consumption of sugar-sweetened beverages (SSB) has been associated with risk of obesity, but little evidence exists to evaluate if age of introduction and cumulative SSB consumption increases risk in children. The objective of the study was to estimate the relationship between age of introduction and cumulative SSB consumption with risk of obesity in 227 Mexican children. SSB intake was measured every 6 months; age of introduction and cumulative consumption during the pre-school period were calculated. Height, weight, waist circumference, SSB intake and other relevant variables were measured at age 8-14 years and obesity defined using standard criteria. All participants were introduced to SSB before age 24 months and most (73%) before 12 months. Early SSB introduction (≤12 months) was not significantly associated with increased odds of obesity (odds ratio [OR] = 2.00, 95% confidence interval [CI]: 0.87, 4.59). However, children in the highest tertile of cumulative SSB consumption, compared with the lowest, had almost three times the odds of general (OR = 2.99, 95% CI: 1.27, 7.00) and abdominal (OR = 2.70, 95% CI: 1.03, 7.03) obesity at age 8-14 years. High SSB consumption increased the likelihood of obesity in 8-14-year-old children. Our results suggest that SSB intake should be delayed and excessive SSB consumption in pre-school period should be avoided. © 2015 World Obesity.

Cumulative Psychosocial and Medical Risk as Predictors of Early Infant Development and Parenting Stress in an African-American Preterm Sample

ERIC Educational Resources Information Center

Candelaria, Margo A.; O'Connell, Melissa A.; Teti, Douglas M.

2006-01-01

The present study examined predictive linkages between cumulative psychosocial and medical risk, assessed neonatally, and infant development and parenting stress at 4 months of infant corrected age. Predominantly low-income, African-American mothers and their preterm infants served as participants. Cumulative psychosocial risk predicted early…

Incorporating Nonchemical Stressors Into Cumulative Risk Assessments

PubMed Central

Rider, Cynthia V.; Dourson, Michael L.; Hertzberg, Richard C.; Mumtaz, Moiz M.; Price, Paul S.; Simmons, Jane Ellen

2012-01-01

The role of nonchemical stressors in modulating the human health risk associated with chemical exposures is an area of increasing attention. On 9 March 2011, a workshop titled “Approaches for Incorporating Nonchemical Stressors into Cumulative Risk Assessment” took place during the 50th Anniversary Annual Society of Toxicology Meeting in Washington D.C. Objectives of the workshop included describing the current state of the science from various perspectives (i.e., regulatory, exposure, modeling, and risk assessment) and presenting expert opinions on currently available methods for incorporating nonchemical stressors into cumulative risk assessments. Herein, distinct frameworks for characterizing exposure to, joint effects of, and risk associated with chemical and nonchemical stressors are discussed. PMID:22345310

Phthalates and Cumulative Risk Assessment (NAS Final ...

EPA Pesticide Factsheets

On December 18, 2008, the National Academy of Sciences' National Research Council released a final report, requested and sponsored by the EPA, entitled Phthalates and Cumulative Risk Assessment: The Task Ahead. Risk assessment has become a dominant public policy tool for making choices, based on limited resources, to protect public health and the environment. It has been instrumental to the mission of the U.S. Environmental Protection Agency (EPA) as well as other federal agencies in evaluating public health concerns, informing regulatory and technological decisions, prioritizing research needs and funding, and in developing approaches for cost-benefit analysis. People are exposed to a variety of chemicals throughout their daily lives. To protect public health, regulators use risk assessments to examine the effects of chemical exposures. This book provides guidance for assessing the risk of phthalates, chemicals found in many consumer products that have been shown to affect the development of the male reproductive system of laboratory animals. Because people are exposed to multiple phthalates and other chemicals that affect male reproductive development, a cumulative risk assessment should be conducted that evaluates the combined effects of exposure to all these chemicals. The book suggests an approach for cumulative risk assessment that can serve as a model for evaluating the health risks of other types of chemicals.

Child Temperamental Regulation and Classroom Quality in Head Start: Considering the Role of Cumulative Economic Risk

ERIC Educational Resources Information Center

Rudasill, Kathleen Moritz; Hawley, Leslie R.; LoCasale-Crouch, Jennifer; Buhs, Eric S.

2017-01-01

There is growing recognition that cumulative economic risk places children at higher risk for depressed academic competencies (Crosnoe & Cooper, 2010; NCCP, 2008; Sameroff, 2000). Yet, children's temperamental regulation and the quality of the early childhood classroom environment have been associated with better academic skills. This study is…

Cumulative Trauma Among Mayas Living in Southeast Florida.

PubMed

Millender, Eugenia I; Lowe, John

2017-06-01

Mayas, having experienced genocide, exile, and severe poverty, are at high risk for the consequences of cumulative trauma that continually resurfaces through current fear of an uncertain future. Little is known about the mental health and alcohol use status of this population. This correlational study explored t/he relationship of cumulative trauma as it relates to social determinants of health (years in the United States, education, health insurance status, marital status, and employment), psychological health (depression symptoms), and health behaviors (alcohol use) of 102 Guatemalan Mayas living in Southeast Florida. The results of this study indicated that, as specific social determinants of health and cumulative trauma increased, depression symptoms (particularly among women) and the risk for harmful alcohol use (particularly among men) increased. Identifying risk factors at an early stage before serious disease or problems are manifest provides room for early screening leading to early identification, early treatment, and better outcomes.

CUMULATIVE RISK ANALYSIS FOR ORGANOPHOSPHORUS PESTICIDES

EPA Science Inventory

Cumulative Risk Analysis for Organophosphorus Pesticides
R. Woodrow Setzer, Jr. NHEERL MD-74, USEPA, RTP, NC 27711

The US EPA has recently completed a risk assessment of the effects of exposure to 33 organophosphorous pesticides (OPs) through the diet, water, and resi...

Conceptual models for cumulative risk assessment.

PubMed

Linder, Stephen H; Sexton, Ken

2011-12-01

In the absence of scientific consensus on an appropriate theoretical framework, cumulative risk assessment and related research have relied on speculative conceptual models. We argue for the importance of theoretical backing for such models and discuss 3 relevant theoretical frameworks, each supporting a distinctive "family" of models. Social determinant models postulate that unequal health outcomes are caused by structural inequalities; health disparity models envision social and contextual factors acting through individual behaviors and biological mechanisms; and multiple stressor models incorporate environmental agents, emphasizing the intermediary role of these and other stressors. The conclusion is that more careful reliance on established frameworks will lead directly to improvements in characterizing cumulative risk burdens and accounting for disproportionate adverse health effects.

Beyond Cumulative Risk: A Dimensional Approach to Childhood Adversity.

PubMed

McLaughlin, Katie A; Sheridan, Margaret A

2016-08-01

Children who have experienced environmental adversity-such as abuse, neglect, or poverty-are more likely to develop physical and mental health problems, perform poorly at school, and have difficulties in social relationships than children who have not encountered adversity. What is less clear is how and why adverse early experiences exert such a profound influence on children's development. Identifying developmental processes that are disrupted by adverse early environments is the key to developing better intervention strategies for children who have experienced adversity. Yet, much existing research relies on a cumulative risk approach that is unlikely to reveal these mechanisms. This approach tallies the number of distinct adversities experienced to create a risk score. This risk score fails to distinguish between distinct types of environmental experience, implicitly assuming that very different experiences influence development through the same underlying mechanisms. We advance an alternative model. This novel approach conceptualizes adversity along distinct dimensions, emphasizes the central role of learning mechanisms, and distinguishes between different forms of adversity that might influence learning in distinct ways. A key advantage of this approach is that learning mechanisms provide clear targets for interventions aimed at preventing negative developmental outcomes in children who have experienced adversity.

76 FR 82296 - Pyrethrins/Pyrethroid Cumulative Risk Assessment; Extension of Comment Period

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-30

... Cumulative Risk Assessment; Extension of Comment Period AGENCY: Environmental Protection Agency (EPA). ACTION..., 2011, concerning the availability of EPA's cumulative risk assessment for the naturally occurring... cumulative risk assessment for the pyrethroids. Based on this assessment, the EPA concluded that the...

Childhood Poverty, Cumulative Risk Exposure, and Mental Health in Emerging Adults

PubMed Central

Evans, Gary W.; Cassells, Rochelle C.

2014-01-01

One out of four American children are born into poverty, but little is known about the long-term, mental health implications of early deprivation. The more time in poverty from birth-age-9, the worse mental health as emerging adults (n = 196, M = 17.30 years, 53% male). These results maintain independently of concurrent, adult income levels for self-reported externalizing symptoms and a standard learned helplessness behavioral protocol, but internalizing symptoms were unaffected by childhood poverty. We then demonstrate that part of the reason why early poverty exposure is harmful to mental health among emerging adults is because of elevated cumulative risk exposure assessed at age 13. The significant, prospective, longitudinal relations between early childhood poverty and externalizing symptoms plus learned helplessness behavior are mediated, in part, by exposure to a confluence of psychosocial (violence, family turmoil, child separation from family) and physical (noise, crowding, substandard housing) risk factors during adolescence. PMID:26609499

Conceptual Models for Cumulative Risk Assessment

PubMed Central

Sexton, Ken

2011-01-01

In the absence of scientific consensus on an appropriate theoretical framework, cumulative risk assessment and related research have relied on speculative conceptual models. We argue for the importance of theoretical backing for such models and discuss 3 relevant theoretical frameworks, each supporting a distinctive “family” of models. Social determinant models postulate that unequal health outcomes are caused by structural inequalities; health disparity models envision social and contextual factors acting through individual behaviors and biological mechanisms; and multiple stressor models incorporate environmental agents, emphasizing the intermediary role of these and other stressors. The conclusion is that more careful reliance on established frameworks will lead directly to improvements in characterizing cumulative risk burdens and accounting for disproportionate adverse health effects. PMID:22021317

Relationship Risks in Context: A Cumulative Risk Approach to Understanding Relationship Satisfaction

PubMed Central

Rauer, Amy J.; Karney, Benjamin R.; Garvan, Cynthia W.; Hou, Wei

2009-01-01

Risks associated with less satisfying intimate relationships often co-occur within individuals, raising questions about approaches that consider only their independent impact. Utilizing the cumulative risk model, which acknowledges the natural covariation of risk factors, this study examined individuals in intimate relationships using the Florida Family Formation Survey (n = 2,876) and a replication sample (n = 1,048). Analyses confirmed that not only was relationship satisfaction lower among those with more risks, but the cumulative risk score was predictive above and beyond the individual risk factors. Furthermore, experiencing multiple risks exacerbated the negative associations between individual risks and relationship satisfaction, suggesting that the operation of a risk factor in a relationship is moderated by the presence or absence of other risks. PMID:19587840

Implications of applying cumulative risk assessment to the workplace.

PubMed

Fox, Mary A; Spicer, Kristen; Chosewood, L Casey; Susi, Pam; Johns, Douglas O; Dotson, G Scott

2018-06-01

Multiple changes are influencing work, workplaces and workers in the US including shifts in the main types of work and the rise of the 'gig' economy. Work and workplace changes have coincided with a decline in unions and associated advocacy for improved safety and health conditions. Risk assessment has been the primary method to inform occupational and environmental health policy and management for many types of hazards. Although often focused on one hazard at a time, risk assessment frameworks and methods have advanced toward cumulative risk assessment recognizing that exposure to a single chemical or non-chemical stressor rarely occurs in isolation. We explore how applying cumulative risk approaches may change the roles of workers and employers as they pursue improved health and safety and elucidate some of the challenges and opportunities that might arise. Application of cumulative risk assessment should result in better understanding of complex exposures and health risks with the potential to inform more effective controls and improved safety and health risk management overall. Roles and responsibilities of both employers and workers are anticipated to change with potential for a greater burden of responsibility on workers to address risk factors both inside and outside the workplace that affect health at work. A range of policies, guidance and training have helped develop cumulative risk assessment for the environmental health field and similar approaches are available to foster the practice in occupational safety and health. Copyright © 2018 Elsevier Ltd. All rights reserved.

Cumulative psychosocial stress, coping resources, and preterm birth.

PubMed

McDonald, Sheila W; Kingston, Dawn; Bayrampour, Hamideh; Dolan, Siobhan M; Tough, Suzanne C

2014-12-01

Preterm birth constitutes a significant international public health issue, with implications for child and family well-being. High levels of psychosocial stress and negative affect before and during pregnancy are contributing factors to shortened gestation and preterm birth. We developed a cumulative psychosocial stress variable and examined its association with early delivery controlling for known preterm birth risk factors and confounding environmental variables. We further examined this association among subgroups of women with different levels of coping resources. Utilizing the All Our Babies (AOB) study, an ongoing prospective pregnancy cohort study in Alberta, Canada (n = 3,021), multinomial logistic regression was adopted to examine the independent effect of cumulative psychosocial stress and preterm birth subgroups compared to term births. Stratified analyses according to categories of perceived social support and optimism were undertaken to examine differential effects among subgroups of women. Cumulative psychosocial stress was a statistically significant risk factor for late preterm birth (OR = 1.73; 95 % CI = 1.07, 2.81), but not for early preterm birth (OR = 2.44; 95 % CI = 0.95, 6.32), controlling for income, history of preterm birth, pregnancy complications, reproductive history, and smoking in pregnancy. Stratified analyses showed that cumulative psychosocial stress was a significant risk factor for preterm birth at <37 weeks gestation for women with low levels of social support (OR = 2.09; 95 % CI = 1.07, 4.07) or optimism (OR = 1.87; 95 % CI = 1.04, 3.37). Our analyses suggest that early vulnerability combined with current anxiety symptoms in pregnancy confers risk for preterm birth. Coping resources may mitigate the effect of cumulative psychosocial stress on the risk for early delivery.

Individual differences in the activity of the hypothalamic pituitary adrenal axis: Relations to age and cumulative risk in early childhood.

PubMed

Holochwost, Steven J; Gariépy, Jean-Louis; Mills-Koonce, W Roger; Propper, Cathi B; Kolacz, Jacek; Granger, Douglas A

2017-07-01

This study examined individual differences in the function of the hypothalamic-pituitary-adrenal (HPA) axis with regard to age and cumulative risk during challenging laboratory tasks administered at 6, 12, 24, and 36 months. Saliva samples were collected from a majority-minority sample of N=185 children (57% African American, 50% female) prior to and following these tasks and later assayed for cortisol. Cumulative distal risk was indexed via a composite of maternal marital status, maternal education, income-to-needs ratio, the number of children in the household, and maternal age at childbirth. Probing of hierarchical models in which cortisol levels and age were nested within child revealed significant differences in cortisol as a function of both age and cumulative risk, such that children exposed to high levels of risk exhibited higher levels of cortisol both within and across age. These results highlight the sensitivity of the HPA axis to environmental context at the level of the individual, even as that sensitivity is manifest against the background of species-typical biological development. Copyright © 2017 Elsevier Ltd. All rights reserved.

EPA Workshop on Epigenetics and Cumulative Risk ...

EPA Pesticide Factsheets

Agenda Download the Workshop Agenda (PDF) The workshop included presentations and discussions by scientific experts pertaining to three topics (i.e., epigenetic changes associated with diverse stressors, key science considerations in understanding epigenetic changes, and practical application of epigenetic tools to address cumulative risks from environmental stressors), to address several questions under each topic, and included an opportunity for attendees to participate in break-out groups, provide comments and ask questions. Workshop Goals The workshop seeks to examine the opportunity for use of aggregate epigenetic change as an indicator in cumulative risk assessment for populations exposed to multiple stressors that affect epigenetic status. Epigenetic changes are specific molecular changes around DNA that alter expression of genes. Epigenetic changes include DNA methylation, formation of histone adducts, and changes in micro RNAs. Research today indicates that epigenetic changes are involved in many chronic diseases (cancer, cardiovascular disease, obesity, diabetes, mental health disorders, and asthma). Research has also linked a wide range of stressors including pollution and social factors with occurrence of epigenetic alterations. Epigenetic changes have the potential to reflect impacts of risk factors across multiple stages of life. Only recently receiving attention is the nexus between the factors of cumulative exposure to environmental

HUMAN EXPOSURE MODELING FOR CUMULATIVE RISK

EPA Science Inventory

US EPA's Office of Research and Development (ORD) has identified cumulative risk assessment as a priority research area. This is because humans and other organisms are exposed to a multitude of chemicals, physical agents, and other stressors through multiple pathways, routes, an...

An analysis of cumulative risks based on biomonitoring data for six phthalates using the Maximum Cumulative Ratio

EPA Science Inventory

The Maximum Cumulative Ratio (MCR) quantifies the degree to which a single chemical drives the cumulative risk of an individual exposed to multiple chemicals. Phthalates are a class of chemicals with ubiquitous exposures in the general population that have the potential to cause ...

Affiliation buffers stress: cumulative genetic risk in oxytocin-vasopressin genes combines with early caregiving to predict PTSD in war-exposed young children.

PubMed

Feldman, R; Vengrober, A; Ebstein, R P

2014-03-11

Research indicates that risk for post-traumatic stress disorder (PTSD) is shaped by the interaction between genetic vulnerability and early caregiving experiences; yet, caregiving has typically been assessed by adult retrospective accounts. Here, we employed a prospective longitudinal design with real-time observations of early caregiving combined with assessment of genetic liability along the axis of vasopressin-oxytocin (OT) gene pathways to test G × E contributions to PTSD. Participants were 232 young Israeli children (1.5-5 years) and their parents, including 148 living in zones of continuous war and 84 controls. A cumulative genetic risk factor was computed for each family member by summing five risk alleles across three genes (OXTR, CD38 and AVPR1a) previously associated with psychopathology, sociality and caregiving. Child PTSD was diagnosed and mother-child interactions were observed in multiple contexts. In middle childhood (7-8 years), child psychopathology was re-evaluated. War exposure increased propensity to develop Axis-I disorder by threefold: 60% of exposed children displayed a psychiatric disorder by middle childhood and 62% of those showed several comorbid disorders. On the other hand, maternal sensitive support reduced risk for psychopathology. G × E effect was found for child genetic risk: in the context of war exposure, greater genetic risk on the vasopressin-OT pathway increased propensity for psychopathology. Among exposed children, chronicity of PTSD from early to middle childhood was related to higher child, maternal and paternal genetic risk, low maternal support and greater initial avoidance symptoms. Child avoidance was predicted by low maternal support and reduced mother-child reciprocity. These findings underscore the saliency of both genetic and behavioral facets of the human affiliation system in shaping vulnerability to PTSD as well as providing an underlying mechanism of post-traumatic resilience.

Affiliation buffers stress: cumulative genetic risk in oxytocin–vasopressin genes combines with early caregiving to predict PTSD in war-exposed young children

PubMed Central

Feldman, R; Vengrober, A; Ebstein, R P

2014-01-01

Research indicates that risk for post-traumatic stress disorder (PTSD) is shaped by the interaction between genetic vulnerability and early caregiving experiences; yet, caregiving has typically been assessed by adult retrospective accounts. Here, we employed a prospective longitudinal design with real-time observations of early caregiving combined with assessment of genetic liability along the axis of vasopressin–oxytocin (OT) gene pathways to test G × E contributions to PTSD. Participants were 232 young Israeli children (1.5–5 years) and their parents, including 148 living in zones of continuous war and 84 controls. A cumulative genetic risk factor was computed for each family member by summing five risk alleles across three genes (OXTR, CD38 and AVPR1a) previously associated with psychopathology, sociality and caregiving. Child PTSD was diagnosed and mother–child interactions were observed in multiple contexts. In middle childhood (7–8 years), child psychopathology was re-evaluated. War exposure increased propensity to develop Axis-I disorder by threefold: 60% of exposed children displayed a psychiatric disorder by middle childhood and 62% of those showed several comorbid disorders. On the other hand, maternal sensitive support reduced risk for psychopathology. G × E effect was found for child genetic risk: in the context of war exposure, greater genetic risk on the vasopressin–OT pathway increased propensity for psychopathology. Among exposed children, chronicity of PTSD from early to middle childhood was related to higher child, maternal and paternal genetic risk, low maternal support and greater initial avoidance symptoms. Child avoidance was predicted by low maternal support and reduced mother–child reciprocity. These findings underscore the saliency of both genetic and behavioral facets of the human affiliation system in shaping vulnerability to PTSD as well as providing an underlying mechanism of post-traumatic resilience. PMID:24618689

An Analysis of Cumulative Risks Indicated by Biomonitoring Data of Six Phthalates Using the Maximum Cumulative Ratio

EPA Science Inventory

The Maximum Cumulative Ratio (MCR) quantifies the degree to which a single component of a chemical mixture drives the cumulative risk of a receptor.1 This study used the MCR, the Hazard Index (HI) and Hazard Quotient (HQ) to evaluate co-exposures to six phthalates using biomonito...

Cumulative environmental risk and youth maladjustment: the role of youth attributes.

PubMed

Gerard, Jean M; Buehler, Cheryl

2004-01-01

Using data from 5,070 youth ages 11 to 18 years old who participated in the National Longitudinal Study of Adolescent Health, concurrent and longitudinal associations among cumulative risk, protective factors, and youth maladjustment were examined. Cumulative risk was associated with concurrent conduct problems and depressed mood. For conduct problems, a compensatory effect was found for scholastic achievement and problem-solving ability. For depressed mood, a compensatory effect was found for scholastic achievement. A protective-reactive effect of self-esteem was found for both forms of maladjustment. Youth gender, grade, and ethnicity moderated these associations. Cumulative risk predicted change over time in depressed mood. Scholastic achievement and self-esteem compensated for this risk. Findings indicate that youth attributes offer limited protection when adolescents experience risk factors across life domains.

Phthalates and Cumulative Risk Assessment (NAS Final Report)

EPA Science Inventory

On December 18, 2008, the National Academy of Sciences' National Research Council released a final report, requested and sponsored by the EPA, entitled Phthalates and Cumulative Risk Assessment: The Task Ahead.

Risk assessment has become a dominant public policy ...

Serious, Minor, and Non-Delinquents in Early Adolescence: The Impact of Cumulative Risk and Promotive Factors. The TRAILS Study

ERIC Educational Resources Information Center

van der Laan, Andre M.; Veenstra, Rene; Bogaerts, Stefan; Verhulst, Frank C.; Ormel, Johan

2010-01-01

This study uses a social-ecological approach to the development of delinquency. The authors emphasize that a balance between eliminating risk and enhancing protection across domains is essential in reducing problems and promoting competence. The cumulative risk and promotive effects of temperament, family and school factors in preadolescence were…

Cumulative Risk and Adolescent's Internalizing and Externalizing Problems: The Mediating Roles of Maternal Responsiveness and Self-Regulation

ERIC Educational Resources Information Center

Doan, Stacey N.; Fuller-Rowell, Thomas E.; Evans, Gary W.

2012-01-01

The purpose of the present study was to examine longitudinal associations among maternal responsiveness, self-regulation, and behavioral adjustment in adolescents. The authors used structural equation modeling to test a model that demonstrates that the effects of early cumulative risk on behavioral problems is mediated by maternal responsiveness…

Language delay in severely neglected children: a cumulative or specific effect of risk factors?

PubMed

Sylvestre, Audette; Mérette, Chantal

2010-06-01

This research sought to determine if the language delay (LD) of severely neglected children under 3 years old was better explained by a cumulative risk model or by the specificity of risk factors. The objective was also to identify the risk factors with the strongest impact on LD among various biological, psychological, and environmental factors. Sixty-eight severely neglected children and their mothers participated in this cross-sectional study. Children were between 2 and 36 months of age. Data included information about the child's language development and biological, psychological, and environmental risk factors. Prevalence of LD is significantly higher in this subgroup of children than in the population as a whole. Although we observed that the risk of LD significantly increased with an increase in the cumulative count of the presence of the child's biological-psychological risk factors, the one-by-one analysis of the individual factors revealed that the cumulative effect mainly reflected the specific impact of the child's cognitive development. When we considered also the environmental risk factors, multivariate logistic regression established that cognitive development, the mother's own physical and emotional abuse experience as a child, and the mother's low acceptability level towards her child are linked to LD in severely neglected children. Language development is the result of a complex interaction between risk factors. LD in severely neglected children is better explained by the specificity of risk factors than by the cumulative risk model. Most prevention and early intervention programs promote and target an increase in the quantity and quality of language stimulation offered to the child. Our results suggest that particular attention should be given to other environmental factors, specifically the mother's psychological availability and her sensitivity towards the child. It is essential to suggest interventions targeting various ecological dimensions

The EPA's human exposure research program for assessing cumulative risk in communities.

PubMed

Zartarian, Valerie G; Schultz, Bradley D

2010-06-01

Communities are faced with challenges in identifying and prioritizing environmental issues, taking actions to reduce their exposures, and determining their effectiveness for reducing human health risks. Additional challenges include determining what scientific tools are available and most relevant, and understanding how to use those tools; given these barriers, community groups tend to rely more on risk perception than science. The U.S. Environmental Protection Agency's Office of Research and Development, National Exposure Research Laboratory (NERL) and collaborators are developing and applying tools (models, data, methods) for enhancing cumulative risk assessments. The NERL's "Cumulative Communities Research Program" focuses on key science questions: (1) How to systematically identify and prioritize key chemical stressors within a given community?; (2) How to develop estimates of exposure to multiple stressors for individuals in epidemiologic studies?; and (3) What tools can be used to assess community-level distributions of exposures for the development and evaluation of the effectiveness of risk reduction strategies? This paper provides community partners and scientific researchers with an understanding of the NERL research program and other efforts to address cumulative community risks; and key research needs and opportunities. Some initial findings include the following: (1) Many useful tools exist for components of risk assessment, but need to be developed collaboratively with end users and made more comprehensive and user-friendly for practical application; (2) Tools for quantifying cumulative risks and impact of community risk reduction activities are also needed; (3) More data are needed to assess community- and individual-level exposures, and to link exposure-related information with health effects; and (4) Additional research is needed to incorporate risk-modifying factors ("non-chemical stressors") into cumulative risk assessments. The products of this

Considering Environmental and Occupational Stressors in Cumulative Risk Assessments

EPA Science Inventory

While definitions vary across the global scientific community, cumulative risk assessments (CRAs) typically are described as exhibiting a population focus and analyzing the combined risks posed by multiple stressors. CRAs also may consider risk management alternatives as an anal...

Aggregate Exposure and Cumulative Risk Assessment—Integrating Occupational and Non-occupational Risk Factors

PubMed Central

Lentz, T. J.; Dotson, G. S.; Williams, P. R.D.; Maier, A.; Gadagbui, B.; Pandalai, S. P.; Lamba, A.; Hearl, F.; Mumtaz, M.

2015-01-01

Occupational exposure limits have traditionally focused on preventing morbidity and mortality arising from inhalation exposures to individual chemical stressors in the workplace. While central to occupational risk assessment, occupational exposure limits have limited application as a refined disease prevention tool because they do not account for all of the complexities of the work and non-occupational environments and are based on varying health endpoints. To be of greater utility, occupational exposure limits and other risk management tools could integrate broader consideration of risks from multiple exposure pathways and routes (aggregate risk) as well as the combined risk from exposure to both chemical and non-chemical stressors, within and beyond the workplace, including the possibility that such exposures may cause interactions or modify the toxic effects observed (cumulative risk). Although still at a rudimentary stage in many cases, a variety of methods and tools have been developed or are being used in allied risk assessment fields to incorporate such considerations in the risk assessment process. These approaches, which are collectively referred to as cumulative risk assessment, have potential to be adapted or modified for occupational scenarios and provide a tangible path forward for occupational risk assessment. Accounting for complex exposures in the workplace and the broader risks faced by the individual also requires a more complete consideration of the composite effects of occupational and non-occupational risk factors to fully assess and manage worker health problems. Barriers to integrating these different factors remain, but new and ongoing community-based and worker health-related initiatives may provide mechanisms for identifying and integrating risk from aggregate exposures and cumulative risks from all relevant sources, be they occupational or non-occupational. PMID:26583907

Aggregate Exposure and Cumulative Risk Assessment--Integrating Occupational and Non-occupational Risk Factors.

PubMed

Lentz, T J; Dotson, G S; Williams, P R D; Maier, A; Gadagbui, B; Pandalai, S P; Lamba, A; Hearl, F; Mumtaz, M

2015-01-01

Occupational exposure limits have traditionally focused on preventing morbidity and mortality arising from inhalation exposures to individual chemical stressors in the workplace. While central to occupational risk assessment, occupational exposure limits have limited application as a refined disease prevention tool because they do not account for all of the complexities of the work and non-occupational environments and are based on varying health endpoints. To be of greater utility, occupational exposure limits and other risk management tools could integrate broader consideration of risks from multiple exposure pathways and routes (aggregate risk) as well as the combined risk from exposure to both chemical and non-chemical stressors, within and beyond the workplace, including the possibility that such exposures may cause interactions or modify the toxic effects observed (cumulative risk). Although still at a rudimentary stage in many cases, a variety of methods and tools have been developed or are being used in allied risk assessment fields to incorporate such considerations in the risk assessment process. These approaches, which are collectively referred to as cumulative risk assessment, have potential to be adapted or modified for occupational scenarios and provide a tangible path forward for occupational risk assessment. Accounting for complex exposures in the workplace and the broader risks faced by the individual also requires a more complete consideration of the composite effects of occupational and non-occupational risk factors to fully assess and manage worker health problems. Barriers to integrating these different factors remain, but new and ongoing community-based and worker health-related initiatives may provide mechanisms for identifying and integrating risk from aggregate exposures and cumulative risks from all relevant sources, be they occupational or non-occupational.

A simple scoring system for predicting early major complications in spine surgery: the cumulative effect of age and size of surgery.

PubMed

Brasil, Albert Vincent Berthier; Teles, Alisson R; Roxo, Marcelo Ricardo; Schuster, Marcelo Neutzling; Zauk, Eduardo Ballverdu; Barcellos, Gabriel da Costa; Costa, Pablo Ramon Fruett da; Ferreira, Nelson Pires; Kraemer, Jorge Luiz; Ferreira, Marcelo Paglioli; Gobbato, Pedro Luis; Worm, Paulo Valdeci

2016-10-01

To analyze the cumulative effect of risk factors associated with early major complications in postoperative spine surgery. Retrospective analysis of 583 surgically-treated patients. Early "major" complications were defined as those that may lead to permanent detrimental effects or require further significant intervention. A balanced risk score was built using multiple logistic regression. Ninety-two early major complications occurred in 76 patients (13%). Age > 60 years and surgery of three or more levels proved to be significant independent risk factors in the multivariate analysis. The balanced scoring system was defined as: 0 points (no risk factor), 2 points (1 factor) or 4 points (2 factors). The incidence of early major complications in each category was 7% (0 points), 15% (2 points) and 29% (4 points) respectively. This balanced scoring system, based on two risk factors, represents an important tool for both surgical indication and for patient counseling before surgery.

Cumulative risk hypothesis: Predicting and preventing child maltreatment recidivism.

PubMed

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

2016-08-01

Although Child Protective Services (CPS) and other child welfare agencies aim to prevent further maltreatment in cases of child abuse and neglect, recidivism is common. Having a better understanding of recidivism predictors could aid in preventing additional instances of maltreatment. A previous study identified two CPS interventions that predicted recidivism: psychotherapy for the parent, which was related to a reduced risk of recidivism, and temporary removal of the child from the parent's custody, which was related to an increased recidivism risk. However, counter to expectations, this previous study did not identify any other specific risk factors related to maltreatment recidivism. For the current study, it was hypothesized that (a) cumulative risk (i.e., the total number of risk factors) would significantly predict maltreatment recidivism above and beyond intervention variables in a sample of CPS case files and that (b) therapy for the parent would be related to a reduced likelihood of recidivism. Because it was believed that the relation between temporary removal of a child from the parent's custody and maltreatment recidivism is explained by cumulative risk, the study also hypothesized that that the relation between temporary removal of the child from the parent's custody and recidivism would be mediated by cumulative risk. After performing a hierarchical logistic regression analysis, the first two hypotheses were supported, and an additional predictor, psychotherapy for the child, also was related to reduced chances of recidivism. However, Hypothesis 3 was not supported, as risk did not significantly mediate the relation between temporary removal and recidivism. Copyright © 2016 Elsevier Ltd. All rights reserved.

A Multimethodological Analysis of Cumulative Risk and Allostatic Load among Rural Children.

ERIC Educational Resources Information Center

Evans, Gary W.

2003-01-01

This study modeled physical and psychosocial aspects of home environment and personal characteristics in a cumulative risk heuristic. Found that elevated cumulative risk was associated with heightened cardiovascular and neuroendocrine parameters, increased deposition of body fat, and higher summary index of total allostatic load. Replicated…

CUMULATIVE RISK ASSESSMENT FOR QUANTITATIVE RESPONSE DATA

EPA Science Inventory

The Relative Potency Factor approach (RPF) is used to normalize and combine different toxic potencies among a group of chemicals selected for cumulative risk assessment. The RPF method assumes that the slopes of the dose-response functions are all equal; but this method depends o...

Childhood poverty and health: cumulative risk exposure and stress dysregulation.

PubMed

Evans, Gary W; Kim, Pilyoung

2007-11-01

A massive literature documents the inverse association between poverty or low socioeconomic status and health, but little is known about the mechanisms underlying this robust relation. We examined longitudinal relations between duration of poverty exposure since birth, cumulative risk exposure, and physiological stress in two hundred seven 13-year-olds. Chronic stress was assessed by basal blood pressure and overnight cortisol levels; stress regulation was assessed by cardiovascular reactivity to a standard acute stressor and recovery after exposure to this stressor. Cumulative risk exposure was measured by multiple physical (e.g., substandard housing) and social (e.g., family turmoil) risk factors. The greater the number of years spent living in poverty, the more elevated was overnight cortisol and the more dysregulated was the cardiovascular response (i.e., muted reactivity). Cardiovascular recovery was not affected by duration of poverty exposure. Unlike the duration of poverty exposure, concurrent poverty (i.e., during adolescence) did not affect these physiological stress outcomes. The effects of childhood poverty on stress dysregulation are largely explained by cumulative risk exposure accompanying childhood poverty.

75 FR 69662 - Workshop: Cumulative Mixtures Risk of Six Selected Phthalates in Support of Summary Information...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-15

...: Cumulative Mixtures Risk of Six Selected Phthalates in Support of Summary Information on the Integrated Risk... Workshop on the Cumulative Mixtures Risk of Six Selected Phthalates; Request for Public Comments. SUMMARY...) Review the recommendations for evaluation of the cumulative mixtures risk of phthalates as set forth in...

Cumulative Risk Assessment (CRA): Transforming the Way We Assess Health Risks

PubMed Central

Williams, Pamela R. D.; Dotson, G. Scott; Maier, Andrew

2016-01-01

Human health risk assessments continue to evolve and now focus on the need for cumulative risk assessment (CRA). CRA involves assessing the combined risk from coexposure to multiple chemical and nonchemical stressors for varying health effects. CRAs are broader in scope than traditional chemical risk assessments because they allow for a more comprehensive evaluation of the interaction between different stressors and their combined impact on human health. Future directions of CRA include greater emphasis on local-level community-based assessments; integrating environmental, occupational, community, and individual risk factors; and identifying and implementing common frameworks and risk metrics for incorporating multiple stressors. PMID:22938698

Appraisal and coping as mediators of the effects of cumulative risk on preadolescent adjustment

PubMed Central

Thompson, Stephanie F.; Lengua, Liliana J.; Garcia, Connie Meza

2016-01-01

This study examined the concurrent and longitudinal relations among cumulative risk, appraisal, coping, and adjustment. Longitudinal path models were tested in a community sample of 316 children in preadolescence to examine hypotheses that threat appraisal and avoidant coping mediate the effects of cumulative risk on child adjustment, whereas positive appraisal and active coping were hypothesized to predict better adjustment independently. Children and their mothers were assessed during in-home interviews at three time points at one-year intervals. Children reported on appraisal and coping strategies. Mothers and children reported on child adjustment problems and positive adjustment. Rank-order changes in appraisal and coping predicted rank-order changes in adjustment. Cumulative risk was concurrently related to higher threat appraisal and avoidant coping at each time point. Threat appraisal and avoidant coping mediated the relations of cumulative risk to rank-order changes in adjustment. There is specificity in the relations of cumulative risk to threat appraisal and avoidant coping, whereas positive appraisal and active coping are independent of risk and operate as individual resource factors. PMID:27110087

A Review of Non-Chemical Stressors and Their Importance in Cumulative Risk Assessment

EPA Science Inventory

Cumulative exposure/risk assessments need to include non-chemical stressors as well as human activities and chemical data. Multiple stressor research can offer information on the interactions between chemical and non-chemical stressors needed for cumulative risk assessment resea...

Cumulative Risk for Early Sexual Initiation among American Indian Youth: A Discrete-Time Survival Analysis

ERIC Educational Resources Information Center

Mitchell, Christina M.; Whitesell, Nancy Rumbaugh; Spicer, Paul; Beals, Janette; Kaufman, Carol E.

2007-01-01

Approximately 3 million teens are diagnosed with a sexually transmitted disease (STD) annually; STDs rates for American Indian young adults are among the highest of any racial/ethnic group. An important risk factor for STDs is early initiation of sex. In this study, we examined risk for early initiation with 474 American Indian youth ages 14-18,…

U.S. EPA Authority to Use Cumulative Risk Assessments in Environmental Decision-Making

PubMed Central

Alves, Sarah; Tilghman, Joan; Rosenbaum, Arlene; Payne-Sturges, Devon C.

2012-01-01

Conventionally, in its decision-making, the U.S. EPA has evaluated the effects and risks associated with a single pollutant in a single exposure medium. In reality, people are exposed to mixtures of pollutants or to the same pollutant through a variety of media, including the air, water, and food. It is now more recognized than before that environmental exposure to pollutants occurs via multiple exposure routes and pathways, including inhalation, ingestion, and dermal absorption. Moreover, chemical, biologic, radiologic, physical, and psychologic stressors are all acknowledged as affecting human health. Although many EPA offices attempt to consider cumulative risk assessment and cumulative effects in various ways, there is no Agency-wide policy for considering these risks and the effects of exposure to these risks when making environmental decisions. This article examines how U.S. courts might assess EPA’s general authority and discretion to use cumulative risk assessment as the basis for developing data in support of environmental decision-making, and how courts might assess the validity of a cumulative risk assessment methodology itself. PMID:22829786

Pesticide Cumulative Risk Assessment: Framework for Screening Analysis

EPA Pesticide Factsheets

This document provides guidance on how to screen groups of pesticides for cumulative evaluation using a two-step approach: begin with evaluation of available toxicological information and, if necessary, follow up with a risk-based screening approach.

When More Is Not Better: The Role of Cumulative Risk in Child Behavior Outcomes

ERIC Educational Resources Information Center

Appleyard, Karen; Egeland, Byron; van Dulmen, Manfred H. M.; Sroufe, L. Alan

2005-01-01

Background: Cumulative risk research has established the deleterious effects of co-occurring risk factors on child behavior outcomes. However, extant literature has not addressed potential differential effects of cumulative risk at different points in development and has left open questions about whether a threshold model or a linear risk model…

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

Family cumulative risk and at-risk kindergarteners' social competence: the mediating role of parent representations of the attachment relationship.

PubMed

Sparks, Lauren A; Trentacosta, Christopher J; Owusu, Erika; McLear, Caitlin; Smith-Darden, Joanne

2018-08-01

Secure attachment relationships have been linked to social competence in at-risk children. In the current study, we examined the role of parent secure base scripts in predicting at-risk kindergarteners' social competence. Parent representations of secure attachment were hypothesized to mediate the relationship between lower family cumulative risk and children's social competence. Participants included 106 kindergarteners and their primary caregivers recruited from three urban charter schools serving low-income families as a part of a longitudinal study. Lower levels of cumulative risk predicted greater secure attachment representations in parents, and scores on the secure base script assessment predicted children's social competence. An indirect relationship between lower cumulative risk and kindergarteners' social competence via parent secure base script scores was also supported. Parent script-based representations of the attachment relationship appear to be an important link between lower levels of cumulative risk and low-income kindergarteners' social competence. Implications of these findings for future interventions are discussed.

Cumulative early life adversity predicts longevity in wild baboons

PubMed Central

Tung, Jenny; Archie, Elizabeth A.; Altmann, Jeanne; Alberts, Susan C.

2016-01-01

In humans and other animals, harsh circumstances in early life predict morbidity and mortality in adulthood. Multiple adverse conditions are thought to be especially toxic, but this hypothesis has rarely been tested in a prospective, longitudinal framework, especially in long-lived mammals. Here we use prospective data on 196 wild female baboons to show that cumulative early adversity predicts natural adult lifespan. Females who experience ≥3 sources of early adversity die a median of 10 years earlier than females who experience ≤1 adverse circumstances (median lifespan is 18.5 years). Females who experience the most adversity are also socially isolated in adulthood, suggesting that social processes partially explain the link between early adversity and adult survival. Our results provide powerful evidence for the developmental origins of health and disease and indicate that close ties between early adversity and survival arise even in the absence of health habit and health care-related explanations. PMID:27091302

Cumulative risk assessment for combined health effects from chemical and nonchemical stressors.

PubMed

Sexton, Ken; Linder, Stephen H

2011-12-01

Cumulative risk assessment is a science policy tool for organizing and analyzing information to examine, characterize, and possibly quantify combined threats from multiple environmental stressors. We briefly survey the state of the art regarding cumulative risk assessment, emphasizing challenges and complexities of moving beyond the current focus on chemical mixtures to incorporate nonchemical stressors, such as poverty and discrimination, into the assessment paradigm. Theoretical frameworks for integrating nonchemical stressors into cumulative risk assessments are discussed, the impact of geospatial issues on interpreting results of statistical analyses is described, and four assessment methods are used to illustrate the diversity of current approaches. Prospects for future progress depend on adequate research support as well as development and verification of appropriate analytic frameworks.

Cumulative Risk Assessment for Combined Health Effects From Chemical and Nonchemical Stressors

PubMed Central

Linder, Stephen H.

2011-01-01

Cumulative risk assessment is a science policy tool for organizing and analyzing information to examine, characterize, and possibly quantify combined threats from multiple environmental stressors. We briefly survey the state of the art regarding cumulative risk assessment, emphasizing challenges and complexities of moving beyond the current focus on chemical mixtures to incorporate nonchemical stressors, such as poverty and discrimination, into the assessment paradigm. Theoretical frameworks for integrating nonchemical stressors into cumulative risk assessments are discussed, the impact of geospatial issues on interpreting results of statistical analyses is described, and four assessment methods are used to illustrate the diversity of current approaches. Prospects for future progress depend on adequate research support as well as development and verification of appropriate analytic frameworks. PMID:21551386

Cumulative Risk Exposure and Mental Health Symptoms among Maltreated Youths Placed in Out-of-Home Care

PubMed Central

Raviv, Tali; Taussig, Heather N.; Culhane, Sara E.; Garrido, Edward F.

2010-01-01

Maltreated children placed in out-of-home care are at high risk for exhibiting symptoms of psychopathology by virtue of their exposure to numerous risk factors. Research examining cumulative risk has consistently found that the accumulation of risk factors increases the likelihood of mental health problems. The goal of the current study was to elucidate the relation between cumulative risk and mental health symptomatology within a sample of 252 maltreated youths (aged 9–11) placed in out-of-home care. Results confirmed the high-risk nature of this sample and identified seven salient risk variables. The cumulative risk index comprised of these seven indicators was a strong predictor of mental health symptoms, differentiating between children who scored in the clinical range with regard to mental health symptoms and those who did not. Finally, the data supported a linear model in which each incremental increase in cumulative risk was accompanied by an increase in mental health problems. This is the first known study to examine cumulative risk within a sample of youths in out-of-home care. PMID:20932576

Cumulative radiation exposure and cancer risk estimation in children with heart disease.

PubMed

Johnson, Jason N; Hornik, Christoph P; Li, Jennifer S; Benjamin, Daniel K; Yoshizumi, Terry T; Reiman, Robert E; Frush, Donald P; Hill, Kevin D

2014-07-08

Children with heart disease are frequently exposed to imaging examinations that use ionizing radiation. Although radiation exposure is potentially carcinogenic, there are limited data on cumulative exposure and the associated cancer risk. We evaluated the cumulative effective dose of radiation from all radiation examinations to estimate the lifetime attributable risk of cancer in children with heart disease. Children ≤6 years of age who had previously undergone 1 of 7 primary surgical procedures for heart disease at a single institution between 2005 and 2010 were eligible for the study. Exposure to radiation-producing examinations was tabulated, and cumulative effective dose was calculated in millisieverts. These data were used to estimate lifetime attributable risk of cancer above baseline using the approach of the Committee on Biological Effects of Ionizing Radiation VII. The cohort included 337 children exposed to 13 932 radiation examinations. Conventional radiographs represented 92% of examinations, whereas cardiac catheterization and computed tomography accounted for 81% of cumulative exposure. Overall median cumulative effective dose was 2.7 mSv (range, 0.1-76.9 mSv), and the associated lifetime attributable risk of cancer was 0.07% (range, 0.001%-6.5%). Median lifetime attributable risk of cancer ranged widely depending on surgical complexity (0.006%-1.6% for the 7 surgical cohorts) and was twice as high in females per unit exposure (0.04% versus 0.02% per 1-mSv effective dose for females versus males, respectively; P<0.001). Overall radiation exposures in children with heart disease are relatively low; however, select cohorts receive significant exposure. Cancer risk estimation highlights the need to limit radiation dose, particularly for high-exposure modalities. © 2014 American Heart Association, Inc.

Cumulative neighborhood risk of psychosocial stress and allostatic load in adolescents.

PubMed

Theall, Katherine P; Drury, Stacy S; Shirtcliff, Elizabeth A

2012-10-01

The authors examined the impact of cumulative neighborhood risk of psychosocial stress on allostatic load (AL) among adolescents as a mechanism through which life stress, including neighborhood conditions, may affect health and health inequities. They conducted multilevel analyses, weighted for sampling and propensity score-matched, among adolescents aged 12-20 years in the National Health and Nutrition Examination Survey (1999-2006). Individuals (first level, n = 11,886) were nested within families/households (second level, n = 6,696) and then census tracts (third level, n = 2,191) for examination of the contextual effect of cumulative neighborhood risk environment on AL. Approximately 35% of adolescents had 2 or more biomarkers of AL. A significant amount of variance in AL was explained at the neighborhood level. The likelihood of having a high AL was approximately 10% higher for adolescents living in medium-cumulative-risk neighborhoods (adjusted odds ratio (OR) = 1.09, 95% confidence interval (CI): 1.08, 1.09), 28% higher for those living in high-risk neighborhoods (adjusted OR = 1.28, 95% CI: 1.27, 1.30), and 69% higher for those living in very-high-risk neighborhoods (adjusted OR = 1.69, 95% CI: 1.68, 1.70) as compared with adolescents living in low-risk areas. Effect modification was observed by both individual- and neighborhood-level sociodemographic factors. These findings offer support for the hypothesis that neighborhood risks may culminate in a range of biologically mediated negative health outcomes detectable in adolescents.

Cumulative Neighborhood Risk of Psychosocial Stress and Allostatic Load in Adolescents

PubMed Central

Theall, Katherine P.; Drury, Stacy S.; Shirtcliff, Elizabeth A.

2012-01-01

The authors examined the impact of cumulative neighborhood risk of psychosocial stress on allostatic load (AL) among adolescents as a mechanism through which life stress, including neighborhood conditions, may affect health and health inequities. They conducted multilevel analyses, weighted for sampling and propensity score-matched, among adolescents aged 12–20 years in the National Health and Nutrition Examination Survey (1999–2006). Individuals (first level, n = 11,886) were nested within families/households (second level, n = 6,696) and then census tracts (third level, n = 2,191) for examination of the contextual effect of cumulative neighborhood risk environment on AL. Approximately 35% of adolescents had 2 or more biomarkers of AL. A significant amount of variance in AL was explained at the neighborhood level. The likelihood of having a high AL was approximately 10% higher for adolescents living in medium-cumulative-risk neighborhoods (adjusted odds ratio (OR) = 1.09, 95% confidence interval (CI): 1.08, 1.09), 28% higher for those living in high-risk neighborhoods (adjusted OR = 1.28, 95% CI: 1.27, 1.30), and 69% higher for those living in very-high-risk neighborhoods (adjusted OR = 1.69, 95% CI: 1.68, 1.70) as compared with adolescents living in low-risk areas. Effect modification was observed by both individual- and neighborhood-level sociodemographic factors. These findings offer support for the hypothesis that neighborhood risks may culminate in a range of biologically mediated negative health outcomes detectable in adolescents. PMID:23035140

Tools to Assess Community-Based Cumulative Risk and Exposures

EPA Science Inventory

Multiple agents and stressors can interact in a given community to adversely affect human and ecological conditions. A cumulative risk assessment (CRA) analyzes, characterizes, and potentially quantifies the effects from multiple stressors, which include chemical agents (for exam...

A Topical Overview of Cumulative Risk Assessment Concepts ...

EPA Pesticide Factsheets

Cumulative risk assessments (CRAs) address combined risks from exposures to multiple chemical and nonchemical stressors and may focus on vulnerable communities or populations. Significant contributions have been made to the development of concepts, methods, and applications for CRA over the past decade. Work in both human health and ecological cumulative risk has advanced in two different contexts. First, in assessing the effects of chemical mixtures that share common modes of action, or that cause common adverse outcomes. In this context two primary models are used for predicting mixture effects, dose addition or response addition. The second context is evaluating the combined effects of chemical and nonchemical (e.g., radiation, biological, nutritional, economic, psychological, habitat alteration, land-use change, global climate change, and natural disasters) stressors. CRA can be adapted to address risk in many contexts, and this adaptability is reflected in the range in disciplinary perspectives in the published literature. This article presents the results of a literature search by presenting a range of selected work with the intention to give a broad overview of relevant topics and provide a starting point for researchers interested in CRA applications. This is a select literature review of topics in CRA. As a published article it will allow the citation of an analysis conducted on a rich and diverse set of CRA publications relevant to assessment methods

Children of Misfortune: Early Adversity and Cumulative Inequality in Perceived Life Trajectories1

PubMed Central

Schafer, Markus H.; Ferraro, Kenneth F.; Mustillo, Sarah A.

2011-01-01

Adversity early in life may alter pathways of aging, but what interpretive processes can soften the blow of early insults? Drawing from cumulative inequality theory, the authors analyze trajectories of life evaluations and then consider whether early adversity offsets favorable expectations for the future. Results reveal that early adversity contributes to more negative views of the past but rising expectations for the future. Early adversity also has enduring effects on life evaluations, offsetting the influence of buoyant expectations. The findings draw attention to the limits of human agency under the constraints of early adversity—a process described as biographical structuration. PMID:21648247

Early risk factors for suicide in an epidemiological first episode psychosis cohort.

PubMed

Dutta, Rina; Murray, Robin M; Allardyce, Judith; Jones, Peter B; Boydell, Jane

2011-03-01

Much remains unknown about whether there are early risk factors for suicide in psychosis. The aim of the study was to determine whether there are any identifiable early symptom clusters, aetiological factors or illness course markers for suicide in first episode psychosis. A total of 2132 patients with first episode psychosis presenting to secondary care services in London (1965-2004; n=1474), Nottingham (1997-1999; n=195) and Dumfries and Galloway (1979-1998; n=463) were traced after up to 40 years (mean 13 years) following first presentation. Risk factors were identified from the Operational Checklist for Psychotic Disorders rated for the first year following presentation. Overall, there were 51 suicides and 373 deaths from other causes. Male gender (RR 2.84, 95% CI 1.20-6.69, p=0.02) and a cumulative threshold effect of symptoms early in the illness (RR 6.81, 95% CI 2.33-19.85, p<0.001) were associated with a higher propensity for later completed suicide. There was also a suggestion that early manic symptoms might increase the risk of later suicide irrespective of initial diagnosis. Suicide risk was associated with a cumulative threshold effect of symptoms and manic symptoms. As suicide is a relatively rare event in psychotic disorders, general population-based prevention strategies may have more impact in this vulnerable group as well as the wider population. Copyright © 2010 Elsevier B.V. All rights reserved.

Cumulative childhood risk and adult functioning in abused and neglected children grown up

PubMed Central

HORAN, JACQUELINE M.; WIDOM, CATHY SPATZ

2017-01-01

This paper examines the relationship between childhood exposure to cumulative risk and three indicators of psychosocial adjustment in adulthood (educational attainment, mental health, and criminal behavior) and tests three different models (linear, quadratic, and interaction). Data were collected over several time points from individuals who were part of a prospective cohort design study that matched children with documented cases of abuse and/or neglect with children without such histories and followed them into adulthood. Hierarchical multiple regressions compared linear and quadratic models and then examined potential moderating effects of child abuse/neglect and gender. Exposure to a greater number of childhood risk factors was significantly related to fewer years of education, more anxiety and depression symptomatology, and more criminal arrests in adulthood. The relationship between cumulative risk and years of education demonstrated a curvilinear pattern, whereas the relationship between cumulative risk and both mental health and criminal arrests was linear. Child abuse/neglect did not moderate these relationships, although there were direct effects for both child abuse/neglect and gender on criminal arrests, with more arrests for abused/neglected individuals than controls and more for males than females. Gender interacted with cumulative risk to impact educational attainment and criminal behavior, suggesting that interventions may be more effective if tailored differently for males and females. Interventions may need to be multifaceted and designed to address these different domains of functioning. PMID:25196178

Cumulative childhood risk and adult functioning in abused and neglected children grown up.

PubMed

Horan, Jacqueline M; Widom, Cathy Spatz

2015-08-01

This paper examines the relationship between childhood exposure to cumulative risk and three indicators of psychosocial adjustment in adulthood (educational attainment, mental health, and criminal behavior) and tests three different models (linear, quadratic, and interaction). Data were collected over several time points from individuals who were part of a prospective cohort design study that matched children with documented cases of abuse and/or neglect with children without such histories and followed them into adulthood. Hierarchical multiple regressions compared linear and quadratic models and then examined potential moderating effects of child abuse/neglect and gender. Exposure to a greater number of childhood risk factors was significantly related to fewer years of education, more anxiety and depression symptomatology, and more criminal arrests in adulthood. The relationship between cumulative risk and years of education demonstrated a curvilinear pattern, whereas the relationship between cumulative risk and both mental health and criminal arrests was linear. Child abuse/neglect did not moderate these relationships, although there were direct effects for both child abuse/neglect and gender on criminal arrests, with more arrests for abused/neglected individuals than controls and more for males than females. Gender interacted with cumulative risk to impact educational attainment and criminal behavior, suggesting that interventions may be more effective if tailored differently for males and females. Interventions may need to be multifaceted and designed to address these different domains of functioning.

Cumulative psychosocial risk, parental socialization, and child cognitive functioning: A longitudinal cascade model.

PubMed

Wade, Mark; Madigan, Sheri; Plamondon, Andre; Rodrigues, Michelle; Browne, Dillon; Jenkins, Jennifer M

2018-06-01

Previous studies have demonstrated that various psychosocial risks are associated with poor cognitive functioning in children, and these risks frequently cluster together. In the current longitudinal study, we tested a model in which it was hypothesized that cumulative psychosocial adversity of mothers would have deleterious effects on children's cognitive functioning by compromising socialization processes within families (i.e., parental competence). A prospective community birth cohort of 501 families was recruited when children were newborns. At this time, mothers reported on their current psychosocial circumstances (socioeconomic status, teen parenthood, depression, etc.), which were summed into a cumulative risk score. Families were followed up at 18 months and 3 years, at which point maternal reflective capacity and cognitive sensitivity were measured, respectively. Child cognition (executive functioning, theory of mind, and language ability) was assessed at age 4.5 using age-appropriate observational and standardized tasks. Analyses controlled for child age, gender, number of children in the home, number of years married, and mothers' history of adversity. The results revealed significant declines in child cognition as well as maternal reflective capacity and cognitive sensitivity as the number of psychosocial risks increased. Moreover, longitudinal path analysis showed significant indirect effects from cumulative risk to all three cognitive outcomes via reflective capacity and cognitive sensitivity. Findings suggest that cumulative risk of mothers may partially account for child cognitive difficulties in various domains by disrupting key parental socialization competencies. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

CUMULATIVE RISK ASSESSMENT: GETTING FROM TOXICOLOGY TO QUANTITATIVE ANALYSIS

EPA Science Inventory

INTRODUCTION: GETTING FROM TOXICOLOGY TO QUANTITATIVE ANALYSIS FOR CUMULATIVE RISK

Hugh A. Barton1 and Carey N. Pope2
1US EPA, Office of Research and Development, National Health and Environmental Effects Research Laboratory, Research Triangle Park, NC
2Department of...

