Risk of Fall for Individuals with Intellectual Disability

ERIC Educational Resources Information Center

Chiba, Yoichi; Shimada, Atsuyoshi; Yoshida, Futoshi; Keino, Hiromi; Hasegawa, Mariko; Ikari, Hiroyuki; Miyake, Shikako; Hosokawa, Masanori

2009-01-01

Our aim was to identify risk factors for falling and establish a method to assess risk for falls in adults with intellectual disabilities. In a cross-sectional survey of 144 Japanese adults, we found that age, presence of epilepsy, and presence of paretic conditions were independent risk factors. The Tinetti balance and gait instrument was…

Modeling an internal gear pump

NASA Astrophysics Data System (ADS)

Chen, Zongbin; Xu, Rongwu; He, Lin; Liao, Jian

2018-05-01

Considering the nature and characteristics of construction waste piles, this paper analyzed the factors affecting the stability of the slope of construction waste piles, and established the system of the assessment indexes for the slope failure risks of construction waste piles. Based on the basic principles and methods of fuzzy mathematics, the factor set and the remark set were established. The membership grade of continuous factor indexes is determined using the "ridge row distribution" function, while that for the discrete factor indexes was determined by the Delphi Method. For the weight of factors, the subjective weight was determined by the Analytic Hierarchy Process (AHP) and objective weight by the entropy weight method. And the distance function was introduced to determine the combination coefficient. This paper established a fuzzy comprehensive assessment model of slope failure risks of construction waste piles, and assessed pile slopes in the two dimensions of hazard and vulnerability. The root mean square of the hazard assessment result and vulnerability assessment result was the final assessment result. The paper then used a certain construction waste pile slope as the example for analysis, assessed the risks of the four stages of a landfill, verified the assessment model and analyzed the slope's failure risks and preventive measures against a slide.

[Suicide risk factors in the professional military personnel in the Army of Serbia].

PubMed

Dedić, Gordana; Panić, Milivoje

2010-04-01

Recognition of suicide risk factors is important in taking adequate suicide preventive measures, Suicide Prevention Program for Professional Military Personnel (PMP) implemented in the Army of Serbia in 2003. The aim of our study was to establish suicide risk factors in PMP of the Army of Serbia. Analysis of suicide risk factors in PMP was carried out on the basis of data obtained by psychological suicide autopsy. The controls were demographically similar psychiatric outpatients with no history of suicidal behaviour. A descriptive statistics method was used for risk factors analysis. The t-test was used for testing statistical hypotheses. A total of 30 PMP, aged 22-49 years (30.53 +/- 6.24 on average) committed suicide within the period 1998-2007. Distal suicide risk factors in PMP were considered to be not being married, psychiatric heredity, having no outpatient psychiatric treatment, gambling, regular physical practice (bodybuilding), less transfer to a different post, low motivation for military service (p < 0.001), not having children, parental loss in early childhood, alcohol abuse (p < 0.005), low salary (p < 0.01) uncompleted military school, debts in the family (p < 0.05). The commonest proximal suicide risk factors were: actual family problems (36.6%), actual mental problems (13.3%), burnout (13.3%), negative balance of accounts (13.3%), professional problems (6.7%), behavioral model while for 10.0% PMP suicide risk factors could not be established. According to the presence of multiple suicide risk factors, Suicide Prevention Program for PMP in the Army of Serbia is directed to the prevention of both proximal and distal suicide risk factors.

Differential prevalence of established risk factors for poor cessation outcomes among smokers by level of social anxiety.

PubMed

Watson, Noreen L; Heffner, Jaimee L; McClure, Jennifer B; Mull, Kristen E; Bricker, Jonathan B

2017-03-01

Despite clear associations between social anxiety (SA), high prevalence of smoking, and cessation failure, little is known about factors contributing to these relationships. Moreover, the extent to which smokers with moderate SA represent an at-risk group of smokers is also unknown. This study examined the extent to which established risk factors for poor cessation (eg, sociodemographic, smoking history, mental health comorbidity) are prevalent among smokers with low, moderate, and high levels of SA. Participants (N = 2,637) were adult smokers from a web-based smoking cessation trial. Nineteen characteristics considered risk factors for poor cessation outcomes were assessed at baseline. Those associated with social anxiety were subsequently compared by SA level. Regression models indicated that 10/19 risk factors were associated with SA. Compared to smokers with low SA, those with moderate and high SA endorsed 4/10 and 10/10 risk factors as more prevalent or severe, respectively. Compared to smokers with low SA, High SA was associated with greater sociodemographic risk factors, while both moderate and high SA was associated with more severe mental health symptoms. Smokers with moderate and high levels of SA endorse more risk factors for poor cessation outcomes than those with low levels of SA, particularly mental health symptoms. These factors may help explain the differential smoking outcomes of socially anxious smokers. Results suggest that smokers with both moderate and high levels of SA would likely benefit from cessation interventions that address and consider these risk factors. (Am J Addict 2017;26:176-182). © 2017 American Academy of Addiction Psychiatry.