Incompatible Land Uses and the Topology of Cumulative Risk

NASA Astrophysics Data System (ADS)

Lejano, Raul P.; Smith, C. Scott

2006-02-01

The extensive literature on environmental justice has, by now, well defined the essential ingredients of cumulative risk, namely, incompatible land uses and vulnerability. Most problematic is the case when risk is produced by a large aggregation of small sources of air toxics. In this article, we test these notions in an area of Southern California, Southeast Los Angeles (SELA), which has come to be known as Asthmatown. Developing a rapid risk mapping protocol, we scan the neighborhood for small potential sources of air toxics and find, literally, hundreds of small point sources within a 2-mile radius, interspersed with residences. We also map the estimated cancer risks and noncancer hazard indices across the landscape. We find that, indeed, such large aggregations of even small, nondominant sources of air toxics can produce markedly elevated levels of risk. In this study, the risk profiles show additional cancer risks of up to 800 in a million and noncancer hazard indices of up to 200 in SELA due to the agglomeration of small point sources. This is significant (for example, estimates of the average regional point-source-related cancer risk range from 125 to 200 in a million). Most importantly, if we were to talk about the risk contour as if they were geological structures, we would observe not only a handful of distinct peaks, but a general “mountain range” running all throughout the study area, which underscores the ubiquity of risk in SELA. Just as cumulative risk has deeply embedded itself into the fabric of the place, so, too, must intervention seek to embed strategies into the institutions and practices of SELA. This has implications for advocacy, as seen in a recently initiated participatory action research project aimed at building health research capacities into the community in keeping with an ethic of care.

Cumulative Experiences of Violence among High-Risk Urban Youth

ERIC Educational Resources Information Center

Taylor, Catherine A.; Boris, Neil W.; Heller, Sherryl Scott; Clum, Gretchen A.; Rice, Janet C.; Zeanah, Charles H.

2008-01-01

This study examines type-specific and cumulative experiences of violence among a vulnerable population of youth. Sixty high-risk, shelter-dwelling, urban youth were interviewed regarding their history of childhood maltreatment, exposure to community violence (ECV), and experience with intimate partner violence (IPV). Results show a high prevalence…

Cumulative Risk: Toxicity and Interactions of Physical and Chemical Stressors

EPA Science Inventory

ABSTRACT Recent efforts to update cumulative risk assessment procedures to incorporate nonchemical stressors ranging from physical to psychosocial, reflect increased interest in consideratio of the totality of variables affecting human health and the growing desire to develop co...

Postmenopausal breast cancer risk and cumulative number of menstrual cycles.

PubMed

Chavez-MacGregor, Mariana; Elias, Sjoerd G; Onland-Moret, N Charlotte; van der Schouw, Yvonne T; Van Gils, Carla H; Monninkhof, Evelyn; Grobbee, Diederick E; Peeters, Petra H M

2005-04-01

To explore whether the lifetime cumulative number of menstrual cycles, as an index for total exposure to endogenous estrogens, and the number of menstrual cycles until a first full-term pregnancy (FFTP), are associated with breast cancer risk in postmenopausal women. Population-based study with data from the Prospect-European Prospective Investigation into Cancer and Nutrition study. Naturally menopausal participants were eligible (n = 6,718). The cumulative number of menstrual cycles was computed in 6,031 (90%) women. We calculated the number of cycles until FFTP among parous participants. The number of menstrual cycles was impossible to compute in women who reported to be always irregular; therefore, we added the "always irregular" category in the analysis. During the 46,746 person-years of follow-up, 168 breast cancer cases were identified. Cox regression models were used and adjustments were made to account for potential confounders. Even when our data does not show a clear linear gradient, we observed an increased breast cancer risk in women with a higher number of cumulative menstrual cycles in their lifetime. Using < or = 415 cycles as reference, the hazard ratio for the irregular group, 416-453, 454-490, and > or = 491 cycles was 1.11 (.56, 2.19), 1.88 (1.14, 3.12), 1.74 (1.05, 2.87), and 1.80 (1.09, 2.96), respectively. Although not statistically significant, and of less magnitude, the risk estimates for the number of cycles before FFTP showed the same tendency. Among women who underwent natural menopause, a higher number of menstrual cycles in lifetime, reflecting a longer exposure to endogenous estrogens, is associated with an increased breast cancer risk.

Fetal Substance Exposure and Cumulative Environmental Risk in an African American Cohort

ERIC Educational Resources Information Center

Yumoto, Chie; Jacobson, Sandra W.; Jacobson, Joseph L.

2008-01-01

Two models of vulnerability to socioenvironmental risk were examined in 337 African American children (M = 7.8 years) recruited to overrepresent prenatal alcohol or cocaine exposure: The cumulative risk model predicted synergistic effects from exposure to multiple risk factors, and the fetal patterning of disease model predicted that prenatal…

Cumulative radiation exposure and associated cancer risk estimates for scoliosis patients: Impact of repetitive full spine radiography.

PubMed

Law, Martin; Ma, Wang-Kei; Lau, Damian; Chan, Eva; Yip, Lawrance; Lam, Wendy

2016-03-01

To quantitatively evaluate the cumulative effective dose and associated cancer risk for scoliotic patients undergoing repetitive full spine radiography during their diagnosis and follow up periods. Organ absorbed doses of full spine exposed scoliotic patients at different age were computer simulated with the use of PCXMC software. Gender specific effective dose was then calculated with the ICRP-103 approach. Values of lifetime attributable cancer risk for patients exposed at different age were calculated for both patient genders and for Asian and Western population. Mathematical fitting for effective dose and for lifetime attributable cancer risk, as function of exposed age, was analytically obtained to quantitatively estimate patient cumulated effective dose and cancer risk. The cumulative effective dose of full spine radiography with posteroanterior and lateral projection for patients exposed annually at age between 5 and 30 years using digital radiography system was calculated as 15mSv. The corresponding cumulative lifetime attributable cancer risk for Asian and Western population was calculated as 0.08-0.17%. Female scoliotic patients would be at a statistically significant higher cumulated cancer risk than male patients under the same full spine radiography protocol. We demonstrate the use of computer simulation and analytic formula to quantitatively obtain the cumulated effective dose and cancer risk at any age of exposure, both of which are valuable information to medical personnel and patients' parents concern about radiation safety in repetitive full spine radiography. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Cumulative Risk Assessment: An Overview of Methodological Approaches for Evaluating Combined Health Effects from Exposure to Multiple Environmental Stressors

PubMed Central

Sexton, Ken

2012-01-01

Systematic evaluation of cumulative health risks from the combined effects of multiple environmental stressors is becoming a vital component of risk-based decisions aimed at protecting human populations and communities. This article briefly examines the historical development of cumulative risk assessment as an analytical tool, and discusses current approaches for evaluating cumulative health effects from exposure to both chemical mixtures and combinations of chemical and nonchemical stressors. A comparison of stressor-based and effects-based assessment methods is presented, and the potential value of focusing on viable risk management options to limit the scope of cumulative evaluations is discussed. The ultimate goal of cumulative risk assessment is to provide answers to decision-relevant questions based on organized scientific analysis; even if the answers, at least for the time being, are inexact and uncertain. PMID:22470298

Cumulative adversity in childhood and emergent risk factors for long-term health.

PubMed

Slopen, Natalie; Koenen, Karestan C; Kubzansky, Laura D

2014-03-01

To examine whether and when effects of cumulative adversity in the first 7 years of life are evident in relation to 3 childhood markers of risk for poor adult physical health. The study data are from an English birth cohort. Parental reports of 8 social risk factors were obtained during the child's first 7 years, and scores were created to reflect cumulative adversity at 4 developmental periods. At age 7 and 11 years, weight, height, and blood pressure (BP) were measured by clinic staff, and caregivers reported behavior problems. Linear regression was used to estimate associations of cumulative adversity with each outcome (n = 4361) and changes in these outcomes between 7 and 11 years (n = 3348). At age 7 years, mean adversity and chronic exposure to high adversity were associated with elevated body mass index (BMI) and internalizing and externalizing symptoms (P < .05), but not elevated BP. Adversity in all developmental periods was associated with elevated numbers of internalizing and externalizing symptoms (P < .0001), but associations were less robust for BMI. Adversity did not predict change in BMI or BP between age 7 and 11 years, however, it predicted increases in internalizing and externalizing symptoms (P < .0001). Cumulative adversity was associated with BMI and behavior problems at age 7 years, and our data indicate that timing and chronicity of exposure to adversity differentially influence diverse indicators of long-term health risk commonly measured in childhood. This research suggests the hypothesis that interventions to address adversity could reduce the development of multiple chronic disease risk factors and limit their effects on health. Copyright © 2014 Mosby, Inc. All rights reserved.

Cumulative risk on the oxytocin receptor gene (OXTR) underpins empathic communication difficulties at the first stages of romantic love

PubMed Central

Schneiderman, Inna; Kanat-Maymon, Yaniv; Ebstein, Richard P.

2014-01-01

Empathic communication between couples plays an important role in relationship quality and individual well-being and research has pointed to the role of oxytocin in providing the neurobiological substrate for pair-bonding and empathy. Here, we examined links between genetic variability on the oxytocin receptor gene (OXTR) and empathic behaviour at the initiation of romantic love. Allelic variations on five OXTR single nucleotide polymorphisms (SNPs) previously associated with susceptibility to disorders of social functioning were genotyped in 120 new lovers: OXTRrs13316193, rs2254298, rs1042778, rs2268494 and rs2268490. Cumulative genetic risk was computed by summing risk alleles on each SNP. Couples were observed in support-giving interaction and behaviour was coded for empathic communication, including affective congruence, maintaining focus on partner, acknowledging partner's distress, reciprocal exchange and non-verbal empathy. Hierarchical linear modelling indicated that individuals with high OXTR risk exhibited difficulties in empathic communication. OXTR risk predicted empathic difficulties above and beyond the couple level, relationship duration, and anxiety and depressive symptoms. Findings underscore the involvement of oxytocin in empathic behaviour during the early stages of social affiliation, and suggest the utility of cumulative risk and plasticity indices on the OXTR as potential biomarkers for research on disorders of social dysfunction and the neurobiology of empathy. PMID:23974948

Use of cumulative mortality data in patients with acute myocardial infarction for early detection of variation in clinical practice: observational study.

PubMed

Lawrance, R A; Dorsch, M F; Sapsford, R J; Mackintosh, A F; Greenwood, D C; Jackson, B M; Morrell, C; Robinson, M B; Hall, A S

2001-08-11

Use of cumulative mortality adjusted for case mix in patients with acute myocardial infarction for early detection of variation in clinical practice. Observational study. 20 hospitals across the former Yorkshire region. All 2153 consecutive patients with confirmed acute myocardial infarction identified during three months. Variable life-adjusted displays showing cumulative differences between observed and expected mortality of patients; expected mortality calculated from risk model based on admission characteristics of age, heart rate, and systolic blood pressure. The performance of two individual hospitals over three months was examined as an example. One, the smallest district hospital in the region, had a series of 30 consecutive patients but had five more deaths than predicted. The variable life-adjusted display showed minimal variation from that predicted for the first 15 patients followed by a run of unexpectedly high mortality. The second example was the main tertiary referral centre for the region, which admitted 188 consecutive patients. The display showed a period of apparently poor performance followed by substantial improvement, where the plot rose steadily from a cumulative net lives saved of -4 to 7. These variations in patient outcome are unlikely to have been revealed during conventional audit practice. Variable life-adjusted display has been integrated into surgical care as a graphical display of risk-adjusted survival for individual surgeons or centres. In combination with a simple risk model, it may have a role in monitoring performance and outcome in patients with acute myocardial infarction.

HESI EXPOSURE FACTORS DATABASE FOR AGGREGATE AND CUMULATIVE RISK ASSESSMENT

EPA Science Inventory

In recent years, the risk analysis community has broadened its use of complex aggregate and cumulative residential exposure models (e.g., to meet the requirements of the 1996 Food Quality Protection Act). The value of these models is their ability to incorporate a range of inp...

The Role of Child Temperament on Head Start Preschoolers' Social Competence in the Context of Cumulative Risk

ERIC Educational Resources Information Center

Corapci, Feyza

2008-01-01

This study examined the main and interactive effects of cumulative risk and child temperament on teacher ratings of social competence and observer ratings of peer play in a sample of Head Start preschoolers. A cumulative risk index (CRI) was computed by summing the total number of risk factors for each family. There was a difference in the…

The impact of physical activity on cumulative cardiovascular disease risk factors among Malaysian adults.

PubMed

Rasiah, Rajah; Thangiah, Govindamal; Yusoff, Khalid; Manikam, Rishya; Chandrasekaran, Sankara Kumar; Mustafa, Rujhan; Bakar, Najmin Binti Abu

2015-12-16

Numerous studies have shown the importance of physical activity in reducing the morbidity and mortality rates caused by cardiovascular disease (CVD). However, most of these studies emphasise little on the cumulative effect of CVD risk factors. Hence, this study investigates the association between physical exercise and cumulative CVD risk factors among adults in three different age groups. Using a sample of 7276 respondents drawn from community centers, the REDISCOVER team gathered information on physical activity, CVD risk factors (obesity, diabetes, hypertension, hypercholesterolemia, tobacco use) and socioeconomic and demographic variables in Malaysia. Because the study required medical examination, a convenience sampling frame was preferred in which all volunteers were included in the study. Fasting blood samples and anthropometric (height, weight and more) measurements were collected by trained staffs. Socio-demographic and physical activity variables were recorded through questionnaires. A Chi-square test was performed to identify the bivariate association between the covariates (socioeconomic variables, demographic variables and physical activity) and outcome variable. The association between the main exposure, physical activity, and the outcome variable, cumulative CVD risk factors, was assessed using an ordinal logistic regression model, controlling for socioeconomic status and demographic influences in three different age groups, 35-49, 50-64 and 65 and above. The mean age of participants is 51.8 (SD = 9.4). Respondents in the age groups of 35-49 (aORmoderate = 0.12; 95 % CI: 0.02 - 0.53 ) and 65 and above (aORhigh = 0.58; 95 % CI: 0.24, 0.78) showed a statistically significant inverse relationship between physical activity and cumulative CVD risk factors. However, this relationship was not significant among respondents in the 50-64 age group suggesting the possible influence of other variables, such as stress and environment. The

Cumulative Risk of Bovine Mastitis Treatments in Denmark, Finland, Norway and Sweden

PubMed Central

Valde, JP; Lawson, LG; Lindberg, A; Agger, JF; Saloniemi, H; Østerås, O

2004-01-01

Data from the national dairy cow recording systems during 1997 were used to calculate lactation-specific cumulative risk of mastitis treatments and cumulative risk of removal from the herds in Denmark, Finland Norway and Sweden. Sweden had the lowest risk of recorded mastitis treatments during 305 days of lactation and Norway had the highest risk. The incidence risk of recorded mastitis treatments during 305 days of lactation in Denmark, Finland, Norway and Sweden was 0.177, 0.139, 0.215 and 0.127 for first parity cows and 0.228, 0.215, 0.358 and 0.204 for parities higher than three, respectively. The risk of a first parity cow being treated for mastitis was almost 3 times higher at calving in Norway than in Sweden. The period with the highest risk for mastitis treatments was from 2 days before calving until 14 days after calving and the highest risk for removal was from calving to 10 days after calving in all countries. The study clearly demonstrated differences in bovine mastitis treatment patterns among the Nordic countries. The most important findings were the differences in treatment risks during different lactations within each country, as well as differences in strategies with respect to the time during lactation mastitis was treated. PMID:15663080

Cumulative risk of bovine mastitis treatments in Denmark, Finland, Norway and Sweden.

PubMed

Valde, J P; Lawson, L G; Lindberg, A; Agger, J F; Saloniemi, H; Osterås, O

2004-01-01

Data from the national dairy cow recording systems during 1997 were used to calculate lactation-specific cumulative risk of mastitis treatments and cumulative risk of removal from the herds in Denmark, Finland Norway and Sweden. Sweden had the lowest risk of recorded mastitis treatments during 305 days of lactation and Norway had the highest risk. The incidence risk of recorded mastitis treatments during 305 days of lactation in Denmark, Finland, Norway and Sweden was 0.177, 0.139, 0.215 and 0.127 for first parity cows and 0.228, 0.215, 0.358 and 0.204 for parities higher than three, respectively. The risk of a first parity cow being treated for mastitis was almost 3 times higher at calving in Norway than in Sweden. The period with the highest risk for mastitis treatments was from 2 days before calving until 14 days after calving and the highest risk for removal was from calving to 10 days after calving in all countries. The study clearly demonstrated differences in bovine mastitis treatment patterns among the Nordic countries. The most important findings were the differences in treatment risks during different lactations within each country, as well as differences in strategies with respect to the time during lactation mastitis was treated.

Cumulative risk effects in the bullying of children and young people with autism spectrum conditions.

PubMed

Hebron, Judith; Oldfield, Jeremy; Humphrey, Neil

2017-04-01

Students with autism are more likely to be bullied than their typically developing peers. However, several studies have shown that their likelihood of being bullied increases in the context of exposure to certain risk factors (e.g. behaviour difficulties and poor peer relationships). This study explores vulnerability to bullying from a cumulative risk perspective, where the number of risks rather than their nature is considered. A total of 722 teachers and 119 parents of young people with autism spectrum conditions participated in the study. Established risk factors were summed to form a cumulative risk score in teacher and parent models. There was evidence of a cumulative risk effect in both models, suggesting that as the number of risks increased, so did exposure to bullying. A quadratic effect was found in the teacher model, indicating that there was a disproportionate increase in the likelihood of being bullied in relation to the number of risk factors to which a young person was exposed. In light of these findings, it is proposed that more attention needs to be given to the number of risks to which children and young people with autism spectrum conditions are exposed when planning interventions and providing a suitable educational environment.

Cumulative Risk, Maternal Responsiveness, and Allostatic Load among Young Adolescents

ERIC Educational Resources Information Center

Evans, Gary W.; Kim, Pilyoung; Ting, Albert H.; Tesher, Harris B.; Shannis, Dana

2007-01-01

The purpose of this study was to examine the impact of cumulative risk exposure in concert with maternal responsiveness on physiological indicators of chronic stress in children and youth. Middle-school children exposed to greater accumulated psychosocial (e.g., family turmoil, poverty) and physical (e.g., crowding, substandard housing) risk…

Cumulative risk on the oxytocin receptor gene (OXTR) underpins empathic communication difficulties at the first stages of romantic love.

PubMed

Schneiderman, Inna; Kanat-Maymon, Yaniv; Ebstein, Richard P; Feldman, Ruth

2014-10-01

Empathic communication between couples plays an important role in relationship quality and individual well-being and research has pointed to the role of oxytocin in providing the neurobiological substrate for pair-bonding and empathy. Here, we examined links between genetic variability on the oxytocin receptor gene (OXTR) and empathic behaviour at the initiation of romantic love. Allelic variations on five OXTR single nucleotide polymorphisms (SNPs) previously associated with susceptibility to disorders of social functioning were genotyped in 120 new lovers: OXTRrs13316193, rs2254298, rs1042778, rs2268494 and rs2268490. Cumulative genetic risk was computed by summing risk alleles on each SNP. Couples were observed in support-giving interaction and behaviour was coded for empathic communication, including affective congruence, maintaining focus on partner, acknowledging partner's distress, reciprocal exchange and non-verbal empathy. Hierarchical linear modelling indicated that individuals with high OXTR risk exhibited difficulties in empathic communication. OXTR risk predicted empathic difficulties above and beyond the couple level, relationship duration, and anxiety and depressive symptoms. Findings underscore the involvement of oxytocin in empathic behaviour during the early stages of social affiliation, and suggest the utility of cumulative risk and plasticity indices on the OXTR as potential biomarkers for research on disorders of social dysfunction and the neurobiology of empathy. © The Author (2013). Published by Oxford University Press. For Permissions, please email: journals.permissions@oup.com.

Cumulative effects of mothers' risk and promotive factors on daughters' disruptive behavior.

PubMed

van der Molen, Elsa; Hipwell, Alison E; Vermeiren, Robert; Loeber, Rolf

2012-07-01

Little is known about the ways in which the accumulation of maternal factors increases or reduces risk for girls' disruptive behavior during preadolescence. In the current study, maternal risk and promotive factors and the severity of girls' disruptive behavior were assessed annually among girls' ages 7-12 in an urban community sample (N = 2043). Maternal risk and promotive factors were operative at different time points in girls' development. Maternal warmth explained variance in girls' disruptive behavior, even after controlling for maternal risk factors and relevant child and neighborhood factors. In addition, findings supported the cumulative hypothesis that the number of risk factors increased the chance on girls' disruptive behavior disorder (DBD), while the number of promotive factors decreased this probability. Daughters of mothers with a history of Conduct Disorder (CD) were exposed to more risk factors and fewer promotive factors compared to daughters of mothers without prior CD. The identification of malleable maternal factors that can serve as targets for intervention has important implications for intergenerational intervention. Cumulative effects show that the focus of prevention efforts should not be on single factors, but on multiple factors associated with girls' disruptive behavior.

Cumulative Effects of Mothers’ Risk and Promotive Factors on Daughters’ Disruptive Behavior

PubMed Central

Hipwell, Alison E.; Vermeiren, Robert; Loeber, Rolf

2012-01-01

Little is known about the ways in which the accumulation of maternal factors increases or reduces risk for girls’ disruptive behavior during preadolescence. In the current study, maternal risk and promotive factors and the severity of girls’ disruptive behavior were assessed annually among girls’ ages 7–12 in an urban community sample (N=2043). Maternal risk and promotive factors were operative at different time points in girls’ development. Maternal warmth explained variance in girls’ disruptive behavior, even after controlling for maternal risk factors and relevant child and neighborhood factors. In addition, findings supported the cumulative hypothesis that the number of risk factors increased the chance on girls’ disruptive behavior disorder (DBD), while the number of promotive factors decreased this probability. Daughters of mothers with a history of Conduct Disorder (CD) were exposed to more risk factors and fewer promotive factors compared to daughters of mothers without prior CD. The identification of malleable maternal factors that can serve as targets for intervention has important implications for intergenerational intervention. Cumulative effects show that the focus of prevention efforts should not be on single factors, but on multiple factors associated with girls’ disruptive behavior. PMID:22127641

Tools Available to Communities for Conducting Cumulative Exposure and Risk Assessments

EPA Science Inventory

This paper summarizes and assesses over 70 tools that could aid with gathering information and taking action on environmental issues related to community-based cumulative risk assessments (CBCRA). Information on tool use, development and research needs, was gathered from websites...

Predicting the cumulative risk of death during hospitalization by modeling weekend, weekday and diurnal mortality risks.

PubMed

Coiera, Enrico; Wang, Ying; Magrabi, Farah; Concha, Oscar Perez; Gallego, Blanca; Runciman, William

2014-05-21

Current prognostic models factor in patient and disease specific variables but do not consider cumulative risks of hospitalization over time. We developed risk models of the likelihood of death associated with cumulative exposure to hospitalization, based on time-varying risks of hospitalization over any given day, as well as day of the week. Model performance was evaluated alone, and in combination with simple disease-specific models. Patients admitted between 2000 and 2006 from 501 public and private hospitals in NSW, Australia were used for training and 2007 data for evaluation. The impact of hospital care delivered over different days of the week and or times of the day was modeled by separating hospitalization risk into 21 separate time periods (morning, day, night across the days of the week). Three models were developed to predict death up to 7-days post-discharge: 1/a simple background risk model using age, gender; 2/a time-varying risk model for exposure to hospitalization (admission time, days in hospital); 3/disease specific models (Charlson co-morbidity index, DRG). Combining these three generated a full model. Models were evaluated by accuracy, AUC, Akaike and Bayesian information criteria. There was a clear diurnal rhythm to hospital mortality in the data set, peaking in the evening, as well as the well-known 'weekend-effect' where mortality peaks with weekend admissions. Individual models had modest performance on the test data set (AUC 0.71, 0.79 and 0.79 respectively). The combined model which included time-varying risk however yielded an average AUC of 0.92. This model performed best for stays up to 7-days (93% of admissions), peaking at days 3 to 5 (AUC 0.94). Risks of hospitalization vary not just with the day of the week but also time of the day, and can be used to make predictions about the cumulative risk of death associated with an individual's hospitalization. Combining disease specific models with such time varying- estimates appears to

Weighted comparison of two cumulative incidence functions with R-CIFsmry package.

PubMed

Li, Jianing; Le-Rademacher, Jennifer; Zhang, Mei-Jie

2014-10-01

In this paper we propose a class of flexible weight functions for use in comparison of two cumulative incidence functions. The proposed weights allow the users to focus their comparison on an early or a late time period post treatment or to treat all time points with equal emphasis. These weight functions can be used to compare two cumulative incidence functions via their risk difference, their relative risk, or their odds ratio. The proposed method has been implemented in the R-CIFsmry package which is readily available for download and is easy to use as illustrated in the example. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Mothering and Peer Associations Mediate Cumulative Risk Effects for Latino Youth

ERIC Educational Resources Information Center

Loukas, Alexandra; Prelow, Hazel M.; Suizzo, Marie-Anne; Allua, Shane

2008-01-01

The present study examined whether positive parenting and deviant peer associations mediated the relations between a cumulative risk composite comprising financial strain, neighborhood problems, and maternal psychological distress and subsequent youth adjustment problems. Drawn from the Welfare, Children, and Families: A Three City Study, the…

Estimating greenspace exposure and benefits for cumulative risk assessment applications

Treesearch

Rebecca Gernes; Richard Hertzberg; Margaret MacDonell; Glenn Rice; J. Michael Wright; Glennon Beresin; Travis Miller; Julia Africa; Geoffrey Donovan; J. Aaron Hipp; Perry Hystad; Laura Jackson; Michelle Kondo; Richard Mitchell; Mark Nieuwenhuijsen; Patrick Ryan; William Sullivan; Matilda Annerstedt. van den Bosch

2016-01-01

This document provides a summary of the technical meeting on greenspace and cumulative risk assessment (GS-CRA) convened May 4−5, 2015 in Cincinnati, OH, by the U.S. Environmental Protection Agency (EPA) Office of Research and Development (ORD) National Center for Environmental Assessment (NCEA). This report highlights the presentations, discussions, and practical...

Early life adversity and adult biological risk profiles.

PubMed

Friedman, Esther M; Karlamangla, Arun S; Gruenewald, Tara L; Koretz, Brandon; Seeman, Teresa E

2015-01-01

To determine whether there is a relationship between early life adversity (ELA) and biological parameters known to predict health risks and to examine the extent to which circumstances in midlife mediate this relationship. We analyzed data on 1180 respondents from the biomarker subsample of the second wave of the National Survey of Midlife Development in the United States. ELA assessments were based on childhood socioeconomic disadvantage (i.e., on welfare, perceived low income, and less educated parents) and other stressors (e.g., parental death, parental divorce, and parental physical abuse). The outcome variable was cumulative allostatic load (AL), a marker of biological risk. We also incorporate information on adult circumstances, including than following: education, social relationships, and health behaviors. Childhood socioeconomic adversity and physical abuse were associated with increased AL (B = 0.094, standard error = 0.041, and B = 0.263, standard error = 0.091 respectively), with nonsignificant associations for parental divorce and death with AL. Adult education mediated the relationship between socioeconomic ELA and cumulative AL to the point of nonsignificance, with this factor alone explaining nearly 40% of the relationship. The association between childhood physical abuse and AL remained even after adjusting for adult educational attainments, social relationships, and health behaviors. These associations were most pronounced for secondary stress systems, including inflammation, cardiovascular function, and lipid metabolism. The physiological consequences of early life socioeconomic adversity are attenuated by achieving high levels of schooling later on. The adverse consequences of childhood physical abuse, on the other hand, persist in multivariable-adjusted analysis.

Longitudinal Pathways from Cumulative Contextual Risk at Birth to School Functioning in Adolescence: Analysis of Mediation Effects and Gender Moderation.

PubMed

January, Stacy-Ann A; Mason, W Alex; Savolainen, Jukka; Solomon, Starr; Chmelka, Mary B; Miettunen, Jouko; Veijola, Juha; Moilanen, Irma; Taanila, Anja; Järvelin, Marjo-Riitta

2017-01-01

Children and adolescents exposed to multiple contextual risks are more likely to have academic difficulties and externalizing behavior problems than those who experience fewer risks. This study used data from the Northern Finland Birth Cohort 1986 (a population-based study; N = 6961; 51 % female) to investigate (a) the impact of cumulative contextual risk at birth on adolescents' academic performance and misbehavior in school, (b) learning difficulties and/or externalizing behavior problems in childhood as intervening mechanisms in the association of cumulative contextual risk with functioning in adolescence, and (c) potential gender differences in the predictive associations of cumulative contextual risk at birth with functioning in childhood or adolescence. The results of the structural equation modeling analysis suggested that exposure to cumulative contextual risk at birth had negative associations with functioning 16 years later, and academic difficulties and externalizing behavior problems in childhood mediated some of the predictive relations. Gender, however, did not moderate any of the associations. Therefore, the findings of this study have implications for the prevention of learning and conduct problems in youth and future research on the impact of cumulative risk exposure.

Longitudinal Pathways from Cumulative Contextual Risk at Birth to School Functioning in Adolescence: Analysis of Mediation Effects and Gender Moderation

PubMed Central

January, Stacy-Ann A.; Mason, W. Alex; Savolainen, Jukka; Solomon, Starr; Chmelka, Mary B.; Miettunen, Jouko; Veijola, Juha; Moilanen, Irma; Taanila, Anja; Järvelin, Marjo-Riitta

2016-01-01

Children and adolescents exposed to multiple contextual risks are more likely to have academic difficulties and externalizing behavior problems than those who experience fewer risks. This study used data from the Northern Finland Birth Cohort 1986 (a population-based study; N = 6,961; 51% female) to investigate (a) the impact of cumulative contextual risk at birth on adolescents’ academic performance and misbehavior in school, (b) learning difficulties and/or externalizing behavior problems in childhood as intervening mechanisms in the association of cumulative contextual risk with functioning in adolescence, and (c) potential gender differences in the predictive associations of cumulative contextual risk at birth with functioning in childhood or adolescence. The results of the structural equation modeling analysis suggested that exposure to cumulative contextual risk at birth had negative associations with functioning 16 years later, and academic difficulties and externalizing behavior problems in childhood mediated some of the predictive relations. Gender, however, did not moderate any of the associations. Therefore, the findings of this study have implications for the prevention of learning and conduct problems in youth and future research on the impact of cumulative risk exposure. PMID:27665276

Cumulative Risk and Teacher Well-Being in the Democratic Republic of the Congo

ERIC Educational Resources Information Center

Wolf, Sharon; Torrente, Catalina; McCoy, Marissa; Rasheed, Damira; Aber, J. Lawrence

2015-01-01

Remarkably little systematic research has examined the living and working conditions for teachers in sub-Saharan Africa and how such conditions predict teacher well-being. This study assesses how various risks across several domains of teachers' lives--measured as a "cumulative risk index"--predict motivation, burnout, and job…

A Topical Overview of Cumulative Risk Assessment Concepts, Methods, and Applications (2007–2016)

EPA Science Inventory

Cumulative risk assessments (CRAs) address combined risks from exposures to multiple chemical and nonchemical stressors and may focus on vulnerable communities or populations. Significant contributions have been made to the development of concepts, methods, and applications for C...

DESIGNING STUDIES AND COLLECTING DATA USEFUL FOR CUMULATIVE RISK ASSESSMENT

EPA Science Inventory

DESIGNING STUDIES AND COLLECTING DATA USEFUL FOR CUMULATIVE RISK ASSESSMENT. J E Simmons1, C Gennings2, M Casey2, M J Plewa3, E D Wagner3, W H Carter, Jr.2, A McDonald1,Y M Sey1, L K Teuschler3 1NHEERL, ORD, U.S. EPA, RTP NC, USA; 2VCU, Richmond, VA, USA;3Univ. Illinois, Urba...

Effect of protocol-related variables and women's characteristics on the cumulative false-positive risk in breast cancer screening

PubMed Central

Román, R.; Sala, M.; Salas, D.; Ascunce, N.; Zubizarreta, R.; Castells, X.

2012-01-01

Background: Reducing the false-positive risk in breast cancer screening is important. We examined how the screening-protocol and women's characteristics affect the cumulative false-positive risk. Methods: This is a retrospective cohort study of 1 565 364 women aged 45–69 years who underwent 4 739 498 screening mammograms from 1990 to 2006. Multilevel discrete hazard models were used to estimate the cumulative false-positive risk over 10 sequential mammograms under different risk scenarios. Results: The factors affecting the false-positive risk for any procedure and for invasive procedures were double mammogram reading [odds ratio (OR) = 2.06 and 4.44, respectively], two mammographic views (OR = 0.77 and 1.56, respectively), digital mammography (OR = 0.83 for invasive procedures), premenopausal status (OR = 1.31 and 1.22, respectively), use of hormone replacement therapy (OR = 1.03 and 0.84, respectively), previous invasive procedures (OR = 1.52 and 2.00, respectively), and a familial history of breast cancer (OR = 1.18 and 1.21, respectively). The cumulative false-positive risk for women who started screening at age 50–51 was 20.39% [95% confidence interval (CI) 20.02–20.76], ranging from 51.43% to 7.47% in the highest and lowest risk profiles, respectively. The cumulative risk for invasive procedures was 1.76% (95% CI 1.66–1.87), ranging from 12.02% to 1.58%. Conclusions: The cumulative false-positive risk varied widely depending on the factors studied. These findings are relevant to provide women with accurate information and to improve the effectiveness of screening programs. PMID:21430183

Estimation and comparison of cumulative incidences of biliary self-expandable metallic stent dysfunction accounting for competing risks.

PubMed

Hamada, Tsuyoshi; Nakai, Yousuke; Isayama, Hiroyuki; Togawa, Osamu; Kogure, Hirofumi; Kawakubo, Kazumichi; Tsujino, Takeshi; Sasahira, Naoki; Hirano, Kenji; Yamamoto, Natsuyo; Ito, Yukiko; Sasaki, Takashi; Mizuno, Suguru; Toda, Nobuo; Tada, Minoru; Koike, Kazuhiko

2014-03-01

Self-expandable metallic stent (SEMS) placement is widely carried out for distal malignant biliary obstruction, and survival analysis is used to evaluate the cumulative incidences of SEMS dysfunction (e.g. the Kaplan-Meier [KM] method and the log-rank test). However, these statistical methods might be inappropriate in the presence of 'competing risks' (here, death without SEMS dysfunction), which affects the probability of experiencing the event of interest (SEMS dysfunction); that is, SEMS dysfunction can no longer be observed after death. A competing risk analysis has rarely been done in studies on SEMS. We introduced the concept of a competing risk analysis and illustrated its impact on the evaluation of SEMS outcomes using hypothetical and actual data. Our illustrative study included 476 consecutive patients who underwent SEMS placement for unresectable distal malignant biliary obstruction. A significant difference between cumulative incidences of SEMS dysfunction in male and female patients via theKM method (P = 0.044 by the log-rank test) disappeared after applying a competing risk analysis (P = 0.115 by Gray's test). In contrast, although cumulative incidences of SEMS dysfunction via the KM method were similar with and without chemotherapy (P = 0.647 by the log-rank test), cumulative incidence of SEMS dysfunction in the non-chemotherapy group was shown to be significantly lower (P = 0.031 by Gray's test) in a competing risk analysis. Death as a competing risk event needs to be appropriately considered in estimating a cumulative incidence of SEMS dysfunction, otherwise analytical results may be biased. © 2013 The Authors. Digestive Endoscopy © 2013 Japan Gastroenterological Endoscopy Society.

An Analysis of Cumulative Risks Indicated by Biomonitoring ...

EPA Pesticide Factsheets

The Maximum Cumulative Ratio (MCR) quantifies the degree to which a single component of a chemical mixture drives the cumulative risk of a receptor.1 This study used the MCR, the Hazard Index (HI) and Hazard Quotient (HQ) to evaluate co-exposures to six phthalates using biomonitoring data in 2454 individuals aged 6 years and older from the 2011-12 cycle of the National Health and Nutrition Examination Survey. The values of MCR, HI and phthalate-specific HQs were determined by calculating steady-state doses consistent with the concentrations of phthalate metabolites in urine and using Tolerable Daily Intake values.2 There were 22 individuals (0.9%) predicted to have at least one HQ value > 1 and an additional 17 (0.7%) with no HQ value > 1 but with an HI value > 1. The percent of individuals with HI values > 1 differed by age (0.9% for individuals between 6 – 17 y and 1.9% for individuals > 17 y). There is a statistically significant negative relationship between HI and MCR values in both age groups (p-values 1 and all HQs 1 were 1.1 (1.0-1.3) and 2.8 (1.1-13.7), respectively. The combined assessment found that 17/39 (43%) of the individuals with HI values > 1 are missed by chemical-by-chemical assessments of the phthalates. These findings suggest that determining combined exposures for the six phthalates has a modest impact on the predictions of the chemicals’ risks. Additional individuals with HI values >1 are identified, but HI values in these individual

78 FR 25440 - Request for Information and Citations on Methods for Cumulative Risk Assessment

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-01

... Citations on Methods for Cumulative Risk Assessment AGENCY: Office of the Science Advisor, Environmental... requesting information and citations on approaches and methods for the planning, analysis, assessment, and... approaches to understanding risks to human health and the environment. For example, in Science & Decisions...

Guidance on Cumulative Risk Assessment of Pesticide Chemicals that have a Common Mechanism of Toxicity

EPA Pesticide Factsheets

This document provides guidance to OPP scientists for evaluating and estimating the potential human risks associated with such multichemical and multipathway exposures to pesticides. This process is referred to as cumulative risk assessment.

Effects of Cumulative Family Risk Factors on American Students' Academic Performance

ERIC Educational Resources Information Center

Dunst, Carl J.; Hamby, Deborah W.

2016-01-01

The relationships between cumulative family risk factors and American students' academic performance were examined in all 50 States and the District of Columbia. Data from the 2007 "American Community Survey" were used to ascertain the percent of birth to 18 year old children in the United States who experienced three or more risk…

Cumulative childhood risk is associated with a new measure of chronic inflammation in adulthood.

PubMed

Rasmussen, Line Jee Hartmann; Moffitt, Terrie E; Eugen-Olsen, Jesper; Belsky, Daniel W; Danese, Andrea; Harrington, HonaLee; Houts, Renate M; Poulton, Richie; Sugden, Karen; Williams, Benjamin; Caspi, Avshalom

2018-05-09

Childhood risk factors are associated with elevated inflammatory biomarkers in adulthood, but it is unknown whether these risk factors are associated with increased adult levels of the chronic inflammation marker soluble urokinase plasminogen activator receptor (suPAR). We aimed to test the hypothesis that childhood exposure to risk factors for adult disease is associated with elevated suPAR in adulthood and to compare suPAR with the oft-reported inflammatory biomarker C-reactive protein (CRP). Prospective study of a population-representative 1972-1973 birth cohort; the Dunedin Multidisciplinary Health and Development Study observed participants to age 38 years. Main childhood predictors were poor health, socioeconomic disadvantage, adverse childhood experiences (ACEs), low IQ, and poor self-control. Main adult outcomes were adulthood inflammation measured as suPAR and high-sensitivity CRP (hsCRP). Participants with available plasma samples at age 38 were included (N = 837, 50.5% male). suPAR (mean 2.40 ng/ml; SD 0.91) was positively correlated with hsCRP (r 0.15, p < .001). After controlling for sex, body mass index (BMI), and smoking, children who experienced more ACEs, lower IQ, or had poorer self-control showed elevated adult suPAR. When the five childhood risks were aggregated into a Cumulative Childhood Risk index, and controlling for sex, BMI, and smoking, Cumulative Childhood Risk was associated with higher suPAR (b 0.10; SE 0.03; p = .002). Cumulative Childhood Risk predicted elevated suPAR, after controlling for hsCRP (b 0.18; SE 0.03; p < .001). Exposure to more childhood risk factors was associated with higher suPAR levels, independent of CRP. suPAR is a useful addition to studies connecting childhood risk to adult inflammatory burden. © 2018 Association for Child and Adolescent Mental Health.

Language Delay in Severely Neglected Children: A Cumulative or Specific Effect of Risk Factors?

ERIC Educational Resources Information Center

Sylvestre, Audette; Merette, Chantal

2010-01-01

Objectives: This research sought to determine if the language delay (LD) of severely neglected children under 3 years old was better explained by a cumulative risk model or by the specificity of risk factors. The objective was also to identify the risk factors with the strongest impact on LD among various biological, psychological, and…

USING DOSE ADDITION TO ESTIMATE CUMULATIVE RISKS FROM EXPOSURES TO MULTIPLE CHEMICALS

EPA Science Inventory

The Food Quality Protection Act (FQPA) of 1996 requires the EPA to consider the cumulative risk from exposure to multiple chemicals that have a common mechanism of toxicity. Three methods, hazard index (HI), point-of-departure index (PODI), and toxicity equivalence factor (TEF), ...

TESTING STRATEGIES TO ESTIMATE NEUROTOXIC RISK FOR CUMULATIVE EXPOSURE TO PYRETHROID MIXTURES.

EPA Science Inventory

The Food Quality Protection Act requires EPA to consider the cumulative risk of pesticides with

a common mechanism-of-toxicity. Evidence supports a mechanistic commonality for pyrethroid

insecticides: these chemicals all act on neuronal sodium channels. The lack of ...

Non-Chemical Stressors and Cumulative Risk Assessment: An Overview of Current Initiatives and Potential Air Pollutant Interactions

PubMed Central

Lewis, Ari S.; Sax, Sonja N.; Wason, Susan C.; Campleman, Sharan L.

2011-01-01

Regulatory agencies are under increased pressure to consider broader public health concerns that extend to multiple pollutant exposures, multiple exposure pathways, and vulnerable populations. Specifically, cumulative risk assessment initiatives have stressed the importance of considering both chemical and non-chemical stressors, such as socioeconomic status (SES) and related psychosocial stress, in evaluating health risks. The integration of non-chemical stressors into a cumulative risk assessment framework has been largely driven by evidence of health disparities across different segments of society that may also bear a disproportionate risk from chemical exposures. This review will discuss current efforts to advance the field of cumulative risk assessment, highlighting some of the major challenges, discussed within the construct of the traditional risk assessment paradigm. Additionally, we present a summary of studies of potential interactions between social stressors and air pollutants on health as an example of current research that supports the incorporation of non-chemical stressors into risk assessment. The results from these studies, while suggestive of possible interactions, are mixed and hindered by inconsistent application of social stress indicators. Overall, while there have been significant advances, further developments across all of the risk assessment stages (i.e., hazard identification, exposure assessment, dose-response, and risk characterization) are necessary to provide a scientific basis for regulatory actions and effective community interventions, particularly when considering non-chemical stressors. A better understanding of the biological underpinnings of social stress on disease and implications for chemical-based dose-response relationships is needed. Furthermore, when considering non-chemical stressors, an appropriate metric, or series of metrics, for risk characterization is also needed. Cumulative risk assessment research will benefit

Estimating Greenspace Exposure and Benefits for Cumulative Risk Assessment Applications (Summary Report)

EPA Science Inventory

This document provides a summary of the technical meeting on greenspace (GS) and cumulative risk assessment convened May 4−5, 2015 in Cincinnati, OH, by the U.S. Environmental Protection Agency (EPA) Office of Research and Development (ORD) National Center for Environmental As...

Risk of Fatal Cerebrovascular Accidents after External Beam Radiation Therapy for Early Stage Glottic Larynx Cancer

PubMed Central

Swisher-McClure, Samuel; Mitra, Nandita; Lin, Alexander; Ahn, Peter; Wan, Fei; O’Malley, Bert; Weinstein, Gregory S.; Bekelman, Justin E.

2013-01-01

Background This study compared the risk of fatal cerebrovascular accidents (CVA) in patients with early stage glottic larynx cancer receiving surgery or external beam radiation therapy (EBRT). Methods and Materials Using a competing risks survival analysis, we compared the risk of death due to CVA among patients with early stage glottic larynx cancer receiving surgery or EBRT in the SEER database. Results The cumulative incidence of fatal CVA at 15 years was higher in patients receiving EBRT (2.8 %; 95% CI 2.3%–3.4%) compared to surgery (1.5 %; 95% CI 0.8 %–2.3%, p= 0.024). In multivariable competing risks regression models, EBRT remained associated with an increased risk of fatal CVA compared to surgery (adjusted HR 1.75; 95% CI 1.04–2.96, p= 0.037). Conclusion Treatment of early stage glottic larynx cancer with EBRT was associated with a small increase in the risk of late fatal CVA events relative to surgery. PMID:23595858

Association of cumulative social risk with mortality and adverse cardiovascular disease outcomes.

PubMed

Erqou, Sebhat; Echouffo-Tcheugui, Justin B; Kip, Kevin E; Aiyer, Aryan; Reis, Steven E

2017-05-08

Quantifying the cumulative effect of social risk factors on cardiovascular disease (CVD) risk can help to better understand the sources of disparities in health outcomes. Data from the Heart Strategies Concentrating on Risk Evaluation (HeartSCORE) study were used to create an index of cumulative social risk (CSR) and quantify its association with incident CVD and all-cause mortality. CSR was defined by assigning a score of 1 for the presence of each of 4 social factors: i) racial minority status (Black race), ii) single living status, iii) low income, and iv) low educational level. Hazard ratios (HRs) were computed using Cox-regression models, adjusted for CVD risk factors. Over a median follow-up period of 8.3 years, 127 incident events were observed. The incidence of the primary outcome for subgroups of participants with 0, 1, and ≥2 CSR scores was 5.31 (95% CI, 3.40-7.22), 10.32 (7.16-13.49) and 17.80 (12.94-22.67) per 1000 person-years, respectively. Individuals with CSR score of 1 had an adjusted HR of 1.85 (1.15-2.97) for incident primary outcomes, compared to those with score of 0. The corresponding HR for individuals with CSR score of 2 or more was 2.58 (1.60-4.17). An accumulation of social risk factors independently increased the likelihood of CVD events and deaths in a cohort of White and Black individuals.

Markers of inflammation, oxidative stress, and endothelial dysfunction and the 20-year cumulative incidence of early age-related macular degeneration: the Beaver Dam Eye Study.

PubMed

Klein, Ronald; Myers, Chelsea E; Cruickshanks, Karen J; Gangnon, Ronald E; Danforth, Lorraine G; Sivakumaran, Theru A; Iyengar, Sudha K; Tsai, Michael Y; Klein, Barbara E K

2014-04-01

IMPORTANCE Modifying levels of factors associated with age-related macular degeneration (AMD) may decrease the risk for visual impairment in older persons. OBJECTIVE To examine the relationships of markers of inflammation, oxidative stress, and endothelial dysfunction to the 20-year cumulative incidence of early AMD. DESIGN, SETTING, AND PARTICIPANTS This longitudinal population-based cohort study involved a random sample of 975 persons in the Beaver Dam Eye Study without signs of AMD who participated in the baseline examination in 1988-1990 and up to 4 follow-up examinations in 1993-1995, 1998-2000, 2003-2005, and 2008-2010. EXPOSURES Serum markers of inflammation (high-sensitivity C-reactive protein, tumor necrosis factor-α receptor 2, interleukin-6, and white blood cell count), oxidative stress (8-isoprostane and total carbonyl content), and endothelial dysfunction (soluble vascular cell adhesion molecule-1 and soluble intercellular adhesion molecule-1) were measured. Interactions with complement factor H (rs1061170), age-related maculopathy susceptibility 2 (rs10490924), complement component 3 (rs2230199), and complement component 2/complement factor B (rs4151667) were examined using multiplicative models. Age-related macular degeneration was assessed from fundus photographs. MAIN OUTCOMES AND MEASURES Early AMD defined by the presence of any size drusen and the presence of pigmentary abnormalities or by the presence of large-sized drusen (≥125-μm diameter) in the absence of late AMD. RESULTS The 20-year cumulative incidence of early AMD was 23.0%. Adjusting for age, sex, and other risk factors, high-sensitivity C-reactive protein (odds ratio comparing fourth with first quartile, 2.18; P = .005), tumor necrosis factor-α receptor 2 (odds ratio, 1.78; P = .04), and interleukin-6 (odds ratio, 1.78; P = .03) were associated with the incidence of early AMD. Increased incidence of early AMD was associated with soluble vascular cell adhesion molecule

EFFECTS-BASED CUMULATIVE RISK ASSESSMENT IN A LOW-INCOME URBAN COMMUNITY NEAR A SUPERFUND SITE

EPA Science Inventory

We will introduce into the cumulative risk assessment framework novel methods for non-cancer risk assessment, techniques for dose-response modeling that extend insights from chemical mixtures frameworks to non-chemical stressors, multilevel statistical methods used to address ...

Drought early warning and risk management in a changing environment

NASA Astrophysics Data System (ADS)

Pulwarty, R. S.

2011-12-01

Drought has long been recognized as falling into the category of incremental but long-term and cumulative environmental changes, also termed slow-onset or creeping events. These event types would include: air and water quality decline, desertification processes, deforestation and forest fragmentation, loss of biodiversity and habitats, and nitrogen overloading, among others. Climate scientists continue to struggle with recognizing the onset of drought and scientists and policy makers continue to debate the basis (i.e., criteria) for declaring an end to a drought. Risk-based management approaches to drought planning at the national and regional levels have been recommended repeatedly over the years but their prototyping, testing and operational implementation have been limited. This presentation will outline two avenues for disaster risk reduction in the context of drought (1) integrated early warning information systems, and (2) linking disaster risk reduction to climate change adaptation strategies. Adaptation involves not only using operational facilities and infrastructure to cope with the immediate problems but also leaving slack or reserve for coping with multiple stress problems that produce extreme impacts and surprise. Increasing the 'anticipatability' of an event, involves both monitoring of key indicators from appropriate baseline data, and observing early warning signs that assumptions in risk management plans are failing and critical transitions are occurring. Illustrative cases will be drawn from the IPCC Special Report on Managing the Risks of Extreme Events and Disasters (2011), the UN Global Assessment of Disaster Risk Reduction (2011) and implementation activities in which the author has been engaged. Most drought early warning systems have tended to focus on the development and use of physical system indicators and forecasts of trends and thresholds. We show that successful early warning systems that meet expectations of risk management also have

Psychotic-spectrum symptoms, cumulative adversity exposure and substance use among high-risk girls.

PubMed

Lansing, Amy E; Plante, Wendy Y; Fennema-Notestine, Christine; Golshan, Shahrokh; Beck, Audrey N

2018-02-01

Psychotic-spectrum symptoms are linked to trauma, substance/alcohol use (SAU), criminality/violence and poor functional outcomes, supporting the need for early detection in vulnerable populations. To better understand high-risk girls' mental health, we assessed: (1) psychotic-spectrum symptoms; (2) cumulative trauma, adversity and loss exposures (C-TALE) and adversity-indicators (symptoms, maladaptive coping, stressor-reactivity); and SAU risk-factors; and (3) relationships among psychotic-spectrum symptoms, adversity-indicators and SAU risk-factors. We administered the Structured Clinical Interviews for Psychotic Spectrum, and Trauma and Loss Spectrum to 158 adolescent delinquent girls. Girls' psychotic-spectrum profiles were similar to previously reported adult psychotic patients and characterized by typical symptoms (hallucinations/delusions, reported largely SAU-independent), interpersonal sensitivity, schizoid traits and paranoia (over-interpretation, anger over-reactivity, hypervigilance). Auditory/visual hallucinations (55.7%), delusions (92.4%), ideas of reference (96.8%) and adversity (90.0% ≥10/24 C-TALE-types) were common. Mean loss (4) and trauma (8) onset-age occurred before SAU-onset (12). Significant positive correlations were found among psychotic-spectrum symptoms, stressor-reactivity, C-TALE, adversity-indicators; and number of SAU-types; and a negative correlation occurred between psychotic-spectrum symptoms and earlier alcohol use onset. After controlling for number of SAU-types, stressor-reactivity and adversity-related numbing individually had the largest associations with total psychotic-spectrum symptoms (b = 2.6-4.3). Girls averaged more than 4 maladaptive coping strategies (e.g., 24.8% attempted suicide) in response to adversity, amplifying potential health-disparities. No racial/ethnic differences emerged on psychotic-spectrum symptoms. This symptom constellation during adolescence likely interferes with social and academic

The Effect of Cumulative Risk on Paternal Engagement: Examining Differences among Adolescent and Older Couples

ERIC Educational Resources Information Center

Farrie, Danielle; Lee, Yookyong; Fagan, Jay

2011-01-01

This study examined the association between fathers' and mothers' risk factors and paternal engagement 1 and 3 years postbirth. Distinguishing between new and persistent risk factors, we tested whether cumulative risk has unique effects on couples where one or both parents are adolescents at birth. Results indicated that although fathers' and…

Early physiological markers of cardiovascular risk in community based adolescents with a depressive disorder.

PubMed

Waloszek, Joanna M; Byrne, Michelle L; Woods, Michael J; Nicholas, Christian L; Bei, Bei; Murray, Greg; Raniti, Monika; Allen, Nicholas B; Trinder, John

2015-04-01

Depression is recognised as an independent cardiovascular risk factor in adults. Identifying this relationship early on in life is potentially important for the prevention of cardiovascular disease (CVD). This study investigated whether clinical depression is associated with multiple physiological markers of CVD risk in adolescents from the general community. Participants aged 12-18 years were recruited from the general community and screened for depressive symptoms. Individuals with high and low depressive symptoms were administered a diagnostic interview. Fifty participants, 25 with a current depressive episode and 25 matched healthy controls, subsequently completed cardiovascular assessments. Variables assessed were automatic brachial and continuous beat-to-beat finger arterial blood pressure, heart rate, vascular functioning by pulse amplitude tonometry following reactive hyperaemia and pulse transit time (PTT) at rest. Blood samples were collected to measure cholesterol, glucose and glycohaemoglobin levels and an index of cumulative risk of traditional cardiovascular risk factors was calculated. Depressed adolescents had a significantly lower reactive hyperaemia index and shorter PTT, suggesting deterioration in vascular integrity and structure. Higher fasting glucose and triglyceride levels were also observed in the depressed group, who also had higher cumulative risk scores indicative of increased engagement in unhealthy behaviours and higher probability of advanced atherosclerotic lesions. The sample size and number of males who completed all cardiovascular measures was small. Clinically depressed adolescents had poorer vascular functioning and increased CVD risk compared to controls, highlighting the need for early identification and intervention for the prevention of CVD in depressed youth. Copyright © 2015 Elsevier B.V. All rights reserved.

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

PubMed

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

2002-02-01

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

Cumulative biomedical risk and social cognition in the second year of life: prediction and moderation by responsive parenting.

PubMed

Wade, Mark; Madigan, Sheri; Akbari, Emis; Jenkins, Jennifer M

2015-01-01

At 18 months, children show marked variability in their social-cognitive skill development, and the preponderance of past research has focused on constitutional and contextual factors in explaining this variability. Extending this literature, the current study examined whether cumulative biomedical risk represents another source of variability in social cognition at 18 months. Further, we aimed to determine whether responsive parenting moderated the association between biomedical risk and social cognition. A prospective community birth cohort of 501 families was recruited at the time of the child's birth. Cumulative biomedical risk was measured as a count of 10 prenatal/birth complications. Families were followed up at 18 months, at which point social-cognitive data was collected on children's joint attention, empathy, cooperation, and self-recognition using previously validated tasks. Concurrently, responsive maternal behavior was assessed through observational coding of mother-child interactions. After controlling for covariates (e.g., age, gender, child language, socioeconomic variables), both cumulative biomedical risk and maternal responsivity significantly predicted social cognition at 18 months. Above and beyond these main effects, there was also a significant interaction between biomedical risk and maternal responsivity, such that higher biomedical risk was significantly associated with compromised social cognition at 18 months, but only in children who experienced low levels of responsive parenting. For those receiving comparatively high levels of responsive parenting, there was no apparent effect of biomedical risk on social cognition. This study shows that cumulative biomedical risk may be one source of inter-individual variability in social cognition at 18 months. However, positive postnatal experiences, particularly high levels of responsive parenting, may protect children against the deleterious effects of these risks on social cognition.

Defining subgroups of low socioeconomic status women at risk for depressive symptoms: the importance of perceived stress and cumulative risks.

PubMed

van der Waerden, Judith E B; Hoefnagels, Cees; Hosman, Clemens M H; Jansen, Maria W J

2014-12-01

Most disadvantaged women are exposed to risk factors for depression, but not all necessarily have an identical risk for this mental health problem. A better prediction of which low socioeconomic status (SES) women are most at risk for depressive symptoms can help target preventive interventions at high-risk subgroups most in need of support. Exploring which demographic, socioeconomic and psychological risk factors are associated with self-reported depressive symptoms in a sample of low-SES women and whether the number of risk factors might expose them to an accumulated risk. Between April 2005 and November 2007, 519 disadvantaged women from urban neighbourhoods in Maastricht, a southern Dutch city, participated in a cross-sectional survey on stress and depressive symptoms. Lower education levels, no current employment and lower net monthly family incomes were socioeconomic risk factors associated with higher scores for depressive symptoms. The psychological risk factor 'perceived stress' had the highest explained variance and was most strongly associated with depressive symptoms. Women exposed to multiple risk factors across domains had a cumulated risk for depressive symptomatology. Low-SES women who seem most eligible for targeted preventive action are those with cumulative risks. Depression prevention strategies for this population may benefit from focusing on perceived stress since this is an important modifiable risk factor. © The Author(s) 2014.

Cumulative Risk Exposure and Mental Health Symptoms among Maltreated Youth Placed in Out-of-Home Care

ERIC Educational Resources Information Center

Raviv, Tali; Taussig, Heather N.; Culhane, Sara E.; Garrido, Edward F.

2010-01-01

Objective: Maltreated children placed in out-of-home care are at high risk for exhibiting symptoms of psychopathology by virtue of their exposure to numerous risk factors. Research examining cumulative risk has consistently found that the accumulation of risk factors increases the likelihood of mental health problems. The goal of the current study…

When Dread Risks Are More Dreadful than Continuous Risks: Comparing Cumulative Population Losses over Time.

PubMed

Bodemer, Nicolai; Ruggeri, Azzurra; Galesic, Mirta

2013-01-01

People show higher sensitivity to dread risks, rare events that kill many people at once, compared with continuous risks, relatively frequent events that kill many people over a longer period of time. The different reaction to dread risks is often considered a bias: If the continuous risk causes the same number of fatalities, it should not be perceived as less dreadful. We test the hypothesis that a dread risk may have a stronger negative impact on the cumulative population size over time in comparison with a continuous risk causing the same number of fatalities. This difference should be particularly strong when the risky event affects children and young adults who would have produced future offspring if they had survived longer. We conducted a series of simulations, with varying assumptions about population size, population growth, age group affected by risky event, and the underlying demographic model. Results show that dread risks affect the population more severely over time than continuous risks that cause the same number of fatalities, suggesting that fearing a dread risk more than a continuous risk is an ecologically rational strategy.

Modeling Joint Exposures and Health Outcomes for Cumulative Risk Assessment: the Case of Radon and Smoking

EPA Science Inventory

Community-based cumulative risk assessment requires characterization of exposures to multiple chemical and non-chemical stressors, with consideration of how the non-chemical stressors may influence risks from chemical stressors. Residential radon provides an interesting case exam...

Predictors of re-entry into the child protection system in Singapore: a cumulative ecological-transactional risk model.

PubMed

Li, Dongdong; Chu, Chi Meng; Ng, Wei Chern; Leong, Wai

2014-11-01

This study examines the risk factors of re-entry for 1,750 child protection cases in Singapore using a cumulative ecological-transactional risk model. Using administrative data, the present study found that the overall percentage of Child Protection Service (CPS) re-entry in Singapore is 10.5% based on 1,750 cases, with a range from 3.9% (within 1 year) to 16.5% (within 8 years after case closure). One quarter of the re-entry cases were observed to occur within 9 months from case closure. Seventeen risk factors, as identified from the extant literature, were tested for their utility to predict CPS re-entry in this study using a series of Cox regression analyses. A final list of seven risk factors (i.e., children's age at entry, case type, case closure result, duration of case, household income, family size, and mother's employment status) was used to create a cumulative risk score. The results supported the cumulative risk model in that higher risk score is related to higher risk of CPS re-entry. Understanding the prevalence of CPS re-entry and the risk factors associated with re-entry is the key to informing practice and policy in a culturally relevant way. The results from this study could then be used to facilitate critical case management decisions in order to enhance positive outcomes of families and children in Singapore's care system. Copyright © 2014 Elsevier Ltd. All rights reserved.

Risk of fatal cerebrovascular accidents after external beam radiation therapy for early-stage glottic laryngeal cancer.

PubMed

Swisher-McClure, Samuel; Mitra, Nandita; Lin, Alexander; Ahn, Peter; Wan, Fei; O'Malley, Bert; Weinstein, Gregory S; Bekelman, Justin E

2014-05-01

This study compared the risk of fatal cerebrovascular accidents (CVAs) in patients with early-stage glottic laryngeal cancer receiving surgery or external beam radiation therapy (EBRT). Using a competing risks survival analysis, we compared the risk of death because of CVA among patients with early-stage glottic laryngeal cancer receiving surgery or EBRT in the Surveillance, Epidemiology, and End Results (SEER) database. The cumulative incidence of fatal CVA at 15 years was higher in patients receiving EBRT (2.8%; 95% confidence interval [CI], 2.3% to 3.4%) compared to surgery (1.5%; 95% CI, 0.8% to 2.3%; p = .024). In multivariable competing risks regression models, EBRT remained associated with an increased risk of fatal CVA compared to surgery (adjusted hazard ratio [HR], 1.75; 95% CI, 1.04-2.96; p = .037). Treatment for early-stage glottic laryngeal cancer with EBRT was associated with a small increase in the risk of late fatal CVA events relative to surgery. Copyright © 2013 Wiley Periodicals, Inc.

Cumulative risk effects for the development of behaviour difficulties in children and adolescents with special educational needs and disabilities.

PubMed

Oldfield, Jeremy; Humphrey, Neil; Hebron, Judith

2015-01-01

Research has identified multiple risk factors for the development of behaviour difficulties. What have been less explored are the cumulative effects of exposure to multiple risks on behavioural outcomes, with no study specifically investigating these effects within a population of young people with special educational needs and disabilities (SEND). Furthermore, it is unclear whether a threshold or linear risk model better fits the data for this population. The sample included 2660 children and 1628 adolescents with SEND. Risk factors associated with increases in behaviour difficulties over an 18-month period were summed to create a cumulative risk score, with this explanatory variable being added into a multi-level model. A quadratic term was then added to test the threshold model. There was evidence of a cumulative risk effect, suggesting that exposure to higher numbers of risk factors, regardless of their exact nature, resulted in increased behaviour difficulties. The relationship between risk and behaviour difficulties was non-linear, with exposure to increasing risk having a disproportionate and detrimental impact on behaviour difficulties in child and adolescent models. Interventions aimed at reducing behaviour difficulties need to consider the impact of multiple risk variables. Tailoring interventions towards those exposed to large numbers of risks would be advantageous. Copyright © 2015 Elsevier Ltd. All rights reserved.

A Summary of Publications on Methods and Tools for Assessing Cumulative Risk, Project Summary

EPA Science Inventory

This collection of eight publications on cumulative risk assessment was developed collaboratively among scientists within EPA’s Office of Research and Development and three other organizations. These include scientific collaborations through an Interagency Agreement with Argonne...

Cumulative iron dose and resistance to erythropoietin.

PubMed

Rosati, A; Tetta, C; Merello, J I; Palomares, I; Perez-Garcia, R; Maduell, F; Canaud, B; Aljama Garcia, P

2015-10-01

Optimizing anemia treatment in hemodialysis (HD) patients remains a priority worldwide as it has significant health and financial implications. Our aim was to evaluate in a large cohort of chronic HD patients in Fresenius Medical Care centers in Spain the value of cumulative iron (Fe) dose monitoring for the management of iron therapy in erythropoiesis-stimulating agent (ESA)-treated patients, and the relationship between cumulative iron dose and risk of hospitalization. Demographic, clinical and laboratory parameters from EuCliD(®) (European Clinical Dialysis Database) on 3,591 patients were recorded including ESA dose (UI/kg/week), erythropoietin resistance index (ERI) [U.I weekly/kg/gr hemoglobin (Hb)] and hospitalizations. Moreover the cumulative Fe dose (mg/kg of bodyweight) administered over the last 2 years was calculated. Univariate and multivariate analyses were performed to identify the main predictors of ESA resistance and risk of hospitalization. Patients belonging to the 4th quartile of ERI were defined as hypo-responders. The 2-year iron cumulative dose was significantly higher in the 4th quartile of ERI. In hypo-responders, 2-year cumulative iron dose was the only iron marker associated with ESA resistance. At case-mix adjusted multivariate analysis, 2-year iron cumulative dose was an independent predictor of hospitalization risk. In ESA-treated patients cumulative Fe dose could be a useful tool to monitor the appropriateness of Fe therapy and to prevent iron overload. To establish whether the associations between cumulative iron dose, ERI and hospitalization risk are causal or attributable to selection bias by indication, clinical trials are necessary.

Association between cumulative social risk and ideal cardiovascular health in US adults: NHANES 1999-2006.

PubMed

Caleyachetty, Rishi; Echouffo-Tcheugui, Justin B; Muennig, Peter; Zhu, Wenyi; Muntner, Paul; Shimbo, Daichi

2015-07-15

The American Heart Association developed the Life's Simple 7 metric for defining cardiovascular health. Little is known about the association of co-occurring social risk factors on ideal cardiovascular health. Using data on 11,467 adults aged ≥25 years from the National Health and Nutrition Examination Survey 1999-2006, we examined the association between cumulative social risk and ideal cardiovascular health in US adults. A cumulative risk score (range 0 to 3 or 4) was created by summing four social risk factors (low family income, low education level, minority race, and single-living status). Ideal levels for each component in Life's Simple 7 (blood pressure, cholesterol, glucose, BMI, smoking, physical activity, and diet) were used to create an ideal Life's Simple 7 score [0-1 (low), 2, 3, 4, and 5-7 (high)]. Adults with low income (odds ratio [OR]=0.30 [95% CI 0.23-0.39]), low education [0.22 (0.16-0.28)], who are non-white (0.44 [0.36-0.54]) and single-living [0.79 (0.67-0.95)] were less likely to have 5-7 versus 0 ideal Life's Simple 7 scores after adjustment for age and sex. Adults were less likely to attain 5-7 versus 0 ideal Life's Simple 7 scores as exposure to the number of social risk factors increased [OR (95% CI) of 0.58 (0.49-0.68); 0.27 (0.21-0.35); and 0.19 (0.14-0.27) for cumulative social risk scores of 1, 2, and 3 or 4, respectively, each versus 0]. US adults with an increasing number of socially risk factors, were progressively less likely to attain ideal levels of cardiovascular health factors. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Cumulative Small Effect Genetic Markers and the Risk of Colorectal Cancer in Poland, Estonia, Lithuania, and Latvia

PubMed Central

Serrano-Fernandez, Pablo; Dymerska, Dagmara; Kurzawski, Grzegorz; Derkacz, Róża; Sobieszczańska, Tatiana; Banaszkiewicz, Zbigniew; Roomere, Hanno; Oitmaa, Eneli; Metspalu, Andres; Janavičius, Ramūnas; Elsakov, Pavel; Razumas, Mindaugas; Petrulis, Kestutis; Irmejs, Arvīds; Miklaševičs, Edvīns; Scott, Rodney J.; Lubiński, Jan

2015-01-01

The continued identification of new low-penetrance genetic variants for colorectal cancer (CRC) raises the question of their potential cumulative effect among compound carriers. We focused on 6 SNPs (rs380284, rs4464148, rs4779584, rs4939827, rs6983267, and rs10795668), already described as risk markers, and tested their possible independent and combined contribution to CRC predisposition. Material and Methods. DNA was collected and genotyped from 2330 unselected consecutive CRC cases and controls from Estonia (166 cases and controls), Latvia (81 cases and controls), Lithuania (123 cases and controls), and Poland (795 cases and controls). Results. Beyond individual effects, the analysis revealed statistically significant linear cumulative effects for these 6 markers for all samples except of the Latvian one (corrected P value = 0.018 for the Estonian, corrected P value = 0.0034 for the Lithuanian, and corrected P value = 0.0076 for the Polish sample). Conclusions. The significant linear cumulative effects demonstrated here support the idea of using sets of low-risk markers for delimiting new groups with high-risk of CRC in clinical practice that are not carriers of the usual CRC high-risk markers. PMID:26101521

Cumulative Small Effect Genetic Markers and the Risk of Colorectal Cancer in Poland, Estonia, Lithuania, and Latvia.

PubMed

Serrano-Fernandez, Pablo; Dymerska, Dagmara; Kurzawski, Grzegorz; Derkacz, Róża; Sobieszczańska, Tatiana; Banaszkiewicz, Zbigniew; Roomere, Hanno; Oitmaa, Eneli; Metspalu, Andres; Janavičius, Ramūnas; Elsakov, Pavel; Razumas, Mindaugas; Petrulis, Kestutis; Irmejs, Arvīds; Miklaševičs, Edvīns; Scott, Rodney J; Lubiński, Jan

2015-01-01

The continued identification of new low-penetrance genetic variants for colorectal cancer (CRC) raises the question of their potential cumulative effect among compound carriers. We focused on 6 SNPs (rs380284, rs4464148, rs4779584, rs4939827, rs6983267, and rs10795668), already described as risk markers, and tested their possible independent and combined contribution to CRC predisposition. Material and Methods. DNA was collected and genotyped from 2330 unselected consecutive CRC cases and controls from Estonia (166 cases and controls), Latvia (81 cases and controls), Lithuania (123 cases and controls), and Poland (795 cases and controls). Results. Beyond individual effects, the analysis revealed statistically significant linear cumulative effects for these 6 markers for all samples except of the Latvian one (corrected P value = 0.018 for the Estonian, corrected P value = 0.0034 for the Lithuanian, and corrected P value = 0.0076 for the Polish sample). Conclusions. The significant linear cumulative effects demonstrated here support the idea of using sets of low-risk markers for delimiting new groups with high-risk of CRC in clinical practice that are not carriers of the usual CRC high-risk markers.

Education, income and ethnic differences in cumulative biological risk profiles in a national sample of US adults: NHANES III (1988-1994).

PubMed

Seeman, Teresa; Merkin, Sharon S; Crimmins, Eileen; Koretz, Brandon; Charette, Susan; Karlamangla, Arun

2008-01-01

Data from the nationally representative US National Health and Nutrition Examination Survey (NHANES) III cohort were used to examine the hypothesis that socio-economic status is consistently and negatively associated with levels of biological risk, as measured by nine biological parameters known to predict health risks (diastolic and systolic blood pressure, pulse, HDL and total cholesterol, glycosylated hemoglobin, c-reactive protein, albumin and waist-hip ratio), resulting in greater cumulative burdens of biological risk among those of lower education and/or income. As hypothesized, consistent education and income gradients were seen for biological parameters reflecting cardiovascular, metabolic and inflammatory risk: those with lower education and income exhibiting greater prevalence of high-risk values for each of nine individual biological risk factors. Significant education and income gradients were also seen for summary indices reflecting cumulative burdens of cardiovascular, metabolic and inflammatory risks as well as overall total biological risks. Multivariable cumulative logistic regression models revealed that the education and income effects were each independently and negatively associated with cumulative biological risks, and that these effects remained significant independent of age, gender, ethnicity and lifestyle factors such as smoking and physical activity. There were no significant ethnic differences in the patterns of association between socio-economic status and biological risks, but older age was associated with significantly weaker education and income gradients.

Ecological correlates of multiple sexual partnerships among adolescents and young adults in urban Cape Town: a cumulative risk factor approach.

PubMed

Muchiri, Evans; Odimegwu, Clifford; Banda, Pamela; Ntoimo, Lorreta; Adedini, Sunday

2017-07-01

Studies in South Africa have reported unsafe levels of risky sexual behvaiours among adolescents and young adults, with the country reporting the highest burden of HIV/AIDS globally, as well as a high rate of teenage pregnancy. While determinants of risky sexual behaviours have been investigated for factors occurring at the individual and household levels, not fully explored in the literature is the effect of community level factors. Furthermore, it is unclear whether risk factors occurring within the ecology of adolescents and young adults act cumulatively to influence their sexual practices. This article aims to address this knowledge gap using a case study of the Cape Area Panel Study of adolescents and young adults in urban Cape Town, South Africa. The ecological framework was adopted to guide the selection of risk factors at the individual, household, and community levels. Multivariate linear discriminant function analyses were used to select significant risk factors for multiple sexual partnerships and used to produce risk indices for the respondents. The cumulative risk approach was applied to test whether significant risk factors acted cumulatively. Findings point to the importance of ecological factors in influencing outcomes of multiple sexual partnerships among respondents and further demonstrate that ecological risk factors may act cumulatively. These findings are important for South Africa that is grappling with teenage pregnancy and disproportionate HIV epidemic among the youth.

Community, State, and Federal Approaches to Cumulative Risk Assessment: Challenges and Opportunities for Integration

EPA Science Inventory

Community, state, and federal approaches to conventional and cumulative risk assessment (CRA) were described and compared to assess similarities and differences, and develop recommendations for a consistent CRA approach, acceptable across each level as a rigorous scientific metho...

Failure-to-thrive, maltreatment and the behavior and development of 6-year-old children from low-income, urban families: a cumulative risk model.

PubMed

Kerr, M A; Black, M M; Krishnakumar, A

2000-05-01

A cumulative risk model was used to examine the relationship among failure-to-thrive (FTT), maltreatment, and four aspects of children's development: cognitive performance (standardized testing), adaptive functioning at school, and classroom behavior (teacher report), and behavior at home (maternal report). The sample included 193 6-year-old children and their families, recruited from pediatric clinics serving inner-city, low-income, primarily African-American families, who were part of a longitudinal investigation of child development and maltreatment. Four risk groups were formed based on their growth and maltreatment history: neither FTT nor Maltreatment, FTT Only, Maltreatment Only, and both FTT and Maltreatment. FTT was defined as a deceleration in weight gain (weight-for-age below the 5th percentile) prior to 25 months of age among children born at term with birth weight appropriate for gestational age. Maltreatment was defined as having at least one report to CPS for neglect, physical abuse and/or sexual abuse. Risk status was negatively associated with each of the four developmental outcomes. Children with a history of both FTT and maltreatment had more behavior problems and worse cognitive performance and school functioning than children with neither risk factor. Children with only one risk factor (either FTT or maltreatment) achieved intermediate scores. Findings support a cumulative risk model as being more detrimental to children's development than the presence of a single risk factor alone, consistent with theories linking the accumulation of environmental risks to negative consequences. These results underscore the importance of interventions to prevent both FTT and maltreatment during children's early years.

EPA Peer Consultation Workshop on Cumulative Risk Assessment of Phthalates: Potential Options and Methods for Evaluating the Cumulative Hazard Associated with Six Selected Phthalates

EPA Science Inventory

EPA held a 2-day workshop on December 8 and 9, 2010 at the Doubletree Hotel Washington DC-Crystal City in Arlington, Viriginia. The goal of this workshop was to evaulate methods of determining cumulative risk associated with exposure to mulitple phthalates for inclusion in the EP...

Cumulative incidence and risk factors of prediabetes and type 2 diabetes in a Singaporean Malay cohort.

PubMed

Man, Ryan E K; Charumathi, Sabanayagam; Gan, Alfred Tau Liang; Fenwick, Eva K; Tey, Ching Siong; Chua, Jacqueline; Wong, Tien-Yin; Cheng, Ching-Yu; Lamoureux, Ecosse L

2017-05-01

The aim of this work was to determine the cumulative incidence and independent risk factors of prediabetes and type 2 diabetes (T2DM) in a well-characterized cohort of Malays in Singapore. We included 1137 participants (mean age [SD]: 55 (10) years; 53.6% female) without diabetes (DM) at baseline from the Singapore Malay Eye Study, a population-based longitudinal study with baseline (2004-2006), and follow-up (2010-2013) examinations. Prediabetes was defined as an HbA1c between 5.7% and 6.4%, with no self-reported DM history or insulin/DM medication use. T2DM was defined as a random glucose level ≥200mg/dL or HbA1c>6.4% or use of insulin/DM medication. Age-standardized cumulative incidence was calculated as the crude 6-year cumulative incidence standardized to Singapore's Malay population census. Multivariable modified poisson regression models were utilized to determine the risk factors of incident prediabetes and T2DM. The age-standardized 6-year cumulative incidence was 11.2% (95% CI 9.5, 13.1%) for T2DM, and 20.4% (95% CI 16.4, 25.2%) for prediabetes. Hypertension, higher body mass index (BMI) and higher Hba1c levels were associated with increased risk of T2DM, while older age and higher high density lipoprotein (HDL) cholesterol were protective (all P<0.05). Only higher BMI and HbA1c levels were independently associated with incident prediabetes (all P≤0.001). While only one in ten adult Malays developed T2DM over 6-years, one in five developed prediabetes over the same time period. Our results suggest that evidence-based interventions addressing modifiable risk factors (obesity, prediabetes, hypertension, low HDL cholesterol) are needed to delay or prevent their onset. Copyright © 2017 Elsevier B.V. All rights reserved.

Predicting Family Burden Following Childhood Traumatic Brain Injury: A Cumulative Risk Approach

PubMed Central

Josie, Katherine Leigh; Peterson, Catherine Cant; Burant, Christopher; Drotar, Dennis; Stancin, Terry; Wade, Shari L.; Yeates, Keith; Taylor, H. Gerry

2015-01-01

Objective To examine the utility of a cumulative risk index (CRI) in predicting the family burden of injury (FBI) over time in families of children with traumatic brain injury (TBI). Participants One hundred eight children with severe or moderate TBI and their families participated in the study. Measures The measures used in the study include the Socioeconomic Composite Index, Life Stressors and Social Resources Inventory—Adult Form, Vineland Adaptive Behavior Scales, Child Behavior Checklist, Children’s Depression Inventory, McMaster Family Assessment Device, Brief Symptom Inventory, and Family Burden of Injury Interview. In addition, information on injury-related risk was obtained via medical charts. Methods Participants were assessed immediately, 6, and 12 months postinjury and at a 4-year extended follow-up. Results Risk variables were dichotomized (ie, high- or low-risk) and summed to create a CRI for each child. The CRI predicted the FBI at all assessments, even after accounting for autocorrelations across repeated assessments. Path coefficients between the outcome measures at each time point were significant, as were all path coefficients from the CRI to family burden at each time point. In addition, all fit indices were above the recommended guidelines, and the χ2 statistic indicated a good fit to the data. Conclusions The current study provides initial support for the utility of a CRI (ie, an index of accumulated risk factors) in predicting family outcomes over time for children with TBI. The time period immediately after injury best predicts the future levels of FBI; however, cumulative risk continues to influence the change across successive postinjury assessments. These results suggest that clinical interventions could be proactive or preventive by intervening with identified “at-risk” subgroups immediately following injury. PMID:19033828

Cumulative risk and developmental health: an argument for the importance of a family-wide science.

PubMed

Browne, Dillon T; Plamondon, Andre; Prime, Heather; Puente-Duran, Sofia; Wade, Mark

2015-01-01

A substantial body of research links social disadvantage and developmental health via a cascade running from poverty, to cumulative psychosocial risk, to disrupted family dynamics, to child biological regulatory systems and neurocognitive processing, and finally to morbidity across the lifespan. Most research in this area employs single-dyad or between-family methodology. While informative, there are limitations to this approach. Specifically, it is impossible to determine how risk alters psychosocial environments that are similar for all persons within a household, versus processes that are unique to particular children. This is important in light of literature citing the primacy of child-specific environments in driving developmental health. Methodologically speaking, there are both benefits and challenges to family-wide approaches that differentiate between- and within-family environments. This review describes literature linking cumulative risk and developmental health via family process, while articulating the importance of family-wide approaches. Areas of shortcoming and recommendations for a family-wide science are provided. © 2015 John Wiley & Sons, Ltd.

Effects of cumulative stress and impulsivity on smoking status.

PubMed

Ansell, Emily B; Gu, Peihua; Tuit, Keri; Sinha, Rajita

2012-03-01

The stress-vulnerability model of addiction predicts that environmental factors, such as cumulative stress, will result in individual adaptations that decrease self-control, increase impulsivity, and increase risk for addiction. Impulsivity and cumulative stress are risk factors for tobacco smoking that are rarely examined simultaneously in research. We examined the indirect and direct effects of cumulative adversity in a community sample consisting of 291 men and women who participated in an assessment of cumulative stress, self-reported impulsivity, and smoking history. Data were analyzed using bootstrapping techniques to estimate indirect effects of stress on smoking via impulsivity. Cumulative adversity is associated with smoking status via direct effects and indirect effects through impulsivity scores. Additional models examining specific types of stress indicate contributions of traumatic stress and recent life events as well as chronic relationship stressors. Overall, cumulative stress is associated with increased risk of smoking via increased impulsivity and via pathways independent of impulsivity. These findings support the stress-vulnerability model and highlight the utility of mediation models in assessing how, and for whom, cumulative stress increases risk of current cigarette smoking. Increasing self-control is a target for interventions with individuals who have experienced cumulative adversity. Copyright © 2012 John Wiley & Sons, Ltd.

Effects of cumulative stress and impulsivity on smoking status

PubMed Central

Ansell, Emily B.; Gu, Peihua; Tuit, Keri; Sinha, Rajita

2013-01-01

Objective The stress-vulnerability model of addiction predicts that environmental factors, such as cumulative stress, will result in individual adaptations that decrease self-control, increase impulsivity, and increase risk for addiction. Impulsivity and cumulative stress are risk factors for tobacco smoking that are rarely examined simultaneously in research. Methods We examined the indirect and direct effects of cumulative adversity in a community sample consisting of 291 men and women who participated in an assessment of cumulative stress, self-reported impulsivity, and smoking history. Data were analyzed using bootstrapping techniques to estimate indirect effects of stress on smoking via impulsivity. Results Cumulative adversity is associated with smoking status via direct effects and indirect effects through impulsivity scores. Additional models examining specific types of stress indicate contributions of traumatic stress and recent life events as well as chronic relationship stressors. Conclusions Overall, cumulative stress is associated with increased risk of smoking via increased impulsivity and via pathways independent of impulsivity. These findings support the stress-vulnerability model and highlight the utility of mediation models in assessing how, and for whom, cumulative stress increases risk of current cigarette smoking. Increasing self-control is a target for interventions with individuals who have experienced cumulative adversity. PMID:22389084

HEALTH AND ENVIRONMENTAL SCIENCES INSTITUTE'S EXPOSURE FACTORS DATABASE FOR AGGREGATE AND CUMULATIVE RISK ASSESSMENT

EPA Science Inventory

In recent years, the risk analysis community has broadened its use of complex aggregate and cumulative residential exposure models (e.g., to meet the requirements of the 1996 Food Quality Protection Act). The value of these models is their ability to incorporate a range of input...

Sociodemographic risk, parenting, and inhibitory control in early childhood: the role of respiratory sinus arrhythmia.

PubMed

Holochwost, Steven J; Volpe, Vanessa V; Gueron-Sela, Noa; Propper, Cathi B; Mills-Koonce, W Roger

2018-03-13

Deficits of inhibitory control in early childhood are linked to externalizing behaviors and attention problems. While environmental factors and physiological processes are associated with its etiology, few studies have examined how these factors jointly predict inhibitory control. This study examined whether respiratory sinus arrhythmia (RSA) functioned as a mediator or moderator of both cumulative sociodemographic risk and parenting behaviors on inhibitory control during early childhood. The sample included 206 children and their biological mothers. At 24, 30, and 36 months of child age dyads participated in a series of laboratory visits in which sociodemographic, parenting, and baseline RSA (RSAB) data were collected. Inhibitory control was assessed at 36 months using a gift-wrap delay task. A series of structural equation models yielded no evidence that RSAB mediated the relations of risk or parenting and inhibitory control. RSAB moderated the effects of risk, such that high-risk children with low RSAB performed more poorly on tasks of inhibitory control, while high-risk children with high RSAB did not. These results suggest that higher levels of RSAB may mitigate the influence of environmental risk on the development of inhibitory control early childhood. © 2018 Association for Child and Adolescent Mental Health.

Children neglected: Where cumulative risk theory fails.

PubMed

O'Hara, Mandy; Legano, Lori; Homel, Peter; Walker-Descartes, Ingrid; Rojas, Mary; Laraque, Danielle

2015-07-01

Neglected children, by far the majority of children maltreated, experience an environment most deficient in cognitive stimulation and language exchange. When physical abuse co-occurs with neglect, there is more stimulation through negative parent-child interaction, which may lead to better cognitive outcomes, contrary to Cumulative Risk Theory. The purpose of the current study was to assess whether children only neglected perform worse on cognitive tasks than children neglected and physically abused. Utilizing LONGSCAN archived data, 271 children only neglected and 101 children neglected and physically abused in the first four years of life were compared. The two groups were assessed at age 6 on the WPPSI-R vocabulary and block design subtests, correlates of cognitive intelligence. Regression analyses were performed, controlling for additional predictors of poor cognitive outcome, including socioeconomic variables and caregiver depression. Children only neglected scored significantly worse than children neglected and abused on the WPPSI-R vocabulary subtest (p=0.03). The groups did not differ on the block design subtest (p=0.4). This study shows that for neglected children, additional abuse may not additively accumulate risk when considering intelligence outcomes. Children experiencing only neglect may need to be referred for services that address cognitive development, with emphasis on the linguistic environment, in order to best support the developmental challenges of neglected children. Copyright © 2015 Elsevier Ltd. All rights reserved.

Surgeon Annual and Cumulative Volumes Predict Early Postoperative Outcomes After Brain Tumor Resection.

PubMed

Ramakrishna, Rohan; Hsu, Wei-Chun; Mao, Jialin; Sedrakyan, Art

2018-06-01

Surgeon volume has been previously shown to affect patient outcomes. However, data related to neuro-oncologic surgery are limited and do not include neurologic morbidities as an outcomes measure. In this study, we aimed to determine if 5-year surgeon cumulative and annual volumes predict early postoperative outcomes in patients after brain tumor surgery. A population-based cohort of patients (n = 10,258) undergoing brain tumor resection between 2005 and 2014 were included for study using the New York Statewide Planning and Research Cooperation System. Surgeons were categorized by their cumulative and annual surgical volume. Patients treated by high cumulative/high annual (HC/HA) volume surgeons had shorter length of stay (median, 5 days vs. 8 days vs. 8 days vs. 6 days, respectively; P < 0.01), lower charges (median, 70,025 vs. $77,043 vs. $93,715 vs. $77,018 respectively; P < 0.01) and less nonroutine discharge (41% vs. 48% vs. 50.9% vs. 43.9% respectively; P < 0.01) compared with patients treated by surgeons from the low cumulative/low annual (LC/LA), LC/HA, HC/LA groups. Similarly, HC/HA volume surgeons also had lower rate of hydrocephalus (9.9% vs. 10.4% vs. 13.7% respectively; P = 0.02), medical complications (6.9% vs. 11.2% vs. 11.5% respectively; P < 0.01), neurologic complications (44.1% vs. 46.8% vs. 48.1% respectively; P = 0.03), 30-day reoperation (5.1% vs. 6.9% vs. 7.1% respectively; P < 0.01) and 30-day death (3.3% vs. 5.4% vs. 5.2%; P < 0.01) compared with LC/LA and LC/HA volume surgeons. There is some evidence for improved postoperative outcomes when surgery is performed by HC and HA volume surgeons. This finding suggests that subspecialization in surgical neuro-oncology should be considered. Copyright © 2018 Elsevier Inc. All rights reserved.

Modeling Joint Exposures and Health Outcomes for Cumulative Risk Assessment: The Case of Radon and Smoking

PubMed Central

Chahine, Teresa; Schultz, Bradley D.; Zartarian, Valerie G.; Xue, Jianping; Subramanian, SV; Levy, Jonathan I.

2011-01-01

Community-based cumulative risk assessment requires characterization of exposures to multiple chemical and non-chemical stressors, with consideration of how the non-chemical stressors may influence risks from chemical stressors. Residential radon provides an interesting case example, given its large attributable risk, effect modification due to smoking, and significant variability in radon concentrations and smoking patterns. In spite of this fact, no study to date has estimated geographic and sociodemographic patterns of both radon and smoking in a manner that would allow for inclusion of radon in community-based cumulative risk assessment. In this study, we apply multi-level regression models to explain variability in radon based on housing characteristics and geological variables, and construct a regression model predicting housing characteristics using U.S. Census data. Multi-level regression models of smoking based on predictors common to the housing model allow us to link the exposures. We estimate county-average lifetime lung cancer risks from radon ranging from 0.15 to 1.8 in 100, with high-risk clusters in areas and for subpopulations with high predicted radon and smoking rates. Our findings demonstrate the viability of screening-level assessment to characterize patterns of lung cancer risk from radon, with an approach that can be generalized to multiple chemical and non-chemical stressors. PMID:22016710

The cumulative MeHg and PCBs exposure and risk of tribal ...

EPA Pesticide Factsheets

Studies have shown that the U.S. population continues to be exposed to methyl mercury (MeHg) and polychlorinated biphenyls (PCBs) due to the long half-life of those environmental contaminants. Fish intake of Tribal populations is much higher than the U.S. general population due to dietary habits and unique cultural practices. Large fish tissue concentration data sets from the Environmental Protections Agency’s (EPA’s) Office of Water, USGS’s EMMMA program, and other data sources, were integrated, analyzed, and combined with recent tribal fish intake data for exposure analyses using the dietary module within EPA’s SHEDS-Multimedia model. SHEDS-Multimedia is a physically-based, probabilistic model, which can simulate cumulative (multiple chemicals) or aggregate (single chemical) exposures over time for a population via various pathways of exposure for a variety of multimedia, multipathway environmental chemicals. Our results show that MeHg and total PCBs exposure of tribal populations from fish are about 3 to 10 and 5 to 15 times higher than the US general population, respectively, and that the estimated exposures pose potential health risks. The cumulative exposures of MeHg and total PCBs will be assessed to generate the joint exposure profiles for Tribal and US general populations. Model sensitivity analyses will identify the important contributions of the cumulative exposures of MeHg and total PCBs such as fish types, locations, and size, and key expos

Cumulative Association of Obstructive Sleep Apnea Severity and Short Sleep Duration with the Risk for Hypertension

PubMed Central

Priou, Pascaline; Le Vaillant, Marc; Meslier, Nicole; Paris, Audrey; Pigeanne, Thierry; Nguyen, Xuan-Lan; Alizon, Claire; Bizieux-Thaminy, Acya; Leclair-Visonneau, Laurene; Humeau, Marie-Pierre; Gagnadoux, Frédéric

2014-01-01

Obstructive sleep apnea (OSA) and short sleep duration are individually associated with an increased risk for hypertension (HTN). The aim of this multicenter cross-sectional study was to test the hypothesis of a cumulative association of OSA severity and short sleep duration with the risk for prevalent HTN. Among 1,499 patients undergoing polysomnography for suspected OSA, 410 (27.3%) previously diagnosed as hypertensive and taking antihypertensive medication were considered as having HTN. Patients with total sleep time (TST) <6 h were considered to be short sleepers. Logistic regression procedures were performed to determine the independent association of HTN with OSA and sleep duration. Considering normal sleepers (TST ≥6 h) without OSA as the reference group, the odds ratio (OR) (95% confidence intervals) for having HTN was 2.51 (1.35–4.68) in normal sleepers with OSA and 4.37 (2.18–8.78) in short sleepers with OSA after adjustment for age, gender, obesity, diabetes, depression, current smoking, use of thyroid hormones, daytime sleepiness, poor sleep complaint, time in bed, sleep architecture and fragmentation, and study site. The risk for HTN appeared to present a cumulative association with OSA severity and short sleep duration (p<0.0001 for linear trend). The higher risk for HTN was observed in short sleepers with severe OSA (AHI ≥30) (OR, 4.29 [2.03–9.07]). In patients investigated for suspected OSA, sleep-disordered breathing severity and short sleep duration have a cumulative association with the risk for prevalent HTN. Further studies are required to determine whether interventions to optimize sleep may contribute to lower BP in patients with OSA. PMID:25531468

[Acute risk assessment of cumulative dietary exposure to organophosphorus pesticide among people in Jiangsu province].

PubMed

Zhao, Minxian; Wang, Cannan; Li, Tingting; Yi, Nannan; He, Xiansong; Wu, Hui; Yao, Xinya

2013-09-01

To understand the cumulative dietary exposure of Jiangsu residents to organophosphorus (OPs) pesticide and make acute risk assessment. Integrated the data of the nutrition and health status of residents in Jiangsu and the data of monitoring of OPs pesticide in agricultural products. Chlorpyrifos was selected as index compound (index chemical, IC), then use relative potency factor (RPF) approach which commended by EPA and simple distribution evaluation. Caloulated the dietary cumulative exposure of OPs pesticide among Jiangsu residents and compared with acute reference dose (ARfD), then made risk assessment. The exposure of rural group of age 3-6 and 7-11 were 133.84 microg/kg BW and 154.32 microg/kg BW, exceeded ARfD. The exposure level of kids and elder was higher than adults. The exposure level of rural residents were higher than urban residents. The highest contribution to the food of each age group was greengrocery and leek. The average level of exposure was safety in Jiangsu, high exposure children were at acute poisoning risk. High contribution food such as greengrocery and leek should be strengthen monitoring.

Cumulants, free cumulants and half-shuffles

PubMed Central

Ebrahimi-Fard, Kurusch; Patras, Frédéric

2015-01-01

Free cumulants were introduced as the proper analogue of classical cumulants in the theory of free probability. There is a mix of similarities and differences, when one considers the two families of cumulants. Whereas the combinatorics of classical cumulants is well expressed in terms of set partitions, that of free cumulants is described and often introduced in terms of non-crossing set partitions. The formal series approach to classical and free cumulants also largely differs. The purpose of this study is to put forward a different approach to these phenomena. Namely, we show that cumulants, whether classical or free, can be understood in terms of the algebra and combinatorics underlying commutative as well as non-commutative (half-)shuffles and (half-) unshuffles. As a corollary, cumulants and free cumulants can be characterized through linear fixed point equations. We study the exponential solutions of these linear fixed point equations, which display well the commutative, respectively non-commutative, character of classical and free cumulants. PMID:27547078

Estimating the burden of recurrent events in the presence of competing risks: the method of mean cumulative count.

PubMed

Dong, Huiru; Robison, Leslie L; Leisenring, Wendy M; Martin, Leah J; Armstrong, Gregory T; Yasui, Yutaka

2015-04-01

Cumulative incidence has been widely used to estimate the cumulative probability of developing an event of interest by a given time, in the presence of competing risks. When it is of interest to measure the total burden of recurrent events in a population, however, the cumulative incidence method is not appropriate because it considers only the first occurrence of the event of interest for each individual in the analysis: Subsequent occurrences are not included. Here, we discuss a straightforward and intuitive method termed "mean cumulative count," which reflects a summarization of all events that occur in the population by a given time, not just the first event for each subject. We explore the mathematical relationship between mean cumulative count and cumulative incidence. Detailed calculation of mean cumulative count is described by using a simple hypothetical example, and the computation code with an illustrative example is provided. Using follow-up data from January 1975 to August 2009 collected in the Childhood Cancer Survivor Study, we show applications of mean cumulative count and cumulative incidence for the outcome of subsequent neoplasms to demonstrate different but complementary information obtained from the 2 approaches and the specific utility of the former. © The Author 2015. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Cumulative contextual risk at birth in relation to adolescent substance use, conduct problems, and risky sex: General and specific predictive associations in a Finnish birth cohort.

PubMed

Mason, W Alex; January, Stacy-Ann A; Chmelka, Mary B; Parra, Gilbert R; Savolainen, Jukka; Miettunen, Jouko; Järvelin, Marjo-Riitta; Taanila, Anja; Moilanen, Irma

2016-07-01

Research indicates that risk factors cluster in the most vulnerable youth, increasing their susceptibility for adverse developmental outcomes. However, most studies of cumulative risk are cross-sectional or short-term longitudinal, and have been based on data from the United States or the United Kingdom. Using data from the Northern Finland Birth Cohort 1986 Study (NFBC1986), we examined cumulative contextual risk (CCR) at birth as a predictor of adolescent substance use and co-occurring conduct problems and risky sex to determine the degree to which CCR predicts specific outcomes over-and-above its effect on general problem behavior, while testing for moderation of associations by gender. Analyses of survey data from 6963 participants of the NFBC1986 followed from the prenatal/birth period into adolescence were conducted using structural equation modeling. CCR had long-term positive associations with first-order substance use, conduct problems, and risky sex factors, and, in a separate analysis, with a second-order general problem behavior factor. Further analyses showed that there was a positive specific effect of CCR on risky sex, over-and-above general problem behavior, for girls only. This study, conducted within the Finnish context, showed that CCR at birth had long-term general and specific predictive associations with substance use and co-occurring problem behaviors in adolescence; effects on risky sex were stronger for girls. Results are consistent with the hypothesis that early exposure to CCR can have lasting adverse consequences, suggesting the need for early identification and intervention efforts for vulnerable children. Copyright © 2016 Elsevier Ltd. All rights reserved.

Assessing Stress-Related Treatment Needs among Girls at Risk for Poor Functional Outcomes: The Impact of Cumulative Adversity, Criterion Traumas, and Non-Criterion Events

PubMed Central

Lansing, Amy E.; Plante, Wendy Y.; Beck, Audrey N.

2016-01-01

Despite growing recognition that cumulative adversity (total stressor exposure), including complex trauma, increases the risk for psychopathology and impacts development, assessment strategies lag behind: Trauma-related mental health needs (symptoms, functional impairment, maladaptive coping) are typically assessed in response to only one qualifying Criterion-A event. This is especially problematic for youth at-risk for health and academic disparities who experience cumulative adversity, including non-qualifying events (parental separations) which may produce more impairing symptomatology. Data from 118 delinquent girls demonstrate: 1) an average of 14 adverse Criterion-A and non-Criterion event exposures; 2) serious maladaptive coping strategies (self-injury) directly in response to cumulative adversity; 3) more cumulative adversity-related than worst-event related symptomatology and functional impairment; and 4) comparable symptomatology, but greater functional impairment, in response to non-Criterion events. These data support the evaluation of mental health needs in response to cumulative adversity for optimal identification and tailoring of services in high-risk populations to reduce disparities. PMID:27745922

Cumulative psychological stress and cardiovascular disease risk in middle aged and older women: Rationale, design, and baseline characteristics.

PubMed

Albert, Michelle A; Durazo, Eva M; Slopen, Natalie; Zaslavsky, Alan M; Buring, Julie E; Silva, Ted; Chasman, Daniel; Williams, David R

2017-10-01

Although a growing body of evidence indicates strong links between psychological stress (stress) and untoward cardiovascular disease (CVD) outcomes, comprehensive examination of these effects remains lacking. The "Cumulative Psychological Stress and Cardiovascular Disease Risk in Middle Aged and Older Women" study is embedded within the landmark Women's Health Study (WHS) follow-up cohort and seeks to evaluate the individual and joint effects of stressors (cumulative stress) on incident CVD risk, including myocardial infarction, stroke, coronary revascularization and CVD death. GWAS data will be used for exploratory analyses to identify any genes associated with stress and CVD. This study prospectively follows 25,335 women (mean age 72.2 ± 6.04 years) without CVD who returned a short mailed stress questionnaire at baseline and 3 years of follow-up inquiring about their experiences with stress including perceived stress, work stress, work-family spillover, financial stress, traumatic and major life events, discrimination and neighborhood environment/stressors. Other domains ascertained were sleep, anger, cynical hostility, depression, anxiety, social support, intimate partner relations, and volunteer and social activities. Higher levels of cumulative stress were associated with younger age and black race/ethnicity, divorced or separated marital status, increased prevalence of obesity, smoking, diabetes, depression and anxiety (p<0.001 for each). Findings from this study will provide clinically important, new information about associations of cumulative stress, environmental, lifestyle and genetic factors with incident CVD risk in aging women. Copyright © 2017 Elsevier Inc. All rights reserved.

Cumulative hip contact stress predicts osteoarthritis in DDH.

PubMed

Mavcic, Blaz; Iglic, Ales; Kralj-Iglic, Veronika; Brand, Richard A; Vengust, Rok

2008-04-01

Hip stresses are generally believed to influence whether a hip develops osteoarthritis (OA); similarly, various osteotomies have been proposed to reduce contact stresses and the risk of OA. We asked whether elevated hip contact stress predicted osteoarthritis in initially asymptomatic human hips. We identified 58 nonoperatively treated nonsubluxated hips with developmental dysplasia (DDH) without symptoms at skeletal maturity; the control group included 48 adult hips without hip disease. The minimum followup was 20 years (mean, 29 years; range, 20-41 years). Peak contact stress was computed with the HIPSTRESS method using anteroposterior pelvic radiographs at skeletal maturity. The cumulative contact stress was determined by multiplying the peak contact stress by age at followup. We compared WOMAC scores and radiographic indices of OA. Dysplastic hips had higher mean peak contact and higher mean cumulative contact stress than normal hips. Mean WOMAC scores and percentage of asymptomatic hips in the study group (mean age 51 years) were similar to those in the control group (mean age 68 years). After adjusting for gender and age, the cumulative contact stress, Wiberg center-edge angle, body mass index, but not the peak contact stress, independently predicted the final WOMAC score in dysplastic hips but not in normal hips. Cumulative contact stress predicted early hip OA better than the Wiberg center-edge angle. Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Predicting Academic Achievement from Cumulative Home Risk: The Mediating Roles of Effortful Control, Academic Relationships, and School Avoidance

ERIC Educational Resources Information Center

Swanson, Jodi; Valiente, Carlos; Lemery-Chalfant, Kathryn

2012-01-01

Components of the home environment are associated with children's academic functioning. The accumulation of risks in the home are expected to prove more detrimental to achievement than any one risk alone, but the processes accounting for this relation are unclear. Using an index of cumulative home risk (CHR) inclusive of protective factors, as…

Cumulative occupational mechanical exposures during working life and risk of sickness absence and disability pension: prospective cohort study.

PubMed

Sundstrup, Emil; Hansen, Åse Marie; Mortensen, Erik Lykke; Poulsen, Otto Melchior; Clausen, Thomas; Rugulies, Reiner; Møller, Anne; Andersen, Lars L

2017-09-01

Objectives The aim of this study was to determine the prospective association of cumulative mechanical exposure during working life with health-related labor market outcomes. Methods This prospective cohort study combines data from 5076 older workers (age 49-63 years) from the Copenhagen Aging and Midlife Biobank with a job exposure matrix and a national register containing information on social transfer payment. By coding individual job histories from the Danish version of ISCO-codes (International Standard Classification of Occupations), we calculated cumulative occupational mechanical exposures from a JEM for ton-years (lifting 1000 kg each day in one year), lifting-years (lifting loads weighing ≥20 kg >10 times each day in one year), kneeling-years (kneeling for one hour each day in one year) and vibration-years (whole-body vibration for one hour each day in one year). Cox-regression analyses estimated the relative risk of register-based long-term sickness absence (LTSA) and disability pension with cumulative occupational mechanical exposures throughout working life. Analyses were censored for competing events and adjusted for multiple confounders. Results During the follow-up period, 970 persons (19.3%) had ≥1 episode of LTSA and 85 persons (1.7%) were granted a disability pension. Number of ton-, lifting- and kneeling-years showed an exposure-response association with increased risk of LTSA (P<0.0001). In addition, both long term [≥20 years; hazard ratio (HR) 1.76 95% CI 1.39-2.22] and short term (<10 years; HR 1.20 95% CI 1.02-1.41) exposure to kneeling work increased the risk of LTSA. Lifting-years, but not the other mechanical exposures, were associated with risk of disability pension (HR 1.75 95% CI 1.01-3.04). Conclusions Cumulative occupational mechanical exposures during working life - such as lifting and kneeling work - increased the risk of LTSA. Importantly, being exposed to lifting increased the risk of disability pension.

Cumulative incidence of cancer after solid organ transplantation.

PubMed

Hall, Erin C; Pfeiffer, Ruth M; Segev, Dorry L; Engels, Eric A

2013-06-15

Solid organ transplantation recipients have elevated cancer incidence. Estimates of absolute cancer risk after transplantation can inform prevention and screening. The Transplant Cancer Match Study links the US transplantation registry with 14 state/regional cancer registries. The authors used nonparametric competing risk methods to estimate the cumulative incidence of cancer after transplantation for 2 periods (1987-1999 and 2000-2008). For recipients from 2000 to 2008, the 5-year cumulative incidence, stratified by organ, sex, and age at transplantation, was estimated for 6 preventable or screen-detectable cancers. For comparison, the 5-year cumulative incidence was calculated for the same cancers in the general population at representative ages using Surveillance, Epidemiology, and End Results data. Among 164,156 recipients, 8520 incident cancers were identified. The absolute cancer risk was slightly higher for recipients during the period from 2000 to 2008 than during the period from 1987 to 1999 (5-year cumulative incidence: 4.4% vs. 4.2%; P = .006); this difference arose from the decreasing risk of competing events (5-year cumulative incidence of death, graft failure, or retransplantation: 26.6% vs. 31.9%; P < .001). From 2000 to 2008, the 5-year cumulative incidence of non-Hodgkin lymphoma was highest at extremes of age, especially in thoracic organ recipients (ages 0-34 years: range, 1.74%-3.28%; aged >50 years; range, 0.36%-2.22%). For recipients aged >50 years, the 5-year cumulative incidence was higher for colorectal cancer (range, 0.33%-1.94%) than for the general population at the recommended screening age (aged 50 years: range, 0.25%-0.33%). For recipients aged >50 years, the 5-year cumulative incidence was high for lung cancer among thoracic organ recipients (range, 1.16%-3.87%) and for kidney cancer among kidney recipients (range, 0.53%-0.84%). The 5-year cumulative incidence for prostate cancer and breast cancer was similar or lower in

A Missing Link in the Evolution of the Cumulative Recorder

ERIC Educational Resources Information Center

Asano, Toshio; Lattal, Kennon A.

2012-01-01

A recently recovered cumulative recorder provides a missing link in the evolution of the cumulative recorder from a modified kymograph to a reliably operating, scientifically and commercially successful instrument. The recorder, the only physical evidence of such an early precommercial cumulative recorder yet found, was sent to Keio University in…

Repeated exposure to high-frequency spanking and child externalizing behavior across the first decade: a moderating role for cumulative risk.

PubMed

MacKenzie, Michael J; Nicklas, Eric; Brooks-Gunn, Jeanne; Waldfogel, Jane

2014-12-01

This study used the Fragile Families and Child Well-Being Study to examine the effects of repeated exposure to harsh parenting on child externalizing behavior across the first decade of life, and a moderating role for cumulative ecological risk. Maternal report of harsh parenting, defined as high frequency spanking, was assessed at age 1, 3, 5, and 9, along with child externalizing at age 9 (N=2,768). Controlling for gender, race, maternal nativity, and city of residence, we found a cumulative risk index to significantly moderate the effects of repeated harsh parenting on child behavior, with the effects of repeated high-frequency spanking being amplified for those experiencing greater levels of cumulative risk. Harsh parenting, in the form of high frequency spanking, remains a too common experience for children, and results demonstrate that the effects of repeated exposure to harsh parenting across the first decade are amplified for those children already facing the most burden. Copyright © 2014. Published by Elsevier Ltd.

Repeated exposure to high-frequency spanking and child externalizing behavior across the first decade: A moderating role for cumulative risk

PubMed Central

MacKenzie, Michael J.; Nicklas, Eric; Brooks-Gunn, Jeanne; Waldfogel, Jane

2016-01-01

This study used the Fragile Families and Child Well-being study to examine the effects of repeated exposure to harsh parenting on child externalizing behavior across the first decade of life, and a moderating role for cumulative ecological risk. Maternal report of harsh parenting, defined as high frequency spanking, was assessed at age 1, 3, 5, and 9, along with child externalizing at age 9 (N=2768). Controlling for gender, race, maternal nativity, and city of residence, we found a cumulative risk index to significantly moderate the effects of repeated harsh parenting on child behavior, with the effects of repeated high-frequency spanking being amplified for those experiencing greater levels of cumulative risk. Harsh parenting, in the form of high frequency spanking, remains a too common experience for children, and results demonstrate that the effects of repeated exposure to harsh parenting across the first decade are amplified for those children already facing the most burden. PMID:25465318

Social Determinants of Health in Environmental Justice Communities: Examining Cumulative Risk in Terms of Environmental Exposures and Social Determinants of Health

PubMed Central

Prochaska, John D.; Nolen, Alexandra B.; Kelley, Hilton; Sexton, Ken; Linder, Stephen H.; Sullivan, John

2014-01-01

Residents of environmental justice (EJ) communities may bear a disproportionate burden of environmental health risk, and often face additional burdens from social determinants of health. Accounting for cumulative risk should include measures of risk from both environmental sources and social determinants. This study sought to better understand cumulative health risk from both social and environmental sources in a disadvantaged community in Texas. Key outcomes were determining what data are currently available for this assessment, clarifying data needs, identifying data gaps, and considering how those gaps could be filled. Analyses suggested that the traditionally defined EJ community in Port Arthur may have a lower environmental risk from air toxics than the rest of the City of Port Arthur (although the entire city has a higher risk than the average for the state), but may have a larger burden from social determinants of health. However, the results should be interpreted in light of the availability of data, the definitions of community boundaries, and the areal unit utilized. Continued focus on environmental justice communities and the cumulative risks faced by their residents is critical to protecting these residents and, ultimately, moving towards a more equitable distribution and acceptable level of risk throughout society. PMID:24771993

Social Determinants of Health in Environmental Justice Communities: Examining Cumulative Risk in Terms of Environmental Exposures and Social Determinants of Health.

PubMed

Prochaska, John D; Nolen, Alexandra B; Kelley, Hilton; Sexton, Ken; Linder, Stephen H; Sullivan, John

2014-01-01

Residents of environmental justice (EJ) communities may bear a disproportionate burden of environmental health risk, and often face additional burdens from social determinants of health. Accounting for cumulative risk should include measures of risk from both environmental sources and social determinants. This study sought to better understand cumulative health risk from both social and environmental sources in a disadvantaged community in Texas. Key outcomes were determining what data are currently available for this assessment, clarifying data needs, identifying data gaps, and considering how those gaps could be filled. Analyses suggested that the traditionally defined EJ community in Port Arthur may have a lower environmental risk from air toxics than the rest of the City of Port Arthur (although the entire city has a higher risk than the average for the state), but may have a larger burden from social determinants of health. However, the results should be interpreted in light of the availability of data, the definitions of community boundaries, and the areal unit utilized. Continued focus on environmental justice communities and the cumulative risks faced by their residents is critical to protecting these residents and, ultimately, moving towards a more equitable distribution and acceptable level of risk throughout society.

Relations of Growth in Effortful Control to Family Income, Cumulative Risk, and Adjustment in Preschool-age Children

PubMed Central

Lengua, Liliana J.; Moran, Lyndsey; Zalewski, Maureen; Ruberry, Erika; Kiff, Cara; Thompson, Stephanie

2014-01-01

The study examined growth in effortful control (executive control, delay ability) in relation to income, cumulative risk (aggregate of demographic and psychosocial risk factors), and adjustment in 306 preschool-age children (50% girls, 50% boys) from families representing a range of income (29% at- or near-poverty; 28% lower-income; 25% middle-income; 18% upper-income), with 4 assessments starting at 36–40 mos. Income was directly related to levels of executive control and delay ability. Cumulative risk accounted for the effects of income on delay ability but not executive control. Higher initial executive control and slope of executive control and delay ability predicted academic readiness, whereas levels, but not growth, of executive control and delay ability predicted social competence and adjustment problems. Low income is a marker for lower effortful control, which demonstrates additive or mediating effects in the relation of income to children’s preschool adjustment. PMID:25253079

Cumulative Risk of Type 2 Diabetes in a Working Population: The Japan Epidemiology Collaboration on Occupational Health Study.

PubMed

Hu, Huanhuan; Nakagawa, Tohru; Okazaki, Hiroko; Nishiura, Chihiro; Imai, Teppei; Miyamoto, Toshiaki; Sasaki, Naoko; Yamamoto, Makoto; Murakami, Taizo; Kochi, Takeshi; Eguchi, Masafumi; Tomita, Kentaro; Nagahama, Satsue; Kuwahara, Keisuke; Kabe, Isamu; Mizoue, Tetsuya; Dohi, Seitaro

2018-05-04

We estimated the cumulative risk of type 2 diabetes from age 30 to 65 years in a large working population in Japan. We used data from the Japan Epidemiology Collaboration on Occupational Health Study. Participants (46,065 men and 7,763 women) were aged 30-59 years, free of diabetes at baseline, and followed up for a maximum of 7 years. Incident type 2 diabetes was defined based on fasting and casual glucose, glycated hemoglobin, and current medical treatment for type 2 diabetes. We calculated the sex-specific cumulative risk of type 2 diabetes using the Practical Incidence Estimator macro, which was created to produce several estimates of disease incidence for prospective cohort studies based on a modified Kaplan-Meier method. During 274,349 person-years of follow-up, 3,587 individuals (3,339 men and 248 women) developed type 2 diabetes. The cumulative risk was 34.7% (95% confidence interval, 33.1-36.3%) for men and 18.6% (95% confidence interval, 15.5-21.7%) for women. In BMI-stratified analysis, obese (BMI ≥30 kg/m 2 ) and overweight (BMI 25-29.9 kg/m 2 ) men and women had a much higher cumulative risk of type 2 diabetes (obese: 77.3% for men and 64.8% for women; overweight: 49.1% and 35.7%, respectively) than those with BMI <25 kg/m 2 (26.2% and 13.4% for men and women, respectively). The present data highlight the public health burden of type 2 diabetes in the working population. There is a need for effective programs for weight management and type 2 diabetes screening, especially for young obese employees, to prevent or delay the development of type 2 diabetes.

Association of Cumulative Childhood Adversity and Adolescent Violent Offending With Suicide in Early Adulthood.

PubMed

Björkenstam, Emma; Hjern, Anders; Björkenstam, Charlotte; Kosidou, Kyriaki

2018-02-01

Childhood adversity (CA) is associated with an increased risk of suicide in young adulthood that might be explained by maladaptive trajectories during adolescence. Although adolescent violent offending is linked with suicide, little is known about its role in the association between CA and suicide. To examine whether adolescent violent offending mediates the association between CA and suicide in early adulthood. This population-based, longitudinal cohort study with a follow-up time spanning 5 to 9 years included 476 103 individuals born in Sweden between 1984 and 1988. The study population was prospectively followed up from 20 years of age until December 31, 2013, with respect to suicide. Data analysis was performed from January 1, 1984, to December 31, 2013. Register-based CAs included parental death, parental substance abuse and psychiatric disorder, parental criminal offending, parental separation, public assistance recipiency, child welfare intervention, and residential instability. Adolescent violent offending was defined as being convicted of a violent crime between the ages of 15 and 19 years. Estimates of risk of suicide after 20 years of age (from 2004 if born in 1984 and from 2008 if born in 1988) until the end of 2013 were calculated as incidence rate ratios (IRRs) with 95% CIs using Poisson regression analysis. Adjustments were made for demographics and psychiatric disorder. In addition, binary mediation analysis with logistic regression was used. A total of 476 103 individuals (231 699 [48.7%] female) were included in the study. Those with a conviction for violent offending had been exposed to all CAs to a greater extent than those with no violent offending. Cumulative CA was associated with risk of suicide in nonconvicted (adjusted IRR, 2.4; 95% CI, 1.5-3.9) and convicted youths, who had a higher risk of suicide (adjusted IRR, 8.5; 95% CI, 4.6-15.7). Adolescent violent offending partly mediated the association between CA and suicide. Individuals

Integrating human health and ecological data into cumulative risk assessment through the Aggregate Exposure Pathway and Adverse Outcome Pathway frameworks

EPA Science Inventory

Cumulative risk assessment (CRA) methods promote the use of a conceptual site model (CSM) to apportion exposures and integrate risk from relevant stressors across different species. Integration is important to provide a more complete assessment of risk, but evaluating endpoints a...

Temporal Variability of Cumulative Risk Assessment on Phthalates in Chinese Pregnant Women: Repeated Measurement Analysis.

PubMed

Gao, Hui; Zhu, Bei-Bei; Tao, Xing-Yong; Zhu, Yuan-Duo; Tao, Xu-Guang; Tao, Fang-Biao

2018-06-05

The assessment of the combined effects of multiple phthalate exposures at low levels is a newly developed concept to avoid underestimating their actual cumulative health risk. A previous study included 3455 Chinese pregnant women. Each woman provided up to three urine samples (in total 9529). This previous study characterized the concentrations of phthalate metabolites. In the present study, the data from 9529 samples was reanalyzed to examine the cumulative risk assessment (CRA) with two models: (1) the creatinine-based and (2) the volume-based. Hazard index (HI) values for three phthalates, dibutyl phthalate, butyl benzyl phthalate, and di(2-ethylhexyl) phthalate, in the first, second, and third trimesters of pregnancy, were calculated, respectively. In creatinine-based model, 3.43%, 14.63%, and 17.28% of women showed HI based on the European Food Safety Authority tolerable daily intake exceeding 1 in the first, second, and third trimester of pregnancy, respectively. The intraclass correlation coefficient of HI was 0.49 (95% confidence interval: 0.46-0.53). Spearman correlations between HI of the creatinine model and ∑androgen disruptor (a developed potency weighted approach) ranged from 0.824 to 0.984. In summary, this study suggested a considerable risk of cumulative exposure to phthalates during the whole gestation in Chinese pregnant women. In addition, moderate temporal reproducibility indicated that single HI, estimated by the phthalate concentration in single spot of urine, seemed representative to describe the throughout pregnancy CRA. Finally, strong correlation between HI of the creatinine model and ∑androgen disruptor revealed that the creatinine-based model was more appropriate to evaluate the CRA.

Assessing stress-related treatment needs among girls at risk for poor functional outcomes: The impact of cumulative adversity, criterion traumas, and non-criterion events.

PubMed

Lansing, Amy E; Plante, Wendy Y; Beck, Audrey N

2017-05-01

Despite growing recognition that cumulative adversity (total stressor exposure, including complex trauma), increases the risk for psychopathology and impacts development, assessment strategies lag behind: Adversity-related mental health needs (symptoms, functional impairment, maladaptive coping) are typically assessed in response to only one qualifying Criterion-A traumatic event. This is especially problematic for youth at-risk for health and academic disparities who experience cumulative adversity, including non-qualifying events (separation from caregivers) which may produce more impairing symptomatology. Data from 118 delinquent girls demonstrate: (1) an average of 14 adverse Criterion-A and non-Criterion event exposures; (2) serious maladaptive coping strategies (self-injury) directly in response to cumulative adversity; (3) more cumulative adversity-related than worst-event related symptomatology and functional impairment; and (4) comparable symptomatology, but greater functional impairment, in response to non-Criterion events. These data support the evaluation of mental health needs in response to cumulative adversity for optimal identification and tailoring of services in high-risk populations to reduce disparities. Copyright © 2016 Elsevier Ltd. All rights reserved.

Observed Sensitivity during Family Interactions and Cumulative Risk: A Study of Multiple Dyads per Family

ERIC Educational Resources Information Center

Browne, Dillon T.; Leckie, George; Prime, Heather; Perlman, Michal; Jenkins, Jennifer M.

2016-01-01

The present study sought to investigate the family, individual, and dyad-specific contributions to observed cognitive sensitivity during family interactions. Moreover, the influence of cumulative risk on sensitivity at the aforementioned levels of the family was examined. Mothers and 2 children per family were observed interacting in a round robin…

The effects of cumulative risks and promotive factors on urban adolescent alcohol and other drug use: a longitudinal study of resiliency.

PubMed

Ostaszewski, Krzysztof; Zimmerman, Marc A

2006-12-01

Resiliency theory provides a conceptual framework for studying why some youth exposed to risk factors do not develop the negative behaviors they predict. The purpose of this study was to test compensatory and protective models of resiliency in a longitudinal sample of urban adolescents (80% African American). The data were from Years 1 (9th grade) and 4 (12th grade). The study examined effects of cumulative risk and promotive factors on adolescent polydrug use including alcohol, tobacco and marijuana. Cumulative measures of risk/promotive factors represented individual characteristics, peer influence, and parental/familial influences. After controlling for demographics, results of multiple regression of polydrug use support the compensatory model of resiliency both cross-sectionally and longitudinally. Promotive factors were also found to have compensatory effects on change in adolescent polydrug use. The protective model of resiliency evidenced cross-sectionally was not supported in longitudinal analysis. The findings support resiliency theory and the use of cumulative risk/promotive measures in resiliency research. Implications focused on utilizing multiple assets and resources in prevention programming are discussed.

Cumulative Incidence of Cancer among HIV-infected Individuals in North America

PubMed Central

Silverberg, Michael J.; Lau, Bryan; Achenbach, Chad J.; Jing, Yuezhou; Althoff, Keri N.; D’Souza, Gypsyamber; Engels, Eric A.; Hessol, Nancy; Brooks, John T.; Burchell, Ann N.; Gill, M. John; Goedert, James J.; Hogg, Robert; Horberg, Michael A.; Kirk, Gregory D.; Kitahata, Mari M.; Korthuis, Phillip T.; Mathews, William C.; Mayor, Angel; Modur, Sharada P.; Napravnik, Sonia; Novak, Richard M.; Patel, Pragna; Rachlis, Anita R.; Sterling, Timothy R.; Willig, James H.; Justice, Amy C.; Moore, Richard D.; Dubrow, Robert

2016-01-01

Background Cancer is increasingly common among HIV patients given improved survival. Objective To examine calendar trends in cumulative cancer incidence and hazard rate by HIV status. Design Cohort study Setting North American AIDS Cohort Collaboration on Research and Design during 1996–2009 Patients 86,620 HIV-infected and 196,987 uninfected adults Measurements We estimated cancer-type-specific cumulative incidence by age 75 years by HIV status and calendar era, and examined calendar trends in cumulative incidence and hazard rates. Results Cumulative incidences (%) of cancer by age 75 (HIV+/HIV−) were: Kaposi sarcoma (KS), 4.4/0.01; non-Hodgkin’s lymphoma (NHL), 4.5/0.7; lung, 3.4/2.8; anal, 1.5/0.1; colorectal, 1.0/1.5; liver, 1.1/0.4; Hodgkin lymphoma (HL), 0.9/0.1; melanoma, 0.5/0.6; and oral cavity/pharyngeal, 0.8/0.8. Among HIV-infected subjects, we observed decreasing calendar trends in cumulative incidence and hazard rate for KS and NHL. For anal, colorectal and liver cancers, increasing cumulative incidence, but not hazard rate trends, were due to the decreasing mortality rate trend (−9% per year), allowing greater opportunity to be diagnosed with these cancer types. Despite decreasing hazard rate trends for lung, HL, and melanoma, we did not observe cumulative incidence trends due to the compensating effect of the declining mortality rate on cumulative incidence. Limitations Secular trends in screening, smoking, and viral co-infections were not evaluated. Conclusions Our analytic approach helped disentangle the effects of improved survival and changing cancer-specific hazard rates on cumulative incidence trends among HIV patients. Cumulative cancer incidence by age 75, approximating lifetime risk in HIV patients, may have clinical utility in this population. The high cumulative incidences by age 75 for KS, NHL, and lung cancer supports early and sustained ART and smoking cessation. Primary Funding Source National Institutes of Health PMID:26436616

Is Serotonin Transporter Genotype Associated with Epigenetic Susceptibility or Vulnerability? Examination of the Impact of SES Risk on African American Youth

PubMed Central

Beach, S. R. H.; Brody, G. H.; Lei, M.K.; Kim, S.; Cui, J.

2014-01-01

We hypothesized that presence of the s allele in the promoter region of the serotonin transporter (5-HTTLR) would moderate the effect of early cumulative SES risk on epigenetic change among African American youth. Contrasting hypotheses regarding the shape of the interaction effect were generated using vulnerability and susceptibility frameworks and applied to data from a sample of 388 African American youth. Early, cumulative SES risk assessed at 11–13 years based on parent report interacted with presence of the s allele to predict differential methylation assessed at age 19. Across multiple tests, a differential susceptibility perspective rather than a diathesis stress framework best fit the data for genes associated with depression, consistently demonstrating greater epigenetic response to early cumulative SES risk among s allele carriers. A pattern consistent with greater impact among s allele carriers also was observed using all CpG sites across the genome that were differentially affected by early cumulative SES risk. We conclude that the s allele is associated with increased responsiveness to early cumulative SES risk among African American youth, leading to epigenetic divergence for depression-related genes in response to exposure to heightened SES risk among s allele carriers in a “for better” or “for worse” pattern. PMID:24438855

DOSE-RESPONSE MODELING FOR THE ASSESSMENT OF CUMULATIVE RISK DUE TO EXPOSURE TO N-METHYL CARBAMATE PESTICIDES

EPA Science Inventory

The US EPAs N-Methyl Carbamate Cumulative Risk Assessment (NMCRA) assesses the effect on acetylcholine esterase (AChE) activity of exposure to 10 N-methyl carbamate (NMC) pesticides through dietary, drinking water, and residential exposures.

THE SIGNIFICANCE OF CUMULATIVE WATER BALANCE IN THE DEVELOPMENT OF EARLY COMPLICATIONS AFTER MAJOR ABDOMINAL SURGERY.

PubMed

Musaeva, T S; Karipidi, M K; Zabolotskikh, I B

2016-11-01

a comprehensive assessment of the water balance on the basis of daily, cumulative balance and 10% of the body weight gain and their role in the development of early complications after major abdominal surgery. A retrospective study of the perioperative period in 150 patients who underwent major abdomi- nal surgery was performed. The physical condition of the patients corresponded to ASA 3 class. The average age was 46 (38-62) years. The following stages ofresearch: an analysis of daily balance and cumulative balance in complicated and uncomplicated group and their role in the development of complications; the timing of development ofcomplications and possible relationship with fluid overload and the development of complications; changes in the level of albumin within 10 days of the postoperative period. The analysis of complications didn't show significant differences between complicated and uncomplicated groups according to the water balance during the surgery and by the end of the first day. When constructing the area under the ROC curve (A UROC) low resolution ofthe balance in intraoperative period and the first day and the balance on the second day to predict complications was shown. Significant diferences according to the cumulative balance was observed from the third day of the postoperative period Also with the third day of the postoperative period there is a good resolution for prediction ofpostoperative complications according to the cumulative balance with the cut-offpoint > of 50,7 ml/kg. the excessive infusion therapy is a predictor of adverse outcome in patients after major abdominal surgery. Therefore, after 3 days of postoperative period it is important to maintain mechanisms for the excretion of excess fluid or limitations of infusion therapy.

Cumulative Risk and Physiological Stress Responses in African American Adolescents.

PubMed

Kliewer, Wendy; Robins, Jo Lynne W

2017-07-01

To investigate associations between components of cumulative risk (CR) and physiological stress responses in African American adolescents and evaluate emotion regulation as a mediator and sex as a moderator of these associations. Cortisol and salivary alpha amylase (sAA) were collected in adolescents ( N = 205; 55% female; 12.1 ± 1.6 years at baseline) as part of a longitudinal study of stress and adjustment in families. CR was assessed at baseline and emotion regulation was assessed at baseline and 2 years later at Wave 3 (W3) using caregiver and adolescent reports. Cortisol and sAA responses to the social competence interview were assessed at W3. Repeated-measures analyses of variance predicting cortisol and controlling for time of day, adolescent age, medication usage, and pubertal status revealed significant interactions of time with both psychosocial and sociodemographic risk. In both analyses, youths with higher levels of risk showed a steeper decline in cortisol than youths with lower levels of risk. In parallel analyses predicting sAA, time interacted with psychosocial but not with sociodemographic risk. There were no interactions with sex in any of the analyses. Although CR was associated with changes in emotion regulation, there was no evidence that these changes accounted for the observed CR-stress response associations. These findings illustrate the potential importance of disentangling CR and suggest that additional work is needed to help explicate why and how CR is associated with specific physiological responses to stress.

Benchmark Dose Analysis from Multiple Datasets: The Cumulative Risk Assessment for the N-Methyl Carbamate Pesticides

EPA Science Inventory

The US EPA’s N-Methyl Carbamate (NMC) Cumulative Risk assessment was based on the effect on acetylcholine esterase (AChE) activity of exposure to 10 NMC pesticides through dietary, drinking water, and residential exposures, assuming the effects of joint exposure to NMCs is dose-...

Cumulative risk of false positive test in relation to breast symptoms in mammography screening: a historical prospective cohort study.

PubMed

Singh, Deependra; Pitkäniemi, Janne; Malila, Nea; Anttila, Ahti

2016-09-01

Mammography has been found effective as the primary screening test for breast cancer. We estimated the cumulative probability of false positive screening test results with respect to symptom history reported at screen. A historical prospective cohort study was done using individual screening data from 413,611 women aged 50-69 years with 2,627,256 invitations for mammography screening between 1992 and 2012 in Finland. Symptoms (lump, retraction, and secretion) were reported at 56,805 visits, and 48,873 visits resulted in a false positive mammography result. Generalized linear models were used to estimate the probability of at least one false positive test and true positive at screening visits. The estimates were compared among women with and without symptoms history. The estimated cumulative probabilities were 18 and 6 % for false positive and true positive results, respectively. In women with a history of a lump, the cumulative probabilities of false positive test and true positive were 45 and 16 %, respectively, compared to 17 and 5 % with no reported lump. In women with a history of any given symptom, the cumulative probabilities of false positive test and true positive were 38 and 13 %, respectively. Likewise, women with a history of a 'lump and retraction' had the cumulative false positive probability of 56 %. The study showed higher cumulative risk of false positive tests and more cancers detected in women who reported symptoms compared to women who did not report symptoms at screen. The risk varies substantially, depending on symptom types and characteristics. Information on breast symptoms influences the balance of absolute benefits and harms of screening.

Cumulative positive fluid balance is a risk factor for acute kidney injury and requirement for renal replacement therapy after liver transplantation.

PubMed

Codes, Liana; de Souza, Ygor Gomes; D'Oliveira, Ricardo Azevedo Cruz; Bastos, Jorge Luiz Andrade; Bittencourt, Paulo Lisboa

2018-04-24

To analyze whether fluid overload is an independent risk factor of adverse outcomes after liver transplantation (LT). One hundred and twenty-one patients submitted to LT were retrospectively evaluated. Data regarding perioperative and postoperative variables previously associated with adverse outcomes after LT were reviewed. Cumulative fluid balance (FB) in the first 12 h and 4 d after surgery were compared with major adverse outcomes after LT. Most of the patients were submitted to a liberal approach of fluid administration with a mean cumulative FB over 5 L and 10 L, respectively, in the first 12 h and 4 d after LT. Cumulative FB in 4 d was independently associated with occurrence of both AKI and requirement for renal replacement therapy (RRT) (OR = 2.3; 95%CI: 1.37-3.86, P = 0.02 and OR = 2.89; 95%CI: 1.52-5.49, P = 0.001 respectively). Other variables on multivariate analysis associated with AKI and RRT were, respectively, male sex and Acute Physiology and Chronic Health Disease Classification System (APACHE II) levels and sepsis or septic shock. Mortality was shown to be independently related to AST and APACHE II levels (OR = 2.35; 95%CI: 1.1-5.05, P = 0.02 and 2.63; 95%CI: 1.0-6.87, P = 0.04 respectively), probably reflecting the degree of graft dysfunction and severity of early postoperative course of LT. No effect of FB on mortality after LT was disclosed. Cumulative positive FB over 4 d after LT is independently associated with the development of AKI and the requirement of RRT. Survival was not independently related to FB, but to surrogate markers of graft dysfunction and severity of postoperative course of LT.

Is Cumulative Exposure to Suicide Attempts and Deaths A Risk Factor for Suicidal Behavior among Firefighters? A Preliminary Study

PubMed Central

Kimbrel, Nathan A.; Pennington, Michelle L.; Cammarata, Claire M.; Leto, Frank; Ostiguy, William J.; Gulliver, Suzy B.

2016-01-01

The present study examined the association between cumulative exposure to suicide attempts and deaths and suicidal behavior in a sample of 61 professional firefighters. On average, firefighters reported 13.1 (SD=16.6) exposures over the course of their lifetime. Cumulative exposure to suicide attempts and deaths was positively correlated with suicidal behavior (r = 0.38, p = 0.004). Moreover, firefighters with 12+ exposures were more likely to screen positive for risk of suicidal behavior (OR = 7.885, p = 0.02). Additional research on the potential impact of cumulative exposure to suicide attempts and deaths on firefighters’ health and safety is needed. PMID:27371810

Effect of Cumulating Exposure to Abacavir on the Risk of Cardiovascular Disease Events in Patients From the Swiss HIV Cohort Study.

PubMed

Young, Jim; Xiao, Yongling; Moodie, Erica E M; Abrahamowicz, Michal; Klein, Marina B; Bernasconi, Enos; Schmid, Patrick; Calmy, Alexandra; Cavassini, Matthias; Cusini, Alexia; Weber, Rainer; Bucher, Heiner C

2015-08-01

Patients with HIV exposed to the antiretroviral drug abacavir may have an increased risk of cardiovascular disease (CVD). There is concern that this association arises because of a channeling bias. Even if exposure is a risk, it is not clear how that risk changes as exposure cumulates. We assess the effect of exposure to abacavir on the risk of CVD events in the Swiss HIV Cohort Study. We use a new marginal structural Cox model to estimate the effect of abacavir as a flexible function of past exposures while accounting for risk factors that potentially lie on a causal pathway between exposure to abacavir and CVD. A total of 11,856 patients were followed for a median of 6.6 years; 365 patients had a CVD event (4.6 events per 1000 patient-years). In a conventional Cox model, recent--but not cumulative--exposure to abacavir increased the risk of a CVD event. In the new marginal structural Cox model, continued exposure to abacavir during the past 4 years increased the risk of a CVD event (hazard ratio = 2.06; 95% confidence interval: 1.43 to 2.98). The estimated function for the effect of past exposures suggests that exposure during the past 6-36 months caused the greatest increase in risk. Abacavir increases the risk of a CVD event: the effect of exposure is not immediate, rather the risk increases as exposure cumulates over the past few years. This gradual increase in risk is not consistent with a rapidly acting mechanism, such as acute inflammation.

Potential Health Risks Posed by Plant-Derived Cumulative Neurotoxic Bufadienolides in South Africa.

PubMed

Botha, Christo

2016-03-16

Bufadienolide-type cardiac glycosides have a worldwide distribution and are mainly synthesized by plants, but there are also animal sources. In South Africa, members of three genera of the Crassulaceae (Cotyledon, Tylecodon and Kalanchoe) cause a unique chronic form of cardiac glycoside poisoning, predominantly in small stock. This paretic/paralytic condition is referred to as "krimpsiekte", cotyledonosis or "nenta". "Krimpsiekte" is a plant poisoning only reported from South Africa and is regarded as the most important plant poisoning of small stock in the semi-arid Little Karoo and southern fringes of the Great Karoo. The toxicosis is caused by cumulative bufadienolides which have neurotoxic properties. Four types of cumulative neurotoxic bufadienolides, namely cotyledoside, and the tyledosides, orbicusides and lanceotoxins, have been isolated. Based on the structure activity relationships and certain toxicokinetic parameters possible reasons for their accumulation are presented. Consumption of edible tissues from animals that have ingested these plants poses a potential risk to humans.

Cumulative Risk on the Oxytocin Receptor Gene (OXTR) Predicts Empathic Communication by Physician Assistant Students.

PubMed

Floyd, Kory; Generous, Mark Alan; Clark, Lou; McLeod, Ian; Simon, Albert

2017-10-01

In the relationship between patients and health care providers, few communicative features are as significant as the providers' ability to express empathy. A robust empirical literature describes the importance of physician communication skills-particularly those that convey empathy-yet few studies have examined empathic communication by physician assistants, who provide primary care for an increasing number of Americans. The present study examines the empathic communication of physician assistant students in interactions with standardized patients. Over a 6-month period, each student conducted three clinical interviews, each of which was evaluated for empathic communication by the patients, the students' clinical instructors, and third-party observers. Students also provided saliva samples for genotyping six single-nucleotide polymorphisms on the oxytocin receptor gene (OXTR) that are linked empirically to empathic behavior. Consistent with recent research, this study adopted a cumulative risk approach wherein students were scored for their number of risky alleles on the single-nucleotide polymorphisms. Results indicated that cumulative risk on OXTR receptor gene predicted lower patient empathy scores as rated by instructors and observers, but not by standardized patients.

Observed sensitivity during family interactions and cumulative risk: A study of multiple dyads per family.

PubMed

Browne, Dillon T; Leckie, George; Prime, Heather; Perlman, Michal; Jenkins, Jennifer M

2016-07-01

The present study sought to investigate the family, individual, and dyad-specific contributions to observed cognitive sensitivity during family interactions. Moreover, the influence of cumulative risk on sensitivity at the aforementioned levels of the family was examined. Mothers and 2 children per family were observed interacting in a round robin design (i.e., mother-older sibling, mother younger-sibling and sibling-dyad, N = 385 families). Data were dyadic, in that there were 2 directional scores per interaction, and were analyzed using a multilevel formulation of the Social Relations Model. Variance partitioning revealed that cognitive sensitivity is simultaneously a function of families, individuals and dyads, though the importance of these components varies across family roles. Cognitive sensitivity for mothers was primarily attributable to individual differences, whereas cognitive sensitivity for children was predominantly attributable to family and dyadic differences, especially for youngest children. Cumulative risk explained family and individual variance in cognitive sensitivity, particularly when actors were older or in a position of relative competence or authority (i.e., mother to children, older to younger siblings). Overall, this study demonstrates that cognitive sensitivity operates across levels of family organization, and is negatively impacted by psychosocial risk. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Cumulative risk of breast cancer screening outcomes according to the presence of previous benign breast disease and family history of breast cancer: supporting personalised screening.

PubMed

Román, M; Quintana, M J; Ferrer, J; Sala, M; Castells, X

2017-05-23

Our aim was to assess the cumulative risk of false-positive screening results, screen-detected cancer, and interval breast cancer in mammography screening among women with and without a previous benign breast disease and a family history of breast cancer. The cohort included 42 928 women first screened at the age of 50-51 years at three areas of the Spanish Screening Programme (Girona, and two areas in Barcelona) between 1996 and 2011, and followed up until December 2012. We used discrete-time survival models to estimate the cumulative risk of each screening outcome over 10 biennial screening exams. The cumulative risk of false-positive results, screen-detected breast cancer, and interval cancer was 36.6, 5.3, and 1.4 for women with a previous benign breast disease, 24.1, 6.8, and 1.6% for women with a family history of breast cancer, 37.9, 9.0, and 3.2%; for women with both a previous benign breast disease and a family history, and 23.1, 3.2, and 0.9% for women without either of these antecedents, respectively. Women with a benign breast disease or a family history of breast cancer had an increased cumulative risk of favourable and unfavourable screening outcomes than women without these characteristics. A family history of breast cancer did not increase the cumulative risk of false-positive results. Identifying different risk profiles among screening participants provides useful information to stratify women according to their individualised risk when personalised screening strategies are discussed.

Cumulative impact assessment: A case study

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

Irving, J.S.; Bain, M.B.

The National Environmental Policy Act of 1969 (NEPA) indirectly addressed cumulative impacts. Attempts to include cumulative impacts in environmental impact assessments, however, did not began until the early 1980's. One such effort began when The Federal Energy and Regulatory Commission (FERC) received over 1200 applications for hydroelectric projects in the Pacific Northwest. Federal and State Agencies, Indian tribes and environmental groups realized the potential cumulative effect such development could have on fish and wildfire resources. In response, the FERC developed the Cluster Impact Assessment Procedure (CIAP). The CIAP consisted of public scoping meetings; interactive workshops designed to identify projects withmore » potential for cumulative effects, important resources, available data; and preparation of a NEPA document (EA or EIS). The procedure was modifies to assess the cumulative impacts of fifteen hydroelectric projects in the Salmon River Basin, Idaho. The methodology achieved its basic objective of evaluating the impact of hydroelectric development on fish and wildfire resources. In addition, the use of evaluative techniques to determine project interactions and degrees of impact hindered acceptance of the conclusions. Notwithstanding these problems, the studies provided a basis for decision-makers to incorporate the potential effects of cumulative impacts into the decision-making process. 22 refs., 2 figs., 4 tabs.« less

Cumulative Risk of Guillain–Barré Syndrome Among Vaccinated and Unvaccinated Populations During the 2009 H1N1 Influenza Pandemic

PubMed Central

Iqbal, Shahed; Stewart, Brock; Tokars, Jerome; DeStefano, Frank

2014-01-01

Objectives. We sought to assess risk of Guillain–Barré syndrome (GBS) among influenza A (H1N1) 2009 monovalent (pH1N1) vaccinated and unvaccinated populations at the end of the 2009 pandemic. Methods. We applied GBS surveillance data from a US population catchment area of 45 million from October 15, 2009, through May 31, 2010. GBS cases meeting Brighton Collaboration criteria were included. We calculated the incidence density ratio (IDR) among pH1N1 vaccinated and unvaccinated populations. We also estimated cumulative GBS risk using life table analysis. Additionally, we used vaccine coverage data and census population estimates to calculate denominators. Results. There were 392 GBS cases; 64 (16%) occurred after pH1N1vaccination. The vaccinated population had lower average risk (IDR = 0.83, 95% confidence interval = 0.63, 1.08) and lower cumulative risk (6.6 vs 9.2 cases per million persons, P = .012) of GBS. Conclusions. Our findings suggest that at the end of the influenza season cumulative GBS risk was less among the pH1N1vaccinated than the unvaccinated population, suggesting the benefit of vaccination as it relates to GBS. The observed potential protective effect on GBS attributed to vaccination warrants further study. PMID:24524517

Meta-analysis for aggregated survival data with competing risks: a parametric approach using cumulative incidence functions.

PubMed

Bonofiglio, Federico; Beyersmann, Jan; Schumacher, Martin; Koller, Michael; Schwarzer, Guido

2016-09-01

Meta-analysis of a survival endpoint is typically based on the pooling of hazard ratios (HRs). If competing risks occur, the HRs may lose translation into changes of survival probability. The cumulative incidence functions (CIFs), the expected proportion of cause-specific events over time, re-connect the cause-specific hazards (CSHs) to the probability of each event type. We use CIF ratios to measure treatment effect on each event type. To retrieve information on aggregated, typically poorly reported, competing risks data, we assume constant CSHs. Next, we develop methods to pool CIF ratios across studies. The procedure computes pooled HRs alongside and checks the influence of follow-up time on the analysis. We apply the method to a medical example, showing that follow-up duration is relevant both for pooled cause-specific HRs and CIF ratios. Moreover, if all-cause hazard and follow-up time are large enough, CIF ratios may reveal additional information about the effect of treatment on the cumulative probability of each event type. Finally, to improve the usefulness of such analysis, better reporting of competing risks data is needed. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Emotion dysregulation mediates the relationship between lifetime cumulative adversity and depressive symptomatology.

PubMed

Abravanel, Benjamin T; Sinha, Rajita

2015-02-01

Repeated exposure to stressful events across the lifespan, referred to as cumulative adversity, is a potent risk factor for depression. Research indicates that cumulative adversity detrimentally affects emotion regulation processes, which may represent a pathway linking cumulative adversity to vulnerability to depression. However, empirical evidence that emotion dysregulation mediates the relationship between cumulative adversity and depression is limited, particularly in adult populations. We examined the direct and indirect effects of cumulative adversity on depressive symptomatology in a large community sample of adults (n = 745) who were further characterized by risk status: never-depressed (n = 638) and "at-risk" remitted mood-disordered (n = 107). All participants completed the Cumulative Adversity Inventory (CAI), the Difficulties in Emotion Regulation Scale (DERS), and the Center for Epidemiologic Studies Depression Scale (CES-D). Bootstrapped confidence intervals were computed to estimate the indirect effect of emotion dysregulation on the relationship between cumulative adversity and depressive symptomatology and to test whether this indirect effect was moderated by risk status. Emotion dysregulation partially and significantly mediated the relationship between cumulative adversity and depressive symptomatology independent of risk status. Overall, cumulative adversity and emotion dysregulation accounted for 50% of the variance in depressive symptomatology. These findings support the hypothesis that disruption of adaptive emotion regulation processes associated with repeated exposure to stressful life events represents an intrapersonal mechanism linking the experience of adverse events to depression. Our results support the utility of interventions that simultaneously emphasize stress reduction and emotion regulation to treat and prevent depressive vulnerability and pathology. Copyright © 2014 Elsevier Ltd. All rights reserved.

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

EPA Science Inventory

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

Risk factors for early adolescent drug use in four ethnic and racial groups.

PubMed

Vega, W A; Zimmerman, R S; Warheit, G J; Apospori, E; Gil, A G

1993-02-01

It is widely believed that risk factors identified in previous epidemiologic studies accurately predict adolescent drug use. Comparative studies are needed to determine how risk factors vary in prevalence, distribution, sensitivity, and pattern across the major US ethnic/racial groups. Baseline questionnaire data from a 3-year epidemiologic study of early adolescent development and drug use were used to conduct bivariate and multivariate risk factor analyses. Respondents (n = 6760) were sixth- and seventh-grade Cuban, other Hispanic, Black, and White non-Hispanic boys in the 48 middle schools of the greater Miami (Dade County) area. Findings indicate 5% lifetime illicit drug use, 4% lifetime inhalant use, 37% lifetime alcohol use, and 21% lifetime tobacco use, with important intergroup differences. Monotonic relationships were found between 10 risk factors and alcohol and illicit drug use. Individual risk factors were distributed disproportionately, and sensitivity and patterning of risk factors varied widely by ethnic/racial subsample. While the cumulative prevalence of risk factors bears a monotonic relationship to drug use, ethnic/racial differences in risk factor profiles, especially for Blacks, suggest differential predictive value based on cultural differences.

Single and Cumulative Relations of Social Risk Factors with Children's Dental Health and Care-Utilization Within Regions of the United States.

PubMed

Yang, Alyssa J; Gromoske, Andrea N; Olson, Melissa A; Chaffin, Jeffrey G

2016-03-01

The purpose is to examine the relation of social risk factors, and the cumulative burden of social risk factors, on parent-reported dental health and dental care-seeking behavior. National Survey of Children's Health data (2011-2012) were analyzed for US children by Title V Block Grant regions. Multivariate logistic regressions were estimated for ten social risk factors, as well as a cumulative risk index, to find any associations with poor condition of teeth, presence of dental caries, and no dental care visits. Almost all of the risk factors were significantly associated with poor condition of teeth and presence of dental caries for the US. Models associating no dental care visits suggested that low family income (OR 1.58), poor maternal mental health (OR 1.54), high school education or less (OR 1.34), and multi-racial/other race (OR 1.18) were significant factors for the US. Regional variation existed for those risk factors and their association with the outcomes, but income, education, and poor maternal mental health consistently played a significant role in adverse outcomes. The cumulative risk index was strongly related to poor oral health outcomes, with a weaker relationship to dental care utilization. US children experiencing certain social risk factors, such as low family income, high school education or less, and poor maternal mental health, are likely to be at greater risk for poor dental health and low levels of dental-care seeking behavior. Children experiencing multiple social risks are at greater risk for poor oral outcomes than children who experience fewer social risks. An approach that involves the social determinants of health is needed to address these issues.

Kaplan-Meier survival analysis overestimates cumulative incidence of health-related events in competing risk settings: a meta-analysis.

PubMed

Lacny, Sarah; Wilson, Todd; Clement, Fiona; Roberts, Derek J; Faris, Peter; Ghali, William A; Marshall, Deborah A

2018-01-01

Kaplan-Meier survival analysis overestimates cumulative incidence in competing risks (CRs) settings. The extent of overestimation (or its clinical significance) has been questioned, and CRs methods are infrequently used. This meta-analysis compares the Kaplan-Meier method to the cumulative incidence function (CIF), a CRs method. We searched MEDLINE, EMBASE, BIOSIS Previews, Web of Science (1992-2016), and article bibliographies for studies estimating cumulative incidence using the Kaplan-Meier method and CIF. For studies with sufficient data, we calculated pooled risk ratios (RRs) comparing Kaplan-Meier and CIF estimates using DerSimonian and Laird random effects models. We performed stratified meta-analyses by clinical area, rate of CRs (CRs/events of interest), and follow-up time. Of 2,192 identified abstracts, we included 77 studies in the systematic review and meta-analyzed 55. The pooled RR demonstrated the Kaplan-Meier estimate was 1.41 [95% confidence interval (CI): 1.36, 1.47] times higher than the CIF. Overestimation was highest among studies with high rates of CRs [RR = 2.36 (95% CI: 1.79, 3.12)], studies related to hepatology [RR = 2.60 (95% CI: 2.12, 3.19)], and obstetrics and gynecology [RR = 1.84 (95% CI: 1.52, 2.23)]. The Kaplan-Meier method overestimated the cumulative incidence across 10 clinical areas. Using CRs methods will ensure accurate results inform clinical and policy decisions. Copyright © 2017 Elsevier Inc. All rights reserved.

PHYSIOLOGICALLY-BASED PHARMACOKINETICS/PHARMACODYNAMIC MODELING AND CUMULATIVE RISK ASSESSMENT: CASE STUDY FOR THE N-METHYL CARBMATE PESTICIDES

EPA Science Inventory

The Food Quality Protection Act of 1996 [PL 104-170: 110 STAT. 1513] requires EPA to consider potential cumulative human health risks resulting from aggregate exposure to pesticide chemicals acting through a common mechanism of toxicity. This includes all anticipated dietary e...

Risk behaviours among early adolescents: risk and protective factors.

PubMed

Wang, Ruey-Hsia; Hsu, Hsiu-Yueh; Lin, Shu-Yuan; Cheng, Chung-Ping; Lee, Shu-Li

2010-02-01

This paper is a report of a study conducted to examine the influence of risk/protective factors on risk behaviours of early adolescents and whether protective factors moderate their impact. An understanding of how risk and protective factors operate to influence risk behaviours of early adolescents will better prepare nurses to perform interventions appropriately to reduce risk behaviours of early adolescents. A cross-sectional study was carried out, based on a sample of public junior high schools (from 7th to 9th grades) in one city and one county in Taiwan. An anonymous questionnaire designed to measure five risk factors, six protective factors and risk behaviours was administered from October 2006 to March 2007. Data from 878 students were used for the present analysis. Pearson's correlations, anova with random effect models, and generalized linear models were used to analyse the statistically significant explanatory variables for risk behaviours. Gender, perceived father's risk behaviour, perceived mother's risk behaviour, health self-efficacy, interaction of health self-efficacy and perceived peers' risk behaviour, and interaction of emotional regulation and perceived peers' risk behaviour were statistically significant explanatory variables of risk behaviours. Health self-efficacy and emotional regulation moderated the negative effects of peers' perceived risk behaviour on risk behaviours. All protective factors were negative statistically correlated with risk behaviours, and all risk factors positively statistically correlated with risk behaviours. Male adolescents should be considered an at-risk group for risk behaviour intervention. Nurses could provide early adolescents with training regarding health self-efficacy improvement, self-esteem enhancement, emotional regulation skills to reduce their risk behaviours.

Life Course Associations between Victimization and Aggression: Distinct and Cumulative Contributions

PubMed Central

Logan-Greene, Patricia; Nurius, Paula S.; Hooven, Carole; Thompson, Elaine Adams

2014-01-01

The connections between early maltreatment and later aggression are well established in the literature, however gaps remain in our understanding of developmental processes. This study investigates the cascading lifecourse linkages between victimization experiences from childhood through early adulthood andlater aggressive behavior. The diverse, at-risk sample is of particular importance to child and adolescent specialists, as it represents highly vulnerable youth accessible through conventional school settings. In addition to direct pathways from proximal life periods, path analysis revealed significant indirect mediated pathways through which earlier life victimizationcontributes to aggressive behaviors in later life periods as well as revictimization. Multivariateregressions support theorized cumulative effects of multi-form victimization as well as distinct contributions of victimization domains (emotional, witnessing, physical, property, and sexual) in explaining aggressive behavior.Consistent with theorizing about the developmental impact of early maltreatment, results bolster the importance of interrupting pathways from victimization to revictimization and later aggression. Findings are evaluated in light of implications for early identification and prevention programming. PMID:26190899

Cumulative Risk Exposure and Waist Circumference in Preschool-Aged Children: the Mediating Role of Television and Moderating Role of Sex.

PubMed

Grummon, Anna H; Vaughn, Amber; Jones, Deborah J; Ward, Dianne S

2017-08-01

Children exposed to multiple stressors are more likely to be overweight, but little is known about the mechanisms explaining this association. This cross-sectional study examined whether children exposed to multiple stressors had higher waist circumference, and whether this association was mediated through children's television time. Participants were 319 parent-child dyads. Children were 2-5 years old and had at least one overweight parent (BMI ≥ 25 kg/m 2 ). Data were collected at baseline of a larger childhood obesity prevention study and included information on psychosocial stressors (e.g., parenting stress), demographic stressors (e.g., low income), children's television time, and children's waist circumference. Two cumulative risk scores were created by summing stressors in each domain (demographic and psychosocial). Mediation and moderated mediation analyses were conducted. Indirect effects of both cumulative risk scores on waist circumference through television time were not significant; however, moderated mediation analyses found significant moderation by gender. The indirect effects of both risk scores on waist circumference through television time were significant and positive for girls, but near-zero for boys. Reducing television time should be explored as a strategy for buffering against the negative health effects of exposure to multiple stressors among girls. Longitudinal and intervention research is needed to confirm these results and to identify mediating factors between cumulative risk and body weight among boys.

Engaging Communities in Research on Cumulative Risk and Social Stress-Environment Interactions: Lessons Learned from EPA's STAR Program

PubMed Central

Korfmacher, Katrina Smith; Cory-Slechta, Deborah A.; Jimenez, Maria; Symanski, Elaine; Carr Shmool, Jessie L.; Dotson-Newman, Ogonnaya; Clougherty, Jane E.; French, Robert; Levy, Jonathan I.; Laumbach, Robert; Rodgers, Kathryn; Bongiovanni, Roseann; Scammell, Madeleine K.

2015-01-01

Abstract Studies have documented cumulative health effects of chemical and nonchemical exposures, particularly chronic environmental and social stressors. Environmental justice groups have advocated for community participation in research that assesses how these interactions contribute to health disparities experienced by low-income and communities of color. In 2009, the U.S. Environmental Protection Agency issued a request for research applications (RFA), “Understanding the Role of Nonchemical Stressors and Developing Analytic Methods for Cumulative Risk Assessments.” Seven research projects were funded to help address this knowledge gap. Each engaged with communities in different ways. We describe the community engagement approaches of the seven research projects, which ranged from outreach through shared leadership/participatory. We then assess the experiences of these programs with respect to the community engagement goals of the RFA. We present insights from these community engagement efforts, including how the grants helped to build or enhance the capacity of community organizations in addition to contributing to the research projects. Our analysis of project proposals, annual grantee reports, and participant observation of these seven projects suggests guidelines for the development of future funding mechanisms and for conducting community-engaged research on cumulative risk involving environmental and social stressors including: 1) providing for flexibility in the mode of community engagement; 2) addressing conflict between research timing and engagement needs, 3) developing approaches for communicating about the uniquely sensitive issues of nonchemical stressors and social risks; and 4) encouraging the evaluation of community engagement efforts. PMID:27688822

Engaging Communities in Research on Cumulative Risk and Social Stress-Environment Interactions: Lessons Learned from EPA's STAR Program.

PubMed

Payne-Sturges, Devon C; Korfmacher, Katrina Smith; Cory-Slechta, Deborah A; Jimenez, Maria; Symanski, Elaine; Carr Shmool, Jessie L; Dotson-Newman, Ogonnaya; Clougherty, Jane E; French, Robert; Levy, Jonathan I; Laumbach, Robert; Rodgers, Kathryn; Bongiovanni, Roseann; Scammell, Madeleine K

2015-12-01

Studies have documented cumulative health effects of chemical and nonchemical exposures, particularly chronic environmental and social stressors. Environmental justice groups have advocated for community participation in research that assesses how these interactions contribute to health disparities experienced by low-income and communities of color. In 2009, the U.S. Environmental Protection Agency issued a request for research applications (RFA), "Understanding the Role of Nonchemical Stressors and Developing Analytic Methods for Cumulative Risk Assessments." Seven research projects were funded to help address this knowledge gap. Each engaged with communities in different ways. We describe the community engagement approaches of the seven research projects, which ranged from outreach through shared leadership/participatory. We then assess the experiences of these programs with respect to the community engagement goals of the RFA. We present insights from these community engagement efforts, including how the grants helped to build or enhance the capacity of community organizations in addition to contributing to the research projects. Our analysis of project proposals, annual grantee reports, and participant observation of these seven projects suggests guidelines for the development of future funding mechanisms and for conducting community-engaged research on cumulative risk involving environmental and social stressors including: 1) providing for flexibility in the mode of community engagement; 2) addressing conflict between research timing and engagement needs, 3) developing approaches for communicating about the uniquely sensitive issues of nonchemical stressors and social risks; and 4) encouraging the evaluation of community engagement efforts.

Association between adjuvant chemotherapy and risk of acute kidney injury in elderly women diagnosed with early-stage breast cancer.

PubMed

Li, Shuling; Liu, Jiannong; Virnig, Beth A; Collins, Allan J

2017-02-01

We studied elderly Medicare enrollees newly diagnosed with early-stage breast cancer to examine the association between adjuvant chemotherapy and acute kidney injury (AKI). Using the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database, we conducted a retrospective cohort study including women diagnosed with stages I-III breast cancer at ages 66-89 years between 1992 and 2007. We performed one-to-one matching on time-dependent propensity score on the day of adjuvant chemotherapy initiation within 6 months after the first cancer-directed surgery based on the estimated probability of chemotherapy initiation at each day for each patient, using a Cox proportional hazards model. We estimated the cumulative incidence of AKI using Kaplan-Meier methods. We used Cox proportional hazards models to evaluate the association between chemotherapy and the risk of AKI, and compared the risk among major chemotherapy types. The study included 28,048 women. The 6-month cumulative incidence of AKI was 0.80% for chemotherapy-treated patients, compared with 0.30% for untreated patients (P < 0.001). Adjuvant chemotherapy was associated with a nearly threefold increased risk of AKI [hazard ratio (HR) 2.73; 95% CI 1.8-4.1]. Compared with anthracycline-based chemotherapy, the HRs (95% CIs) were 1.66 (0.94-2.91), 0.88 (0.53-1.47), and 1.15 (0.57-2.32) for taxane-based, CMF, and other chemotherapy, respectively. Our findings showed that adjuvant chemotherapy was associated with increased risk of AKI in elderly women diagnosed with early-stage breast cancer. The risk seemed to vary by regimen type, but the differences were not statistically significant.

Health risks of children's cumulative and aggregative exposure to metals and metalloids in a typical urban environment in China.

PubMed

Cao, Suzhen; Duan, Xiaoli; Zhao, Xiuge; Chen, Yiting; Wang, Beibei; Sun, Chengye; Zheng, Binghui; Wei, Fusheng

2016-03-01

Rapid development of industrialization and urbanization results in serious environmental contamination by metal(loid)s, which would consequently cause deleterious health effects to the exposed people through multi-pathways. Therefore, total health risk assessment for the population in urban environment is very important. Unfortunately, few studies to date investigate the cumulative health risks of metal(loid)s through aggregative pathways in Children who are often susceptible population. 12 metal(loid)s including Lead(Pb), Cadmium(Cd), Arsenic(As), Chromium(Cr), Zinc(Zn), Copper(Cu), Nickel(Ni), Manganese(Mn), Cobalt(Co), Selenium(Se), Antimony(Se) and Vanadium(V), were analyzed in PM10, drinking water, food, soil and indoor dust in this study. The cumulative and aggregative risks of these metal(loid)s among the local children were then evaluated on a field sampling and questionnaire-survey basis. The results showed that the environments were heavily polluted by metal(loid)s. For most metal(loid)s, food ingestion accounted for more than 80% of the total daily exposure dose. The non-cancer risks were up to 30 times higher than the acceptable level due to the food ingestion via Pb, Cr, Cu, Zn, As, Se, Cd and Sb, and the PM10 inhalation via Cr and Mn. While, the cancer risks were mainly attributed to Cr via food ingestion and As via food and dust ingestion, and approximately 100 times of the maximum acceptable level of 1.0 × 10(-4). The study highlights the cumulative and aggregative exposure assessment, instead of pollutant investigation to evaluate the potential health risks and emphasizes concerns to improve indoor hygienic and environmental quality and to decrease the potential harmful health effects of children living in urban area. Copyright © 2016 Elsevier Ltd. All rights reserved.

Emotion Dysregulation Mediates the Relationship between Lifetime Cumulative Adversity and Depressive Symptomatology

PubMed Central

Abravanel, Benjamin T.; Sinha, Rajita

2014-01-01

Repeated exposure to stressful events across the lifespan, referred to as cumulative adversity, is a potent risk factor for depression. Research indicates that cumulative adversity detrimentally affects emotion regulation processes, which may represent a pathway linking cumulative adversity to vulnerability to depression. However, empirical evidence that emotion dysregulation mediates the relationship between cumulative adversity and depression is limited, particularly in adult populations. We examined the direct and indirect effects of cumulative adversity on depressive symptomatology in a large community sample of adults (n = 745) who were further characterized by risk status: never-depressed (n = 638) and “at-risk” remitted mood-disordered (n = 107). All participants completed the Cumulative Adversity Inventory (CAI), the Difficulties in Emotion Regulation Scale (DERS), and the Center for Epidemiologic Studies Depression Scale (CES-D). Bootstrapped confidence intervals were computed to estimate the indirect effect of emotion dysregulation on the relationship between cumulative adversity and depressive symptomatology and to test whether this indirect effect was moderated by risk status. Emotion dysregulation partially and significantly mediated the relationship between cumulative adversity and depressive symptomatology independent of risk status. Overall, cumulative adversity and emotion dysregulation accounted for 50% of the variance in depressive symptomatology. These findings support the hypothesis that disruption of adaptive emotion regulation processes associated with repeated exposure to stressful life events represents an intrapersonal mechanism linking the experience of adverse events to depression. Our results support the utility of interventions that simultaneously emphasize stress reduction and emotion regulation to treat and prevent depressive vulnerability and pathology. PMID:25528603

Approaches for grouping of pesticides into cumulative assessment groups for risk assessment of pesticide residues in food.

PubMed

Colnot, Thomas; Dekant, Wolfgang

2017-02-01

The European Food Safety Authority (EFSA) is developing approaches to cumulative risk assessment of pesticides by assigning individual pesticides to cumulative assessment groups (CAGs). For assignment to CAGs, EFSA recommended to rely on adverse effects on the specific target system. Contractors to EFSA have proposed to allocate individual pesticides into CAGs relying on NOAELs for effects on target organs. This manuscript evaluates the assignments by applying EFSAs criteria to the CAGs "Toxicity to the nervous system" and "Toxicity to the thyroid hormone system (gland or hormones)". Assignment to the CAG "Toxicity to the nervous system" based, for example, on neurochemical effects like choline esterase inhibition is well supported, whereas assignment to the CAG "Toxicity to the thyroid hormone system (gland or hormones)" has been based in the examined case studies on non-reproducible effects seen in single studies or on observations that are not adverse. Therefore, a more detailed effects evaluation is required to assign a pesticide to a CAG for a target organ where many confounders regarding effects are present. Relative potency factors in cumulative risk assessment should be based on benchmark doses from studies in one species with identical study design and human relevance of effects on specific target organs should be analyzed to define minimal margins of exposure. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Are all risks equal? Early experiences of poverty-related risk and children's functioning.

PubMed

Roy, Amanda L; Raver, C Cybele

2014-06-01

Using cumulative risk and latent class analysis (LCA) models, we examined how exposure to deep poverty (income-to-needs ratio <0.50) and 4 poverty-related risks (i.e., single-parent household, residential crowding, caregiver depression, and multiple life stressors) in preschool is related to children's future difficulty in school in a longitudinal sample of 602 Head Start-enrolled, low-income families. Results from the LCA revealed 4 risk profiles: low risk, deep poverty and single, single and stressed, and deep poverty and crowded household. Tests of measurement invariance across racial/ethnic groups established that, although patterns of risk are similar across groups (i.e., risks covary in the same way), the prevalence of risk profiles differs. African American families were overrepresented in the "deep poverty and single" profile while Latino and White families were overrepresented in the "deep poverty and crowded" profile. Finally, children's third grade functioning in 3 domains (i.e., academic performance, behavior problems, and self-regulatory skills) was predicted using a cumulative risk index and LCA-identified risk profiles. Both approaches demonstrated that children who experienced higher levels of risk in preschool had worse school performance than children with low levels of risk. However, LCA also revealed that children who experienced "single and stressed" family settings had more behavior problems than low-risk children while children who experienced "deep poverty and crowded" family settings had worse academic performance. The results indicate that all risks are not equal for children's development and highlight the utility of LCA for tailoring intervention efforts to best meet the needs of target populations. PsycINFO Database Record (c) 2014 APA, all rights reserved

Cumulative Impact of HIV and Multiple Concurrent Human Papillomavirus Infections on the Risk of Cervical Dysplasia

PubMed Central

Adler, David H.; Wallace, Melissa; Bennie, Thola; Abar, Beau; Meiring, Tracy L.; Williamson, Anna-Lise; Bekker, Linda-Gail

2016-01-01

Infection with HIV is known to increase the risk of cervical cancer. In addition, evidence suggests that concurrent infection with multiple human papillomavirus (HPV) genotypes increases the risk of cervical dysplasia more than infection with a single HPV genotype. However, the impact of the combination of HIV coinfection and presence of multiple concurrent HPV infections on the risk of cervical dysplasia is uncertain. We compared the results of HPV testing and Pap smears between HIV-infected and HIV-uninfected young women to assess the cumulative impact of these two conditions. We found that both HIV and the presence of multiple concurrent HPV infections are associated with increased risk of associated Pap smear abnormality and that the impact of these two risk factors may be additive. PMID:26997954

Breast cancer epidemic in the early twenty-first century: evaluation of risk factors, cumulative questionnaires and recommendations for preventive measures.

PubMed

Golubnitschaja, Olga; Debald, Manuel; Yeghiazaryan, Kristina; Kuhn, Walther; Pešta, Martin; Costigliola, Vincenzo; Grech, Godfrey

2016-10-01

Rapidly increasing incidence of breast cancer is a new social challenge resulting from a spectrum of internal and external risk factors which appear to be well accepted as an attribute of the early twenty-first century, being, however, new for female sub-populations compared to the past. These include altered socio-economical conditions such as occupational exposure, rotating shift work, specific environmental factors (increased pollution and environmental toxicity, altered dietary habits, quality and composition of meal) as well as consequently shifted and/or adapted physiologic factors such as lower age at menarche, late age of first full-term pregnancy, if any, shorter periods of breastfeeding and later menopause. Consolidated expert statements suggest that over 50 % of all breast cancer cases may be potentially prevented by risk reduction strategy such as regulation of modifiable risk factors. Currently available risk assessment models may estimate potential breast cancer predisposition, in general; however, they are not able to predict the disease manifestation individually. Further, current deficits in risk assessment and effective breast cancer prevention have been recently investigated and summarised as follows: gaps in risk estimation, preventive therapy, lifestyle prevention, understanding of the biology of breast cancer risk and implementation of known preventive measures. This paper overviews the most relevant risk factors, provides recommendations for improved risk assessment and proposes an extended questionnaire for effective preventive measures.

Toward the breast screening balance sheet: cumulative risk of false positives for annual versus biennial mammograms commencing at age 40 or 50.

PubMed

Winch, Caleb J; Sherman, Kerry A; Boyages, John

2015-01-01

This study aimed to: (1) Estimate cumulative risk of recall from breast screening where no cancer is detected (a harm) in Australia; (2) Compare women screened annually versus biennially, commencing age 40 versus 50; and (3) Compare with international findings. At the no-cost metropolitan program studied, women attended biennial screening, but were offered annual screening if regarded at elevated risk for breast cancer. The cumulative risk of at least one recall was estimated using discrete-time survival analysis. Cancer detection statistics were computed. In total, 801,636 mammograms were undertaken in 231,824 women. Over 10 years, cumulative risk of recall was 13.3 % (95 % CI 12.7-13.8) for those screened biennially, and 19.9 % (CI 16.6-23.2) for those screened annually from age 50-51. Cumulative risk of complex false positive involving a biopsy was 3.1 % (CI 2.9-3.4) and 5.0 % (CI 3.4-6.6), respectively. From age 40-41, the risk of recall was 15.1 % (CI 14.3-16.0) and 22.5 % (CI 17.9-27.1) for biennial and annual screening, respectively. Corresponding rates of complex false positive were 3.3 % (CI 2.9-3.8) and 6.3 % (CI 3.4-9.1). Over 10 mammograms, invasive cancer was detected in 3.4 % (CI 3.3-3.5) and ductal carcinoma in situ in 0.7 % (CI 0.6-0.7) of women, with a non-significant trend toward a larger proportion of Tis and T1N0 cancers in women screened annually (74.5 %) versus biennially (70.1 %), χ (2) = 2.77, p = 0.10. Cancer detection was comparable to international findings. Recall risk was equal to European estimates for women screening from 50 and lower for screening from 40. Recall risk was half of United States' rates across start age and rescreening interval categories. Future benefit/harm balance sheets may be useful for communicating these findings to women.

Integrating etiological models of social anxiety and depression in youth: evidence for a cumulative interpersonal risk model.

PubMed

Epkins, Catherine C; Heckler, David R

2011-12-01

Models of social anxiety and depression in youth have been developed separately, and they contain similar etiological influences. Given the high comorbidity of social anxiety and depression, we examine whether the posited etiological constructs are a correlate of, or a risk factor for, social anxiety and/or depression at the symptom level and the diagnostic level. We find core risk factors of temperament, genetics, and parent psychopathology (i.e., depression and anxiety) are neither necessary nor sufficient for the development of social anxiety and/or depression. Instead, aspects of children's relationships with parents and/or peers either mediates (i.e., explains) or moderates (i.e., interacts with) these core risks being related to social anxiety and/or depression. We then examine various parent- and peer-related constructs contained in the separate models of social anxiety and depression (i.e., parent-child attachment, parenting, social skill deficits, peer acceptance and rejection, peer victimization, friendships, and loneliness). Throughout our review, we report evidence for a Cumulative Interpersonal Risk model that incorporates both core risk factors and specific interpersonal risk factors. Most studies fail to consider comorbidity, thus little is known about the specificity of these various constructs to depression and/or social anxiety. However, we identify shared, differential, and cumulative risks, correlates, consequences, and protective factors. We then put forth demonstrated pathways for the development of depression, social anxiety, and their comorbidity. Implications for understanding comorbidity are highlighted throughout, as are theoretical and research directions for developing and refining models of social anxiety, depression, and their comorbidity. Prevention and treatment implications are also noted.

Exposure to Violence Predicting Cortisol Response During Adolescence and Early Adulthood: Understanding Moderating Factors

PubMed Central

Heinze, Justin E.; Miller, Alison L.; Stoddard, Sarah A.; Zimmerman, Marc A.

2014-01-01

Previous research on the association between violence and biological stress regulation has been largely cross-sectional, and has also focused on childhood. Using longitudinal data from a low-income, high-risk, predominantly African-American sample (n = 266; 57 % female), we tested hypotheses about the influence of cumulative exposure to violence during adolescence and early adulthood on cortisol responses in early adulthood. We found that cumulative exposure to violence predicted an attenuated cortisol response. Further, we tested whether sex, mothers’ support, or fathers’ support moderated the effect of exposure to violence on cortisol responses. We found that the effect of cumulative exposure to violence on cortisol was modified by sex; specifically, males exposed to violence exhibited a more attenuated response pattern. In addition, the effect of cumulative exposure to violence on cortisol was moderated by the presence of fathers’ support during adolescence. The findings contribute to a better understanding of how cumulative exposure to violence influences biological outcomes, emphasizing the need to understand sex and parental support as moderators of risk. PMID:24458765

Childhood Adversity and Cumulative Life Stress: Risk Factors for Cancer-Related Fatigue.

PubMed

Bower, Julienne E; Crosswell, Alexandra D; Slavich, George M

2014-01-01

Fatigue is a common symptom in healthy and clinical populations, including cancer survivors. However, risk factors for cancer-related fatigue have not been identified. On the basis of research linking stress with other fatigue-related disorders, we tested the hypothesis that stress exposure during childhood and throughout the life span would be associated with fatigue in breast cancer survivors. Stress exposure was assessed using the Stress and Adversity Inventory, a novel computer-based instrument that assesses for 96 types of acute and chronic stressors that may affect health. Results showed that breast cancer survivors with persistent fatigue reported significantly higher levels of cumulative lifetime stress exposure, including more stressful experiences in childhood and in adulthood, compared to a control group of nonfatigued survivors. These findings identify a novel risk factor for fatigue in the growing population of cancer survivors and suggest targets for treatment.

Childhood Adversity and Cumulative Life Stress: Risk Factors for Cancer-Related Fatigue

PubMed Central

Bower, Julienne E.; Crosswell, Alexandra D.; Slavich, George M.

2013-01-01

Fatigue is a common symptom in healthy and clinical populations, including cancer survivors. However, risk factors for cancer-related fatigue have not been identified. On the basis of research linking stress with other fatigue-related disorders, we tested the hypothesis that stress exposure during childhood and throughout the life span would be associated with fatigue in breast cancer survivors. Stress exposure was assessed using the Stress and Adversity Inventory, a novel computer-based instrument that assesses for 96 types of acute and chronic stressors that may affect health. Results showed that breast cancer survivors with persistent fatigue reported significantly higher levels of cumulative lifetime stress exposure, including more stressful experiences in childhood and in adulthood, compared to a control group of nonfatigued survivors. These findings identify a novel risk factor for fatigue in the growing population of cancer survivors and suggest targets for treatment. PMID:24377083

(BOSC) DOSE-RESPONSE MODELING FOR THE ASSESSMENT OF CUMULATIVE RISK DUE TO EXPOSURE TO N-METHYL CARBAMATE PRESTICIDES

EPA Science Inventory

THE US EPA'S N-METHYL CARBAMATE CUMULATIVE RISK ASSESSMENT (NMCRA) ASSESSES THE EFFECT ON ACETYLCHOLINE ESTERASE (AChE) ACTIVITY OF EXPOSURE TO 10 N-METHLY CARBAMATE (NMC)PESTICIDES THROUGH DIETARY, DRINKING WATER, AND RESIDENTIAL EXPOSURES. THESE DATA THUS INFORM, BUT DO NOT COM...

Cumulative risk assessment lessons learned: a review of case studies and issue papers.

PubMed

Gallagher, Sarah S; Rice, Glenn E; Scarano, Louis J; Teuschler, Linda K; Bollweg, George; Martin, Lawrence

2015-02-01

Cumulative risk assessments (CRAs) examine potential risks posed by exposure to multiple and sometimes disparate environmental stressors. CRAs are more resource intensive than single chemical assessments, and pose additional challenges and sources of uncertainty. CRAs may examine the impact of several factors on risk, including exposure magnitude and timing, chemical mixture composition, as well as physical, biological, or psychosocial stressors. CRAs are meant to increase the relevance of risk assessments, providing decision makers with information based on real world exposure scenarios that improve the characterization of actual risks and hazards. The U.S. Environmental Protection Agency has evaluated a number of CRAs, performed by or commissioned for the Agency, to seek insight into CRA concepts, methods, and lessons learned. In this article, ten case studies and five issue papers on key CRA topics are examined and a set of lessons learned are identified for CRA implementation. The lessons address the iterative nature of CRAs, importance of considering vulnerability, need for stakeholder engagement, value of a tiered approach, new methods to assess multiroute exposures to chemical mixtures, and the impact of geographical scale on approach and purpose. Copyright © 2014 Elsevier Ltd. All rights reserved.

Interaction between prenatal risk and infant parasympathetic and sympathetic stress reactivity predicts early aggression.

PubMed

Suurland, J; van der Heijden, K B; Huijbregts, S C J; van Goozen, S H M; Swaab, H

2017-09-01

Nonreciprocal action of the parasympathetic (PNS) and sympathetic (SNS) nervous systems, increases susceptibility to emotional and behavioral problems in children exposed to adversity. Little is known about the PNS and SNS in interaction with early adversity during infancy. Yet this is when the physiological systems involved in emotion regulation are emerging and presumably most responsive to environmental influences. We examined whether parasympathetic respiratory sinus arrhythmia (RSA) and sympathetic pre-ejection period (PEP) response and recovery at six months, moderate the association between cumulative prenatal risk and physical aggression at 20 months (N=113). Prenatal risk predicted physical aggression, but only in infants exhibiting coactivation of PNS and SNS (i.e., increase in RSA and decrease in PEP) in response to stress. These findings indicate that coactivation of the PNS and SNS in combination with prenatal risk is a biological marker for the development of aggression. Copyright © 2017 Elsevier B.V. All rights reserved.

Cumulative Incidence of Cancer Among Persons With HIV in North America: A Cohort Study.

PubMed

Silverberg, Michael J; Lau, Bryan; Achenbach, Chad J; Jing, Yuezhou; Althoff, Keri N; D'Souza, Gypsyamber; Engels, Eric A; Hessol, Nancy A; Brooks, John T; Burchell, Ann N; Gill, M John; Goedert, James J; Hogg, Robert; Horberg, Michael A; Kirk, Gregory D; Kitahata, Mari M; Korthuis, Philip T; Mathews, William C; Mayor, Angel; Modur, Sharada P; Napravnik, Sonia; Novak, Richard M; Patel, Pragna; Rachlis, Anita R; Sterling, Timothy R; Willig, James H; Justice, Amy C; Moore, Richard D; Dubrow, Robert

2015-10-06

Cancer is increasingly common among persons with HIV. To examine calendar trends in cumulative cancer incidence and hazard rate by HIV status. Cohort study. North American AIDS Cohort Collaboration on Research and Design during 1996 to 2009. 86 620 persons with HIV and 196 987 uninfected adults. Cancer type-specific cumulative incidence by age 75 years and calendar trends in cumulative incidence and hazard rates, each by HIV status. Cumulative incidences of cancer by age 75 years for persons with and without HIV, respectively, were as follows: Kaposi sarcoma, 4.4% and 0.01%; non-Hodgkin lymphoma, 4.5% and 0.7%; lung cancer, 3.4% and 2.8%; anal cancer, 1.5% and 0.05%; colorectal cancer, 1.0% and 1.5%; liver cancer, 1.1% and 0.4%; Hodgkin lymphoma, 0.9% and 0.09%; melanoma, 0.5% and 0.6%; and oral cavity/pharyngeal cancer, 0.8% and 0.8%. Among persons with HIV, calendar trends in cumulative incidence and hazard rate decreased for Kaposi sarcoma and non-Hodgkin lymphoma. For anal, colorectal, and liver cancer, increasing cumulative incidence, but not hazard rate trends, were due to the decreasing mortality rate trend (-9% per year), allowing greater opportunity to be diagnosed. Despite decreasing hazard rate trends for lung cancer, Hodgkin lymphoma, and melanoma, cumulative incidence trends were not seen because of the compensating effect of the declining mortality rate. Secular trends in screening, smoking, and viral co-infections were not evaluated. Cumulative cancer incidence by age 75 years, approximating lifetime risk in persons with HIV, may have clinical utility in this population. The high cumulative incidences by age 75 years for Kaposi sarcoma, non-Hodgkin lymphoma, and lung cancer support early and sustained antiretroviral therapy and smoking cessation.

Barriers to Success in Parent Training for Young Children with Developmental Delay: The Role of Cumulative Risk

ERIC Educational Resources Information Center

Bagner, Daniel M.; Graziano, Paulo A.

2013-01-01

The purpose of this study was to examine the effect of cumulative risk on dropout and treatment outcome in parent training. Participants were 44 families of young children (mean age of 49.59 months) who presented with elevated externalizing behavior problems and developmental delay or borderline developmental delay. All families were offered to…

A framework for cumulative risk assessment in the 21st century.

PubMed

Moretto, Angelo; Bachman, Ammie; Boobis, Alan; Solomon, Keith R; Pastoor, Timothy P; Wilks, Martin F; Embry, Michelle R

2017-02-01

The ILSI Health and Environmental Sciences Institute (HESI) has developed a framework to support a transition in the way in which information for chemical risk assessment is obtained and used (RISK21). The approach is based on detailed problem formulation, where exposure drives the data acquisition process in order to enable informed decision-making on human health safety as soon as sufficient evidence is available. Information is evaluated in a transparent and consistent way with the aim of optimizing available resources. In the context of risk assessment, cumulative risk assessment (CRA) poses additional problems and questions that can be addressed using the RISK21 approach. The focus in CRA to date has generally been on chemicals that have common mechanisms of action. Recently, concern has also been expressed about chemicals acting on multiple pathways that lead to a common health outcome, and non-chemical other conditions (non-chemical stressors) that can lead to or modify a common outcome. Acknowledging that CRAs, as described above, are more conceptually, methodologically and computationally complex than traditional single-stressor risk assessments, RISK21 further developed the framework for implementation of workable processes and procedures for conducting assessments of combined effects from exposure to multiple chemicals and non-chemical stressors. As part of the problem formulation process, this evidence-based framework allows the identification of the circumstances in which it is appropriate to conduct a CRA for a group of compounds. A tiered approach is then proposed, where additional chemical stressors and/or non-chemical modulating factors (ModFs) are considered sequentially. Criteria are provided to facilitate the decision on whether or not to include ModFs in the formal quantitative assessment, with the intention to help focus the use of available resources to have the greatest potential to protect public health.

An Overview of Literature Topics Related to Current Concepts, Methods, Tools, and Applications for Cumulative Risk Assessment (2007-2016).

PubMed

Fox, Mary A; Brewer, L Elizabeth; Martin, Lawrence

2017-04-07

Cumulative risk assessments (CRAs) address combined risks from exposures to multiple chemical and nonchemical stressors and may focus on vulnerable communities or populations. Significant contributions have been made to the development of concepts, methods, and applications for CRA over the past decade. Work in both human health and ecological cumulative risk has advanced in two different contexts. The first context is the effects of chemical mixtures that share common modes of action, or that cause common adverse outcomes. In this context two primary models are used for predicting mixture effects, dose addition or response addition. The second context is evaluating the combined effects of chemical and nonchemical (e.g., radiation, biological, nutritional, economic, psychological, habitat alteration, land-use change, global climate change, and natural disasters) stressors. CRA can be adapted to address risk in many contexts, and this adaptability is reflected in the range in disciplinary perspectives in the published literature. This article presents the results of a literature search and discusses a range of selected work with the intention to give a broad overview of relevant topics and provide a starting point for researchers interested in CRA applications.

Are All Risks Equal? Early Experiences of Poverty-Related Risk and Children’s Functioning

PubMed Central

Roy, Amanda L.; Raver, C. Cybele

2014-01-01

Using cumulative risk and latent class analysis (LCA) models, this research examines how exposure to deep poverty (income-to-needs ratio <.50) and four poverty-related risks (single-parent household, residential crowding, caregiver depression, and multiple life stressors) in preschool is related to children’s future difficulty in school in a longitudinal sample of 602 Head-Start enrolled, low-income families. Results from the LCA revealed four risk profiles: low risk, deep poverty and single, single and stressed, and deep poverty and crowded household. Tests of measurement invariance across racial/ethnic groups established that although patterns of risk are similar across groups (i.e. risks co-vary in the same way), the prevalence of risk profiles differ. African American families were over-represented in the ‘deep poverty and single’ profile while Latino and White families were over-represented in the ‘deep poverty and crowded’ profile. Finally, children’s third grade functioning in three domains (academic performance, behavior problems, self-regulatory skills) was predicted using a cumulative risk index and LCA identified risk profiles. Both approaches demonstrated that children who experienced higher levels of risk in preschool had worse school performance than children with low levels of risk. However, the LCA also revealed that children who experienced ‘single and stressed’ family settings had more behavior problems than low risk children while children who experienced ‘deep poverty and crowded’ family settings had worse academic performance. The results indicate that all risks are not equal for children’s development and highlight the utility of LCA for tailoring intervention efforts to best meet the needs of target populations. PMID:24749652

Cumulative Environmental Impacts: Science and Policy to Protect Communities.

PubMed

Solomon, Gina M; Morello-Frosch, Rachel; Zeise, Lauren; Faust, John B

2016-01-01

Many communities are located near multiple sources of pollution, including current and former industrial sites, major roadways, and agricultural operations. Populations in such locations are predominantly low-income, with a large percentage of minorities and non-English speakers. These communities face challenges that can affect the health of their residents, including limited access to health care, a shortage of grocery stores, poor housing quality, and a lack of parks and open spaces. Environmental exposures may interact with social stressors, thereby worsening health outcomes. Age, genetic characteristics, and preexisting health conditions increase the risk of adverse health effects from exposure to pollutants. There are existing approaches for characterizing cumulative exposures, cumulative risks, and cumulative health impacts. Although such approaches have merit, they also have significant constraints. New developments in exposure monitoring, mapping, toxicology, and epidemiology, especially when informed by community participation, have the potential to advance the science on cumulative impacts and to improve decision making.

Life Course Associations between Victimization and Aggression: Distinctive and Cumulative Contributions

PubMed Central

Logan-Greene, Patricia; Nurius, Paula S.; Hooven, Carole; Thompson, Elaine Adams

2014-01-01

The connections between early maltreatment and later aggression are well established in the literature, however gaps remain in our understanding of developmental processes. This study investigates the cascading life course linkages between victimization experiences from childhood through early adulthood and later aggressive behavior. The diverse, at-risk sample is of particular importance to child and adolescent specialists, as it represents highly vulnerable youth accessible through conventional school settings. In addition to direct pathways from proximal life periods, path analysis revealed significant indirect mediated pathways through which earlier life victimization contributes to aggressive behaviors in later life periods as well as revictimization. Multivariate regressions support theorized cumulative effects of multi-form victimization as well as distinct contributions of victimization domains (emotional, witnessing, physical, property, and sexual) in explaining aggressive behavior. Consistent with theorizing about the developmental impact of early maltreatment, results bolster the importance of interrupting pathways from victimization to revictimization and later aggression. Findings are evaluated in light of implications for early identification and prevention programming. PMID:26190900

The Roles of School Readiness and Poverty-Related Risk for 6th Grade Outcomes

PubMed Central

Pressler, Emily; Raver, C. Cybele; Friedman-Krauss, Allison H.; Roy, Amanda

2016-01-01

Low-income students are at increased risk for grade retention and suspension, which dampens their chances of high school graduation, college attendance, and future success. Drawing from a sample of 357 children and their families who participated in the Chicago School Readiness Project, we examine whether greater exposure to cumulative poverty-related risk from preschool through 5th grade is associated with greater risk of student retention and suspension in 6th grade. Logistic regression results indicate that exposure to higher levels of cumulative risk across the elementary school years is associated with students’ increased risk of retention in 6th grade, even after controlling for child school readiness skills and other covariates. Importantly, findings of the association between average cumulative risk exposure and student suspension are more complex; the role of poverty-related risk is reduced to non-significance once early indicators of child school readiness and other covariates are included in regression models. While, children’s early externalizing behavior prior to kindergarten places children at greater risk of suspension 7 years later, children’s higher levels of internalizing behaviors and early math skills are associated with significantly decreased risk of suspension in the 6th grade. Together, findings from the study suggest the complex ways that both early school readiness and subsequent exposure to poverty-related risk may both serve as compelling predictors of children’s likelihood of “staying on track” academically in the 6th grade. PMID:27867447

Aging and Cumulative Inequality: How Does Inequality Get Under the Skin?

ERIC Educational Resources Information Center

Ferraro, Kenneth F.; Shippee, Tetyana Pylypiv

2009-01-01

Purpose: This article draws from cumulative disadvantage and life course theories to develop a new theory for the social scientific study of aging. Design and Methods: Five axioms of "cumulative inequality (CI) theory" are articulated to identify how life course trajectories are influenced by early and accumulated inequalities but can be modified…

Attachment and attention: protection in relation to gender and cumulative social-contextual adversity.

PubMed

Fearon, R M Pasco; Belsky, Jay

2004-01-01

Data from 918 children from the National Institute of Child Health and Human Development (NICHD) Study of Early Child Care were examined to test the interrelation of attachment and attentional performance and 2 known risks for poor attentional performance: male gender and social-contextual adversity. Attachment was measured using the Strange Situation at 15 months, attentional performance by a Continuous Performance Test (CPT) and maternal questionnaires at 54 months, and social-contextual adversity by a variety of measures from birth to 54 months. Findings indicated (a) that children with secure attachment were less susceptible to the effects of cumulative risk and gender on CPT attentional performance than their insecure counterparts and that (b) no such differential risk susceptibility was evident for maternal reports of attention-related behavior problems.

Actionable Intelligence about Early Childhood Risks in Philadelphia

ERIC Educational Resources Information Center

LeBoeuf, Whitney A.; Barghaus, Katherine; Fantuzzo, John; Coe, Kristen; Brumley, Benjamin

2016-01-01

"Early childhood risks" are markers of early childhood experiences that extensive research has shown to be detrimental to later academic and behavioral outcomes. In Philadelphia, evidence indicates that seven early childhood risks tracked by public agencies have negative effects on early school outcomes. These risks include low…

Cumulative family risks across income levels predict deterioration of children’s general health during childhood and adolescence

PubMed Central

Seo, Dong-Chul

2017-01-01

Family is considered an important agent in the health development of children. This process is significant but quite complex because the prevalence of potential risk factors in the family can hinder children’s health. This study examined if multiple family risks might have cumulative effect on children and youth’s health across various levels of household income. The data in this study were drawn from the 2011–2012 U.S. National Survey of Children’s Health (N = 79,601). A cumulative family risk (CFR) index was developed, which included such constructs as single-parenthood, unstable employment, large family, parenting stress, poor maternal education, poor maternal general health and poor maternal mental health. Multiple logistic regression analyses showed that CFR level was significantly related to children and youth’s poor health outcome (p < .001). When poverty levels were considered, however, the impact of CFRs on children and youth’s health was attenuated. The impact of CFRs was higher on children and youth from affluent families than on those from poor families. Overall there was a consistent pattern of trend in the point estimate as well as confidence limits as levels of affluence and numbers of family risk increased although some of the confidence intervals overlapped. Living in disadvantaged families might serve as a protective factor against CFRs possibly through repeated exposure to hardships and subsequent formation of resilience among some of the disadvantaged children. PMID:28520758

Testing the cumulative stress and mismatch hypotheses of psychopathology in a rat model of early-life adversity.

PubMed

Daskalakis, Nikolaos P; Oitzl, Melly S; Schächinger, Hartmut; Champagne, Danielle L; de Kloet, E Ronald

2012-07-16

In the present study, we tested both the cumulative stress and the mismatch hypothesis of psychopathology. For this purpose the combined effects of early-life adversity and later-life stress exposure on behavioral markers of psychosis susceptibility were studied in male Wistar rats. Experiment I: rat pups divided on the basis of the levels of their maternal care experience in low, medium or high maternal care groups, were reared post-weaning in groups (Exp. IA) or in social isolation (Exp. IB) and tested at adulthood under basal conditions or after an acute corticosterone (CORT) administration. Maternal care levels were assessed by measuring the dam's licking and grooming (LG) the first postnatal week of life. Experiment II: rat pups exposed as neonates to daily sessions of 8h of maternal separation (MS) on postnatal days 3, 4 and 5 either altogether in their home cage (HOME SEP) or alone in a novel environment (NOVEL SEP), were reared post-weaning in groups and tested at adulthood under basal conditions. Adult testing included behaviors marking psychosis susceptibility: apomorphine-induced gnawing (APO-gnawing), acoustic startle response and its modulation by a prepulse stimulus (PPI). The behavior of the Medium LG offspring was used as baseline reference for all the three experiments. Experiment I: Low maternal LG history alone had limited effects on the behavior of Wistar offspring, although increased acoustic startle and increased PPI, at high prepulse intensity levels, were observed. When low maternal LG history was combined with post-weaning social isolation, basal APO-gnawing was decreased and PPI increased, compared to High LG and Med LG offspring. This reflects attenuated psychosis susceptibility. High LG offspring reared in isolation displayed, however, the highest APO-gnawing and the lowest PPI levels among rats reared in social isolation, which is indicative for increased psychosis susceptibility. These findings support the mismatch hypothesis. For

An Overview of Literature Topics Related to Current Concepts, Methods, Tools, and Applications for Cumulative Risk Assessment (2007–2016)

PubMed Central

Fox, Mary A.; Brewer, L. Elizabeth; Martin, Lawrence

2017-01-01

Cumulative risk assessments (CRAs) address combined risks from exposures to multiple chemical and nonchemical stressors and may focus on vulnerable communities or populations. Significant contributions have been made to the development of concepts, methods, and applications for CRA over the past decade. Work in both human health and ecological cumulative risk has advanced in two different contexts. The first context is the effects of chemical mixtures that share common modes of action, or that cause common adverse outcomes. In this context two primary models are used for predicting mixture effects, dose addition or response addition. The second context is evaluating the combined effects of chemical and nonchemical (e.g., radiation, biological, nutritional, economic, psychological, habitat alteration, land-use change, global climate change, and natural disasters) stressors. CRA can be adapted to address risk in many contexts, and this adaptability is reflected in the range in disciplinary perspectives in the published literature. This article presents the results of a literature search and discusses a range of selected work with the intention to give a broad overview of relevant topics and provide a starting point for researchers interested in CRA applications. PMID:28387705

Measuring women's cumulative neighborhood deprivation exposure using longitudinally linked vital records: a method for life course MCH research.

PubMed

Kramer, Michael R; Dunlop, Anne L; Hogue, Carol J R

2014-02-01

A life course conceptual framework for MCH research demands new tools for understanding population health and measuring exposures. We propose a method for measuring population-based socio-environmental trajectories for women of reproductive age. We merged maternal longitudinally-linked births to Georgia-resident women from 1994 to 2007 with census economic and social measures using residential geocodes to create woman-centered socio-environmental trajectories. We calculated a woman's neighborhood deprivation index (NDI) at the time of each of her births and, from these, we calculated a cumulative NDI. We fit Loess curves to describe average life course NDI trajectories and binomial regression models to test specific life course theory hypotheses relating cumulative NDI to risk for preterm birth. Of the 1,815,944 total live births, we linked 1,000,437 live births to 413,048 unique women with two or more births. Record linkage had high specificity but relatively low sensitivity which appears non-differential with respect to maternal characteristics. Georgia women on average experienced upward mobility across the life course, although differences by race, early life neighborhood quality, and age at first birth produced differences in cumulative NDI. Adjusted binomial models found evidence for modification of the effect of history of prior preterm birth and advancing age on risk for preterm birth by cumulative NDI. The creation of trajectories from geocoded maternal longitudinally-linked vital records is one method to carry out life course MCH research. We discuss approaches for investigating the impact of truncation of the life course, selection bias from migration, and misclassification of cumulative exposure.

No added value of age at menopause and the lifetime cumulative number of menstrual cycles for cardiovascular risk prediction in postmenopausal women.

PubMed

Atsma, Femke; van der Schouw, Yvonne T; Grobbee, Diederick E; Hoes, Arno W; Bartelink, Marie-Louise E L

2008-11-12

The aim of the present study was to investigate the added value of age at menopause and the lifetime cumulative number of menstrual cycles in cardiovascular risk prediction in postmenopausal women. This study included 971 women. The ankle-arm index was used as a proxy for cardiovascular morbidity and mortality. The ankle-arm index was calculated for each leg by dividing the highest ankle systolic blood pressure by the highest brachial systolic blood pressure. A cut-off value of 0.95 was used to differentiate between low and high risk women. Three cardiovascular risk models were constructed. In the initial model all classical predictors for cardiovascular disease were investigated. This model was then extended by age at menopause or the lifetime cumulative number of menstrual cycles to test their added value for cardiovascular risk prediction. Differences in discriminative power between the models were investigated by comparing the area under the receiver operating characteristic (ROC) curves. The mean age was 66.0 (+/-5.6) years. The 6 independent predictors for cardiovascular disease were age, systolic blood pressure, total to HDL cholesterol ratio, current smoking, glucose level, and body mass index > or =30 kg/m(2). The ROC area was 0.69 (0.64-0.73) and did not change when age at menopause or the lifetime cumulative number of menstrual cycles was added. The findings in this study among postmenopausal women did not support the view that age at menopause or a refined estimation of lifetime endogenous estrogen exposure would improve cardiovascular risk prediction as approximated by the ankle-arm index.

Latent Classes and Cumulative Impacts of Adverse Childhood Experiences.

PubMed

Barboza, Gia Elise

2018-05-01

Studies of adverse childhood experiences (ACEs) have gauged severity using a cumulative risk (CR) index. Few studies have focused on the nature of the context of adversity and their association with psychosocial outcomes. The objective of this study was to examine the patterning of ACEs and to explore the resultant patterns' association with HIV risk-taking, problem drinking, and depressive symptoms in adulthood. Latent class analysis (LCA) was used to identify homogeneous, mutually exclusive "classes" of 11 of the most commonly used ACEs. The LCA resulted in four high-risk profiles and one low-risk profile, which were labeled: (1) highly abusive and dysfunctional (3.3%; n = 1,983), (2) emotionally abusive alcoholic with parental conflict (6%, n = 3,303), (3) sexual abuse only (4.3%, n = 2,260), (4) emotionally abusive and alcoholic (30.3%, n = 17,460), and (5) normative, low risk (56.3%, n = 32,950). Compared to the low-risk class, each high-risk profile was differentially associated with adult psychosocial outcomes even when the conditional CR within that class was similar. The results further our understanding about the pattern of ACEs and the unique pathways to poor health. Implications for child welfare systems when dealing with individuals who have experienced multiple forms of early childhood maltreatment and/or household dysfunction are discussed.

Re-conceptualising prenatal life stressors in predicting post-partum depression: cumulative-, specific-, and domain-specific approaches to calculating risk.

PubMed

Liu, Cindy H; Tronick, Ed

2013-09-01

Prenatal life stress predicts post-partum depression (PPD); however, studies generally examine individual stressors (a specific approach) or the summation of such exposure (a cumulative approach) and their associations with PPD. Such approaches may oversimplify prenatal life stress as a risk factor for PPD. We evaluated approaches in assessing prenatal life stress as a predictor of PPD diagnosis, including a domain-specific approach that captures cumulative life stress while accounting for stress across different life stress domains: financial, relational, and physical health. The Pregnancy Risk Assessment Monitoring System, a population-based survey, was used to analyse the association of prenatal life stressors with PPD diagnoses among 3566 New York City post-partum women. Specific stressors were not associated with PPD diagnosis after controlling for sociodemographic variables. Exposure to a greater number of stressors was associated with PPD diagnosis, even after adjusting for both sociodemographic variables and specific stressors [odds ratio (OR) = 3.1, 95% confidence interval (CI) = 1.5, 6.7]. Individuals reporting a moderate-to-high number of financial problems along with a moderate-to-high number of physical problems were at greater odds of PPD (OR = 4.2, 95% CI = 1.2, 15.3); those with a moderate-to-high number of problems in all three domains were at over fivefold increased odds of PPD (OR = 5.5, CI = 1.1, 28.5). In assessing prenatal stress, clinicians should consider the extent to which stressors occur across different life domains; this association appears stronger with PPD diagnosis than simple assessments of individual stressors, which typically overestimate risk or cumulative exposures. © 2013 John Wiley & Sons Ltd.

CUMPOIS- CUMULATIVE POISSON DISTRIBUTION PROGRAM

NASA Technical Reports Server (NTRS)

Bowerman, P. N.

1994-01-01

The Cumulative Poisson distribution program, CUMPOIS, is one of two programs which make calculations involving cumulative poisson distributions. Both programs, CUMPOIS (NPO-17714) and NEWTPOIS (NPO-17715), can be used independently of one another. CUMPOIS determines the approximate cumulative binomial distribution, evaluates the cumulative distribution function (cdf) for gamma distributions with integer shape parameters, and evaluates the cdf for chi-square distributions with even degrees of freedom. It can be used by statisticians and others concerned with probabilities of independent events occurring over specific units of time, area, or volume. CUMPOIS calculates the probability that n or less events (ie. cumulative) will occur within any unit when the expected number of events is given as lambda. Normally, this probability is calculated by a direct summation, from i=0 to n, of terms involving the exponential function, lambda, and inverse factorials. This approach, however, eventually fails due to underflow for sufficiently large values of n. Additionally, when the exponential term is moved outside of the summation for simplification purposes, there is a risk that the terms remaining within the summation, and the summation itself, will overflow for certain values of i and lambda. CUMPOIS eliminates these possibilities by multiplying an additional exponential factor into the summation terms and the partial sum whenever overflow/underflow situations threaten. The reciprocal of this term is then multiplied into the completed sum giving the cumulative probability. The CUMPOIS program is written in C. It was developed on an IBM AT with a numeric co-processor using Microsoft C 5.0. Because the source code is written using standard C structures and functions, it should compile correctly on most C compilers. The program format is interactive, accepting lambda and n as inputs. It has been implemented under DOS 3.2 and has a memory requirement of 26K. CUMPOIS was

Early menarche, nulliparity and the risk for premature and early natural menopause.

PubMed

Mishra, Gita D; Pandeya, Nirmala; Dobson, Annette J; Chung, Hsin-Fang; Anderson, Debra; Kuh, Diana; Sandin, Sven; Giles, Graham G; Bruinsma, Fiona; Hayashi, Kunihiko; Lee, Jung Su; Mizunuma, Hideki; Cade, Janet E; Burley, Victoria; Greenwood, Darren C; Goodman, Alissa; Simonsen, Mette Kildevæld; Adami, Hans-Olov; Demakakos, Panayotes; Weiderpass, Elisabete

2017-03-01

Are parity and the timing of menarche associated with premature and early natural menopause? Early menarche (≤11 years) is a risk factor for both premature menopause (final menstrual period, FMP <40 years) and early menopause (FMP 40-44 years), a risk that is amplified for nulliparous women. Women with either premature or early menopause face an increased risk of chronic conditions in later life and of early death. Findings from some studies suggest that early menarche and nulliparity are associated with early menopause, however overall the evidence is mixed. Much of the evidence for a direct relationship is hampered by a lack of comparability across studies, failure to adjust for confounding factors and inadequate statistical power. This pooled study comprises 51 450 postmenopausal women from nine observational studies in the UK, Scandinavia, Australia and Japan that contribute to the International collaboration for a Life course Approach to reproductive health and Chronic disease Events (InterLACE). Age at menarche (categorized as ≤11, 12, 13, 14 and 15 or more years) and parity (categorized as no children, one child and two or more children) were exposures of interest. Age at FMP was confirmed by at least 12 months of cessation of menses where this was not the result of an intervention (such as surgical menopause due to bilateral oophorectomy or hysterectomy) and categorized as premature menopause (FMP before age 40), early menopause (FMP 40-44 years), 45-49 years, 50-51 years, 52-53 years and 54 or more years. We used multivariate multinomial logistic regression models to estimate relative risk ratio (RRR) and 95% CI for associations between menarche, parity and age at FMP adjusting for within-study correlation. The median age at FMP was 50 years (interquartile range 48-53 years), with 2% of the women experiencing premature menopause and 7.6% early menopause. Women with early menarche (≤11 years, compared with 12-13 years) were at higher risk of premature

Novel Risk Stratification Score for Predicting Early Distant Brain Failure and Salvage Whole Brain Radiotherapy after Stereotactic Radiosurgery for Brain Metastases

PubMed Central

Press, Robert H.; Prabhu, Roshan S.; Nickleach, Dana C.; Liu, Yuan; Shu, Hui-Kuo G.; Kandula, Shravan; Patel, Kirtesh R.; Curran, Walter J.; Crocker, Ian

2015-01-01

Background The purpose of this study was to evaluate predictors of early distant brain failure (DBF) and salvage whole brain radiotherapy (WBRT) after treatment with stereotactic radiosurgery (SRS) for brain metastases and create a clinically relevant risk score in order to stratify patients’ risk of these events. Methods We reviewed records of 270 patients with brain metastases treated with SRS between 2003-2012. Pre-treatment patient and tumor characteristics were analyzed by univariate and multivariable analyses. Cumulative incidence (CI) of first DBF and salvage WBRT were calculated. Significant factors were used to create a score for stratifying early (6-month) DBF risk. Results No prior WBRT, total lesion volume <1.3 cm3, primary breast cancer or malignant melanoma histology, and multiple metastases (≥2) were found to be significant predictors for early DBF. Each factor was ascribed one point due to similar hazard ratios. Scores of 0-1, 2, and 3-4 were considered low, intermediate, and high risk, respectively. This correlated with 6-month CI of DBF of 16.6%, 28.8%, and 54.4%, respectively (p<0.001). For patients without prior WBRT, the 6-month CI of salvage WBRT by 6-months was 2%, 17.7%, and 25.7%, respectively (p<0.001). Conclusion Early DBF after SRS requiring salvage WBRT remains a significant clinical problem. Patient stratification for early DBF can better inform the decision for initial treatment strategy for brain metastases. The provided risk score may help predict for early DBF and subsequent salvage WBRT if initial SRS is used. External validation is needed prior to clinical implementation. PMID:26242475

Cumulative Socioeconomic Status Risk, Allostatic Load, and Adjustment: A Prospective Latent Profile Analysis with Contextual and Genetic Protective Factors

ERIC Educational Resources Information Center

Brody, Gene H.; Yu, Tianyi; Chen, Yi-Fu; Kogan, Steven M.; Evans, Gary W.; Beach, Steven R. H.; Windle, Michael; Simons, Ronald L.; Gerrard, Meg; Gibbons, Frederick X.; Philibert, Robert A.

2013-01-01

The health disparities literature has identified a common pattern among middle-aged African Americans that includes high rates of chronic disease along with low rates of psychiatric disorders despite exposure to high levels of cumulative socioeconomic status (SES) risk. The current study was designed to test hypotheses about the developmental…

Likelihood of early detection of breast cancer in relation to false-positive risk in life-time mammographic screening: population-based cohort study.

PubMed

Otten, J D M; Fracheboud, J; den Heeten, G J; Otto, S J; Holland, R; de Koning, H J; Broeders, M J M; Verbeek, A L M

2013-10-01

Women require balanced, high-quality information when making an informed decision on screening benefits and harms before attending biennial mammographic screening. The cumulative risk of a false-positive recall and/or (small) screen-detected or interval cancer over 13 consecutive screening examinations for women aged 50 from the start of screening were estimated using data from the Nijmegen programme, the Netherlands. Women who underwent 13 successive screens in the period 1975-1976 had a 5.3% cumulative chance of a screen-detected cancer, with a 4.2% risk of at least one false-positive recall. The risk of being diagnosed with interval cancer was 3.7%. Two decades later, these estimates were 6.9%, 7.3% and 2.9%, respectively. The chance of detection of a small, favourable invasive breast cancer, anticipating a normal life-expectancy, rose from 2.3% to 3.7%. Extrapolation to digital screening mammography indicates that the proportion of false-positive results will rise to 16%. Dutch women about to participate in the screening programme can be reassured that the chance of false-positive recall in the Netherlands is relatively low. A new screening policy and improved mammography have increased the detection of an early screening carcinoma and lowering the risk of interval carcinoma.

Community, State, and Federal Approaches to Cumulative Risk Assessment: Challenges and Opportunities for Integration

PubMed Central

Barzyk, Timothy M.; Wilson, Sacoby; Wilson, Anthony

2015-01-01

Community, state, and federal approaches to conventional and cumulative risk assessment (CRA) were described and compared to assess similarities and differences, and develop recommendations for a consistent CRA approach, acceptable across each level as a rigorous scientific methodology, including partnership formation and solution development as necessary practices. Community, state, and federal examples were described and then summarized based on their adherence to CRA principles of: (1) planning, scoping, and problem formulation; (2) risk analysis and ranking, and (3) risk characterization, interpretation, and management. While each application shared the common goal of protecting human health and the environment, they adopted different approaches to achieve this. For a specific project-level analysis of a particular place or instance, this may be acceptable, but to ensure long-term applicability and transferability to other projects, recommendations for developing a consistent approach to CRA are provided. This approach would draw from best practices, risk assessment and decision analysis sciences, and historical lessons learned to provide results in an understandable and accepted manner by all entities. This approach is intended to provide a common ground around which to develop CRA methods and approaches that can be followed at all levels. PMID:25918910

Long-term cumulative depressive symptom burden and risk of cognitive decline and dementia among very old women.

PubMed

Zeki Al Hazzouri, Adina; Vittinghoff, Eric; Byers, Amy; Covinsky, Ken; Blazer, Dan; Diem, Susan; Ensrud, Kristine E; Yaffe, Kristine

2014-05-01

Depressive symptoms and cognitive outcomes are strongly interrelated. Despite that rates of depressive symptoms fluctuate during late life, little is known about the impact of long-term cumulative depressive symptom burden on cognitive decline and dementia in older adults. This study examines the association of nearly 20 years of cumulative depressive symptoms with cognitive outcomes in a cohort of older women. We assessed depressive symptoms in 7,240 women using the Geriatric Depression scale (GDS) at serial visits. We used a Poisson model with random slopes to estimate GDS trajectories for each participant from baseline to death or end of follow-up, and then characterized depressive symptom burden by quartile of the area under the curve. We assessed cognitive outcomes using repeated measures of the Mini-Mental State Examination (MMSE) and Trails B score over 20 years, Year-20 neuropsychological test battery, and adjudicated dementia and mild cognitive impairment (MCI). Adjusting for potential confounders, compared with women in the lowest quartile of cumulative depressive symptoms burden, women in the highest quartile had 21% more MMSE errors over time (95% CI = 17%, 26%), 20% worse Trails B score over time (95% CI = 17%, 23%), worse scores on most of the Year-20 cognitive tests, and a twofold greater likelihood of developing dementia or MCI (95% CI = 1.48, 3.11). Long-term cumulative depressive symptom burden was associated with cognitive decline and risk of dementia or MCI. Older adults with a history of depression should be closely monitored for recurrent episodes or unresolved depressive symptoms as well as any cognitive deficits.

Cumulative effective dose and cancer risk for pediatric population in repetitive full spine follow-up imaging: How micro dose is the EOS microdose protocol?

PubMed

Law, Martin; Ma, Wang-Kei; Lau, Damian; Cheung, Kenneth; Ip, Janice; Yip, Lawrance; Lam, Wendy

2018-04-01

To evaluate and to obtain analytic formulation for the calculation of the effective dose and associated cancer risk using the EOS microdose protocol for scoliotic pediatric patients undergoing full spine imaging at different age of exposure; to demonstrate the microdose protocol capable of delivering lesser radiation dose and hence of further reducing cancer risk induction when compared with the EOS low dose protocol; to obtain cumulative effective dose and cancer risk for both genders scoliotic pediatrics of US and Hong Kong population using the microdose protocol. Organ absorbed doses of full spine exposed scoliotic pediatric patients have been simulated with the use of EOS microdose protocol imaging parameters input to the Monte Carlo software PCXMC. Gender and age specific effective dose has been calculated with the simulated organ absorbed dose using the ICRP-103 approach. The associated radiation induced cancer risk, expressed as lifetime attributable risk (LAR), has been estimated according to the method introduced in the Biological Effects of Ionizing Radiation VII report. Values of LAR have been estimated for scoliotic patients exposed repetitively during their follow up period at different age for US and Hong Kong population. The effective doses of full spine imaging with simultaneous posteroanterior and lateral projection for patients exposed at the age between 5 and 18 years using the EOS microdose protocol have been calculated within the range of 2.54-14.75 μSv. The corresponding LAR for US and Hong Kong population was ranged between 0.04 × 10 -6 and 0.84 × 10 -6 . Cumulative effective dose and cancer risk during follow-up period can be estimated using the results and are of information to patients and their parents. With the use of computer simulation and analytic formulation, we obtained the cumulative effective dose and cancer risk at any age of exposure for pediatric patients of US and Hong Kong population undergoing repetitive

Cumulative effects of antiandrogenic chemical mixtures and their relevance to human health risk assessment.

PubMed

Howdeshell, Kembra L; Hotchkiss, Andrew K; Gray, L Earl

2017-03-01

Toxicological studies of defined chemical mixtures assist human health risk assessment by establishing how chemicals interact with one another to induce an effect. This paper reviews how antiandrogenic chemical mixtures can alter reproductive tract development in rats with a focus on the reproductive toxicant phthalates. The reviewed studies compare observed mixture data to mathematical mixture model predictions based on dose addition or response addition to determine how the individual chemicals in a mixture interact (e.g., additive, greater, or less than additive). Phthalate mixtures were observed to act in a dose additive manner based on the relative potency of the individual phthalates to suppress fetal testosterone production. Similar dose additive effects have been reported for mixtures of phthalates with antiandrogenic pesticides of differing mechanisms of action. Overall, data from these phthalate experiments in rats can be used in conjunction with human biomonitoring data to determine individual hazard indices, and recent cumulative risk assessments in humans indicate an excess risk to antiandrogenic chemical mixtures that include phthalates only or phthalates in combination with other antiandrogenic chemicals. Published by Elsevier GmbH.

Consideration of the FQPA Safety Factor and Other Uncertainty Factors in Cumulative Risk Assessment of Chemicals Sharing a Common Mechanism of Toxicity

EPA Pesticide Factsheets

This guidance document provides OPP's current thinking on application of the provision in FFDCA about an additional safety factor for the protection of infants and children in the context of cumulative risk assessments.

A missing link in the evolution of the cumulative recorder.

PubMed

Asano, Toshio; Lattal, Kennon A

2012-09-01

A recently recovered cumulative recorder provides a missing link in the evolution of the cumulative recorder from a modified kymograph to a reliably operating, scientifically and commercially successful instrument. The recorder, the only physical evidence of such an early precommercial cumulative recorder yet found, was sent to Keio University in Tokyo, Japan, in 1952 at the behest of B. F. Skinner at Harvard University. Last used in research in the late 1960s, the cumulative recorder remained locked in a storage room until 2007, when it was found again. A historical context for the recorder is followed by a description of the recorder and a comparison between it and the commercially successful Gerbrands Model C-1 recorder. Labeled the Keio recorder, it is a testament to Skinner's persistence in developing a reliable means of quantifying the behavior of living organisms in real time.

Risk Associated with Cumulative Oral Glucocorticoid Use in Patients with Giant Cell Arteritis in Real-World Databases from the USA and UK.

PubMed

Gale, Sara; Wilson, Jessica C; Chia, Jenny; Trinh, Huong; Tuckwell, Katie; Collinson, Neil; Dimonaco, Sophie; Jick, Susan; Meier, Christoph; Mohan, Shalini V; Sarsour, Khaled

2018-05-11

Treatment of giant cell arteritis (GCA) involves immediate initiation of high-dose glucocorticoid therapy with slow tapering of the dose over many months. Chronic exposure to glucocorticoids is associated with serious comorbidities. The objective of this analysis was to determine the glucocorticoid exposure and risk of glucocorticoid-related adverse events (AEs) in real-world patients with GCA. Data from the Truven Healthcare MarketScan ® database (from January 1, 2000, to June 30, 2015) and the Clinical Practice Research Datalink (CPRD; from January 1, 1995, to August 31, 2013) were used to retrospectively analyze patients aged ≥ 50 years with GCA in the USA and UK, respectively. Outcomes included oral glucocorticoid use (cumulative prednisone-equivalent exposure), glucocorticoid-related AEs and the association of AE risk with glucocorticoid exposure over 52 weeks. Of the 4804 patients in the US MarketScan database and 3973 patients in the UK CPRD database included, 71.3 and 74.6% were women and mean age was 73.4 and 73.0 years, respectively. Median starting glucocorticoid dose and cumulative glucocorticoid dose at 52 weeks were 20-50 mg/day and 4000-4800 mg, respectively. The most frequent glucocorticoid-related AEs were hypertension and eye, bone health, and glucose tolerance conditions. In the first year after diagnosis, the likelihood of any glucocorticoid-related AE was significantly increased for each 1 g increase in cumulative glucocorticoid dose in the US and UK cohorts (odds ratio [95% CI], 1.170 [1.063, 1.287] and 1.06 [1.03, 1.09], respectively; P < 0.05 for both). Similar trends were observed for the risk of glucocorticoid-related AEs over full follow-up (mean, USA: 3.9 years, UK: 6.3 years). In real-world patients with GCA, increased cumulative glucocorticoid exposure was associated with an increased risk of glucocorticoid-related AEs. F. Hoffmann-La Roche Ltd. Plain language summary available for this article.

Mismatch or cumulative stress: the pathway to depression is conditional on attention style.

PubMed

Nederhof, Esther; Ormel, Johan; Oldehinkel, Albertine J

2014-03-01

In the study reported here, the main question we investigated was whether attention style could be a conditional adaptation. We organized participants of the TRacking Adolescents' Individual Lives Survey (TRAILS; N = 2,230) into shifters, sustainers, and two comparison groups, depending on their performance on a shifting- and a sustained-attention task at age 11 years. Compared with sustainers, shifters reported more pre- and perinatal risk factors and more childhood stress, and they adopted a faster life-history strategy. These differences were not found between the comparison groups, who performed well or poorly on both tasks, which suggests that specialization for either sustained or shifting attention is the key to conditional adaptation. In a subsample (n = 860), we found that stress did not increase depression risk in shifters, whereas a mismatch between early and recent stress predicted depression in sustainers. Cumulative stress predicted depression in the comparison group. These results suggest that shifters retain high levels of plasticity throughout life, whereas sustainers' adapted their phenotype early in life to the expected mature environment.

Risk of early surgery for Crohn's disease: implications for early treatment strategies.

PubMed

Sands, Bruce E; Arsenault, Joanne E; Rosen, Michael J; Alsahli, Mazen; Bailen, Laurence; Banks, Peter; Bensen, Steven; Bousvaros, Athos; Cave, David; Cooley, Jeffrey S; Cooper, Herbert L; Edwards, Susan T; Farrell, Richard J; Griffin, Michael J; Hay, David W; John, Alex; Lidofsky, Sheldon; Olans, Lori B; Peppercorn, Mark A; Rothstein, Richard I; Roy, Michael A; Saletta, Michael J; Shah, Samir A; Warner, Andrew S; Wolf, Jacqueline L; Vecchio, James; Winter, Harland S; Zawacki, John K

2003-12-01

In this study we aimed to define the rate of early surgery for Crohn's disease and to identify risk factors associated with early surgery as a basis for subsequent studies of early intervention in Crohn's disease. We assembled a retrospective cohort of patients with Crohn's disease diagnosed between 1991 and 1997 and followed for at least 3 yr, who were identified in 16 community and referral-based practices in New England. Chart review was performed for each patient. Details of baseline demographic and disease features were recorded. Surgical history including date of surgery, indication, and procedure were also noted. Risk factors for early surgery (defined as major surgery for Crohn's disease within 3 yr of diagnosis, exclusive of major surgery at time of diagnosis) were identified by univariate analysis. Multiple logistic regression was used to identify independent risk factors. Of 345 eligible patients, 69 (20.1%) required surgery within 3 yr of diagnosis, excluding the 14 patients (4.1%) who had major surgery at the time of diagnosis. Overall, the interval between diagnosis and surgery was short; one half of all patients who required surgery underwent operation within 6 months of diagnosis. Risk factors identified by univariate analysis as significantly associated with early surgery included the following: smoking; disease of small bowel without colonic involvement; nausea and vomiting or abdominal pain on presentation; neutrophil count; and steroid use in the first 6 months. Disease localized to the colon only, blood in the stool, use of 5-aminosalicylate, and lymphocyte count were inversely associated with risk of early surgery. Logistic regression confirmed independent associations with smoking as a positive risk factor and involvement of colon without small bowel as a negative risk factor for early surgery. The rate of surgery is high in the first 3 yr after diagnosis of Crohn's disease, particularly in the first 6 months. These results suggest that

Multiple imputation methods for nonparametric inference on cumulative incidence with missing cause of failure

PubMed Central

Lee, Minjung; Dignam, James J.; Han, Junhee

2014-01-01

We propose a nonparametric approach for cumulative incidence estimation when causes of failure are unknown or missing for some subjects. Under the missing at random assumption, we estimate the cumulative incidence function using multiple imputation methods. We develop asymptotic theory for the cumulative incidence estimators obtained from multiple imputation methods. We also discuss how to construct confidence intervals for the cumulative incidence function and perform a test for comparing the cumulative incidence functions in two samples with missing cause of failure. Through simulation studies, we show that the proposed methods perform well. The methods are illustrated with data from a randomized clinical trial in early stage breast cancer. PMID:25043107

Changes in corneal endothelial cell density and the cumulative risk of corneal decompensation after Ahmed glaucoma valve implantation.

PubMed

Kim, Kyoung Nam; Lee, Sung Bok; Lee, Yeon Hee; Lee, Jong Joo; Lim, Hyung Bin; Kim, Chang-Sik

2016-07-01

To evaluate changes in the corneal endothelial cell density (ECD) and corneal decompensation following Ahmed glaucoma valve (AGV) implantation. This study was retrospective and observational case series. Patients with refractory glaucoma who underwent AGV implantation and were followed >5 years were consecutively enrolled. We reviewed the medical records, including the results of central corneal specular microscopy. Of the 127 enrolled patients, the annual change in ECD (%) was determined using linear regression for 72 eyes evaluated at least four times using serial specular microscopic examination and compared with 31 control eyes (fellow glaucomatous eyes under medical treatment). The main outcome measures were cumulative risk of corneal decompensation and differences in the ECD loss rates between subjects and controls. The mean follow-up after AGV implantation was 43.1 months. There were no cases of postoperative tube-corneal touch. The cumulative risk of corneal decompensation was 3.3%, 5 years after AGV implantation. There was a more rapid loss of ECD in the 72 subject eyes compared with the 31 controls (-7.0% and -0.1%/year, respectively; p<0.001). However, the rate of loss decreased over time and statistical significance compared with control eyes disappeared after 2 years postoperatively: -10.7% from baseline to 1 year (p<0.01), -7.0% from 1 year to 2 years (p=0.037), -4.2% from 2 years to 3 years (p=0.230) and -2.7% from 3 years to the final follow-up (p=0.111). In case of uncomplicated AGV implantation, the cumulative risk of corneal decompensation was 3.3%, 5 years after the operation. The ECD loss was statistically greater in eyes with AGV than in control eyes without AGV, but the difference was significant only up to 2 years post surgery. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Cumulative Socioeconomic Status Risk, Allostatic Load, and Adjustment: A Prospective Latent Profile Analysis With Contextual and Genetic Protective Factors

PubMed Central

Brody, Gene H.; Yu, Tianyi; Chen, Yi-fu; Kogan, Steven M.; Evans, Gary W.; Beach, Steven R. H.; Windle, Michael; Simons, Ronald L.; Gerrard, Meg; Gibbons, Frederick X.; Philibert, Robert A.

2012-01-01

The health disparities literature identified a common pattern among middle-aged African Americans that includes high rates of chronic disease along with low rates of psychiatric disorders despite exposure to high levels of cumulative SES risk. The current study was designed to test hypotheses about the developmental precursors to this pattern. Hypotheses were tested with a representative sample of 443 African American youths living in the rural South. Cumulative SES risk and protective processes were assessed at 11-13 years; psychological adjustment was assessed at ages 14-18 years; genotyping at the 5-HTTLPR was conducted at age 16 years; and allostatic load (AL) was assessed at age 19 years. A Latent Profile Analysis identified 5 profiles that evinced distinct patterns of SES risk, AL, and psychological adjustment, with 2 relatively large profiles designated as focal profiles: a physical health vulnerability profile characterized by high SES risk/high AL/low adjustment problems, and a resilient profile characterized by high SES risk/low AL/low adjustment problems. The physical health vulnerability profile mirrored the pattern found in the adult health disparities literature. Multinomial logistic regression analyses indicated that carrying an s allele at the 5-HTTLPR and receiving less peer support distinguished the physical health vulnerability profile from the resilient profile. Protective parenting and planful self-regulation distinguished both focal profiles from the other 3 profiles. The results suggest the public health importance of preventive interventions that enhance coping and reduce the effects of stress across childhood and adolescence. PMID:22709130

Cumulative socioeconomic status risk, allostatic load, and adjustment: a prospective latent profile analysis with contextual and genetic protective factors.

PubMed

Brody, Gene H; Yu, Tianyi; Chen, Yi-fu; Kogan, Steven M; Evans, Gary W; Beach, Steven R H; Windle, Michael; Simons, Ronald L; Gerrard, Meg; Gibbons, Frederick X; Philibert, Robert A

2013-05-01

The health disparities literature has identified a common pattern among middle-aged African Americans that includes high rates of chronic disease along with low rates of psychiatric disorders despite exposure to high levels of cumulative socioeconomic status (SES) risk. The current study was designed to test hypotheses about the developmental precursors to this pattern. Hypotheses were tested with a representative sample of 443 African American youths living in the rural South. Cumulative SES risk and protective processes were assessed at ages 11-13 years; psychological adjustment was assessed at ages 14-18 years; genotyping at the 5-HTTLPR was conducted at age 16 years; and allostatic load (AL) was assessed at age 19 years. A latent profile analysis identified 5 profiles that evinced distinct patterns of SES risk, AL, and psychological adjustment, with 2 relatively large profiles designated as focal profiles: a physical health vulnerability profile characterized by high SES risk/high AL/low adjustment problems, and a resilient profile characterized by high SES risk/low AL/low adjustment problems. The physical health vulnerability profile mirrored the pattern found in the adult health disparities literature. Multinomial logistic regression analyses indicated that carrying an s allele at the 5-HTTLPR and receiving less peer support distinguished the physical health vulnerability profile from the resilient profile. Protective parenting and planful self-regulation distinguished both focal profiles from the other 3 profiles. The results suggest the public health importance of preventive interventions that enhance coping and reduce the effects of stress across childhood and adolescence.

Cumulative poor psychosocial and behavioral health among low-income women at 6 weeks postpartum.

PubMed

Walker, Lorraine O; Sterling, Bobbie Sue; Guy, Sarah; Mahometa, Michael J

2013-01-01

During the postpartum period, women may experience unfavorable psychosocial and behavioral health in multiple domains with adverse effects on parenting and maternal and infant health. Yet, little is known about the accumulation of poor health across the domains of depressive symptoms; body image; diet and physical activity; substance use including smoking and alcohol; and general self-care at 6 weeks postpartum, the usual end of maternity care. The aims of this study were to evaluate relationships among the domains comprising psychosocial and behavioral health and to examine the distribution and risk factors associated with cumulative poor psychosocial and behavioral health at 6 weeks postpartum. This study was a secondary analysis of cumulative poor health assessed by self-report scales for depressive symptoms, body image dissatisfaction, diet and exercise, substance use, and general self-care among 419 low-income White, African American, and Hispanic women at 6 weeks postpartum. Multivariable Poisson and logistic regression were used in key analyses. The correlation among psychosocial and behavioral domains had a range of r = .50-.00. In this sample of women, 45% had two or more domains in which they had poor health. The model testing risk factors for cumulative poor health was significant (likelihood ratio chi-square = 39.26, df = 11, p < 0.05), with two significant factors: not exclusively breastfeeding (odds ratio [OR] = 1.459, 95% confidence interval [CI] [1.119, 1.901]) and Hispanic ethnicity (OR = 0.707, 95% CI [0.582, 0.858], psuedo-R = .029). Within individual domains, significant risk factors (body mass index, not exclusively breastfeeding, ethnicity, education level, and parity) varied by domain. Many low-income women postpartum have poor psychosocial and behavioral health in multiple domains, which constitute areas for health promotion and early disease prevention.

Early life socioeconomic position and immune response to persistent infections among elderly Latinos.

PubMed

Meier, Helen C S; Haan, Mary N; Mendes de Leon, Carlos F; Simanek, Amanda M; Dowd, Jennifer B; Aiello, Allison E

2016-10-01

Persistent infections, such as cytomegalovirus (CMV), herpes simplex virus-1 (HSV-1), Helicobacter pylori (H. pylori), and Toxoplasma gondii (T. gondii), are common in the U.S. but their prevalence varies by socioeconomic status. It is unclear if early or later life socioeconomic position (SEP) is a more salient driver of disparities in immune control of these infections. Using data from the Sacramento Area Latino Study on Aging, we examined whether early or later life SEP was the strongest predictor of immune control later in life by contrasting two life course models, the critical period model and the chain of risk model. Early life SEP was measured as a latent variable, derived from parental education and occupation, and food availability. Indicators for SEP in later life included education level and occupation. Individuals were categorized by immune response to each pathogen (seronegative, low, medium and high) with increasing immune response representing poorer immune control. Cumulative immune response was estimated using a latent profile analysis with higher total immune response representing poorer immune control. Structural equation models were used to examine direct, indirect and total effects of early life SEP on each infection and cumulative immune response, controlling for age and gender. The direct effect of early life SEP on immune response was not statistically significant for the infections or cumulative immune response. Higher early life SEP was associated with lower immune response for T. gondii, H. pylori and cumulative immune response through pathways mediated by later life SEP. For CMV, higher early life SEP was both directly associated and partially mediated by later life SEP. No association was found between SEP and HSV-1. Findings from this study support a chain of risk model, whereby early life SEP acts through later life SEP to affect immune response to persistent infections in older age. Copyright © 2016 Elsevier Ltd. All rights

Interactive Contributions of Cumulative Peer Stress and Executive Function Deficits to Depression in Early Adolescence.

PubMed

Agoston, Anna M; Rudolph, Karen D

2016-01-01

Exposure to peer stress contributes to adolescent depression, yet not all youth experience these effects. Thus, it is important to identify individual differences that shape the consequences of peer stress. This research investigated the interactive contribution of cumulative peer stress during childhood (second-fifth grades) and executive function (EF) deficits to depression during early adolescence (sixth grade). Youth (267 girls, 227 boys; X̄ age at Wave 1 = 7.95, SD = .37) completed questionnaires and semi-structured interviews to assess peer stress and depression, respectively; teachers completed the Behavior Rating Scale of Executive Function to assess everyday performance in several EF domains. As anticipated, exposure to peer stress in childhood predicted heightened sixth-grade depression in girls but not boys with higher levels of EF deficits. This study extends theory and research on individual differences in vulnerability to adolescent depression, in turn elucidating potential intervention targets.

Interactive Contributions of Cumulative Peer Stress and Executive Function Deficits to Depression in Early Adolescence

PubMed Central

Agoston, Anna M.; Rudolph, Karen D.

2017-01-01

Exposure to peer stress contributes to adolescent depression, yet not all youth experience these effects. Thus, it is important to identify individual differences that shape the consequences of peer stress. This research investigated the interactive contribution of cumulative peer stress during childhood (second-fifth grades) and executive function (EF) deficits to depression during early adolescence (sixth grade). Youth (267 girls, 227 boys; X̄age at Wave 1 = 7.95, SD = .37) completed questionnaires and semi-structured interviews to assess peer stress and depression, respectively; teachers completed the Behavior Rating Scale of Executive Function to assess everyday performance in several EF domains. As anticipated, exposure to peer stress in childhood predicted heightened sixth-grade depression in girls but not boys with higher levels of EF deficits. This study extends theory and research on individual differences in vulnerability to adolescent depression, in turn elucidating potential intervention targets. PMID:28936024

Mismatch or cumulative stress: toward an integrated hypothesis of programming effects.

PubMed

Nederhof, Esther; Schmidt, Mathias V

2012-07-16

This paper integrates the cumulative stress hypothesis with the mismatch hypothesis, taking into account individual differences in sensitivity to programming. According to the cumulative stress hypothesis, individuals are more likely to suffer from disease as adversity accumulates. According to the mismatch hypothesis, individuals are more likely to suffer from disease if a mismatch occurs between the early programming environment and the later adult environment. These seemingly contradicting hypotheses are integrated into a new model proposing that the cumulative stress hypothesis applies to individuals who were not or only to a small extent programmed by their early environment, while the mismatch hypothesis applies to individuals who experienced strong programming effects. Evidence for the main effects of adversity as well as evidence for the interaction between adversity in early and later life is presented from human observational studies and animal models. Next, convincing evidence for individual differences in sensitivity to programming is presented. We extensively discuss how our integrated model can be tested empirically in animal models and human studies, inviting researchers to test this model. Furthermore, this integrated model should tempt clinicians and other intervenors to interpret symptoms as possible adaptations from an evolutionary biology perspective. Copyright © 2011 Elsevier Inc. All rights reserved.

Individual Impact Magnitude vs. Cumulative Magnitude for Estimating Concussion Odds.

PubMed

O'Connor, Kathryn L; Peeters, Thomas; Szymanski, Stefan; Broglio, Steven P

2017-08-01

Helmeted impact devices have allowed researchers to investigate the biomechanics of head impacts in vivo. While increased impact magnitude has been associated with greater concussion risk, a definitive concussive threshold has not been established. It is likely that concussion risk is not determined by a single impact itself, but a host of predisposing factors. These factors may include genetics, fatigue, and/or prior head impact exposure. The objective of the current paper is to investigate the association between cumulative head impact magnitude and concussion risk. It is hypothesized that increased cumulative magnitudes will be associated with greater concussion risk. This retrospective analysis included participants that were recruited from regional high-schools in Illinois and Michigan from 2007 to 2014 as part of an ongoing study on concussion biomechanics. Across seven seasons, 185 high school football athletes were instrumented with the Head Impact Telemetry system. Out of 185 athletes, 31 (17%) sustained a concussion, with two athletes sustaining two concussions over the study period, yielding 33 concussive events. The system recorded 78,204 impacts for all concussed players. Linear acceleration, rotational acceleration, and head impact telemetry severity profile (HITsp) magnitudes were summed within five timeframes: the day of injury, three days prior to injury, seven days prior to injury, 30 days prior to injury, and prior in-season exposure. Logistic regressions were modeled to explain concussive events based on the singular linear acceleration, rotational acceleration, and HITsp event along with the calculated summations over time. Linear acceleration, rotational acceleration, and HITsp all produced significant models estimating concussion (p < 0.05). The strongest estimators of a concussive impact were the linear acceleration (OR = 1.040, p < 0.05), rotational acceleration (OR = 1.001, p < 0.05), and HITsp (OR = 1.003, p < 0.05) for the

Phthalates in Commercial Chinese Rice Wines: Concentrations and the Cumulative Risk Assessment to Adult Males in Shanghai.

PubMed

Huang, Yue; Lu, Wen Wei; Chen, Bo; You, Jie; Wu, Min; Li, Shu Guang

2014-10-01

The concentrations of 16 phthalates in 164 commercial Chinese rice wines (CRW) were detected by GC-MS, and consumption data on CRW in different packaging types was investigated from 634 adult males in Shanghai using a food frequency questionnaire. Based on the principles of probabilistic modelling and cumulative risk assessment, the exposure and health risk of phthalates from CRW to adult males in Shanghai was evaluated. DMP, DEP, DIBP, DnBP, BBP, and DEHP were detected in the samples, the range of detection frequency of individual phthalates varied from 6.10% for BBP to 15.24% for DIBP, and the detected concentrations were 51.06-200.34 ng/mL. All the respondents consumed CRW, 90.69% of them consumed CRW 0.01-49.9 mL/d, the minimum value of the average daily intake of CRW was 6.25 mL/d, the median was 13.72 mL/d and the maximum was 300 mL/d. The median exposure level of the 6 detected Phthalates to adult males in Shanghai were 6.58-7.10 ng/(d•kg), and the maximum exposure level were 137.38-540.47 ng/(d•kg). The cumulative exposure health risk index (HI) based on the median and maximum exposure level of the 6 Phthalates (DMP, DEP, DIBP, DnBP, BBP, and DEHP) were 0.001147 and 0.063396, both were far less than 1. In conclusion, CRW were generally consumed by the adult males in Shanghai, although multiple phthalates were detected in commercial CRW, health risk of such exposure levels from commercial CRW to the target adult males in Shanghai was very low. Copyright © 2014 The Editorial Board of Biomedical and Environmental Sciences. Published by China CDC. All rights reserved.

Process monitoring in intensive care with the use of cumulative expected minus observed mortality and risk-adjusted P charts.

PubMed

Cockings, Jerome G L; Cook, David A; Iqbal, Rehana K

2006-02-01

A health care system is a complex adaptive system. The effect of a single intervention, incorporated into a complex clinical environment, may be different from that expected. A national database such as the Intensive Care National Audit & Research Centre (ICNARC) Case Mix Programme in the UK represents a centralised monitoring, surveillance and reporting system for retrospective quality and comparative audit. This can be supplemented with real-time process monitoring at a local level for continuous process improvement, allowing early detection of the impact of both unplanned and deliberately imposed changes in the clinical environment. Demographic and UK Acute Physiology and Chronic Health Evaluation II (APACHE II) data were prospectively collected on all patients admitted to a UK regional hospital between 1 January 2003 and 30 June 2004 in accordance with the ICNARC Case Mix Programme. We present a cumulative expected minus observed (E-O) plot and the risk-adjusted p chart as methods of continuous process monitoring. We describe the construction and interpretation of these charts and show how they can be used to detect planned or unplanned organisational process changes affecting mortality outcomes. Five hundred and eighty-nine adult patients were included. The overall death rate was 0.78 of predicted. Calibration showed excess survival in ranges above 30% risk of death. The E-O plot confirmed a survival above that predicted. Small transient variations were seen in the slope that could represent random effects, or real but transient changes in the quality of care. The risk-adjusted p chart showed several observations below the 2 SD control limits of the expected mortality rate. These plots provide rapid analysis of risk-adjusted performance suitable for local application and interpretation. The E-O chart provided rapid easily visible feedback of changes in risk-adjusted mortality, while the risk-adjusted p chart allowed statistical evaluation. Local analysis of

Eye lens radiation exposure to interventional cardiologists: a retrospective assessment of cumulative doses.

PubMed

Jacob, Sophie; Donadille, Laurent; Maccia, Carlo; Bar, Olivier; Boveda, Serge; Laurier, Dominique; Bernier, Marie-Odile

2013-03-01

Radiation dose to the eye lens is a crucial issue for interventional cardiologists (ICs) who are exposed during the procedures they perform. This paper presents a retrospective assessment of the cumulative eye lens doses of ICs enrolled in the O'CLOC study for Occupational Cataracts and Lens Opacities in interventional Cardiology. Information on the workload in the catheterisation laboratory, radiation protection equipment, eye lens dose per procedure and dose reduction factors associated with eye-protective equipment were considered. For the 129 ICs at an average age of 51 who had worked for an average period of 22 years, the estimated cumulative eye lens dose ranged from 25 mSv to more than 1600 mSv; the mean ± SD was 423 ± 359 mSv. After several years of practice, without eye protection, ICs may exceed the new ICRP lifetime eye dose threshold of 500 mSv and be at high risk of developing early radiation-induced cataracts. Radiation protection equipment can reduce these doses and should be used routinely.

Higher-order cumulants and spectral kurtosis for early detection of subterranean termites

NASA Astrophysics Data System (ADS)

de la Rosa, Juan José González; Moreno Muñoz, Antonio

2008-02-01

This paper deals with termite detection in non-favorable SNR scenarios via signal processing using higher-order statistics. The results could be extrapolated to all impulse-like insect emissions; the situation involves non-destructive termite detection. Fourth-order cumulants in time and frequency domains enhance the detection and complete the characterization of termite emissions, non-Gaussian in essence. Sliding higher-order cumulants offer distinctive time instances, as a complement to the sliding variance, which only reveal power excesses in the signal; even for low-amplitude impulses. The spectral kurtosis reveals non-Gaussian characteristics (the peakedness of the probability density function) associated to these non-stationary measurements, specially in the near ultrasound frequency band. Contrasted estimators have been used to compute the higher-order statistics. The inedited findings are shown via graphical examples.

Cumulative Risk, Negative Emotionality, and Emotion Regulation as Predictors of Social Competence in Transition to School: A Mediated Moderation Model

ERIC Educational Resources Information Center

Chang, Hyein; Shelleby, Elizabeth C.; Cheong, JeeWon; Shaw, Daniel S.

2012-01-01

The goals of this study were to examine the additive and interactive effects of cumulative risk and child negative emotionality on children's social competence in the transition from preschool to school and to test whether these associations were mediated by child emotion regulation within a sample of 310 low-income, ethnically diverse boys.…

Cumulative hazard: The case of nuisance flooding

NASA Astrophysics Data System (ADS)

Moftakhari, Hamed R.; AghaKouchak, Amir; Sanders, Brett F.; Matthew, Richard A.

2017-02-01

The cumulative cost of frequent events (e.g., nuisance floods) over time may exceed the costs of the extreme but infrequent events for which societies typically prepare. Here we analyze the likelihood of exceedances above mean higher high water and the corresponding property value exposure for minor, major, and extreme coastal floods. Our results suggest that, in response to sea level rise, nuisance flooding (NF) could generate property value exposure comparable to, or larger than, extreme events. Determining whether (and when) low cost, nuisance incidents aggregate into high cost impacts and deciding when to invest in preventive measures are among the most difficult decisions for policymakers. It would be unfortunate if efforts to protect societies from extreme events (e.g., 0.01 annual probability) left them exposed to a cumulative hazard with enormous costs. We propose a Cumulative Hazard Index (CHI) as a tool for framing the future cumulative impact of low cost incidents relative to infrequent extreme events. CHI suggests that in New York, NY, Washington, DC, Miami, FL, San Francisco, CA, and Seattle, WA, a careful consideration of socioeconomic impacts of NF for prioritization is crucial for sustainable coastal flood risk management.

Male chromosomal polymorphisms reduce cumulative live birth rate for IVF couples.

PubMed

Ni, Tianxiang; Li, Jing; Chen, Hong; Gao, Yuan; Gao, Xuan; Yan, Junhao; Chen, Zi-Jiang

2017-08-01

Chromosomal polymorphisms are associated with infertility, but their effects on assisted reproductive outcomes are still quite conflicting, especially after IVF treatment. This study evaluated the role of chromosomal polymorphisms of different genders in IVF pregnancy outcomes. Four hundred and twenty-five infertile couples undergoing IVF treatment were divided into three groups: 214 couples with normal chromosomes (group A, control group), 86 couples with female polymorphisms (group B), and 125 couples with male polymorphisms (group C). The pregnancy outcomes after the first and cumulative transfer cycles were analyzed, and the main outcome measures were live birth rate (LBR) after the first transfer cycle and cumulative LBR after a complete IVF cycle. Comparison of pregnancy outcomes after the first transfer cycle within group A, group B, and group C demonstrated a similar LBR as well as other rates of implantation, clinical pregnancy, early miscarriage, and ongoing pregnancy (P > 0.05). However, the analysis of cumulative pregnancy outcomes indicated that compared with group A, group C had a significantly lower LBR per cycle (80.4 vs 68.00%), for a rate ratio of 1.182 (95% CI 1.030 to 1.356, P = 0.01) and a significantly higher cumulative early miscarriage rate (EMR) among clinical pregnancies (7.2 vs 14.7%), for a rate ratio of 0.489 (95% CI 0.248 to 0.963, P = 0.035). Couples with chromosomal polymorphisms in only male partners have poor pregnancy outcomes after IVF treatment manifesting as high cumulative EMR and low LBR after a complete cycle.

Concepts, Methods, and Data Sources for Cumulative Health Risk Assessment of Multiple Chemicals, Exposures and Effects: A Resource Document (Final Report, 2008)

EPA Science Inventory

EPA announced the availability of the final report, Concepts, Methods, and Data Sources for Cumulative Health Risk Assessment of Multiple Chemicals, Exposures and Effects: A Resource Document. This report provides the concepts, methods and data sources needed to assist in...

[Early detection on the onset of scarlet fever epidemics in Beijing, using the Cumulative Sum].

PubMed

Li, Jing; Yang, Peng; Wu, Shuang-sheng; Wang, Xiao-li; Liu, Shuang; Wang, Quan-yi

2013-05-01

Based on data related to scarlet fever which was collected from the Disease Surveillance Information Reporting System in Beijing from 2005 to 2011, to explore the efficiency of Cumulative Sum (CUSUM) in detecting the onset of scarlet fever epidemics. Models as C1-MILD (C1), C2-MEDIUM (C2) and C3-ULTRA (C3) were used. Tools for evaluation as Youden's index and detection time were calculated to optimize the parameters and optimal model. Data on 2011 scarlet fever surveillance was used to verify the efficacy of these models. C1 (k = 0.5, H = 2σ), C2 (k = 0.7, H = 2σ), C3 (k = 1.1, H = 2σ) appeared to be the optimal parameters among these models. Youden's index of C1 was 83.0% and detection time being 0.64 weeks, Youden's index of C2 was 85.4% and detection time being 1.27 weeks, Youden's index of C1 was 85.1% and detection time being 1.36 weeks. Among the three early warning detection models, C1 had the highest efficacy. Three models all triggered the signals within 4 weeks after the onset of scarlet fever epidemics. The early warning detection model of CUSUM could be used to detect the onset of scarlet fever epidemics, with good efficacy.

A case study to illustrate the utility of the Aggregate Exposure Pathway and Adverse Outcome Pathway frameworks for integrating human health and ecological data into cumulative risk assessment

EPA Science Inventory

Cumulative risk assessment (CRA) methods, which evaluate the risk of multiple adverse outcomes (AOs) from multiple chemicals, promote the use of a conceptual site model (CSM) to integrate risk from relevant stressors. The Adverse Outcome Pathway (AOP) framework can inform these r...

Examining cumulative victimization, community violence exposure, and stigma as contributors to PTSD symptoms among high-risk young women.

PubMed

Kennedy, Angie C; Bybee, Deborah; Greeson, Megan R

2014-05-01

This study examines patterns of lifetime victimization within the family, community violence exposure, and stigma as contributors to posttraumatic stress disorder (PTSD) symptoms within a sample of 198 high-risk young women who are pregnant or parenting. We used cluster analysis to identify 5 profiles of cumulative victimization, based on participants' levels of witnessing intimate partner violence (IPV), physical abuse by an adult caregiver, and sexual victimization, all beginning by age 12. Hierarchical regression was used to examine these 5 clusters (ranging from a High All Victimization cluster characterized by high levels of all 3 forms of violence, to a Low All Victimization cluster characterized by low levels of all 3 forms), along with community violence exposure and stigma, as predictors of PTSD symptoms. We found that 3 of the cumulative victimization clusters, in comparison with Low All Victimization, were significant predictors of PTSD symptoms, as was stigma, while community violence exposure was not a significant predictor. PsycINFO Database Record (c) 2014 APA, all rights reserved

External Validity of a Risk Stratification Score Predicting Early Distant Brain Failure and Salvage Whole Brain Radiation Therapy After Stereotactic Radiosurgery for Brain Metastases.

PubMed

Press, Robert H; Boselli, Danielle M; Symanowski, James T; Lankford, Scott P; McCammon, Robert J; Moeller, Benjamin J; Heinzerling, John H; Fasola, Carolina E; Burri, Stuart H; Patel, Kirtesh R; Asher, Anthony L; Sumrall, Ashley L; Curran, Walter J; Shu, Hui-Kuo G; Crocker, Ian R; Prabhu, Roshan S

2017-07-01

A scoring system using pretreatment factors was recently published for predicting the risk of early (≤6 months) distant brain failure (DBF) and salvage whole brain radiation therapy (WBRT) after stereotactic radiosurgery (SRS) alone. Four risk factors were identified: (1) lack of prior WBRT; (2) melanoma or breast histologic features; (3) multiple brain metastases; and (4) total volume of brain metastases <1.3 cm 3 , with each factor assigned 1 point. The purpose of this study was to assess the validity of this scoring system and its appropriateness for clinical use in an independent external patient population. We reviewed the records of 247 patients with 388 brain metastases treated with SRS between 2010 at 2013 at Levine Cancer Institute. The Press (Emory) risk score was calculated and applied to the validation cohort population, and subsequent risk groups were analyzed using cumulative incidence. The low-risk (LR) group had a significantly lower risk of early DBF than did the high-risk (HR) group (22.6% vs 44%, P=.004), but there was no difference between the HR and intermediate-risk (IR) groups (41.2% vs 44%, P=.79). Total lesion volume <1.3 cm 3  (P=.004), malignant melanoma (P=.007), and multiple metastases (P<.001) were validated as predictors for early DBF. Prior WBRT and breast cancer histologic features did not retain prognostic significance. Risk stratification for risk of early salvage WBRT were similar, with a trend toward an increased risk for HR compared with LR (P=.09) but no difference between IR and HR (P=.53). The 3-level Emory risk score was shown to not be externally valid, but the model was able to stratify between 2 levels (LR and not-LR [combined IR and HR]) for early (≤6 months) DBF. These results reinforce the importance of validating predictive models in independent cohorts. Further refinement of this scoring system with molecular information and in additional contemporary patient populations is warranted. Copyright © 2017

Black-White Disparity in Young Adults' Disease Risk: An Investigation of Variation in the Vulnerability of Black Young Adults to Early and Later Adversity.

PubMed

Wickrama, Kandauda A S; Bae, Dayoung; O'Neal, Catherine Walker

2016-08-01

Socioeconomic adversity in early years and young adulthood are risk factors for poor health in young adulthood. Population differences in exposure to stressful socioeconomic conditions partly explain the higher prevalence of disease among black young adults. Another plausible mechanism is that blacks are differentially vulnerable to socioeconomic adversity (differential vulnerability hypothesis), which has not been adequately investigated in previous research. The present study investigated variation in the vulnerability of black young adults leading to cardiometabolic (CM) disease risk. We used a nationally representative sample of 8,824 adolescents who participated in the Add Health study. Early and later adversity was measured using a cumulative index of social and material adversity in adolescence and young adulthood. CM disease risk was assessed using nine biomarkers. Path analysis within a structural equation modeling framework was used. The findings indicated that both early and later socioeconomic adversity act as stressors with independent additive influences on young adults' CM disease risk, consistent with the differential exposure hypothesis. Moreover, the results showed that black youth are less vulnerable to early socioeconomic adversity than whites, but they are more vulnerable to later adversity. The findings provide support for the unique and additive influences of early and later socioeconomic adversity on CM disease risk contributing to the black-white health disparity in young adulthood. The results also suggest that vulnerability to adversity varies depending on the life stage, which highlights the need for life-stage specific interventions to mitigate the existing black-white disparity in young adults' physical health. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Cumulative Risk and Impact Modeling on Environmental Chemical and Social Stressors.

PubMed

Huang, Hongtai; Wang, Aolin; Morello-Frosch, Rachel; Lam, Juleen; Sirota, Marina; Padula, Amy; Woodruff, Tracey J

2018-03-01

The goal of this review is to identify cumulative modeling methods used to evaluate combined effects of exposures to environmental chemicals and social stressors. The specific review question is: What are the existing quantitative methods used to examine the cumulative impacts of exposures to environmental chemical and social stressors on health? There has been an increase in literature that evaluates combined effects of exposures to environmental chemicals and social stressors on health using regression models; very few studies applied other data mining and machine learning techniques to this problem. The majority of studies we identified used regression models to evaluate combined effects of multiple environmental and social stressors. With proper study design and appropriate modeling assumptions, additional data mining methods may be useful to examine combined effects of environmental and social stressors.

Predicting Readmission at Early Hospitalization Using Electronic Clinical Data: An Early Readmission Risk Score.

PubMed

Tabak, Ying P; Sun, Xiaowu; Nunez, Carlos M; Gupta, Vikas; Johannes, Richard S

2017-03-01

Identifying patients at high risk for readmission early during hospitalization may aid efforts in reducing readmissions. We sought to develop an early readmission risk predictive model using automated clinical data available at hospital admission. We developed an early readmission risk model using a derivation cohort and validated the model with a validation cohort. We used a published Acute Laboratory Risk of Mortality Score as an aggregated measure of clinical severity at admission and the number of hospital discharges in the previous 90 days as a measure of disease progression. We then evaluated the administrative data-enhanced model by adding principal and secondary diagnoses and other variables. We examined the c-statistic change when additional variables were added to the model. There were 1,195,640 adult discharges from 70 hospitals with 39.8% male and the median age of 63 years (first and third quartile: 43, 78). The 30-day readmission rate was 11.9% (n=142,211). The early readmission model yielded a graded relationship of readmission and the Acute Laboratory Risk of Mortality Score and the number of previous discharges within 90 days. The model c-statistic was 0.697 with good calibration. When administrative variables were added to the model, the c-statistic increased to 0.722. Automated clinical data can generate a readmission risk score early at hospitalization with fair discrimination. It may have applied value to aid early care transition. Adding administrative data increases predictive accuracy. The administrative data-enhanced model may be used for hospital comparison and outcome research.

Rainfall Intensity and Frequency Explain Production Basis Risk in Cumulative Rain Index Insurance

NASA Astrophysics Data System (ADS)

Muneepeerakul, Chitsomanus P.; Muneepeerakul, Rachata; Huffaker, Ray G.

2017-12-01

With minimal moral hazard and adverse selection, weather index insurance promises financial resilience to farmers struck by harsh weather conditions through swift compensation at affordable premium. Despite these advantages, the very nature of indexing gives rise to production basis risk as the selected weather indexes do not sufficiently correspond to actual damages. To address this problem, we develop a stochastic yield model, built upon a stochastic soil moisture model driven by marked Poisson rainfall. Our analysis shows that even under similar temperature and rainfall amount yields can differ significantly; this was empirically supported by a 2-year field experiment in which rain-fed maize was grown under very similar total rainfall. Here, the year with more intense, less-frequent rainfall produces a better yield—a rare counter evidence to most climate change projections. Through a stochastic yield model, we demonstrate the crucial roles of rainfall intensity and frequency in determining the yield. Importantly, the model allows us to compute rainfall pattern-related basis risk inherent in cumulative rain index insurance. The model results and a case study herein clearly show that total rainfall is a poor indicator of yield, imposing unnecessary production basis risk on farmers and false-positive payouts on insurers. Incorporating rainfall intensity and frequency in the design of rain index insurance can offer farmers better protection, while maintaining the attractive features of the weather index insurance and thus fulfilling its promise of financial resilience.

Cash plus care: social protection cumulatively mitigates HIV-risk behaviour among adolescents in South Africa.

PubMed

Cluver, Lucie D; Orkin, F Mark; Boyes, Mark E; Sherr, Lorraine

2014-07-01

It is not known whether cumulative 'cash plus care' interventions can reduce adolescent HIV-infection risks in sub-Saharan Africa. This study investigated whether parental AIDS and other environmental adversities increase adolescent HIV-risk behaviour and whether social protection provision of 'cash' or integrated 'cash plus care' reduces HIV-risk behaviour. A prospective observational study with random sampling (<2.5% baseline refusal, 1-year follow-up, 96.8% retention). Three thousand five hundred and fifteen 10-18 year-olds (56.7% girls) were interviewed in South Africa between 2009-2010 and 2011-2012. All homes with a resident adolescent were sampled, within randomly selected census areas in two urban and two rural districts in two provinces. Measures included potential environmental risks (e.g. parental HIV/AIDS, poverty), social protection: receipt of cash/food support (e.g. child grants, school feeding), care (e.g. positive parenting) and HIV-risk behaviours (e.g. unprotected sex). Analyses used logistic regression. Cash alone was associated with reduced HIV risk for girls [odds ratio (OR) 0.63; 95% confidence interval (95% CI) 0.44-0.91, P = 0.02] but not for boys. Integrated cash plus care was associated with halved HIV-risk behaviour incidence for both sexes (girls OR 0.55; 95% CI 0.35-0.85, P = 0.007; boys OR 0.50; 95% CI 0.31-0.82, P = 0.005), compared with no support and controlling for confounders. Follow-up HIV-risk behaviour was reduced from 41 to 15% for girls and from 42 to 17% for boys. Girls in AIDS-affected families and informal-dwelling boys had higher HIV-risk behaviour, but were less likely to access integrated social protection. Integrated cash plus care reduces male and female adolescent HIV-risk behaviours. Increasing adolescent access to social protection may be an effective HIV prevention strategy in Sub-Saharan Africa.

Cumulative Effects of Growing Up in Separate and Unequal Neighborhoods on Racial Disparities in Self-rated Health in Early Adulthood

PubMed Central

Kravitz-Wirtz, Nicole

2017-01-01

Evidence suggests that living in a socioeconomically deprived neighborhood is associated with worse health. Yet most research relies on cross-sectional data, which implicitly ignore variation in longer-term exposure that may be more consequential for health. Using data from the 1970 to 2011 waves of the Panel Study of Income Dynamics merged with census data on respondents’ neighborhoods (N = 1,757), this study estimates a marginal structural model with inverse probability of treatment and censoring weights to examine: (1) whether cumulative exposure to neighborhood disadvantage from birth through age 17 affects self-rated health in early adulthood, and (2) the extent to which variation in such exposure helps to explain racial disparities therein. Findings reveal that prolonged exposure to neighborhood disadvantage throughout childhood and adolescence is strikingly more common among nonwhite versus white respondents and is associated with significantly greater odds of experiencing an incidence of fair or poor health in early adulthood. PMID:27799591

Comparative Risks of Cancer from Drywall Finishing Based on Stochastic Modeling of Cumulative Exposures to Respirable Dusts and Chrysotile Asbestos Fibers.

PubMed

Boelter, Fred W; Xia, Yulin; Dell, Linda

2015-05-01

Sanding joint compounds is a dusty activity and exposures are not well characterized. Until the mid 1970s, asbestos-containing joint compounds were used by some people such that sanding could emit dust and asbestos fibers. We estimated the distribution of 8-h TWA concentrations and cumulative exposures to respirable dusts and chrysotile asbestos fibers for four worker groups: (1) drywall specialists, (2) generalists, (3) tradespersons who are bystanders to drywall finishing, and (4) do-it-yourselfers (DIYers). Data collected through a survey of experienced contractors, direct field observations, and literature were used to develop prototypical exposure scenarios for each worker group. To these exposure scenarios, we applied a previously developed semi-empirical mathematical model that predicts area as well as personal breathing zone respirable dust concentrations. An empirical factor was used to estimate chrysotile fiber concentrations from respirable dust concentrations. On a task basis, we found mean 8-h TWA concentrations of respirable dust and chrysotile fibers are numerically highest for specialists, followed by generalists, DIYers, and bystander tradespersons; these concentrations are estimated to be in excess of the respective current but not historical Threshold Limit Values. Due to differences in frequency of activities, annual cumulative exposures are highest for specialists, followed by generalists, bystander tradespersons, and DIYers. Cumulative exposure estimates for chrysotile fibers from drywall finishing are expected to result in few, if any, mesothelioma or excess lung cancer deaths according to recently published risk assessments. Given the dustiness of drywall finishing, we recommend diligence in the use of readily available source controls. © 2014 Society for Risk Analysis.

76 FR 69726 - Pyrethrins/Pyrethroid Cumulative Risk Assessment; Notice of Availability

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-09

... to consider available information concerning the cumulative effects on human health resulting from... stakeholders including environmental, human health, farm worker, and agricultural advocates; the chemical... factors, may have atypical or disproportionately high and adverse human health impacts or environmental...

Early mantle heterogeneities in the Réunion hotspot source inferred from highly siderophile elements in cumulate xenoliths

NASA Astrophysics Data System (ADS)

Peters, Bradley J.; Day, James M. D.; Taylor, Lawrence A.

2016-08-01

Ultramafic cumulate rocks form during intrusive crystallization of high-MgO magmas, incorporating relatively high abundances of compatible elements, including Cr and Ni, and high abundances of the highly siderophile elements (HSE: Os, Ir, Ru, Pt, Pd, Re). Here, we utilize a suite of cumulate xenoliths from Piton de la Fournaise, La Réunion (Indian Ocean), to examine the mantle source composition of the Réunion hotspot using HSE abundances and Os isotopes. Dunite and wherlite xenoliths and associated lavas from the Piton de la Fournaise volcanic complex span a range of MgO contents (46 to 7 wt.%), yet exhibit remarkably homogeneous 187Os/188Os (0.1324 ± 0.0014, 2σ), representing the Os-isotopic composition of Réunion hotspot primary melts. A significant fraction of the xenoliths also have primitive upper-mantle (PUM) normalized HSE patterns with elevated Ru and Pd (PUM-normalized Ru/Ir and Pd/Ir of 0.8-6.3 and 0.2-7.2, respectively). These patterns are not artifacts of alteration, fractional crystallization, or partial melting processes, but rather require a primary magma with similar relative enrichments. Some highly olivine-phyric (>40 modal percent olivine) Piton de la Fournaise lavas also preserve these relative Ru and Pd enrichments, while others preserve a pattern that is likely related to sulfur saturation in evolved melts. The estimate of HSE abundances in PUM indicates high Ru/Ir and Pd/Pt values relative to carbonaceous, ordinary and enstatite chondrite meteorite groups. Thus, the existence of cumulate rocks with even more fractionated HSE patterns relative to PUM suggests that the Réunion hotspot samples a yet unrecognized mantle source. The origin of fractionated HSE patterns in Réunion melts may arise from sampling of a mantle source that experienced limited late accretion (<0.2% by mass) compared with PUM (0.5-0.8%), possibly involving impactors that were distinct from present-day chondrites, or limited core-mantle interactions. Given the

Individual differences in early adolescents' latent trait cortisol (LTC): Relation to early adversity.

PubMed

Stroud, Catherine B; Chen, Frances R; Doane, Leah D; Granger, Douglas A

2016-09-01

Substantial evidence suggests that youth who experience early adversity exhibit alterations in hypothalamic pituitary adrenal (HPA) axis functioning, thereby increasing risk for negative health outcomes. However, few studies have explored whether early adversity alters enduring trait indicators of HPA axis activity. Using objective contextual stress interviews with adolescents and their mothers to assess early adversity, we examined the cumulative impact of nine types of early adversity on early adolescents girls' latent trait cortisol (LTC). Adolescents (n = 122; M age = 12.39 years) provided salivary cortisol samples three times a day (waking, 30 min post-waking, and bedtime) over 3 days. Latent state-trait modeling indicated that the waking and 30 min post-waking samples contributed to a LTC factor. Moreover, greater early adversity was associated with a lower LTC level. Implications of LTC for future research examining the impact of early adversity on HPA axis functioning are discussed. © 2016 Wiley Periodicals, Inc. Dev Psychobiol 58:700-713, 2016. © 2016 Wiley Periodicals, Inc.

Cumulative Lifetime Marijuana Use and Incident Cardiovascular Disease in Middle Age: The Coronary Artery Risk Development in Young Adults (CARDIA) Study.

PubMed

Reis, Jared P; Auer, Reto; Bancks, Michael P; Goff, David C; Lewis, Cora E; Pletcher, Mark J; Rana, Jamal S; Shikany, James M; Sidney, Stephen

2017-04-01

To investigate the effects of marijuana in the development of incident cardiovascular and cerebrovascular outcomes. Participants were 5113 adults aged 18 to 30 years at baseline (1985-1986) from the Coronary Artery Risk Development in Young Adults study, who were followed for more than 25 years. We estimated cumulative lifetime exposure to marijuana using repeated assessments collected at examinations every 2 to 5 years. The primary outcome was incident cardiovascular disease (CVD) through 2013. A total of 84% (n = 4286) reported a history of marijuana use. During a median 26.9 years (131 990 person-years), we identified 215 CVD events, including 62 strokes or transient ischemic attacks, 104 cases of coronary heart disease, and 50 CVD deaths. Compared with no marijuana use, cumulative lifetime and recent marijuana use showed no association with incident CVD, stroke or transient ischemic attacks, coronary heart disease, or CVD mortality. Marijuana use was not associated with CVD when stratified by age, gender, race, or family history of CVD. Neither cumulative lifetime nor recent use of marijuana is associated with the incidence of CVD in middle age.

Cumulative Poisson Distribution Program

NASA Technical Reports Server (NTRS)

Bowerman, Paul N.; Scheuer, Ernest M.; Nolty, Robert

1990-01-01

Overflow and underflow in sums prevented. Cumulative Poisson Distribution Program, CUMPOIS, one of two computer programs that make calculations involving cumulative Poisson distributions. Both programs, CUMPOIS (NPO-17714) and NEWTPOIS (NPO-17715), used independently of one another. CUMPOIS determines cumulative Poisson distribution, used to evaluate cumulative distribution function (cdf) for gamma distributions with integer shape parameters and cdf for X (sup2) distributions with even degrees of freedom. Used by statisticians and others concerned with probabilities of independent events occurring over specific units of time, area, or volume. Written in C.

EARLY LIFE RISKS, ANTISOCIAL TENDENCIES, AND PRETEEN DELINQUENCY.

PubMed

Staff, Jeremy; Whichard, Corey; Siennick, Sonja; Maggs, Jennifer

2015-11-01

Early age-of-onset delinquency and substance use confer a major risk for continued criminality, alcohol and drug abuse, and other serious difficulties throughout the life course. Our objective is to examine the developmental roots of preteen delinquency and substance use. Using nationally representative longitudinal data from the UK Millennium Cohort Study ( n = 13,221), we examine the influence of early childhood developmental and family risks on latent pathways of antisocial tendencies from ages 3 to 7, and the influence of those pathways on property crime and substance use by age 11. We identified a normative, non-antisocial pathway; a pathway marked by oppositional behavior and fighting; a pathway marked by impulsivity and inattention; and a rare pathway characterized by a wide range of antisocial tendencies. Children with developmental and family risks that emerged by age 3-specifically difficult infant temperament, low cognitive ability, weak parental closeness, and disadvantaged family background-face increased odds of antisocial tendencies. There is minimal overlap between the risk factors for early antisocial tendencies and those for preteen delinquency. Children on an antisocial pathway are more likely to engage in preteen delinquency and substance use by age 11, even after accounting for early life risk factors.

EARLY LIFE RISKS, ANTISOCIAL TENDENCIES, AND PRETEEN DELINQUENCY*

PubMed Central

Staff, Jeremy; Whichard, Corey; Siennick, Sonja; Maggs, Jennifer

2015-01-01

Early age-of-onset delinquency and substance use confer a major risk for continued criminality, alcohol and drug abuse, and other serious difficulties throughout the life course. Our objective is to examine the developmental roots of preteen delinquency and substance use. Using nationally representative longitudinal data from the UK Millennium Cohort Study (n = 13,221), we examine the influence of early childhood developmental and family risks on latent pathways of antisocial tendencies from ages 3 to 7, and the influence of those pathways on property crime and substance use by age 11. We identified a normative, non-antisocial pathway; a pathway marked by oppositional behavior and fighting; a pathway marked by impulsivity and inattention; and a rare pathway characterized by a wide range of antisocial tendencies. Children with developmental and family risks that emerged by age 3—specifically difficult infant temperament, low cognitive ability, weak parental closeness, and disadvantaged family background—face increased odds of antisocial tendencies. There is minimal overlap between the risk factors for early antisocial tendencies and those for preteen delinquency. Children on an antisocial pathway are more likely to engage in preteen delinquency and substance use by age 11, even after accounting for early life risk factors. PMID:26900167

The Role of Violent Media Preference in Cumulative Developmental Risk for Violence and General Aggression

PubMed Central

Huesmann, L. Rowell; Bushman, Brad J.; O'Brien, Maureen; Moceri, Dominic

2015-01-01

The impact of exposure to violence in the media on the long-term development and short-term expression of aggressive behavior has been well documented. However, gaps in this literature remain, and in particular the role of violent media exposure in shaping violent and other serious antisocial behavior has not been investigated. Further, studies of violent media effects typically have not sampled from populations with confirmed histories of violent and/or nonviolent antisocial behavior. In this study, we analyzed data on 820 youth, including 390 juvenile delinquents and 430 high school students, to examine the relation of violent media use to involvement in violence and general aggression. Using criterion scores developed through cross-informant modeling of data from self, parent/guardian, and teacher/staff reports, we observed that childhood and adolescent violent media preferences contributed significantly to the prediction of violence and general aggression from cumulative risk totals. Findings represent a new and important direction for research on the role of violent media use in the broader matrix of risk factors for youth violence. PMID:19636754

The role of violent media preference in cumulative developmental risk for violence and general aggression.

PubMed

Boxer, Paul; Huesmann, L Rowell; Bushman, Brad J; O'Brien, Maureen; Moceri, Dominic

2009-03-01

The impact of exposure to violence in the media on the long-term development and short-term expression of aggressive behavior has been well documented. However, gaps in this literature remain, and in particular the role of violent media exposure in shaping violent and other serious antisocial behavior has not been investigated. Further, studies of violent media effects typically have not sampled from populations with confirmed histories of violent and/or nonviolent antisocial behavior. In this study, we analyzed data on 820 youth, including 390 juvenile delinquents and 430 high school students, to examine the relation of violent media use to involvement in violence and general aggression. Using criterion scores developed through cross-informant modeling of data from self, parent/guardian, and teacher/staff reports, we observed that childhood and adolescent violent media preferences contributed significantly to the prediction of violence and general aggression from cumulative risk totals. Findings represent a new and important direction for research on the role of violent media use in the broader matrix of risk factors for youth violence.

Community Engaged Cumulative Risk Assessment of Exposure to Inorganic Well Water Contaminants, Crow Reservation, Montana

PubMed Central

Doyle, John T.; Lefthand, Myra J.; Young, Sara L.; Kindness, Larry; Other Medicine, Roberta; Ford, Timothy E.; Dietrich, Eric; Parker, Albert E.; Hoover, Joseph H.; Camper, Anne K.

2018-01-01

An estimated 11 million people in the US have home wells with unsafe levels of hazardous metals and nitrate. The national scope of the health risk from consuming this water has not been assessed as home wells are largely unregulated and data on well water treatment and consumption are lacking. Here, we assessed health risks from consumption of contaminated well water on the Crow Reservation by conducting a community-engaged, cumulative risk assessment. Well water testing, surveys and interviews were used to collect data on contaminant concentrations, water treatment methods, well water consumption, and well and septic system protection and maintenance practices. Additive Hazard Index calculations show that the water in more than 39% of wells is unsafe due to uranium, manganese, nitrate, zinc and/or arsenic. Most families’ financial resources are limited, and 95% of participants do not employ water treatment technologies. Despite widespread high total dissolved solids, poor taste and odor, 80% of families consume their well water. Lack of environmental health literacy about well water safety, pre-existing health conditions and limited environmental enforcement also contribute to vulnerability. Ensuring access to safe drinking water and providing accompanying education are urgent public health priorities for Crow and other rural US families with low environmental health literacy and limited financial resources. PMID:29304032

Towards personalized screening: cumulative risk of breast cancer screening outcomes in women with and without a first-degree relative with a history of breast cancer

PubMed Central

Ripping, T.M.; Hubbard, R.A.; Otten, J.D.M.; den Heeten, G.J.; Verbeek, A.L.M.; Broeders, M.J.M.

2016-01-01

Several reviews have estimated the balance of benefits and harms of mammographic screening in the general population. The balance may, however, differ between individuals with and without family history. Therefore, our aim is to assess the cumulative risk of screening outcomes; screen-detected breast cancer, interval cancer, and false-positive results, in women screenees aged 50–75 and 40–75, with and without a first-degree relative with a history of breast cancer at the start of screening. Data on screening attendance, recall and breast cancer detection were collected for each woman living in Nijmegen (the Netherlands) since 1975. We used a discrete time survival model to calculate the cumulative probability of each major screening outcome over 19 screening rounds. Women with a family history of breast cancer had a higher risk of all screening outcomes. For women screened from age 50–75, the cumulative risk of screen-detected breast cancer, interval cancer and false-positive results were 9.0%, 4.4% and 11.1% for women with a family history and 6.3%, 2.7% and 7.3% for women without a family history, respectively. The results for women 40–75 followed the same pattern for women screened 50–75 for cancer outcomes, but were almost doubled for false-positive results. To conclude, women with a first-degree relative with a history of breast cancer are more likely to experience benefits and harms of screening than women without a family history. To complete the balance and provide risk-based screening recommendations, the breast cancer mortality reduction and overdiagnosis should be estimated for family history subgroups. PMID:26537645

Towards personalized screening: Cumulative risk of breast cancer screening outcomes in women with and without a first-degree relative with a history of breast cancer.

PubMed

Ripping, Theodora Maria; Hubbard, Rebecca A; Otten, Johannes D M; den Heeten, Gerard J; Verbeek, André L M; Broeders, Mireille J M

2016-04-01

Several reviews have estimated the balance of benefits and harms of mammographic screening in the general population. The balance may, however, differ between individuals with and without family history. Therefore, our aim is to assess the cumulative risk of screening outcomes; screen-detected breast cancer, interval cancer, and false-positive results, in women screenees aged 50-75 and 40-75, with and without a first-degree relative with a history of breast cancer at the start of screening. Data on screening attendance, recall and breast cancer detection were collected for each woman living in Nijmegen (The Netherlands) since 1975. We used a discrete time survival model to calculate the cumulative probability of each major screening outcome over 19 screening rounds. Women with a family history of breast cancer had a higher risk of all screening outcomes. For women screened from age 50-75, the cumulative risk of screen-detected breast cancer, interval cancer and false-positive results were 9.0, 4.4 and 11.1% for women with a family history and 6.3, 2.7 and 7.3% for women without a family history, respectively. The results for women 40-75 followed the same pattern for women screened 50-75 for cancer outcomes, but were almost doubled for false-positive results. To conclude, women with a first-degree relative with a history of breast cancer are more likely to experience benefits and harms of screening than women without a family history. To complete the balance and provide risk-based screening recommendations, the breast cancer mortality reduction and overdiagnosis should be estimated for family history subgroups. © 2015 UICC.

PRESSCA: A regional operative Early Warning System for landslides risk scenario assessment

NASA Astrophysics Data System (ADS)

Ponziani, Francesco; Stelluti, Marco; Berni, Nicola; Brocca, Luca; Moramarco, Tommaso

2013-04-01

The Italian national alert system for the hydraulic and hydrogeological risk is ensured by the National Civil Protection Department, through the "Functional Centres" Network, together with scientific/technical Support Centres, named "Competence Centres". The role of the Functional Centres is to alert regional/national civil protection network, to manage the prediction and the monitoring phases, thus ensuring the flow of data for the management of the emergency. The Umbria regional alerting procedure is based on three increasing warning levels of criticality for 6 sub-areas (~1200 km²). Specifically, for each duration (from 1 to 48 hours), three criticality levels are assigned to the rainfall values corresponding to a recurrence interval of 2, 5, and 10 years. In order to improve confidence on the daily work for hydrogeological risk assessment and management, a simple and operational early warning system for the prediction of shallow landslide triggering on regional scale was implemented. The system is primarily based on rainfall thresholds, which represent the main element of evaluation for the early-warning procedures of the Italian Civil Protection system. Following previous studies highlighting that soil moisture conditions play a key role on landslide triggering, a continuous physically-based soil water balance model was implemented for the estimation of soil moisture conditions over the whole regional territory. In fact, a decreasing trend between the cumulated rainfall values over 24, 36 and 48 hours and the soil moisture conditions prior to past landslide events was observed. This trend provides an easy-to-use tool to dynamically adjust the operational rainfall thresholds with the soil moisture conditions simulated by the soil water balance model prior to rainfall events. The application of this procedure allowed decreasing the uncertainties tied to the application of the rainfall thresholds only. The system is actually operational in real-time and it was

Thyroid peroxidase antibodies during early gestation and the subsequent risk of first-onset postpartum depression: A prospective cohort study.

PubMed

Wesseloo, Richard; Kamperman, Astrid M; Bergink, Veerle; Pop, Victor J M

2018-01-01

During the postpartum period, women are at risk for the new onset of both auto-immune thyroid disorders and depression. The presence of thyroid peroxidase antibodies (TPO-ab) during early gestation is predictive for postpartum auto-immune thyroid dysfunction. The aim of this study was to investigate the association between TPO-ab status during early gestation and first-onset postpartum depression. Prospective cohort study (n = 1075) with follow-up during pregnancy up to one year postpartum. Thyroid function and TPO-ab status were measured during early gestation. Depressive symptomatology was assessed during each trimester and at four time points postpartum with the Edinburgh Depression Scale (EDS). Women with antenatal depression were not eligible for inclusion. Self-reported postpartum depression was defined with an EDS cut-off of ≥ 13. The cumulative incidence of self-reported first-onset depression in the first postpartum year was 6.3%. A positive TPO-ab status was associated with an increased risk for self-reported first-onset depression at four months postpartum (adjusted OR 3.8; 95% CI 1.3-11.6), but not at other postpartum time points. Prevalence rates of self-reported postpartum depression declined after four months postpartum in the TPO-ab positive group, but remained constant in the TPO-ab negative group. Depression was defined with a self-rating questionnaire (EDS). Women with an increased TPO-ab titer during early gestation are at increased risk for self-reported first-onset depression. The longitudinal pattern of self-reported postpartum depression in the TPO-ab positive group was similar to the typical course of postpartum TPO-ab titers changes. This suggests overlap in the etiology of first-onset postpartum depression and auto-immune thyroid dysfunction. Thyroid function should be evaluated in women with first-onset postpartum depression. Copyright © 2017 Elsevier B.V. All rights reserved.

Effects of cumulative risk on behavioral and psychological well-being in first grade: moderation by neighborhood context.

PubMed

Lima, Julie; Caughy, Margaret; Nettles, Saundra M; O'Campo, Patricia J

2010-10-01

This study builds upon existing research by examining whether risk indices for child psychological well-being behave in the same way in different types of neighborhoods. Specifically, we sought to determine if neighborhood characteristics acted to exacerbate or, alternatively, to buffer risk factors at the family and/or child level. Families with a child entering first grade in Fall 2002 were recruited from Baltimore City neighborhoods, defined as census block groups. This study included 405 children, and data came from an interview with the primary caregiver and an assessment of the first grader. The dependent variables were externalizing behavior and internalizing problems. A family risk index consisting of 13 measures, and a child risk index consisting of three measures were the main independent variables of interest. We examined the effects of these indices on child psychological well-being and behavior across two neighborhood characteristics: neighborhood potential for community involvement with children and neighborhood negative social climate. Results of multivariate analyses indicated that cumulative family risk was associated with an increase in both internalizing and externalizing behavior problems. Perceived negative social climate moderated the effect of family risks on behavior problems such that more risk was associated with a larger increment in both externalizing behavior problems and psychological problems for children living in high versus low risk neighborhoods. These findings further emphasize the importance of considering neighborhood context in the study of child psychological well-being. Copyright © 2010 Elsevier Ltd. All rights reserved.

Cumulative childhood stress and autoimmune diseases in adults.

PubMed

Dube, Shanta R; Fairweather, DeLisa; Pearson, William S; Felitti, Vincent J; Anda, Robert F; Croft, Janet B

2009-02-01

To examine whether childhood traumatic stress increased the risk of developing autoimmune diseases as an adult. Retrospective cohort study of 15,357 adult health maintenance organization members enrolled in the Adverse Childhood Experiences (ACEs) Study from 1995 to 1997 in San Diego, California, and eligible for follow-up through 2005. ACEs included childhood physical, emotional, or sexual abuse; witnessing domestic violence; growing up with household substance abuse, mental illness, parental divorce, and/or an incarcerated household member. The total number of ACEs (ACE Score range = 0-8) was used as a measure of cumulative childhood stress. The outcome was hospitalizations for any of 21 selected autoimmune diseases and 4 immunopathology groupings: T- helper 1 (Th1) (e.g., idiopathic myocarditis); T-helper 2 (Th2) (e.g., myasthenia gravis); Th2 rheumatic (e.g., rheumatoid arthritis); and mixed Th1/Th2 (e.g., autoimmune hemolytic anemia). Sixty-four percent reported at least one ACE. The event rate (per 10,000 person-years) for a first hospitalization with any autoimmune disease was 31.4 in women and 34.4 in men. First hospitalizations for any autoimmune disease increased with increasing number of ACEs (p < .05). Compared with persons with no ACEs, persons with >or=2 ACEs were at a 70% increased risk for hospitalizations with Th1, 80% increased risk for Th2, and 100% increased risk for rheumatic diseases (p < .05). Childhood traumatic stress increased the likelihood of hospitalization with a diagnosed autoimmune disease decades into adulthood. These findings are consistent with recent biological studies on the impact of early life stress on subsequent inflammatory responses.

Early sport specialization: roots, effectiveness, risks.

PubMed

Malina, Robert M

2010-01-01

Year-round training in a single sport beginning at a relatively young age is increasingly common among youth. Contributing factors include perceptions of Eastern European sport programs, a parent's desire to give his or her child an edge, labeling youth as talented at an early age, pursuit of scholarships and professional contracts, the sporting goods and services industry, and expertise research. The factors interact with the demands of sport systems. Limiting experiences to a single sport is not the best path to elite status. Risks of early specialization include social isolation, overdependence, burnout, and perhaps risk of overuse injury. Commitment to a single sport at an early age immerses a youngster in a complex world regulated by adults, which is a setting that facilitates manipulation - social, dietary, chemical, and commercial. Youth sport must be kept in perspective. Participants, including talented young athletes, are children and adolescents with the needs of children and adolescents.

Psychobiology of cumulative trauma: hair cortisol as a risk marker for stress exposure in women.

PubMed

Morris, Matthew C; Abelson, James L; Mielock, Alyssa S; Rao, Uma

2017-07-01

Childhood trauma (CT) is associated with long-lasting alterations of the hypothalamic-pituitary-adrenal (HPA) axis and elevated risk for stress exposure in adulthood. Although HPA alterations are present in the early aftermath of trauma, it remains unclear how initial HPA activity is associated with subsequent stress exposure and whether CT exposure influences the strength and direction of this association. The present study examined prospective associations between hair cortisol content (HCC) and stress exposure from baseline to 3-month follow-up in young adult women with recent (i.e. past 3 months) exposure to interpersonal violence (IPV; i.e. physical or sexual assault) and non-traumatized controls. History of significant CT abuse or neglect was determined based on clinical cutoffs for a self-report CT measure: 12 women had abuse or neglect and recent IPV exposure (CT + IPV); 7 women had abuse or neglect but no IPV exposure (CT); 15 women had no history of trauma (NTC). HCC was computed for 3 cm sections reflecting cortisol secretion during the 3 months preceding the baseline assessment. The interaction of cumulative trauma and HCC predicted stress exposure over 3-month follow-up, controlling for baseline stress exposure and depressive symptoms. Simple slopes analyses revealed that lower baseline HCC predicted greater stress exposure in the CT + IPV group compared to the CT group; HCC was not associated with stress exposure in the NTC group. The present findings highlight the potential utility of HCC as a predictor of stress exposure for women with a history of childhood abuse or neglect, particularly in the context of recent IPV. Lay summary Adults with a history of CT show long-lasting alterations in major stress response systems, including the HPA axis. They are also more likely to experience stressful life events in adulthood. However, it is not clear how altered HPA activity influences risk for stress exposure and whether CT affects their

Identification and Quantification of Cumulative Factors that Increase Environmental Exposures and Impacts

EPA Science Inventory

Evaluating the combined adverse effects of multiple stressors upon human health is an imperative component of cumulative risk assessment (CRA)1. In addition to chemical stressors, other non-chemical factors are also considered. For examples, smoking will elevate the risks of havi...

Early identification and high-risk strategies for bipolar disorder.

PubMed

Correll, Christoph U; Penzner, Julie B; Lencz, Todd; Auther, Andrea; Smith, Christopher W; Malhotra, Anil K; Kane, John M; Cornblatt, Barbara A

2007-06-01

To describe and compare the relative merits of different identification strategies for individuals at risk for bipolar disorder (BPD). Selective review of data that support early identification in BPD, with a particular focus on emerging clinical high-risk strategies. Early detection of individuals at risk for BPD can utilize genetic, endophenotypic and clinical methods. Most published work focuses on genetic familial endophenotypic risk markers for BPD. However, despite encouraging results, problems with specificity and sensitivity limit the application of these data to early prevention programs. In addition, offspring studies of BPD patients systematically exclude the majority of subjects without a first-degree bipolar relative. On the other hand, emerging work in the clinical-high-risk arena has already produced encouraging results. Although still preliminary, the identification of individuals in subsyndromal or attenuated symptom 'prodromal' stages of BPD seems to be an under-researched area that holds considerable promise deserving increased attention. Required next steps include the development of rating tools for attenuated and subsyndromal manic and depressive symptoms and of prodromal criteria that will allow prodromal symptomatology to be systematically studied in patients with recent-onset bipolar, as well as in prospective population-based phenomenology trials and attenuated symptom-based high-risk studies. Given the current limitations of each early identification method, combining clinical, endophenotypic and genetic strategies will increase prediction accuracy. Since reliable biological markers for BPD have not been established and since most patients with BPD lack a first-degree relative with this disorder, clinical high-risk approaches have great potential to inform early identification and intervention programs.

Cumulative HIV viremia during highly active antiretroviral therapy is a strong predictor of AIDS-related lymphoma.

PubMed

Zoufaly, Alexander; Stellbrink, Hans-Jürgen; Heiden, Matthias An der; Kollan, Christian; Hoffmann, Christian; van Lunzen, Jan; Hamouda, Osamah

2009-07-01

AIDS-related lymphoma contributes to significant morbidity and mortality among human immunodeficiency virus (HIV)-infected patients receiving highly active antiretroviral therapy (HAART). We assessed the predictive role of cumulative HIV viremia and other risk factors in the development of AIDS-related non-Hodgkin lymphoma. Data from the Clinical Surveillance of HIV Disease (ClinSurv) study, an ongoing, observational, open cohort study of HIV-infected patients from different urban areas in Germany, were analyzed using a Cox proportional hazards model. In the Cox model, which comprised 6022 patients and 27,812 patient-years of follow-up while patients were receiving HAART from 1999 through 2006, cumulative HIV viremia was found to be independently associated with the risk of lymphoma (hazard ratio, [HR], 1.67 [95% confidence interval {CI}, 1.27-2.20]) (P < .001]). This association differed markedly between lymphoma subtypes. Although the association was more pronounced for Burkitt-type lymphoma (HR, 3.45 [95% CI, 1.52-7.85]) (P = .003), there was no association between cumulative HIV viremia and the incidence of primary central nervous system lymphoma (HR, 1.00 [95% CI, 0.39-2.57]) (P = .997). Other risk factors associated with an increased risk in a multivariable analysis included the latest CD4 T cell count as well as age per 10-year increment. Cumulative HIV viremia is an independent and strong predictor of AIDS-related lymphoma among patients receiving HAART. The influence of cumulative HIV viremia may differ between lymphoma subtypes.

Mechanisms and risk of cumulative impacts to coastal ecosystem services: An expert elicitation approach.

PubMed

Singh, Gerald G; Sinner, Jim; Ellis, Joanne; Kandlikar, Milind; Halpern, Benjamin S; Satterfield, Terre; Chan, Kai M A

2017-09-01

Coastal environments are some of the most populated on Earth, with greater pressures projected in the future. Managing coastal systems requires the consideration of multiple uses, which both benefit from and threaten multiple ecosystem services. Thus understanding the cumulative impacts of human activities on coastal ecosystem services would seem fundamental to management, yet there is no widely accepted approach for assessing these. This study trials an approach for understanding the cumulative impacts of anthropogenic change, focusing on Tasman and Golden Bays, New Zealand. Using an expert elicitation procedure, we collected information on three aspects of cumulative impacts: the importance and magnitude of impacts by various activities and stressors on ecosystem services, and the causal processes of impact on ecosystem services. We assessed impacts to four ecosystem service benefits - fisheries, shellfish aquaculture, marine recreation and existence value of biodiversity-addressing three main research questions: (1) how severe are cumulative impacts on ecosystem services (correspondingly, what potential is there for restoration)?; (2) are threats evenly distributed across activities and stressors, or do a few threats dominate?; (3) do prominent activities mainly operate through direct stressors, or do they often exacerbate other impacts? We found (1) that despite high uncertainty in the threat posed by individual stressors and impacts, total cumulative impact is consistently severe for all four ecosystem services. (2) A subset of drivers and stressors pose important threats across the ecosystem services explored, including climate change, commercial fishing, sedimentation and pollution. (3) Climate change and commercial fishing contribute to prominent indirect impacts across ecosystem services by exacerbating regional impacts, namely sedimentation and pollution. The prevalence and magnitude of these indirect, networked impacts highlights the need for approaches

Cumulative probability of neodymium: YAG laser posterior capsulotomy after phacoemulsification.

PubMed

Ando, Hiroshi; Ando, Nobuyo; Oshika, Tetsuro

2003-11-01

To retrospectively analyze the cumulative probability of neodymium:YAG (Nd:YAG) laser posterior capsulotomy after phacoemulsification and to evaluate the risk factors. Ando Eye Clinic, Kanagawa, Japan. In 3997 eyes that had phacoemulsification with an intact continuous curvilinear capsulorhexis, the cumulative probability of posterior capsulotomy was computed by Kaplan-Meier survival analysis and risk factors were analyzed using the Cox proportional hazards regression model. The variables tested were sex; age; type of cataract; preoperative best corrected visual acuity (BCVA); presence of diabetes mellitus, diabetic retinopathy, or retinitis pigmentosa; type of intraocular lens (IOL); and the year the operation was performed. The IOLs were categorized as 3-piece poly(methyl methacrylate) (PMMA), 1-piece PMMA, 3-piece silicone, and acrylic foldable. The cumulative probability of capsulotomy after cataract surgery was 1.95%, 18.50%, and 32.70% at 1, 3, and 5 years, respectively. Positive risk factors included a better preoperative BCVA (P =.0005; risk ratio [RR], 1.7; 95% confidence interval [CI], 1.3-2.5) and the presence of retinitis pigmentosa (P<.0001; RR, 6.6; 95% CI, 3.7-11.6). Women had a significantly greater probability of Nd:YAG laser posterior capsulotomy (P =.016; RR, 1.4; 95% CI, 1.1-1.8). The type of IOL was significantly related to the probability of Nd:YAG laser capsulotomy, with the foldable acrylic IOL having a significantly lower probability of capsulotomy. The 1-piece PMMA IOL had a significantly higher risk than 3-piece PMMA and 3-piece silicone IOLs. The probability of Nd:YAG laser capsulotomy was higher in women, in eyes with a better preoperative BCVA, and in patients with retinitis pigmentosa. The foldable acrylic IOL had a significantly lower probability of capsulotomy.

Adaptive strategies for cumulative cultural learning.

PubMed

Ehn, Micael; Laland, Kevin

2012-05-21

The demographic and ecological success of our species is frequently attributed to our capacity for cumulative culture. However, it is not yet known how humans combine social and asocial learning to generate effective strategies for learning in a cumulative cultural context. Here we explore how cumulative culture influences the relative merits of various pure and conditional learning strategies, including pure asocial and social learning, critical social learning, conditional social learning and individual refiner strategies. We replicate the Rogers' paradox in the cumulative setting. However, our analysis suggests that strategies that resolved Rogers' paradox in a non-cumulative setting may not necessarily evolve in a cumulative setting, thus different strategies will optimize cumulative and non-cumulative cultural learning. Copyright © 2012 Elsevier Ltd. All rights reserved.

When there Seem to be No Predetermining Factors: Early Child and Proximal Family Risk Predicting Externalizing Behavior in Young Children Incurring No Distal Family Risk

ERIC Educational Resources Information Center

Roskam, I.; Meunier, J.-C.; Stievenart, M.; Noel, M.-P.

2013-01-01

The main objective of the current study was to examine the impact of two child risk factors, i.e. personality and inhibition, and two proximal family risk factors, i.e. parenting and attachment, and the impact of their cumulative effect on later externalizing behavior among young children incurring no distal family risk. Data were collected in a…

Vitamin D and calcium intake and risk of early menopause.

PubMed

Purdue-Smithe, Alexandra C; Whitcomb, Brian W; Szegda, Kathleen L; Boutot, Maegan E; Manson, JoAnn E; Hankinson, Susan E; Rosner, Bernard A; Troy, Lisa M; Michels, Karin B; Bertone-Johnson, Elizabeth R

2017-06-01

Background: Early menopause, defined as the cessation of ovarian function before the age of 45 y, affects ∼10% of women and is associated with higher risk of cardiovascular disease, osteoporosis, and other conditions. Few modifiable risk factors for early menopause have been identified, but emerging data suggest that high vitamin D intake may reduce risk. Objective: We evaluated how intakes of vitamin D and calcium are associated with the incidence of early menopause in the prospective Nurses' Health Study II (NHS2). Design: Intakes of vitamin D and calcium from foods and supplements were measured every 4 y with the use of a food-frequency questionnaire. Cases of incident early menopause were identified from all participants who were premenopausal at baseline in 1991; over 1.13 million person-years, 2041 women reported having natural menopause before the age of 45 y. We used Cox proportional hazards regression to evaluate relations between intakes of vitamin D and calcium and incident early menopause while accounting for potential confounding factors. Results: After adjustment for age, smoking, and other factors, women with the highest intake of dietary vitamin D (quintile median: 528 IU/d) had a significant 17% lower risk of early menopause than women with the lowest intake [quintile median: 148 IU/d; HR: 0.83 (95% CI: 0.72, 0.95); P -trend = 0.03]. Dietary calcium intake in the highest quintile (median: 1246 mg/d) compared with the lowest (median: 556 mg/d) was associated with a borderline significantly lower risk of early menopause (HR: 0.87; 95% CI: 0.76, 1.00; P -trend = 0.03). Associations were stronger for vitamin D and calcium from dairy sources than from nondairy dietary sources, whereas high supplement use was not associated with lower risk. Conclusions: Findings suggest that high intakes of dietary vitamin D and calcium may be modestly associated with a lower risk of early menopause. Further studies evaluating 25-hydroxyvitamin D concentrations, other

Early life exposures and the risk of adult glioma.

PubMed

Anic, Gabriella M; Madden, Melissa H; Sincich, Kelly; Thompson, Reid C; Nabors, L Burton; Olson, Jeffrey J; LaRocca, Renato V; Browning, James E; Pan, Edward; Egan, Kathleen M

2013-09-01

Exposure to common infections in early life may stimulate immune development and reduce the risk for developing cancer. Birth order and family size are proxies for the timing of exposure to childhood infections with several studies showing a reduced risk of glioma associated with a higher order of birth (and presumed younger age at infection). The aim of this study was to examine whether birth order, family size, and other early life exposures are associated with the risk of glioma in adults using data collected in a large clinic-based US case-control study including 889 glioma cases and 903 community controls. A structured interviewer-administered questionnaire was used to collect information on family structure, childhood exposures and other potential risk factors. Logistic regression was used to calculate odds ratios (OR) and corresponding 95% confidence intervals (CI) for the association between early life factors and glioma risk. Persons having any siblings were at significantly lower risk for glioma when compared to those reporting no siblings (OR=0.64; 95% CI 0.44-0.93; p=0.020). Compared to first-borns, individuals with older siblings had a significantly lower risk (OR=0.75; 95% CI 0.61-0.91; p=0.004). Birth weight, having been breast fed in infancy, and season of birth were not associated with glioma risk. The current findings lend further support to a growing body of evidence that early exposure to childhood infections reduces the risk of glioma onset in children and adults.

Estimated Daily Intake and Cumulative Risk Assessment of Phthalates in the General Taiwanese after the 2011 DEHP Food Scandal

NASA Astrophysics Data System (ADS)

Chang, Jung-Wei; Lee, Ching-Chang; Pan, Wen-Harn; Chou, Wei-Chun; Huang, Han-Bin; Chiang, Hung-Che; Huang, Po-Chin

2017-03-01

A food scandal occurred in Taiwan in 2011 because the DEHP (di-2-ethylhexyl phthalate) had been intentionally used in food products. We assessed the daily intakes (DIs) and cumulative risk of phthalates in Taiwan’s general population after the scandal. The DIs of 6 phthalates, including di-n-butyl phthalate (DnBP), di-iso-butyl phthalate (DiBP), and DEHP, were evaluated using urinary phthalate metabolites. Hazard quotients of phthalates classified as affecting the reproductive (HQrep) and hepatic (HQhep) systems were assessed using cumulative approach. The creatinine-based model showed that the highest DI values in children 7-to 12- years-old were for DEHP (males: median: 4.79 μg/kg bw/d; females: median: 2.62 μg/kg bw/d). The 95th percentile (P95) of HQrep values were all >1 in the 7- to 12-year-old and 18- to 40-year-old male groups. The P95 of HQhep values were all >1 in the 7- to 18- year-old male groups. Most of the HQrep was attributable to the HQs of DnBP and DiBP (53.9-84.7%), and DEHP contributed most to HQhep (83.1-98.6%), which reveals that DnBP, DiBP and DEHP were the main risk of phthalate exposure for Taiwanese. Taiwan’s general population is widely exposed to DnBP, DiBP and DEHP, especially for young children.

Lagged cumulative spruce budworm defoliation affects the risk of fire ignition in Ontario, Canada.

PubMed

James, Patrick M A; Robert, Louis-Etienne; Wotton, B Mike; Martell, David L; Fleming, Richard A

2017-03-01

Detailed understanding of forest disturbance interactions is needed for effective forecasting, modelling, and management. Insect outbreaks are a significant forest disturbance that alters forest structure as well as the distribution and connectivity of combustible fuels at broad spatial scales. The effect of insect outbreaks on fire activity is an important but contentious issue with significant policy consequences. The eastern spruce budworm (Choristoneura fumiferana) is a native defoliating insect in eastern North America whose periodic outbreaks create large patches of dead fir and spruce trees. Of particular concern to fire and forest managers is whether these patches represent an increased fire risk, if so, for how long, and how the relationship between defoliation and fire risk varies through space and time. Previous work suggests a temporary increase in flammability in budworm-killed forests, but regional and seasonal variability in these relationships has not been examined. Using an extensive database on historical lightning-caused fire ignitions and spruce budworm defoliation between 1963 and 2000, we assess the relative importance of cumulative defoliation and fire weather on the probability of ignition in Ontario, Canada. We modeled fire ignition using a generalized additive logistic regression model that accounts for temporal autocorrelation in fire weather. We compared two ecoregions in eastern Ontario (Abitibi Plains) and western Ontario (Lake of the Woods) that differ in terms of climate, geomorphology, and forest composition. We found that defoliation has the potential to both increase and decrease the probability of ignition depending on the time scale, ecoregion, and season examined. Most importantly, we found that lagged spruce budworm defoliation (8-10 yr) increases the risk of fire ignition whereas recent defoliation (1 yr) can decrease this risk. We also found that historical defoliation has a greater influence on ignition risk during the

Cumulative Effects of Nutrient Enrichment and Elevated Temperature Compromise the Early Life History Stages of the Coral Acropora tenuis

PubMed Central

Noonan, Sam H. C.; Willis, Bette L.; Fabricius, Katharina E.; Negri, Andrew P.

2016-01-01

Inshore coral reefs are experiencing the combined pressures of excess nutrient availability associated with coastal activities and warming seawater temperatures. Both pressures are known to have detrimental effects on the early life history stages of hard corals, but studies of their combined effects on early demographic stages are lacking. We conducted a series of experiments to test the combined effects of nutrient enrichment (three levels) and elevated seawater temperature (up to five levels) on early life history stages of the inshore coral Acropora tenuis, a common species in the Indo-Pacific and Red Sea. Gamete fertilization, larval survivorship and larval settlement were all significantly reduced as temperature increased, but only fertilization was further affected by simultaneous nutrient enrichment. Combined high temperatures and nutrient enrichment affected fertilization in an additive manner, whereas embryo abnormalities increased synergistically. Higher than normal temperatures (32°C) increased coral juvenile growth rates 1.6-fold, but mortality also increased by 50%. The co-occurrence of nutrient enrichment with high temperatures reduced juvenile mortality to 36%, ameliorating temperature stress (antagonistic interaction). Overall, the types of effect (additive vs synergistic or antagonistic) and their magnitude varied among life stages. Gamete and embryo stages were more affected by temperature stress and, in some cases, also by nutrient enrichment than juveniles. The data suggest that coastal runoff events might exacerbate the impacts of warming temperatures on fertilization if these events co-occur during corals spawning. The cumulative impacts of simultaneous exposure to nutrient enrichment and elevated temperatures over all early life history stages increases the likelihood for failure of larval supply and recruitment for this coral species. Our results suggest that improving the water quality of river discharges into coastal areas might help to

Neighborhood Disadvantage and Cumulative Biological Risk Among a Socioeconomically Diverse Sample of African American Adults: An Examination in the Jackson Heart Study.

PubMed

Barber, Sharrelle; Hickson, DeMarc A; Kawachi, Ichiro; Subramanian, S V; Earls, Felton

2016-09-01

Neighborhoods characterized by disadvantage influence multiple risk factors for chronic disease and are considered potential drivers of racial and ethnic health inequities in the USA. The objective of the present study was to examine the relationship between neighborhood disadvantage and cumulative biological risk (CBR) and the extent to which the association differs by individual income and education among a large, socioeconomically diverse sample of African American adults. Data from the baseline examination of the Jackson Heart Study (2000-2004) were used for the analyses. The sample consisted of African American adults ages 21-85 with complete, geocoded data on CBR biomarkers and behavioral covariates (n = 4410). Neighborhood disadvantage was measured using a composite score of socioeconomic indicators from the 2000 US Census. Eight biomarkers representing cardiovascular, metabolic, inflammatory, and neuroendocrine systems were used to create a CBR score. We fit two-level linear regression models with random intercepts and included cross-level interaction terms between neighborhood disadvantage and individual socioeconomic status (SES). Living in a disadvantaged neighborhood was associated with greater CBR after covariate adjustment (B = 0.18, standard error (SE) 0.07, p < 0.05). Interactions showed a weaker association for individuals with ≤high school education but were not statistically significant. Disadvantaged neighborhoods contribute to poor health among African American adults via cumulative biological risk. Policies directly addressing the socioeconomic conditions of these environments should be considered as viable options to reduce disease risk in this group and mitigate racial/ethnic health inequities.

Neighborhood Disadvantage and Cumulative Biological Risk Among a Socioeconomically Diverse Sample of African American Adults: An Examination in the Jackson Heart Study

PubMed Central

Barber, Sharrelle; Hickson, DeMarc A.; Kawachi, Ichiro; Subramanian, S.V.; Earls, Felton

2015-01-01

Objectives Neighborhoods characterized by disadvantage influence multiple risk factors for chronic disease and are considered potential drivers of racial and ethnic health inequities in the United States. The objective of the present study was to examine the relationship between neighborhood disadvantage and cumulative biological risk (CBR) and the extent to which the association differs by individual income and education among a large, socio-economically diverse sample of African American adults. Methods Data from the baseline examination of the Jackson Heart Study (2000-2004) were used for the analyses. The sample consisted of African American adults ages 21-85 with complete, geocoded data on CBR biomarkers and behavioral covariates (n=4,410). Neighborhood disadvantage was measured using a composite score of socioeconomic indicators from the 2000 US Census. Eight biomarkers representing cardiovascular, metabolic, inflammatory, and neuroendocrine systems were used to create a CBR score. We fit two-level linear regression models with random intercepts and included cross-level interaction terms between neighborhood disadvantage and individual SES. Results Living in a disadvantaged neighborhood was associated with greater CBR after covariate adjustment (B=0.18, SE: 0.07, p<0.05). Interactions showed a weaker association for individuals with ≤ high school education, but were not statistically significant. Conclusion Disadvantaged neighborhoods contribute to poor health among African American adults via cumulative biological risk. Policies directly addressing the socioeconomic conditions of these environments should be considered as viable options to reduce disease risk in this group and mitigate racial/ethnic health inequities. PMID:27294737

Early Onset Obesity and Risk of Metabolic Syndrome Among Chilean Adolescents

PubMed Central

Pacheco, Lorena Sonia; Blanco, Estela; Burrows, Raquel; Reyes, Marcela; Lozoff, Betsy

2017-01-01

Introduction Obesity and metabolic syndrome (MetS) indicators have increased globally among the pediatric population. MetS indicators in the young elevate their risk of cardiovascular disease and metabolic disorders later in life. This study examined early onset obesity as a risk factor for MetS risk in adolescence. Methods A cohort of Chilean participants (N = 673) followed from infancy was assessed at age 5 years and in adolescence (mean age, 16.8 y). Adiposity was measured at both time points; blood pressure and fasting blood samples were assessed in adolescence only. Early onset obesity was defined as a World Health Organization z score of 2 standard deviations (SDs) or more for body mass index (BMI) at age 5 years. We used linear regression to examine the association between early onset obesity and adolescent MetS risk z score, adjusting for covariates. Results Eighteen percent of participants had early onset obesity, and 50% of these remained obese in adolescence. Mean MetS risk z score in adolescence was significantly higher among those with early onset obesity than among those without (1.0; SD, 0.8 vs 0.2; SD, 0.8 [P < .001]). In the multivariable model, early onset obesity independently contributed to a higher MetS risk score in adolescence (β = 0.27, P < .001), controlling for obesity status at adolescence and sex, and explained 39% of the variance in MetS risk. Conclusion Early onset obesity as young as age 5 years relates to higher MetS risk. PMID:29023232

Origins and implications of the relationship between warming and cumulative carbon emissions

NASA Astrophysics Data System (ADS)

Raupach, M. R.; Davis, S. J.; Peters, G. P.; Andrew, R. M.; Canadell, J.; Le Quere, C.

2014-12-01

A near-linear relationship between warming (T) and cumulative carbon emissions (Q) is a robust finding from numerous studies. This finding opens biophysical questions concerning (1) its theoretical basis, (2) the treatment of non-CO2 forcings, and (3) uncertainty specifications. Beyond these biophysical issues, a profound global policy question is raised: (4) how can a quota on cumulative emissions be shared? Here, an integrated survey of all four issues is attempted. (1) Proportionality between T and Q is an emergent property of a linear carbon-climate system forced by exponentially increasing CO2 emissions. This idealisation broadly explains past but not future near-proportionality between T and Q: in future, the roles of non-CO2 forcings and carbon-climate nonlinearities become important, and trajectory dependence becomes stronger. (2) The warming effects of short-lived non-CO2 forcers depend on instantaneous rather than cumulative fluxes. However, inertia in emissions trajectories reinstates some of the benefits of a cumulative emissions approach, with residual trajectory dependence comparable to that for CO2. (3) Uncertainties arise from several sources: climate projections, carbon-climate feedbacks, and residual trajectory dependencies in CO2 and other emissions. All of these can in principle be combined into a probability distribution P(T|Q) for the warming T from given cumulative CO2 emissions Q. Present knowledge of P(T|Q) allows quantification of the tradeoff between mitigation ambition and climate risk. (4) Cumulative emissions consistent with a given warming target and climate risk are a finite common resource that will inevitably be shared, creating a tragedy-of-the-commons dilemma. Sharing options range from "inertia" (present distribution of emissions is maintained) to "equity" (cumulative emissions are distributed equally per-capita). Both extreme options lead to emissions distributions that are unrealisable in practice, but a blend of the two

Longitudinal patterns of poverty and health in early childhood: exploring the influence of concurrent, previous, and cumulative poverty on child health outcomes.

PubMed

Béatrice, Nikiéma; Lise, Gauvin; Victoria, Zunzunegui Maria; Louise, Séguin

2012-09-04

Although the links between poverty and health have often been studied , the dynamics of poverty and physical health in early childhood remain under-investigated. In particular, it is not known whether the health of young children is affected differently from that of adults by patterns of poverty unique to them. We examined patterns of health from 5 to 41 months of age as a function of concurrent, lagged, and chronic exposure to insufficient income. Using data from the first four rounds of the Quebec Longitudinal Study of Child Development, we performed multilevel logistic and multilevel Poisson regressions and latent growth curve analyses to explore associations between exposure to poverty and mother-reported asthma-like attacks, and maternal perception of health status controlling for neonatal, maternal, and environmental characteristics. The mean number of mother-reported asthma-like attacks significantly decreased as children aged. The likelihood of being perceived in a poorer health status also decreased across time. Concurrent poverty was associated with more mother-reported asthma-like attacks and with a higher risk of being perceived in poorer health status. One-period-lagged poverty was associated with more mother-reported asthma-like attacks and this remained significant after controlling for concurrent poverty. The number of mother-reported asthma-like attacks was significantly higher among children in the chronic poverty class compared to those in the never-poor class, particularly at 17 and 29 months. Perceived health status at 5-months was significantly poorer among chronically poor children compared to never-poor children. Exposure to poverty negatively affects two major health indicators in early childhood - maternal perception of child health and mother-reported asthma-like attacks. Patterns of the effects vary according to timing and duration of poverty exposure. Further longitudinal research is warranted to disentangle time-specific from

Growth of Korean preterm infants in a family-centered tradition during early infancy: the influence of health risks, maternal employment, and the sex of infants.

PubMed

Ahn, Youngmee; Sohn, Min; Lee, Sangmi

2014-10-01

The physical growth of mild preterm infants (<32 weeks of gestation at birth) needs to be explored in terms of bio-sociocultural factors considering the sociocultural aspects of child-care practice. A retrospective cohort study was conducted with 238 Korean mild preterm infants from birth up to 6 months of corrected age regarding four of the biological and sociocultural factors such as health risks (at birth and discharge), maternal employment status, and the infant sex. There were four noteworthy findings on growth variation in Korean mild preterm infants during early infancy: (i) the secular trend of intrauterine growth; (ii) the cumulative adverse effects of four risk factors; (iii) the possible burden of maternal employment if insufficient support; and (iv) the possibility of the cultural favoritism to male infants regardless of the modern industrialized society. The study suggests that, in a modern society, while mild preterm infants could sustain typical fetal growth, the early postnatal growth may vary based on health risks and sociocultural circumstances related to child-bearing and -rearing practices surrounding them. © 2013 The Authors. Japan Journal of Nursing Science © 2013 Japan Academy of Nursing Science.

Risk of cardiovascular events from current, recent, and cumulative exposure to abacavir among persons living with HIV who were receiving antiretroviral therapy in the United States: a cohort study.

PubMed

Dorjee, Kunchok; Baxi, Sanjiv M; Reingold, Arthur L; Hubbard, Alan

2017-10-27

There is ongoing controversy regarding abacavir use in the treatment of HIV infection and the risk of subsequent development of cardiovascular disease. It is unclear how the risk varies as exposure accumulates. Using an administrative health-plan dataset, risk of cardiovascular disease events (CVDe), defined as the first episode of an acute myocardial infarction or a coronary intervention procedure, associated with abacavir exposure was assessed among HIV-infected individuals receiving antiretroviral therapy across the U.S. from October 2009 through December 2014. The data were longitudinal, and analyzed using marginal structural models. Over 114,470 person-years (n = 72,733) of ART exposure, 714 CVDe occurred at an incidence rate (IR) (95% CI) of 6·23 (5·80, 6·71)/1000 person-years. Individuals exposed to abacavir had a higher IR of CVDe of 9·74 (8·24, 11·52)/1000 person-years as compared to 5·75 (5·30, 6·24)/1000 person-years for those exposed to other antiretroviral agents. The hazard (HR; 95% CI) of CVDe was increased for current (1·43; 1·18, 1·73), recent (1·41; 1·16, 1·70), and cumulative [(1·18; 1·06, 1·31) per year] exposure to abacavir. The risk for cumulative exposure followed a bell-shaped dose-response curve peaking at 24-months of exposure. Risk was similarly elevated among participants free of pre-existing heart disease or history of illicit substance use at baseline. Current, recent, and cumulative use of abacavir was associated with an increased risk of CVDe. The findings were consistent irrespective of underlying cardiovascular risk factors.

Cumulative Assessment of Risk from Pesticides

EPA Pesticide Factsheets

EPA protects human health and the environment by evaluating the risk associated with pesticides before allowing them to be used in the United States. Learn about the tools and processes used in risk assessment for pesticides.

Long-Term Cumulative Effects of Childcare on Children's Mental Development and Socioemotional Adjustment in a Non-Risk Sample: The Moderating Effects of Gender

ERIC Educational Resources Information Center

Bornstein, Marc H.; Hahn, Chun-Shin; Gist, Nancy F.; Haynes, O. Maurice

2006-01-01

We studied the long-term cumulative effects of two common indices of childcare--the total number of hours of non-maternal care and the mean hour-weighted child-to-caregiver ratio per caregiving situation--on mental development and socioemotional adjustment from birth to 4.5 years old in a non-risk middle-class sample of girls and boys after taking…

Understanding the Relation of Low Income to HPA-Axis Functioning in Preschool Children: Cumulative Family Risk and Parenting as Pathways to Disruptions in Cortisol

ERIC Educational Resources Information Center

Zalewski, Maureen; Lengua, Liliana J.; Kiff, Cara J.; Fisher, Philip A.

2012-01-01

This study examined the relation of low income and poverty to cortisol levels, and tested potential pathways from low income to disruptions in cortisol through cumulative family risk and parenting. The sample of 306 mothers and their preschool children included 29 % families at or near poverty, 27 % families below the median income, and the…

Kindergarten stressors and cumulative adrenocortical activation: the "first straws" of allostatic load?

PubMed

Bush, Nicole R; Obradović, Jelena; Adler, Nancy; Boyce, W Thomas

2011-11-01

Using an ethnically diverse longitudinal sample of 338 kindergarten children, this study examined the effects of cumulative contextual stressors on children's developing hypothalamic-pituitary-adrenocortical (HPA) axis regulation as an early life indicator of allostatic load. Chronic HPA axis regulation was assessed using cumulative, multiday measures of cortisol in both the fall and spring seasons of the kindergarten year. Hierarchical linear regression analyses revealed that contextual stressors related to ethnic minority status, socioeconomic status, and family adversity each uniquely predicted children's daily HPA activity and that some of those associations were curvilinear in conformation. Results showed that the quadratic, U-shaped influences of family socioeconomic status and family adversity operate in different directions to predict children's HPA axis regulation. Results further suggested that these associations differ for White and ethnic minority children. In total, this study revealed that early childhood experiences contribute to shifts in one of the principal neurobiological systems thought to generate allostatic load, confirming the importance of early prevention and intervention efforts. Moreover, findings suggested that analyses of allostatic load and developmental theories accounting for its accrual would benefit from an inclusion of curvilinear associations in tested predictive models.

Effect modification of the association of cumulative exposure and cancer risk by intensity of exposure and time since exposure cessation: a flexible method applied to cigarette smoking and lung cancer in the SYNERGY Study.

PubMed

Vlaanderen, Jelle; Portengen, Lützen; Schüz, Joachim; Olsson, Ann; Pesch, Beate; Kendzia, Benjamin; Stücker, Isabelle; Guida, Florence; Brüske, Irene; Wichmann, Heinz-Erich; Consonni, Dario; Landi, Maria Teresa; Caporaso, Neil; Siemiatycki, Jack; Merletti, Franco; Mirabelli, Dario; Richiardi, Lorenzo; Gustavsson, Per; Plato, Nils; Jöckel, Karl-Heinz; Ahrens, Wolfgang; Pohlabeln, Hermann; Tardón, Adonina; Zaridze, David; Field, John K; 't Mannetje, Andrea; Pearce, Neil; McLaughlin, John; Demers, Paul; Szeszenia-Dabrowska, Neonila; Lissowska, Jolanta; Rudnai, Peter; Fabianova, Eleonora; Stanescu Dumitru, Rodica; Bencko, Vladimir; Foretova, Lenka; Janout, Vladimir; Boffetta, Paolo; Forastiere, Francesco; Bueno-de-Mesquita, Bas; Peters, Susan; Brüning, Thomas; Kromhout, Hans; Straif, Kurt; Vermeulen, Roel

2014-02-01

The indiscriminate use of the cumulative exposure metric (the product of intensity and duration of exposure) might bias reported associations between exposure to hazardous agents and cancer risk. To assess the independent effects of duration and intensity of exposure on cancer risk, we explored effect modification of the association of cumulative exposure and cancer risk by intensity of exposure. We applied a flexible excess odds ratio model that is linear in cumulative exposure but potentially nonlinear in intensity of exposure to 15 case-control studies of cigarette smoking and lung cancer (1985-2009). Our model accommodated modification of the excess odds ratio per pack-year of cigarette smoking by time since smoking cessation among former smokers. We observed negative effect modification of the association of pack-years of cigarette smoking and lung cancer by intensity of cigarette smoke for persons who smoked more than 20-30 cigarettes per day. Patterns of effect modification were similar across individual studies and across major lung cancer subtypes. We observed strong negative effect modification by time since smoking cessation. Application of our method in this example of cigarette smoking and lung cancer demonstrated that reducing a complex exposure history to a metric such as cumulative exposure is too restrictive.

Effect Modification of the Association of Cumulative Exposure and Cancer Risk by Intensity of Exposure and Time Since Exposure Cessation: A Flexible Method Applied to Cigarette Smoking and Lung Cancer in the SYNERGY Study

PubMed Central

Vlaanderen, Jelle; Portengen, Lützen; Schüz, Joachim; Olsson, Ann; Pesch, Beate; Kendzia, Benjamin; Stücker, Isabelle; Guida, Florence; Brüske, Irene; Wichmann, Heinz-Erich; Consonni, Dario; Landi, Maria Teresa; Caporaso, Neil; Siemiatycki, Jack; Merletti, Franco; Mirabelli, Dario; Richiardi, Lorenzo; Gustavsson, Per; Plato, Nils; Jöckel, Karl-Heinz; Ahrens, Wolfgang; Pohlabeln, Hermann; Tardón, Adonina; Zaridze, David; Field, John K.; 't Mannetje, Andrea; Pearce, Neil; McLaughlin, John; Demers, Paul; Szeszenia-Dabrowska, Neonila; Lissowska, Jolanta; Rudnai, Peter; Fabianova, Eleonora; Stanescu Dumitru, Rodica; Bencko, Vladimir; Foretova, Lenka; Janout, Vladimir; Boffetta, Paolo; Forastiere, Francesco; Bueno-de-Mesquita, Bas; Peters, Susan; Brüning, Thomas; Kromhout, Hans; Straif, Kurt; Vermeulen, Roel

2014-01-01

The indiscriminate use of the cumulative exposure metric (the product of intensity and duration of exposure) might bias reported associations between exposure to hazardous agents and cancer risk. To assess the independent effects of duration and intensity of exposure on cancer risk, we explored effect modification of the association of cumulative exposure and cancer risk by intensity of exposure. We applied a flexible excess odds ratio model that is linear in cumulative exposure but potentially nonlinear in intensity of exposure to 15 case-control studies of cigarette smoking and lung cancer (1985–2009). Our model accommodated modification of the excess odds ratio per pack-year of cigarette smoking by time since smoking cessation among former smokers. We observed negative effect modification of the association of pack-years of cigarette smoking and lung cancer by intensity of cigarette smoke for persons who smoked more than 20–30 cigarettes per day. Patterns of effect modification were similar across individual studies and across major lung cancer subtypes. We observed strong negative effect modification by time since smoking cessation. Application of our method in this example of cigarette smoking and lung cancer demonstrated that reducing a complex exposure history to a metric such as cumulative exposure is too restrictive. PMID:24355332

Cumulative exposure to biologics and risk of cancer in psoriasis patients: A meta-analysis of Psonet studies from Israel, Italy, Spain, United Kingdom and Republic of Ireland.

PubMed

Garcia-Doval, I; Descalzo, M A; Mason, K J; Cohen, A D; Ormerod, A D; Gómez-García, F J; Cazzaniga, S; Feldhamer, I; Ali, H; Herrera-Acosta, E; Griffiths, C E M; Stern, R; Naldi, L

2018-05-03

Cancer risk following long-term exposure to systemic immunomodulatory therapies in psoriasis patients is possible. To assess a dose-response relationship between cumulative length of exposure to biologic therapy and risk of cancer. Four national studies (a healthcare database from Israel, and prospective cohorts form Italy, Spain and UK/ROI) collaborating through Psonet (European Registry of Psoriasis) participated in these nested case-control studies, including nearly 60.000 person-years of observation. Cases were patients who developed an incident cancer. Patients with previous cancers and benign or in-situ tumours were excluded. Four cancer-free controls were matched to each case on year of birth, gender, geographic area, and registration year. Follow-up for controls was censored at the date of cancer diagnosis for the matched case. Conditional logistic regression was performed by each registry. Results were pooled using random effects meta-analysis. 728 cases and 2671 controls were identified. After matching, differences between cases and controls were present for the Charlson comorbidity index in all three registries, and in the prevalence of previous exposure to psoralen-ultraviolet-A (PUVA) and smoking (BADBIR only). The risk of first cancers was not significantly associated with cumulative exposure to biologics (adjusted odds ratio per year of exposure 1.02; 95%CI 0.92, 1.13). Results were similar if squamous and basal cell carcinomas were included in the outcome. Cumulative length of exposure to biologic therapies of psoriasis patients in real-world clinical practice does not appear to be linked to a higher risk of cancer after several years of use. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

An application of the Aggregate Exposure Pathway (AEP) and Adverse Outcome Pathway (AOP) frameworks to mechanistically integrate data sources across multiple species into cumulative risk assessment (CRA)

EPA Science Inventory

Toxicologists use dose-response data from both in vivo and in vitro experiments to evaluate the effects of chemical contaminants on organisms. Cumulative risk assessments (CRAs) consider the effects of multiple stressors on multiple endpoints, and utilize environmental exposure ...

Atmospheric Teleconnections From Cumulants

NASA Astrophysics Data System (ADS)

Sabou, F.; Kaspi, Y.; Marston, B.; Schneider, T.

2011-12-01

Multi-point cumulants of fields such as vorticity provide a way to visualize atmospheric teleconnections, complementing other approaches such as the method of empirical orthogonal functions (EOFs). We calculate equal-time two-point cumulants of the vorticity from NCEP reanalysis data during the period 1980 -- 2010 and from direct numerical simulation (DNS) using an idealized dry general circulation model (GCM) (Schneider and Walker, 2006). Extratropical correlations seen in the NCEP data are qualitatively reproduced by the model. Three- and four-point cumulants accumulated from DNS quantify departures of the probability distribution function from a normal distribution, shedding light on the efficacy of direct statistical simulation (DSS) of atmosphere dynamics by cumulant expansions (Marston, Conover, and Schneider, 2008; Marston 2011). Lagged-time two-point cumulants between temperature gradients and eddy kinetic energy (EKE), accumulated by DNS of an idealized moist aquaplanet GCM (O'Gorman and Schneider, 2008), reveal dynamics of storm tracks. Regions of enhanced baroclinicity (as found along the eastern boundary of continents) lead to a local enhancement of EKE and a suppression of EKE further downstream as the storm track self-destructs (Kaspi and Schneider, 2011).

Cumulative Incidence of False-Positive Results in Repeated, Multimodal Cancer Screening

PubMed Central

Croswell, Jennifer Miller; Kramer, Barnett S.; Kreimer, Aimee R.; Prorok, Phil C.; Xu, Jian-Lun; Baker, Stuart G.; Fagerstrom, Richard; Riley, Thomas L.; Clapp, Jonathan D.; Berg, Christine D.; Gohagan, John K.; Andriole, Gerald L.; Chia, David; Church, Timothy R.; Crawford, E. David; Fouad, Mona N.; Gelmann, Edward P.; Lamerato, Lois; Reding, Douglas J.; Schoen, Robert E.

2009-01-01

PURPOSE Multiple cancer screening tests have been advocated for the general population; however, clinicians and patients are not always well-informed of screening burdens. We sought to determine the cumulative risk of a false-positive screening result and the resulting risk of a diagnostic procedure for an individual participating in a multimodal cancer screening program. METHODS Data were analyzed from the intervention arm of the ongoing Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial, a randomized controlled trial to determine the effects of prostate, lung, colorectal, and ovarian cancer screening on disease-specific mortality. The 68,436 participants, aged 55 to 74 years, were randomized to screening or usual care. Women received serial serum tests to detect cancer antigen 125 (CA-125), transvaginal sonograms, posteroanterior-view chest radiographs, and flexible sigmoidoscopies. Men received serial chest radiographs, flexible sigmoidoscopies, digital rectal examinations, and serum prostate-specific antigen tests. Fourteen screening examinations for each sex were possible during the 3-year screening period. RESULTS After 14 tests, the cumulative risk of having at least 1 false-positive screening test is 60.4% (95% CI, 59.8%–61.0%) for men, and 48.8% (95% CI, 48.1%–49.4%) for women. The cumulative risk after 14 tests of undergoing an invasive diagnostic procedure prompted by a false-positive test is 28.5% (CI, 27.8%–29.3%) for men and 22.1% (95% CI, 21.4%–22.7%) for women. CONCLUSIONS For an individual in a multimodal cancer screening trial, the risk of a false-positive finding is about 50% or greater by the 14th test. Physicians should educate patients about the likelihood of false positives and resulting diagnostic interventions when counseling about cancer screening. PMID:19433838

Early and Late Recurrent Epistaxis Admissions: Patterns of Incidence and Risk Factors.

PubMed

Cohen, Oded; Shoffel-Havakuk, Hagit; Warman, Meir; Tzelnick, Sharon; Haimovich, Yaara; Kohlberg, Gavriel D; Halperin, Doron; Lahav, Yonatan

2017-09-01

Objective Epistaxis is a common complaint, yet few studies have focused on the incidence and risk factors of recurrent epistaxis. Our objective was to determine the patterns of incidence and risk factors for recurrent epistaxis admission (REA). Study Design Case series with chart review. Settings Single academic center. Subjects and Methods The medical records of patients admitted for epistaxis between 1999 and 2015 were reviewed. The follow-up period was defined as 3 years following initial admission. REAs were categorized as early (30 days) and late (31 days to 3 years) following initial admission. Logistic regression was used to identify potential predictors of REAs. Results A total of 653 patients were included. Eighty-six patients (14%) had REAs: 48 (7.5%) early and 38 (6.5%) late. Nonlinear incidence curve was demonstrated for both early and late REAs. Based on logistic regression, prior nasal surgery and anemia were independent risk factors for early REAs. According to multivariate analysis, thrombocytopenia was significantly associated with late REAs. Conclusion Early and late REAs demonstrate different risk predictors. Knowledge of such risk factors may help in risk stratification for this selected group of patients. All patients at risk should be advised on possible preventive measures. Patients at risk for early REA may benefit from a more proactive approach.

Early childhood caries: risk-based disease prevention and management.

PubMed

Ng, Man Wai; Chase, Isabelle

2013-01-01

Early childhood caries (ECC), common in preschoolers, can lead to pain and infection if left untreated. Yet, ECC is largely preventable, and if it is identified early and the responsible risk factors are addressed, its progression can be halted or slowed. This article reviews the rationale for a first dental visit by age 1 year, caries risk assessment, and risk-based prevention and management of ECC and discusses strategies for providers to implement these contemporary evidence-based concepts into clinical practice. Copyright © 2013 Elsevier Inc. All rights reserved.

The At Risk Child: Early Identification, Intervention, and Evaluation of Early Childhood Strategies.

ERIC Educational Resources Information Center

Lennon, Joan M.

A review of literature was conducted in order to: (1) determine whether factors placing the young child at risk for school failure can be identified; (2) determine whether early family interventions and early childhood programs are effective; and (3) identify policy implications. Findings are summarized, and recommendations are offered. Research…

Comprehensive schoolteachers at risk of early exit from work.

PubMed

Mykletun, R J; Mykletun, A

1999-01-01

Risk of early exit from work for teachers was operationalized as high burnout scores, working part-time due to heavy burden and illness or working part-time while also receiving partial disability pension. Data were collected by mailed questionnaires in a cross-sectional study to a random sample of Norwegian comprehensive schoolteachers, response rate = 86% (N = 1860 valid cases). High age increased the risk of early exit from work, but for cynicism the age effect disappeared when sense of competence and stress were introduced in the regression model. Age had no effect for low professional efficacy. Sense of competence effected burnout, but actual competence level and the gap between actual competence and teaching obligations did not. Stress effected all measures of risk of early exit, especially exhaustion. Change as stress factor increased the exhaustion scores, and were also relevant to risk of having a part-time position, and/or partial disability pension.

Breast cancer risk accumulation starts early: prevention must also.

PubMed

Colditz, Graham A; Bohlke, Kari; Berkey, Catherine S

2014-06-01

Nearly one in four breast cancers is diagnosed before the age of 50, and many early-stage premalignant lesions are present but not yet diagnosed. Therefore, we review evidence to support the strategy that breast cancer prevention efforts must begin early in life. This study follows the literature review methods and format. Exposures during childhood and adolescence affect a woman's long-term risk of breast cancer, but have received far less research attention than exposures that occur later in life. Breast tissue undergoes rapid cellular proliferation between menarche and first full-term pregnancy, and risk accumulates rapidly until the terminal differentiation that accompanies first pregnancy. Evidence on childhood diet and growth in height, and adolescent alcohol intake, among other adolescent factors is related to breast cancer risk and risk of premalignant proliferative benign lesions. Breast cancer prevention efforts will have the greatest effect when initiated at an early age and continued over a lifetime. Gaps in knowledge are identified and deserve increase attention to inform prevention.

Cumulative trauma disorder risk for children using computer products: results of a pilot investigation with a student convenience sample.

PubMed

Burke, Adam; Peper, Erik

2002-01-01

Cumulative trauma disorder is a major health problem for adults. Despite a growing understanding of adult cumulative trauma disorder, however, little is known about the risks for younger populations. This investigation examined issues related to child/adolescent computer product use and upper body physical discomfort. A convenience sample of 212 students, grades 1-12, was interviewed at their homes by a college-age sibling or relative. One of the child's parents was also interviewed. A 22-item questionnaire was used for data-gathering. Questionnaire items included frequency and duration of use, type of computer products/games and input devices used, presence of physical discomfort, and parental concerns related to the child's computer use. Many students experienced physical discomfort attributed to computer use, such as wrist pain (30%) and back pain (15%). Specific computer activities-such as using a joystick or playing noneducational games-were significantly predictive of physical discomfort using logistic multiple regression. Many parents reported difficulty getting their children off the computer (46%) and that their children spent less time outdoors (35%). Computer product use within this cohort was associated with self-reported physical discomfort. Results suggest a need for more extensive study, including multiyear longitudinal surveys.

Early Risk Factors of Overweight Developmental Trajectories during Middle Childhood

PubMed Central

Pryor, Laura E.; Brendgen, Mara; Tremblay, Richard E.; Pingault, Jean-Baptiste; Liu, Xuecheng; Dubois, Lise; Touchette, Evelyne; Falissard, Bruno; Boivin, Michel; Côté, Sylvana M.

2015-01-01

Background Research is needed to identify early life risk factors associated with different developmental paths leading to overweight by adolescence. Objectives To model heterogeneity in overweight development during middle childhood and identify factors associated with differing overweight trajectories. Methods Data was drawn from the Quebec Longitudinal Study of Child Development (QLSCD; 1998-2010). Trained research assistants measured height and weight according to a standardized protocol and conducted yearly home interviews with the child’s caregiver (mother in 98% of cases). Information on several putative early life risk factors for the development of overweight were obtained, including factors related to the child’s perinatal, early behavioral family and social environment. Group-based trajectories of the probability of overweight (6-12 years) were identified with a semiparametric method (n=1678). Logistic regression analyses were used to identify early risk factors (5 months- 5 years) associated with each trajectory. Results Three trajectories of overweight were identified: “early-onset overweight” (11.0 %), “late-onset overweight” (16.6%) and “never overweight” (72.5%). Multinomial analyses indicated that children in the early and late-onset group, compared to the never overweight group, had 3 common types of risk factors: parental overweight, preschool overweight history, and large size for gestational age. Maternal overprotection (OR= 1.12, CI: 1.01-1.25), short nighttime sleep duration (OR=1.66, CI: 1.07-2.57), and immigrant status (OR=2.01, CI: 1.05-3.84) were factors specific to the early-onset group. Finally, family food insufficiency (OR=1.81, CI: 1.00-3.28) was weakly associated with membership in the late-onset trajectory group. Conclusions The development of overweight in childhood follows two different trajectories, which have common and distinct risk factors that could be the target of early preventive interventions. PMID

Early Adolescent Risk Behavior Outcomes of Childhood Externalizing Behavioral Trajectories

ERIC Educational Resources Information Center

Thompson, Richard; Tabone, Jiyoung Kim; Litrownik, Alan J.; Briggs, Ernestine C.; Hussey, Jon M.; English, Diana J.; Dubowitz, Howard

2011-01-01

Little is known about the early childhood indicators of adolescent risk. The link between trajectories of externalizing behavioral problems and early adolescent risk behavior was examined in a longitudinal sample of 875 child participants in the LONGSCAN studies. Five trajectory groups of children defined by externalizing behavior problems were…

Characterization of SNPs Associated with Prostate Cancer in Men of Ashkenazic Descent from the Set of GWAS Identified SNPs: Impact of Cancer Family History and Cumulative SNP Risk Prediction

PubMed Central

Agalliu, Ilir; Wang, Zhaoming; Wang, Tao; Dunn, Anne; Parikh, Hemang; Myers, Timothy

2013-01-01

Background Genome-wide association studies (GWAS) have identified multiple SNPs associated with prostate cancer (PrCa). Population isolates may have different sets of risk alleles for PrCa constituting unique population and individual risk profiles. Methods To test this hypothesis, associations between 31 GWAS SNPs of PrCa were examined among 979 PrCa cases and 1,251 controls of Ashkenazic descent using logistic regression. We also investigated risks by age at diagnosis, pathological features of PrCa, and family history of cancer. Moreover, we examined associations between cumulative number of risk alleles and PrCa and assessed the utility of risk alleles in PrCa risk prediction by comparing the area under the curve (AUC) for different logistic models. Results Of the 31 genotyped SNPs, 8 were associated with PrCa at p≤0.002 (corrected p-value threshold) with odds ratios (ORs) ranging from 1.22 to 1.42 per risk allele. Four SNPs were associated with aggressive PrCa, while three other SNPs showed potential interactions for PrCa by family history of PrCa (rs8102476; 19q13), lung cancer (rs17021918; 4q22), and breast cancer (rs10896449; 11q13). Men in the highest vs. lowest quartile of cumulative number of risk alleles had ORs of 3.70 (95% CI 2.76–4.97); 3.76 (95% CI 2.57–5.50), and 5.20 (95% CI 2.94–9.19) for overall PrCa, aggressive cancer and younger age at diagnosis, respectively. The addition of cumulative risk alleles to the model containing age at diagnosis and family history of PrCa yielded a slightly higher AUC (0.69 vs. 0.64). Conclusion These data define a set of risk alleles associated with PrCa in men of Ashkenazic descent and indicate possible genetic differences for PrCa between populations of European and Ashkenazic ancestry. Use of genetic markers might provide an opportunity to identify men at highest risk for younger age of onset PrCa; however, their clinical utility in identifying men at highest risk for aggressive cancer remains limited

Ketorolac use may increase risk of postoperative pancreatic fistula after pancreaticoduodenectomy.

PubMed

Kowalsky, Stacy J; Zenati, Mazen S; Steve, Jennifer; Lee, Kenneth K; Hogg, Melissa E; Zeh, Herbert J; Zureikat, Amer H

2018-01-01

Ketorolac (Toradol), a commonly used nonselective nonsteroidal anti-inflammatory drug (NSAID) in the postoperative period, has been associated with increased risk of anastomotic leak after colon resection. The effect of postoperative NSAID and ketorolac use on postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) is unknown. Retrospective review of consecutive PDs at a high-volume pancreas center from 2012 to 2015. POPF was identified and graded using International Study Group on Pancreatic Fistula criteria. Demographics, operative variables and 30-d postoperative NSAID use, dosage, and timing (early = postoperative day [POD] 0-5, late > POD 5) were collected. Univariate and multivariate logistic regressions were used to identify predictors of POPF. Four hundred twenty-three PDs were analyzed (mean age 66 y, 47% female), and 60% received NSAIDs postoperatively. Ketorolac (median POD 0-5 cumulative dose = 90 mg, interquartile range 60-165) was used in 35.7% (n = 151). POPF occurred in 90 patients (21.3%). Early (POD 0-5) ketorolac use was associated with increased POPF, especially grade A (odds ratio [OR] 2.16, P = 0.036). Each 25 mg incremental increase in ketorolac use was associated with a 10% increase in the incidence of POPF (OR 1.10, P = 0.021), whereas a cumulative dose of >150 mg was associated with a 44% increased risk of POPF (OR 1.44, 95% confidence interval 1.03-2.01, P = 0.035). A multivariate regression model identified estimated blood loss, soft gland, pancreatic duct diameter, body mass index, and cumulative ketorolac dose >150 mg as independent predictors of POPF (P < 0.0001, pseudo R 2  = 0.149). Increasing doses of ketorolac in the early postoperative period are associated with increased risk of POPF, whereas a cumulative dose of >150 mg is an independent predictor of POPF after PD. Copyright © 2017 Elsevier Inc. All rights reserved.

Vitamin D and calcium intake and risk of early menopause12

PubMed Central

Purdue-Smithe, Alexandra C; Whitcomb, Brian W; Szegda, Kathleen L; Boutot, Maegan E; Manson, JoAnn E; Hankinson, Susan E; Rosner, Bernard A; Troy, Lisa M; Michels, Karin B; Bertone-Johnson, Elizabeth R

2017-01-01

Background: Early menopause, defined as the cessation of ovarian function before the age of 45 y, affects ∼10% of women and is associated with higher risk of cardiovascular disease, osteoporosis, and other conditions. Few modifiable risk factors for early menopause have been identified, but emerging data suggest that high vitamin D intake may reduce risk. Objective: We evaluated how intakes of vitamin D and calcium are associated with the incidence of early menopause in the prospective Nurses’ Health Study II (NHS2). Design: Intakes of vitamin D and calcium from foods and supplements were measured every 4 y with the use of a food-frequency questionnaire. Cases of incident early menopause were identified from all participants who were premenopausal at baseline in 1991; over 1.13 million person-years, 2041 women reported having natural menopause before the age of 45 y. We used Cox proportional hazards regression to evaluate relations between intakes of vitamin D and calcium and incident early menopause while accounting for potential confounding factors. Results: After adjustment for age, smoking, and other factors, women with the highest intake of dietary vitamin D (quintile median: 528 IU/d) had a significant 17% lower risk of early menopause than women with the lowest intake [quintile median: 148 IU/d; HR: 0.83 (95% CI: 0.72, 0.95); P-trend = 0.03]. Dietary calcium intake in the highest quintile (median: 1246 mg/d) compared with the lowest (median: 556 mg/d) was associated with a borderline significantly lower risk of early menopause (HR: 0.87; 95% CI: 0.76, 1.00; P-trend = 0.03). Associations were stronger for vitamin D and calcium from dairy sources than from nondairy dietary sources, whereas high supplement use was not associated with lower risk. Conclusions: Findings suggest that high intakes of dietary vitamin D and calcium may be modestly associated with a lower risk of early menopause. Further studies evaluating 25-hydroxyvitamin D concentrations, other

A Case Study Application of the Aggregate Exposure Pathway (AEP) and Adverse Outcome Pathway (AOP) Frameworks to Facilitate the Integration of Human Health and Ecological End Points for Cumulative Risk Assessment (CRA)

EPA Science Inventory

Cumulative risk assessment (CRA) methods promote the use of a conceptual site model (CSM) to apportion exposures and integrate risk from multiple stressors. While CSMs may encompass multiple species, evaluating end points across taxa can be challenging due to data availability an...

Cumulative exposure to dust causes accelerated decline in lung function in tunnel workers

PubMed Central

Ulvestad, B; Bakke, B; Eduard, W; Kongerud, J; Lund, M

2001-01-01

OBJECTIVES—To examine whether underground construction workers exposed to tunnelling pollutants over a follow up period of 8 years have an increased risk of decline in lung function and respiratory symptoms compared with reference subjects working outside the tunnel atmosphere, and relate the findings to job groups and cumulative exposure to dust and gases.
METHODS—96 Tunnel workers and a reference group of 249 other heavy construction workers were examined in 1991 and re-examined in 1999. Exposure measurements were carried out to estimate personal cumulative exposure to total dust, respirable dust, α-quartz, oil mist, and nitrogen dioxide. The subjects answered a questionnaire on respiratory symptoms and smoking habits, performed spirometry, and had chest radiographs taken. Radiological signs of silicosis were evaluated (International Labour Organisation (ILO) classification). Atopy was determined by a multiple radioallergosorbent test (RAST).
RESULTS—The mean exposure to respirable dust and α-quartz in tunnel workers varied from 1.2-3.6 mg/m3 (respirable dust) and 0.019-0.044 mg/m3 (α-quartz) depending on job task performed. Decrease in forced expiratory volume in 1 second (FEV1) was associated with cumulative exposure to respirable dust (p<0.001) and α-quartz (p=0.02). The multiple regression model predicted that in a worker 40 years of age, the annual decrease in FEV1 would be 25 ml in a non-exposed non-smoker, 35 ml in a non-exposed smoker, and 50-63 ml in a non-smoking tunnel worker (depending on job). Compared with the reference group the odds ratio for the occurrence of new respiratory symptoms during the follow up period was increased in the tunnel workers and associated with cumulative exposure to respirable dust.
CONCLUSIONS—Cumulative exposures to respirable dust and α-quartz are the most important risk factors for airflow limitation in underground heavy construction workers, and cumulative exposure to respirable dust is the

Managing Risks? Early Warning Systems for Climate Change

NASA Astrophysics Data System (ADS)

Sitati, A. M.; Zommers, Z. A.; Habilov, M.

2014-12-01

Early warning systems are a tool with which to minimize risks posed by climate related hazards. Although great strides have been made in developing early warning systems most deal with one hazard, only provide short-term warnings and do not reach the most vulnerable. This presentation will review research results of the United Nations Environment Programme's CLIM-WARN project. The project seeks to identify how governments can better communicate risks by designing multi-hazard early warning systems that deliver actionable warnings across timescales. Household surveys and focus group discussions were conducted in 36 communities in Kenya, Ghana and Burkina Faso in order to identify relevant climate related hazards, current response strategies and early warning needs. Preliminary results show significant variability in both risks and needs within and between countries. For instance, floods are more frequent in rural western parts of Kenya. Droughts are frequent in the north while populations in urban areas face a range of hazards - floods, droughts, disease outbreaks - that sometimes occur simultaneously. The majority of the rural population, especially women, the disabled and the elderly, do not have access to modern media such as radio, television, or internet. While 55% of rural populace never watches television, 64% of urban respondents watch television on a daily basis. Communities have different concepts of how to design warning systems. It will be a challenge for national governments to create systems that accommodate such diversity yet provide standard quality of service to all. There is a need for flexible and forward-looking early warning systems that deliver broader information about risks. Information disseminated through the system could not only include details of hazards, but also long-term adaptation options, general education, and health information, thus increasingly both capabilities and response options.

Cumulative risk and AIDS-orphanhood: interactions of stigma, bullying and poverty on child mental health in South Africa.

PubMed

Cluver, Lucie; Orkin, Mark

2009-10-01

Research shows that AIDS-orphaned children are more likely to experience clinical-range psychological problems. Little is known about possible interactions between factors mediating these high distress levels. We assessed how food insecurity, bullying, and AIDS-related stigma interacted with each other and with likelihood of experiencing clinical-range disorder. In South Africa, 1025 adolescents completed standardised measures of depression, anxiety and post-traumatic stress. 52 potential mediators were measured, including AIDS-orphanhood status. Logistic regressions and hierarchical log-linear modelling were used to identify interactions among significant risk factors. Food insecurity, stigma and bullying all independently increased likelihood of disorder. Poverty and stigma were found to interact strongly, and with both present, likelihood of disorder rose from 19% to 83%. Similarly, bullying interacted with AIDS-orphanhood status, and with both present, likelihood of disorder rose from 12% to 76%. Approaches to alleviating psychological distress amongst AIDS-affected children must address cumulative risk effects.

Interactive effects of cumulative stress and impulsivity on alcohol consumption.

PubMed

Fox, Helen C; Bergquist, Keri L; Peihua, Gu; Rajita, Sinha

2010-08-01

Alcohol addiction may reflect adaptations to stress, reward, and regulatory brain systems. While extensive research has identified both stress and impulsivity as independent risk factors for drinking, few studies have assessed the interactive relationship between stress and impulsivity in terms of hazardous drinking within a community sample of regular drinkers. One hundred and thirty regular drinkers (56M/74F) from the local community were assessed for hazardous and harmful patterns of alcohol consumption using the Alcohol Use Disorders Identification Test (AUDIT). All participants were also administered the Barratt Impulsiveness Scale (BIS-11) as a measure of trait impulsivity and the Cumulative Stress/Adversity Checklist (CSC) as a comprehensive measure of cumulative adverse life events. Standard multiple regression models were used to ascertain the independent and interactive nature of both overall stress and impulsivity as well as specific types of stress and impulsivity on hazardous and harmful drinking. Recent life stress, cumulative traumatic stress, overall impulsivity, and nonplanning-related impulsivity as well as cognitive and motor-related impulsivity were all independently predictive of AUDIT scores. However, the interaction between cumulative stress and total impulsivity scores accounted for a significant amount of the variance, indicating that a high to moderate number of adverse events and a high trait impulsivity rating interacted to affect greater AUDIT scores. The subscale of cumulative life trauma accounted for the most variance in AUDIT scores among the stress and impulsivity subscales. Findings highlight the interactive relationship between stress and impulsivity with regard to hazardous drinking. The specific importance of cumulative traumatic stress as a marker for problem drinking is also discussed.

Interactive Effects of Cumulative Stress and Impulsivity on Alcohol Consumption

PubMed Central

Fox, Helen C.; Bergquist, Keri L.; Gu, Peihua; Sinha, Rajita

2013-01-01

Background Alcohol addiction may reflect adaptations to stress, reward, and regulatory brain systems. While extensive research has identified both stress and impulsivity as independent risk factors for drinking, few studies have assessed the interactive relationship between stress and impulsivity in terms of hazardous drinking within a community sample of regular drinkers. Methods One hundred and thirty regular drinkers (56M/74F) from the local community were assessed for hazardous and harmful patterns of alcohol consumption using the Alcohol Use Disorders Identification Test (AUDIT). All participants were also administered the Barratt Impulsiveness Scale (BIS-11) as a measure of trait impulsivity and the Cumulative Stress/Adversity Checklist (CSC) as a comprehensive measure of cumulative adverse life events. Standard multiple regression models were used to ascertain the independent and interactive nature of both overall stress and impulsivity as well as specific types of stress and impulsivity on hazardous and harmful drinking. Results Recent life stress, cumulative traumatic stress, overall impulsivity, and nonplanning-related impulsivity as well as cognitive and motor-related impulsivity were all independently predictive of AUDIT scores. However, the interaction between cumulative stress and total impulsivity scores accounted for a significant amount of the variance, indicating that a high to moderate number of adverse events and a high trait impulsivity rating interacted to affect greater AUDIT scores. The subscale of cumulative life trauma accounted for the most variance in AUDIT scores among the stress and impulsivity subscales. Conclusions Findings highlight the interactive relationship between stress and impulsivity with regard to hazardous drinking. The specific importance of cumulative traumatic stress as a marker for problem drinking is also discussed. PMID:20491738

Sexual Risk Behavior in Young Adulthood: Broadening the Scope Beyond Early Sexual Initiation

PubMed Central

Epstein, Marina; Bailey, Jennifer A.; Manhart, Lisa E.; Hill, Karl G.; Hawkins, J. David

2013-01-01

A robust link between early sexual initiation and sexual risk-taking behavior is reported in previous studies. The relationship may not be causal, however, as the effect of common risk factors is often not considered. The current study examined whether early initiation is a key predictor of risky sexual behavior in the 20s and 30s, over and above co-occurring individual and environmental factors. Data were drawn from the Seattle Social Development Project, a longitudinal panel of 808 youth. Early predictors (ages 10–15) and sexual risk-taking (ages 21–24 and 30–33) were assessed prospectively. Early sexual initiation (before age 15) was entered into a series of probit regressions that also included family, neighborhood, peer, and individual risk factors. Although a positive bivariate relation between early sexual initiation and sexual risk-taking was observed at both ages, the link did not persist when co-occurring risk factors were included. Behavioral disinhibition and antisocial peer influences emerged as the strongest predictors of sexual risk over and above early sexual initiation. These results suggest that early sexual initiation must be considered in the context of common antecedents; public health policy aimed at delaying sexual intercourse alone is unlikely to substantially reduce sexual risk behavior in young adulthood. PMID:24423058

Overturn of magma ocean ilmenite cumulate layer: Implications for lunar magmatic evolution and formation of a lunar core

NASA Technical Reports Server (NTRS)

Hess, P. C.; Parmentier, E. M.

1993-01-01

We explore a model for the chemical evolution of the lunar interior that explains the origin and evolution of lunar magmatism and possibly the existence of a lunar core. A magma ocean formed during accretion differentiates into the anorthositic crust and chemically stratified cumulate mantle. The cumulative mantle is gravitationally unstable with dense ilmenite cumulate layers overlying olivine-orthopyroxene cumulates with Fe/Mg that decreases with depth. The dense ilmenite layer sinks to the center of the moon forming the core. The remainder of the gravitationally unstable cumulate pile also overturns. Any remaining primitive lunar mantle rises to its level of neutral buoyancy in the cumulate pile. Perhaps melting of primitive lunar mantle due to this decompression results in early lunar Mg-rich magmatism. Because of its high concentration of incompatible heat producing elements, the ilmenite core heats the overlying orthopyroxene-bearing cumulates. As a conductively thickening thermal boundary layer becomes unstable, the resulting mantle plumes rise, decompress, and partially melt to generate the mare basalts. This model explains both the timing and chemical characteristics of lunar magmatism.

Positive and negative reinforcement underlying risk behavior in early adolescents.

PubMed

MacPherson, Laura; Reynolds, Elizabeth K; Daughters, Stacey B; Wang, Frances; Cassidy, Jude; Mayes, Linda C; Lejuez, C W

2010-09-01

The goal of the current study was to examine the combined influence of positive reinforcement processes using a behavioral task measuring risk taking propensity (RTP) and negative reinforcement processes using a behavioral task measuring deficits in distress tolerance (DT) on a range of risk taking behaviors among early adolescents. Participants included a community sample of 230 early adolescents (aged 9-13) who completed two behavioral tasks assessing reinforcement processes as well as reported on past year risk behavior involvement as assessed by items from the Youth Risk Behavior Surveillance System at a baseline and a 1-year follow-up assessment. Data indicated that at the Wave 2 assessment, RTP was positively related to number of risk-taking behaviors in the past year but only for those with low DT, with this finding persisting after controlling for the significant influence of male gender and higher sensation seeking. Results of the present study highlight the importance of considering both positive and negative reinforcement processes in combination when investigating vulnerability factors for early risk behavior engagement in youth.

Cumulative Aggregate Risk Evaluation Software

EPA Science Inventory

CARES is a state-of-the-art software program designed to conduct complex exposure and risk assessments for pesticides, such as the assessments required under the 1996 Food Quality Protection Act (FQPA). CARES was originally developed under the auspices of CropLife America (CLA),...

Length of day during early gestation as a predictor of risk for severe retinopathy of prematurity.

PubMed

Yang, Michael B; Rao, Sujata; Copenhagen, David R; Lang, Richard A

2013-12-01

Fetal mice require light exposure in utero during early gestation for normal vascular development in the eye. Because angiogenic abnormalities in retinopathy of prematurity (ROP) are manifested in preterm infants, we investigated whether day length during early gestation was associated with severe ROP (SROP). Single-center, retrospective cohort study. We included a total of 343 premature infants (401-1250 g birth weight [BW], from 1998-2002): 684 eyes (1 eye each of 2 patients excluded) with 76 eyes developing SROP, defined as (1) classic threshold ROP in zone I or II, (2) type 1 ROP in zone I, or (3) in a few eyes, type 1 ROP in posterior zone II that was treated. For each infant, average day length (ADL) was calculated during different cumulative time periods and time windows after the estimated date of conception (EDC). Multiple logistic regression analysis (with generalized estimating equations to account for inter-eye correlation) was performed. Association of ADL during early gestation with SROP. In a model evaluating all 684 eyes with 76 eyes developing SROP, BW, gestational age, multiple births, race, per capita income in the mother's residence ZIP code, and ADL during the first 90 days after the EDC were factors associated with the development of SROP. Each additional hour of ADL (90 days) decreased the likelihood of SROP by 28% (P = 0.015; odds ratio [OR], 0.72; 95% confidence interval [CI], 0.55-0.94). In a model evaluating the subset of 146 prethreshold ROP eyes with 76 eyes developing SROP, each additional hour of ADL during the first 105 days after the EDC decreased the likelihood of SROP by 46% (P = 0.001; OR, 0.54; 95% CI, 0.37-0.78). Time windows when ADL was most closely associated with SROP were 31 to 60 days and 61 to 90 days after the EDC for the all eyes and the prethreshold ROP eyes models, respectively. Higher ADL during early gestation was associated with a lower risk for SROP and may imply a role for prophylactic light treatment during

Quantitative Relationship Between Cumulative Risk Alleles Based on Genome-Wide Association Studies and Type 2 Diabetes Mellitus: A Systematic Review and Meta-analysis.

PubMed

Kodama, Satoru; Fujihara, Kazuya; Ishiguro, Hajime; Horikawa, Chika; Ohara, Nobumasa; Yachi, Yoko; Tanaka, Shiro; Shimano, Hitoshi; Kato, Kiminori; Hanyu, Osamu; Sone, Hirohito

2018-01-05

Many epidemiological studies have assessed the genetic risk of having undiagnosed or of developing type 2 diabetes mellitus (T2DM) using several single nucleotide polymorphisms (SNPs) based on findings of genome-wide association studies (GWAS). However, the quantitative association of cumulative risk alleles (RAs) of such SNPs with T2DM risk has been unclear. The aim of this meta-analysis is to review the strength of the association between cumulative RAs and T2DM risk. Systematic literature searches were conducted for cross-sectional or longitudinal studies that examined odds ratios (ORs) for T2DM in relation to genetic profiles. Logarithm of the estimated OR (log OR) of T2DM for 1 increment in RAs carried (1-ΔRA) in each study was pooled using a random-effects model. There were 46 eligible studies that included 74,880 cases among 249,365 participants. In 32 studies with a cross-sectional design, the pooled OR for T2DM morbidity for 1-ΔRA was 1.16 (95% confidence interval [CI], 1.13-1.19). In 15 studies that had a longitudinal design, the OR for incident T2DM was 1.10 (95% CI, 1.08-1.13). There was large heterogeneity in the magnitude of log OR (P < 0.001 for both cross-sectional studies and longitudinal studies). The top 10 commonly used genes significantly explained the variance in the log OR (P = 0.04 for cross-sectional studies; P = 0.006 for longitudinal studies). The current meta-analysis indicated that carrying 1-ΔRA in T2DM-associated SNPs was associated with a modest risk of prevalent or incident T2DM, although the heterogeneity in the used genes among studies requires us to interpret the results with caution.

Quantitative Relationship Between Cumulative Risk Alleles Based on Genome-Wide Association Studies and Type 2 Diabetes Mellitus: A Systematic Review and Meta-analysis

PubMed Central

Kodama, Satoru; Fujihara, Kazuya; Ishiguro, Hajime; Horikawa, Chika; Ohara, Nobumasa; Yachi, Yoko; Tanaka, Shiro; Shimano, Hitoshi; Kato, Kiminori; Hanyu, Osamu; Sone, Hirohito

2018-01-01

Many epidemiological studies have assessed the genetic risk of having undiagnosed or of developing type 2 diabetes mellitus (T2DM) using several single nucleotide polymorphisms (SNPs) based on findings of genome-wide association studies (GWAS). However, the quantitative association of cumulative risk alleles (RAs) of such SNPs with T2DM risk has been unclear. The aim of this meta-analysis is to review the strength of the association between cumulative RAs and T2DM risk. Systematic literature searches were conducted for cross-sectional or longitudinal studies that examined odds ratios (ORs) for T2DM in relation to genetic profiles. Logarithm of the estimated OR (log OR) of T2DM for 1 increment in RAs carried (1-ΔRA) in each study was pooled using a random-effects model. There were 46 eligible studies that included 74,880 cases among 249,365 participants. In 32 studies with a cross-sectional design, the pooled OR for T2DM morbidity for 1-ΔRA was 1.16 (95% confidence interval [CI], 1.13–1.19). In 15 studies that had a longitudinal design, the OR for incident T2DM was 1.10 (95% CI, 1.08–1.13). There was large heterogeneity in the magnitude of log OR (P < 0.001 for both cross-sectional studies and longitudinal studies). The top 10 commonly used genes significantly explained the variance in the log OR (P = 0.04 for cross-sectional studies; P = 0.006 for longitudinal studies). The current meta-analysis indicated that carrying 1-ΔRA in T2DM-associated SNPs was associated with a modest risk of prevalent or incident T2DM, although the heterogeneity in the used genes among studies requires us to interpret the results with caution. PMID:29093303

Childhood Risk Factors for Early-Onset Drinking*

PubMed Central

Donovan, John E.; Molina, Brooke S. G.

2011-01-01

Objective: There is relatively little research on the childhood antecedent predictors of early-onset alcohol use. This study examined an array of psychosocial variables assessed at age 10 and reflecting Problem Behavior Theory as potential antecedent risk factors for the initiation of alcohol use at age 14 or younger. Method: A sample of 452 children (238 girls) ages 8 or 10 and their families was drawn from Allegheny County, PA, using targeted-age directory sampling and random-digit dialing procedures. Children and parents were interviewed using computer-assisted interviews. Logistic regression analyses were used to examine the age-10 univariate and multivariate predictors of the initiation of alcohol use by age 14 or younger. Results: Twenty-five percent of the sample reported having more than a sip or a taste of alcohol in their life by age 14. Sex, race, and age cohort did not relate to early drinking status. Children with two parents were less likely to initiate drinking early. Early initiation of drinking related significantly to an array of antecedent risk factors (personality, social environment, and behavioral) assessed at age 10 that reflect psychosocial proneness for problem behavior. In the multivariate model, the variables most predictive of early-onset drinking were having a single parent, sipping or tasting alcohol by age 10, having parents who also started drinking at an early age, and parental drinking frequency. Conclusions: Initiation of alcohol use by age 14 reflects childhood psychosocial proneness to engage in problem behavior as measured by Problem Behavior Theory and having a family environment conducive to alcohol use. PMID:21906502

Sensitive periods of substance abuse: Early risk for the transition to dependence

PubMed Central

Jordan, Chloe J.; Andersen, Susan L.

2016-01-01

Early adolescent substance use dramatically increases the risk of lifelong substance use disorder (SUD). An adolescent sensitive period evolved to allow the development of risk-taking traits that aid in survival; today these may manifest as a vulnerability to drugs of abuse. Early substance use interferes with ongoing neurodevelopment to induce neurobiological changes that further augment SUD risk. Although many individuals use drugs recreationally, only a small percentage transition to SUD. Current theories on the etiology of addiction can lend insights into the risk factors that increase vulnerability from early recreational use to addiction. Building on the work of others, we suggest individual risk for SUD emerges from an immature PFC combined with hyper-reactivity of reward salience, habit, and stress systems. Early identification of risk factors is critical to reducing the occurrence of SUD. We suggest preventative interventions for SUD that can be either tailored to individual risk profiles and/or implemented broadly, prior to the sensitive adolescent period, to maximize resilience to developing substance dependence. Recommendations for future research include a focus on the juvenile and adolescent periods as well as on sex differences to better understand early risk and identify the most efficacious preventions for SUD. PMID:27840157

Cumulative reproductive effects of in utero administration of mixtures of antiandrogens in male SD rats: synergy or additivity?

EPA Science Inventory

In 1996 the USEPA was charged under the FQPA to consider the cumulative effects of chemicals in their risk assessments. Our studies were conducted to provide a framework for assessing the cumulative effects of antiandrogens. Toxicants were administered individually or as mixtures...

Severe physical violence between intimate partners during pregnancy: a risk factor for early cessation of exclusive breast-feeding.

PubMed

Moraes, Claudia L; de Oliveira, Alessandra S D; Reichenheim, Michael E; Lobato, Gustavo

2011-12-01

To investigate the role of severe physical violence during pregnancy (SPVP) between intimate partners in early cessation of exclusive breast-feeding (EBF). A health services survey. The revised Conflict Tactics Scale was used to characterize SPVP; premature breast-feeding cessation was identified using a current status data approach, which was based on the information reported from food recall during the preceding 7 d. The cumulative hazard function was estimated by complementary log-log transformation models, which allowed the ensuing estimation of early breast-feeding cessation rates in different age groups and the ratio of rates of weaning between women exposed and not exposed to violence. Five large public primary health-care facilities of Rio de Janeiro, Brazil. The sample comprised 811 randomly selected mothers of children under 5 months of age who were waiting to be consulted. SPVP is an independent risk factor of cessation of EBF since, after controlling for socio-economic, demographic, reproductive and lifestyle variables, women exposed to violence presented an incidence density that was 31% higher than those who were not exposed (hazard ratio = 1·30, 95% CI 1·01, 1·69). The findings corroborate the hypothesis that SPVP is an important risk factor for EBF. This indicates the need for incentives to adequately train health-care personnel in dealing with lactating women in order to gain a broader view of breast-feeding beyond the biological aspects of lactation, including the maternal psychological dimension.

Participant selection for lung cancer screening by risk modelling (the Pan-Canadian Early Detection of Lung Cancer [PanCan] study): a single-arm, prospective study.

PubMed

Tammemagi, Martin C; Schmidt, Heidi; Martel, Simon; McWilliams, Annette; Goffin, John R; Johnston, Michael R; Nicholas, Garth; Tremblay, Alain; Bhatia, Rick; Liu, Geoffrey; Soghrati, Kam; Yasufuku, Kazuhiro; Hwang, David M; Laberge, Francis; Gingras, Michel; Pasian, Sergio; Couture, Christian; Mayo, John R; Nasute Fauerbach, Paola V; Atkar-Khattra, Sukhinder; Peacock, Stuart J; Cressman, Sonya; Ionescu, Diana; English, John C; Finley, Richard J; Yee, John; Puksa, Serge; Stewart, Lori; Tsai, Scott; Haider, Ehsan; Boylan, Colm; Cutz, Jean-Claude; Manos, Daria; Xu, Zhaolin; Goss, Glenwood D; Seely, Jean M; Amjadi, Kayvan; Sekhon, Harmanjatinder S; Burrowes, Paul; MacEachern, Paul; Urbanski, Stefan; Sin, Don D; Tan, Wan C; Leighl, Natasha B; Shepherd, Frances A; Evans, William K; Tsao, Ming-Sound; Lam, Stephen

2017-11-01

Results from retrospective studies indicate that selecting individuals for low-dose CT lung cancer screening on the basis of a highly predictive risk model is superior to using criteria similar to those used in the National Lung Screening Trial (NLST; age, pack-year, and smoking quit-time). We designed the Pan-Canadian Early Detection of Lung Cancer (PanCan) study to assess the efficacy of a risk prediction model to select candidates for lung cancer screening, with the aim of determining whether this approach could better detect patients with early, potentially curable, lung cancer. We did this single-arm, prospective study in eight centres across Canada. We recruited participants aged 50-75 years, who had smoked at some point in their life (ever-smokers), and who did not have a self-reported history of lung cancer. Participants had at least a 2% 6-year risk of lung cancer as estimated by the PanCan model, a precursor to the validated PLCOm2012 model. Risk variables in the model were age, smoking duration, pack-years, family history of lung cancer, education level, body-mass index, chest x-ray in the past 3 years, and history of chronic obstructive pulmonary disease. Individuals were screened with low-dose CT at baseline (T0), and at 1 (T1) and 4 (T4) years post-baseline. The primary outcome of the study was incidence of lung cancer. This study is registered with ClinicalTrials.gov, number NCT00751660. 7059 queries came into the study coordinating centre and were screened for PanCan risk. 15 were duplicates, so 7044 participants were considered for enrolment. Between Sept 24, 2008, and Dec 17, 2010, we recruited and enrolled 2537 eligible ever-smokers. After a median follow-up of 5·5 years (IQR 3·2-6·1), 172 lung cancers were diagnosed in 164 individuals (cumulative incidence 0·065 [95% CI 0·055-0·075], incidence rate 138·1 per 10 000 person-years [117·8-160·9]). There were ten interval lung cancers (6% of lung cancers and 6% of individuals with cancer

Cumulative stress in childhood is associated with blunted reward-related brain activity in adulthood

PubMed Central

Albert, Dustin; Iselin, Anne-Marie R.; Carré, Justin M.; Dodge, Kenneth A.; Hariri, Ahmad R.

2016-01-01

Early life stress (ELS) is strongly associated with negative outcomes in adulthood, including reduced motivation and increased negative mood. The mechanisms mediating these relations, however, are poorly understood. We examined the relation between exposure to ELS and reward-related brain activity, which is known to predict motivation and mood, at age 26, in a sample followed since kindergarten with annual assessments. Using functional neuroimaging, we assayed individual differences in the activity of the ventral striatum (VS) during the processing of monetary rewards associated with a simple card-guessing task, in a sample of 72 male participants. We examined associations between a cumulative measure of ELS exposure and VS activity in adulthood. We found that greater levels of cumulative stress during childhood and adolescence predicted lower reward-related VS activity in adulthood. Extending this general developmental pattern, we found that exposure to stress early in development (between kindergarten and grade 3) was significantly associated with variability in adult VS activity. Our results provide an important demonstration that cumulative life stress, especially during this childhood period, is associated with blunted reward-related VS activity in adulthood. These differences suggest neurobiological pathways through which a history of ELS may contribute to reduced motivation and increased negative mood. PMID:26443679

Adverse adolescent relationship histories and young adult health: Cumulative effects of loneliness, low parental support, relationship instability, intimate partner violence and loss

PubMed Central

Adam, Emma K.; Chyu, Laura; Hoyt, Lindsay; Doane, Leah D.; Boisjoly, Johanne; Duncan, Greg; Chase-Lansdale, Lindsay; McDade, Thomas W.

2011-01-01

Purpose To examine the associations between adverse interpersonal relationship histories experienced during adolescence and health in young adulthood in a large, nationally representative sample. Methods Using data from Waves I, II and III of the National Longitudinal Study of Adolescent Health, multiple adverse relationship experiences are examined, including high loneliness, low perceived parental support, frequent transitions in romantic relationships (relationship instability), exposure to intimate partner violence, and loss by death of important relationship figures. These histories are assessed, both individually and in a relationship risk index, as predictors of self-reported general health and depressive symptoms at Wave III (ages 18 to 27), controlling for baseline (Wave I) health and for demographic and health behavior covariates. Results Net of baseline health and covariates, each type of relationship risk (experienced between Wave I and Wave III) was related to either depression or general health at Wave III, with the strongest effects seen for exposure to intimate partner violence. In addition, a cumulative relationship risk index examining the extent to which youth experienced high levels of multiple relationship risk factors revealed that each additional adverse relationship experience increased the odds of reporting poor mental and general health at Wave III, with increases occurring in an additive manner. Conclusions Multiple types of adverse relationship experiences predicted increases in poor general health and depressive symptoms from adolescence to early adulthood. Consistent with a cumulative risk hypothesis, the more types of adverse relationship experiences a youth experienced, the worse their young adult health outcomes. PMID:21856520

The Association between Cumulative Psychosocial Risk and Cervical HPV Infection Among Female Adolescents in a Free Vaccination Program

PubMed Central

Linares, Lourdes Oriana; Shankar, Viswanathan; Diaz, Angela; Nucci-Sack, Anne; Strickler, Howard D.; Peake, Ken; Weiss, Jocelyn; Burk, Robert D.; Schlecht, Nicolas F.

2016-01-01

Objective This study investigated the association of cervical Human Papillomavirus (HPV) infection with cumulative psychosocial risk reflecting family disadvantage, psychological distress, and unhealthy life style. Methods The sample (N=745) was comprised of sexually-active female adolescent patients (12-19 years), primarily ethnic minorities, enrolled in a free HPV vaccination program. Subjects completed questionnaires and provided cervical swabs for HPV DNA testing. Unweighted and weighted Principal Component Analyses (PCA) for categorical data were used to derive multi-systemic psychosocial risk indices using nine indicators: low socioeconomic status, lack of adult involvement, not attending high-school/college, history of treatment for depression/anxiety, antisocial/delinquent behavior, number of recent sexual partners, use of alcohol, use of drugs, and dependency risk for alcohol/drugs. The association between cervical HPV (any-type, high risk-types, vaccine-types) assayed by polymerase chain reaction and self-reported number of psychosocial risk indicators was estimated using multivariable logistic regression. Results Subjects had a median of three psychosocial risk indicators. Multiple logistic regression analyses showed associations with unweighted and weighted number of psychosocial indicators for HPV any-type (adjusted odds ratio [aOR]=1.1; 95% confidence interval [CI]: 1.0-1.2 ); with the strongest associations between weighted drug/alcohol use, drug/alcohol dependency risk, and antisocial/delinquent behavior and detection of HPV vaccine-types (aOR=1.5; 95%CI: 1.1-2.0) independent of number of recent sexual partners and vaccine dose (0-3). Conclusion Increased HPV infections including HPV vaccine-types were associated with greater number of psychosocial risk indicators even after controlling for demographics, sexual behavior, history of chlamydia, and vaccine dose. PMID:25985216

40 CFR 1508.7 - Cumulative impact.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 32 2010-07-01 2010-07-01 false Cumulative impact. 1508.7 Section 1508... Cumulative impact. Cumulative impact is the impact on the environment which results from the incremental impact of the action when added to other past, present, and reasonably foreseeable future actions...

Adolescent Risk Factors for Child Maltreatment

PubMed Central

Matsuda, Mauri; Greenman, Sarah J.; Augustyn, Megan Bears; Henry, Kimberly L.; Smith, Carolyn A.; Ireland, Timothy O.

2014-01-01

We investigate adolescent risk factors, measured at both early and late adolescence, for involvement in child maltreatment during adulthood. Comprehensive assessments of risk factors for maltreatment that use representative samples with longitudinal data are scarce and can inform multilevel prevention. We use data from the Rochester Youth Development Study, a longitudinal study begun in 1988 with a sample of 1,000 seventh and eighth graders. Participants have been interviewed 14 times and, at the last assessment (age 31), 80% were retained. Risk factors represent 10 developmental domains: area characteristics, family background/structure, parent stressors, exposure to family violence, parent-child relationships, education, peer relationships, adolescent stressors, antisocial behaviors, and precocious transitions to adulthood. Maltreatment is measured by substantiated reports from Child Protective Services records. Many individual risk factors (20 at early adolescence and 14 at later adolescence) are significantly, albeit moderately, predictive of maltreatment. Several developmental domains stand out, including family background/structure, education, antisocial behaviors, and precocious transitions. In addition, there is a pronounced impact of cumulative risk on the likelihood of maltreatment. For example, only 3% of the youth with no risk domains in their background at early adolescence were involved in later maltreatment, but for those with risk in 9 developmental domains the rate was 45%. Prevention programs targeting youth at high risk for engaging in maltreatment should begin during early adolescence when risk factors are already at play. These programs need to be comprehensive, capable of addressing the multiple and interwoven nature of risk that is associated with maltreatment. PMID:24075569

Genetic Risk Score Analysis in Early-Onset Bipolar Disorder

PubMed Central

Croarkin, Paul E.; Luby, Joan L.; Cercy, Kelly; Geske, Jennifer R.; Veldic, Marin; Simonson, Matthew; Joshi, Paramjit T.; Wagner, Karen Dineen; Walkup, John T.; Nassan, Malik M.; Cuellar-Barboza, Alfredo B.; Casuto, Leah; McElroy, Susan L.; Jensen, Peter S.; Frye, Mark A.; Biernacka, Joanna M.

2018-01-01

Objective In this study, we performed a candidate genetic risk score (GRS) analysis of early-onset bipolar disorder. Method Treatment of Early Age Mania (TEAM) study enrollment and sample collection took place from 2003–2008. Mayo Clinic Bipolar Biobank samples were collected from 2009–2013. Genotyping and analyses for the present study took place from 2013–2014. The diagnosis of bipolar disorder was based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria. Eight single-nucleotide polymorphisms (SNPs), previously reported in genome-wide association studies to be associated with bipolar disorder, were chosen for GRS analysis in early-onset bipolar disease. These SNPs map to 3 genes: CACNA1C (calcium channel, voltage-dependent, L type, alpha 1C subunit), ANK3 (ankyrin-3, node of Ranvier [ankyrin G]), and ODZ4 (teneurin transmembrane protein 4 [formerly “odz, odd Oz/ten-m homolog 4 {Drosophila}, ODZ4”]). The 8 candidate SNPs were genotyped in patients from the TEAM study (n=69), adult patients with bipolar disorder (n=732) including a subset with early-onset illness [n=192]), and healthy controls (n=776). GRS analyses were performed comparing early-onset cases with controls. In addition, associations of early-onset BD with individual SNPs and haplotypes were explored. Results GRS analysis revealed associations of the risk score with early-onset bipolar disorder (P=.01). Gene-level haplotype analysis comparing TEAM patients with controls suggested association of early-onset bipolar disorder with a CACNA1C haplotype (global test, P=.01). At the level of individual SNPs, comparison of TEAM cases with healthy controls provided nominally significant evidence for association of SNP rs10848632 in CACNA1C with early-onset bipolar disorder (P=.017), which did not remain significant after correction for multiple comparisons. Conclusion These preliminary analyses suggest that previously identified bipolar disorder risk loci

Genetic Risk Score Analysis in Early-Onset Bipolar Disorder.

PubMed

Croarkin, Paul E; Luby, Joan L; Cercy, Kelly; Geske, Jennifer R; Veldic, Marin; Simonson, Matthew; Joshi, Paramjit T; Wagner, Karen Dineen; Walkup, John T; Nassan, Malik M; Cuellar-Barboza, Alfredo B; Casuto, Leah; McElroy, Susan L; Jensen, Peter S; Frye, Mark A; Biernacka, Joanna M

In this study, we performed a candidate genetic risk score (GRS) analysis of early-onset bipolar disorder (BD). Treatment of Early Age Mania (TEAM) study enrollment and sample collection took place from 2003 to 2008. Mayo Clinic Bipolar Biobank samples were collected from 2009 to 2013. Genotyping and analyses for the present study took place from 2013 to 2014. The diagnosis of BD was based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria. Eight single-nucleotide polymorphisms (SNPs), previously reported in genome-wide association studies to be associated with BD, were chosen for GRS analysis in early-onset bipolar disease. These SNPs map to 3 genes: CACNA1C (calcium channel, voltage-dependent, L type, alpha 1C subunit), ANK3 (ankyrin-3, node of Ranvier [ankyrin G]), and ODZ4 (teneurin transmembrane protein 4 [formerly "odz, odd Oz/10-m homolog 4 {Drosophila}, ODZ4"]). The 8 candidate SNPs were genotyped in patients from the TEAM study (n = 69); adult patients with BD (n = 732), including a subset with early-onset illness (n = 192); and healthy controls (n = 776). GRS analyses were performed to compare early-onset cases with controls. In addition, associations of early-onset BD with individual SNPs and haplotypes were explored. GRS analysis revealed associations of the risk score with early-onset BD (P = .01). Gene-level haplotype analysis comparing TEAM patients with controls suggested association of early-onset BD with a CACNA1C haplotype (global test, P = .01). At the level of individual SNPs, comparison of TEAM cases with healthy controls provided nominally significant evidence for association of SNP rs10848632 in CACNA1C with early-onset BD (P = .017), which did not remain significant after correction for multiple comparisons. These preliminary analyses suggest that previously identified BD risk loci, especially CACNA1C, have a role in early-onset BD, possibly with stronger effects than for late-onset BD. �

Cumulative Injury

PubMed Central

LaDou, Joseph

1978-01-01

A few states, notably California, are experiencing large increases in the number and cost of disability settlements under workers' compensation. Claims of cumulative injury for coronary heart disease, hypertension, stroke, cancer and neuropsychiatric problems have all been interpreted as compensable under workers' compensation, even when these conditions are clearly related to the aging process. Legal precedents for such claims are building rapidly throughout the country. The resultant costs may lead to the demise of the workers' compensation system. The situation in California is discussed in detail including the legal aspects, cumulative injury claims by type of disease and age of claimants, legal costs to the individual and the employer, and the economic outlook for the workers' compensation insurance system. PMID:151986

Early feeding and risk of type 1 diabetes: experiences from the Trial to Reduce Insulin-dependent diabetes mellitus in the Genetically at Risk (TRIGR).

PubMed

Knip, Mikael; Virtanen, Suvi M; Becker, Dorothy; Dupré, John; Krischer, Jeffrey P; Åkerblom, Hans K

2011-12-01

Short-term breastfeeding and early exposure to complex dietary proteins, such as cow milk proteins and cereals, or to fruit, berries, and roots have been implicated as risk factors for β cell autoimmunity, clinical type 1 diabetes, or both. The Trial to Reduce Insulin-dependent diabetes mellitus in the Genetically at Risk (TRIGR) is an international, randomized, double-blind, controlled intervention trial designed to answer the question of whether weaning to an extensively hydrolyzed formula in infancy will decrease the risk of type 1 diabetes later in childhood. In our pilot study, weaning to a highly hydrolyzed formula decreased by ≈ 50% the cumulative incidence of one or more diabetes-associated autoantibodies by a mean age of 4.7 y. This finding was confirmed in a recent follow-up analysis to 10 y of age. Currently, the full-scale TRIGR takes place in 77 centers in 15 countries. The TRIGR initially recruited 5606 newborn infants with a family member affected by type 1 diabetes and enrolled 2159 eligible subjects who carried a risk-conferring HLA genotype. All recruited mothers were encouraged to breastfeed. The intervention lasted for 6-8 mo with a minimum study formula exposure time of 2 mo, and hydrolyzed casein and standard cow milk-based weaning formulas were compared. Eighty percent of the participants were exposed to the study formula. The overall retention rate over the first 5 y was 87%, and protocol compliance was 94%. The randomization code will be opened when the last recruited child turns 10 y of age (ie, in 2017).

32 CFR 651.16 - Cumulative impacts.

Code of Federal Regulations, 2011 CFR

2011-07-01

... § 651.16 Cumulative impacts. (a) NEPA analyses must assess cumulative effects, which are the impact on the environment resulting from the incremental impact of the action when added to other past, present... 32 National Defense 4 2011-07-01 2011-07-01 false Cumulative impacts. 651.16 Section 651.16...

32 CFR 651.16 - Cumulative impacts.

Code of Federal Regulations, 2010 CFR

2010-07-01

... § 651.16 Cumulative impacts. (a) NEPA analyses must assess cumulative effects, which are the impact on the environment resulting from the incremental impact of the action when added to other past, present... 32 National Defense 4 2010-07-01 2010-07-01 true Cumulative impacts. 651.16 Section 651.16...

Breast cancer risk accumulation starts early – Prevention must also

PubMed Central

Colditz, Graham A; Bohlke, Kari; Berkey, Catherine S.

2014-01-01

Purpose Nearly 1 in 4 breast cancers is diagnosed before the age of 50, and many early-stage premalignant lesions are present but not yet diagnosed. Therefore, we review evidence to support the strategy that breast cancer prevention efforts must begin early in life. Methods Literature review Results Exposures during childhood and adolescence affect a woman’s long-term risk of breast cancer, but have received far less research attention than exposures that occur later in life. Breast tissue undergoes rapid cellular proliferation between menarche and first full-term pregnancy, and risk accumulates rapidly until the terminal differentiation that accompanies first pregnancy. Evidence on childhood diet and growth in height, and adolescent alcohol intake, among other adolescent factors are related to breast cancer risk and risk of premalignant proliferative benign lesions. Conclusion Breast cancer prevention efforts will have the greatest effect when initiated at an early age and continued over a lifetime. Gaps in knowledge are identified and deserve increase attention to inform prevention. PMID:24820413

Longitudinal patterns of poverty and health in early childhood: exploring the influence of concurrent, previous, and cumulative poverty on child health outcomes

PubMed Central

2012-01-01

Background Although the links between poverty and health have often been studied , the dynamics of poverty and physical health in early childhood remain under-investigated. In particular, it is not known whether the health of young children is affected differently from that of adults by patterns of poverty unique to them. Methods We examined patterns of health from 5 to 41 months of age as a function of concurrent, lagged, and chronic exposure to insufficient income. Using data from the first four rounds of the Quebec Longitudinal Study of Child Development, we performed multilevel logistic and multilevel Poisson regressions and latent growth curve analyses to explore associations between exposure to poverty and mother-reported asthma-like attacks, and maternal perception of health status controlling for neonatal, maternal, and environmental characteristics. Results The mean number of mother-reported asthma-like attacks significantly decreased as children aged. The likelihood of being perceived in a poorer health status also decreased across time. Concurrent poverty was associated with more mother-reported asthma-like attacks and with a higher risk of being perceived in poorer health status. One-period-lagged poverty was associated with more mother-reported asthma-like attacks and this remained significant after controlling for concurrent poverty. The number of mother-reported asthma-like attacks was significantly higher among children in the chronic poverty class compared to those in the never-poor class, particularly at 17 and 29 months. Perceived health status at 5-months was significantly poorer among chronically poor children compared to never-poor children. Conclusion Exposure to poverty negatively affects two major health indicators in early childhood – maternal perception of child health and mother-reported asthma-like attacks. Patterns of the effects vary according to timing and duration of poverty exposure. Further longitudinal research is warranted

The impact of youth, family, peer and neighborhood risk factors on developmental trajectories of risk involvement from early through middle adolescence.

PubMed

Wang, Bo; Deveaux, Lynette; Li, Xiaoming; Marshall, Sharon; Chen, Xinguang; Stanton, Bonita

2014-04-01

Few studies have analyzed the development course beginning in pre-/early adolescence of overall engagement in health-risk behaviors and associated social risk factors that place individuals in different health-risk trajectories through mid-adolescence. The current longitudinal study identified 1276 adolescents in grade six and followed them for three years to investigate their developmental trajectories of risk behaviors and to examine the association of personal and social risk factors with each trajectory. Group-based trajectory modeling was applied to identify distinctive trajectory patterns of risk behaviors. Multivariate multinomial logistic regression analyses were performed to examine the effects of the personal and social risk factors on adolescents' trajectories. Three gender-specific behavioral trajectories were identified for males (55.3% low-risk, 37.6% moderate-risk, increasing, and 7.1% high-risk, increasing) and females (41.4% no-risk, 53.4% low-risk, increasing and 5.2% moderate to high-risk, increasing). Sensation-seeking, family, peer, and neighborhood factors at baseline predicted following the moderate-risk, increasing trajectory and the high-risk, increasing trajectory in males; these risk factors predicted following the moderate to high-risk, increasing trajectory in females. The presence of all three social risk factors (high-risk neighborhood, high-risk peers and low parental monitoring) had a dramatic impact on increased probability of being in a high-risk trajectory group. These findings highlight the developmental significance of early personal and social risk factors on subsequent risk behaviors in early to middle adolescence. Future adolescent health behavior promotion interventions might consider offering additional prevention resources to pre- and early adolescent youth who are exposed to multiple contextual risk factors (even in the absence of risk behaviors) or youth who are early-starters of delinquency and substance use behaviors

Combined early and adult life risk factor associations for mid-life obesity in a prospective birth cohort: assessing potential public health impact.

PubMed

Pinto Pereira, Snehal M; van Veldhoven, Karin; Li, Leah; Power, Chris

2016-04-12

The combined effect of life-course influences on obesity development and thus their potential public health impact is unclear. We evaluated combined associations and predicted probabilities for early and adult life risk factors with central and general obesity in mid-adulthood. 1958 British birth cohort. 4629 males and 4670 females with data on waist circumference. 45 year obesity measured via waist circumference, waist-hip ratio (WHR) and BMI. At 45 years, approximately a third of the population were centrally obese and a quarter were generally obese. Three factors (parental overweight, maternal smoking during pregnancy and adult inactivity) were consistently associated with central and general obesity. Predicted probabilities for waist obesity increased from those with none to all three risk factors (0.15-0.33 in men; 0.19-0.39 in women (ptrend<0.001)), with a similar trend for general obesity. Additional factors (adult smoking, low fibre and heavy alcohol consumption) were associated with WHR obesity, although varying by gender. Prevalence of risk factors was higher in manual than non-manual groups: for example, in men 38% versus 25%, respectively, had ≥2 risk factors for waist and general obesity. Early-life and adult factors that are amenable to change are highly prevalent and accumulate in association with central and general obesity in mid-adulthood. The increase in probabilities for mid-adult obesity associated with cumulative levels of risk factors suggests the potential for public health impact. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Double-jeopardy: The joint impact of neighborhood disadvantage and low social cohesion on cumulative risk of disease among African American men and women in the Jackson Heart Study.

PubMed

Barber, Sharrelle; Hickson, DeMarc A; Kawachi, Ichiro; Subramanian, S V; Earls, Felton

2016-03-01

Few studies have examined the joint impact of neighborhood disadvantage and low social cohesion on health. Moreover, no study has considered the joint impact of these factors on a cumulative disease risk profile among a large sample of African American adults. Using data from the Jackson Heart Study, we examined the extent to which social cohesion modifies the relationship between neighborhood disadvantage and cumulative biological risk (CBR)-a measure of accumulated risk across multiple physiological systems. Our analysis included 4408 African American women and men ages 21-85 residing in the Jackson, MS Metropolitan Area. We measured neighborhood disadvantage using a composite score of socioeconomic indicators from the 2000 US Census and social cohesion was assessed using a 5-item validated scale. Standardized z-scores of biomarkers representing cardiovascular, metabolic, inflammatory, and neuroendocrine systems were combined to create a CBR score. We used two-level linear regression models with random intercepts adjusting for socio-demographic and behavioral covariates in the analysis. A three-way interaction term was included to examine whether the relationship between neighborhood disadvantage and CBR differed by levels of social cohesion and gender. The interaction between neighborhood disadvantage, social cohesion and gender was statistically significant (p = 0.05) such that the association between living in a disadvantaged neighborhood and CBR was strongest for men living in neighborhoods with low levels of social cohesion (B = 0.63, SE: 0.32). In gender-specific models, we found a statistically significant interaction between neighborhood disadvantage and social cohesion for men (p = 0.05) but not for women (p = 0.50). Neighborhoods characterized by high levels of economic disadvantage and low levels of social cohesion contribute to higher cumulative risk of disease among African American men. This suggests that they may face a unique set of challenges

Double-Jeopardy: The Joint Impact of Neighborhood Disadvantage and Low Social Cohesion on Cumulative Risk of Disease Among African American Men and Women in the Jackson Heart Study

PubMed Central

Barber, Sharrelle; Hickson, DeMarc A.; Kawachi, Ichiro; Subramanian, S.V.; Earls, Felton

2016-01-01

Objectives Few studies have examined the joint impact of neighborhood disadvantage and low social cohesion on health. Moreover, no study has considered the joint impact of these factors on a cumulative disease risk profile among a large sample of African American adults. Using data from the Jackson Heart Study, we examined the extent to which social cohesion modifies the relationship between neighborhood disadvantage and cumulative biological risk (CBR)—a measure of accumulated risk across multiple physiological systems. Methods Our analysis included 4,408 African American women and men ages 21–85 residing in the Jackson, MS Metropolitan Area. We measured neighborhood disadvantage using a composite score of socioeconomic indicators from the 2000 US Census and social cohesion was assessed using a 5-item validated scale. Standardized z-scores of biomarkers representing cardiovascular, metabolic, inflammatory, and neuroendocrine systems were combined to create a CBR score. We used two-level linear regression models with random intercepts adjusting for socio-demographic and behavioral covariates in the analysis. A three-way interaction term was included to examine whether the relationship between neighborhood disadvantage and CBR differed by levels of social cohesion and gender. Results The interaction between neighborhood disadvantage, social cohesion and gender was statistically significant (p=0.05) such that the association between living in a disadvantaged neighborhood and CBR was strongest for men living in neighborhoods with low levels of social cohesion (B=0.63, SE: 0.32). In gender-specific models, we found a statistically significant interaction between neighborhood disadvantage and social cohesion for men (p=0.05) but not for women (p=0.50). Conclusion Neighborhoods characterized by high levels of economic disadvantage and low levels of social cohesion contribute to higher cumulative risk of disease among African American men. This suggests that they may

Maternal Obesity: Risks for Developmental Delays in Early Childhood.

PubMed

Duffany, Kathleen O'Connor; McVeigh, Katharine H; Kershaw, Trace S; Lipkind, Heather S; Ickovics, Jeannette R

2016-02-01

To assess the risk for neurodevelopmental delays for children of mothers who were obese (≥200 pounds) prior to pregnancy, and to characterize delays associated with maternal obesity among children referred to and found eligible to receive Early Intervention Program services. We conducted a retrospective cohort study (N = 541,816) using a population-based New York City data warehouse with linked birth and Early Intervention data. Risks for children suspected of a delay and 'significantly delayed', with two moderate or one severe delay, were calculated. Among the group of children eligible by delay for Early Intervention, analyses assessed risk for being identified with a moderate-to-severe delay across each of five functional domains as well as risks for multiple delays. Children of mothers who were obese were more likely to be suspected of a delay (adjusted RR 1.19 [CI 1.15-1.22]) and borderline association for 'significantly delayed' (adjusted RR 1.01 [CI 1.00-1.02). Among children eligible by delay, children of mothers who were obese evidenced an increased risk for moderate-to-severe cognitive (adjusted RR 1.04 [CI 1.02-1.07]) and physical (adjusted RR 1.04 [CI 1.01-1.08]) delays and for global developmental delay (adjusted RR 1.05 [CI 1.01-1.08]). Maternal obesity is associated with increased risk of developmental delay in offspring. Among children with moderate or severe delays, maternal obesity is associated with increased risk of cognitive and physical delays as well as with increased risk for global developmental delay. While causation remains uncertain, this adds to the growing body of research reporting an association between maternal obesity and neurodevelopmental delays in offspring.

Interactive Contributions of Cumulative Peer Stress and Executive Function Deficits to Depression in Early Adolescence

ERIC Educational Resources Information Center

Agoston, Anna M.; Rudolph, Karen D.

2016-01-01

Exposure to peer stress contributes to adolescent depression, yet not all youth experience these effects. Thus, it is important to identify individual differences that shape the consequences of peer stress. This research investigated the interactive contribution of cumulative peer stress during childhood (second-fifth grades) and executive…

Head Impact Exposure in Youth Football: High School Ages 14 to 18 Years and Cumulative Impact Analysis

PubMed Central

Urban, Jillian E.; Davenport, Elizabeth M.; Golman, Adam J.; Maldjian, Joseph A.; Whitlow, Christopher T.; Powers, Alexander K.; Stitzel, Joel D.

2015-01-01

Sports-related concussion is the most common athletic head injury with football having the highest rate among high school athletes. Traditionally, research on the biomechanics of football-related head impact has been focused at the collegiate level. Less research has been performed at the high school level, despite the incidence of concussion among high school football players. The objective of this study is to twofold: to quantify the head impact exposure in high school football, and to develop a cumulative impact analysis method. Head impact exposure was measured by instrumenting the helmets of 40 high school football players with helmet mounted accelerometer arrays to measure linear and rotational acceleration. A total of 16,502 head impacts were collected over the course of the season. Biomechanical data were analyzed by team and by player. The median impact for each player ranged from 15.2 to 27.0 g with an average value of 21.7 (±2.4) g. The 95th percentile impact for each player ranged from 38.8 to 72.9 g with an average value of 56.4 (±10.5) g. Next, an impact exposure metric utilizing concussion injury risk curves was created to quantify cumulative exposure for each participating player over the course of the season. Impacts were weighted according to the associated risk due to linear acceleration and rotational acceleration alone, as well as the combined probability (CP) of injury associated with both. These risks were summed over the course of a season to generate risk weighted cumulative exposure. The impact frequency was found to be greater during games compared to practices with an average number of impacts per session of 15.5 and 9.4, respectively. However, the median cumulative risk weighted exposure based on combined probability was found to be greater for practices vs. games. These data will provide a metric that may be used to better understand the cumulative effects of repetitive head impacts, injury mechanisms, and head impact exposure of

Relations between Early Family Risk, Children's Behavioral Regulation, and Academic Achievement

ERIC Educational Resources Information Center

Sektnan, Michaella; McClelland, Megan M.; Acock, Alan; Morrison, Frederick J.

2010-01-01

This study examined relations among early family risk, children's behavioral regulation at 54 months and kindergarten, and academic achievement in first grade using data on 1298 children from the National Institute of Child Health and Human Development (NICHD) Study of Early Child Care and Youth Development. Family risk was indexed by ethnic…

Early Childhood Risk and Protective Factors for Substance Use during Early Adolescence: Gender Differences.

ERIC Educational Resources Information Center

Friedman, Alfred S.; And Others

1995-01-01

Gathered substance use histories from African American male (n=318) and female (n=322) adolescents to determine whether gender differences affected early life risk factors for drug use or abuse. Family variables and subject behavior predicted degree of substance use and frequency of intoxication, but no risk factor applied to both genders. (SNR)

Hearing loss and risk of early retirement. The HUNT study.

PubMed

Helvik, Anne-Sofie; Krokstad, Steinar; Tambs, Kristian

2013-08-01

We explore the possible consequences of measured hearing impairment (HI) and perceived hearing difficulties for early retirement in a large population-based study. Furthermore, we study whether having a part-time position was associated with measured HI and perceived hearing difficulties in the same population. This study included 25,740 persons from the Nord-Trøndelag Health Study (HUNT) aged 20-54 years at baseline in HUNT1 (1984-1986) who also participated in the follow up, HUNT2, including a hearing examination 11 years later. Logistic regression analysis was conducted for men and women separately and in two age strata. Effects of low-, middle- and high-frequency hearing levels were explored, adjusting for each other. Further adjustment was made for socio-economic class and general health in HUNT1. The risk of early retirement increased with degree of loss of low-frequency hearing in young and middle-aged men and middle-aged women. The middle-aged men and women experiencing hearing disability had an increased risk of early retirement. Degree of hearing level was not associated with part-time work, but in middle-aged men, awareness of having a hearing loss was associated with part-time employment. Degree of low-frequency hearing loss was associated with early retirement but not with part-time work. Perceived hearing disability increased the risk of early retirement in middle-aged men and women and also the risk of part-time work in middle-aged men.

Direct comparison of risk-adjusted and non-risk-adjusted CUSUM analyses of coronary artery bypass surgery outcomes.

PubMed

Novick, Richard J; Fox, Stephanie A; Stitt, Larry W; Forbes, Thomas L; Steiner, Stefan

2006-08-01

We previously applied non-risk-adjusted cumulative sum methods to analyze coronary bypass outcomes. The objective of this study was to assess the incremental advantage of risk-adjusted cumulative sum methods in this setting. Prospective data were collected in 793 consecutive patients who underwent coronary bypass grafting performed by a single surgeon during a period of 5 years. The composite occurrence of an "adverse outcome" included mortality or any of 10 major complications. An institutional logistic regression model for adverse outcome was developed by using 2608 contemporaneous patients undergoing coronary bypass. The predicted risk of adverse outcome in each of the surgeon's 793 patients was then calculated. A risk-adjusted cumulative sum curve was then generated after specifying control limits and odds ratio. This risk-adjusted curve was compared with the non-risk-adjusted cumulative sum curve, and the clinical significance of this difference was assessed. The surgeon's adverse outcome rate was 96 of 793 (12.1%) versus 270 of 1815 (14.9%) for all the other institution's surgeons combined (P = .06). The non-risk-adjusted curve reached below the lower control limit, signifying excellent outcomes between cases 164 and 313, 323 and 407, and 667 and 793, but transgressed the upper limit between cases 461 and 478. The risk-adjusted cumulative sum curve never transgressed the upper control limit, signifying that cases preceding and including 461 to 478 were at an increased predicted risk. Furthermore, if the risk-adjusted cumulative sum curve was reset to zero whenever a control limit was reached, it still signaled a decrease in adverse outcome at 166, 653, and 782 cases. Risk-adjusted cumulative sum techniques provide incremental advantages over non-risk-adjusted methods by not signaling a decrement in performance when preoperative patient risk is high.

Clinical and Other Risk Indicators for Early Periodontitis in Adults

PubMed Central

Tanner, Anne C.R.; Kent, Ralph; Van Dyke, Thomas; Sonis, Steven T.; Murray, Lora A.

2005-01-01

Background Periodontal diseases affect over half the adults in the U.S., disproportionately affecting minority populations. Periodontitis can be treated in early stages, but it is not clear what features indicate, or could be risk factors for, early stages of periodontal attachment loss. This study aimed to evaluate associations between clinical and other risk indicators of early periodontitis. Methods A cross-sectional evaluation of 225 healthy and early periodontitis adults aged 20 to 40 years was performed. Clinical measurements, demographic information, and smoking histories were recorded. Analyses evaluated demographic and clinical associations with health and early periodontitis disease categories and periodontal attachment loss. Patterns of attachment loss at interproximal and buccal/lingual sites were evaluated. Results Subject age, plaque, and measures of gingivitis exhibited associations with attachment loss and probing depth. More periodontal attachment loss was detected in African-American and Hispanic subjects compared to Asian and Caucasian subjects. Smoking history was associated with attachment loss. At interproximal sites, lower molars most frequently had attachment loss, whereas at buccal/lingual sites, higher proportions of lower bicuspid teeth demonstrated attachment loss compared with other sites. Conclusions In this study of subjects with minimal attachment loss, gingival inflammation was associated with early periodontitis. Lower molar interproximal sites were frequently associated with interproximal attachment loss, whereas lower bicuspid teeth were at risk for gingival recession on buccal surfaces. PMID:15857098

Children's Executive Function in a CPS-Involved Sample: Effects of Cumulative Adversity and Specific Types of Adversity.

PubMed