Differential Prevalence of Established Risk Factors for Poor Cessation Outcomes among Smokers by Level of Social Anxiety

PubMed Central

Watson, Noreen L.; Heffner, Jaimee L.; McClure, Jennifer B.; Mull, Kristen E.; Bricker, Jonathan B.

2017-01-01

Background and Objectives Despite clear associations between social anxiety (SA), high prevalence of smoking, and cessation failure, little is known about factors contributing to these relationships. Moreover, the extent to which smokers with moderate SA represent an at-risk group of smokers is also unknown. This study examined the extent to which established risk factors for poor cessation (e.g., sociodemographic, smoking history, mental health comorbidity) are prevalent among smokers with low, moderate, and high levels of SA. Methods Participants (N = 2,637) were adult smokers from a web-based smoking cessation trial. Nineteen characteristics considered risk factors for poor cessation outcomes were assessed at baseline. Those associated with social anxiety were subsequently compared by SA level. Results Regression models indicated that 10/19 risk factors were associated with SA. Compared to smokers with low SA, those with moderate and high SA endorsed 4/10 and 10/10 risk factors as more prevalent or severe, respectively. Compared to smokers with low SA, High SA was associated with greater sociodemographic risk factors, while both moderate and high SA was associated with more severe mental health symptoms. Conclusions and Scientific Significance Smokers with moderate and high levels of SA endorse more risk factors for poor cessation outcomes than those with low levels of SA, particularly mental health symptoms. These factors may help explain the differential smoking outcomes of socially anxious smokers. Results suggest that smokers with both moderate and high levels of SA would likely benefit from cessation interventions that address and consider these risk factors. PMID:28191916

Secondary diabetic ketoacidosis and severe hypoglycaemia in patients with established type 1 diabetes mellitus in China: a multicentre registration study.

PubMed

Li, Jin; Yang, Daizhi; Yan, Jinhua; Huang, Bin; Zhang, Yan; Weng, Jianping

2014-09-01

Diabetic ketoacidosis (DKA) and severe hypoglycaemia are common acute complications of type 1 diabetes mellitus (T1DM). This study aimed to determine the incidence of, and risk factors for, these complications in Chinese patients with established T1DM. This cross-sectional study recruited patients with established T1DM from 16 centres in Guangdong Province, China. Incidence rates were expressed as episodes/100 patient-years. Regression models identified risk factors for the occurrence and recurrence of secondary DKA and severe hypoglycaemia. A total of 611 patients with established T1DM (53.7% women) were recruited. The incidence of secondary DKA and severe hypoglycaemia was 26.4 (22.4, 31.0) and 68.8 (62.2, 76.0)/100 patient-years, respectively. Significant risk factors for secondary DKA were female gender [relative risk (RR) = 2.12], medical reimbursement rate <50% (RR = 1.84), uncontrolled diet (RR = 1.76), smoking (RR = 2.18) and poor glycaemic control [glycated haemoglobin A1c (HbA1c)/1.0% increase; RR = 1.15]. Overweight/obesity was a protective factor (RR = 0.57). Significant risk factors for severe hypoglycaemia included male gender (RR = 1.71), medical reimbursement rate < 50% (RR = 1.36), longer duration of T1DM (per 5-year increase, RR = 1.22), underweight (RR = 1.44), uncontrolled diet ('never controlled' or 'sometimes controlled' vs. 'usually controlled', RR = 2.09 or 2.02, respectively), exercise <150 min/week (RR = 1.66), presence of neuropathy (RR = 1.89), smoking (RR = 1.48) and lower HbA1c values (per 1.0% decrease, RR = 1.46). Overweight/obesity was a protective factor (RR = 0.62). Additionally, 34.4% of secondary DKA and 81.1% of severe hypoglycaemia episodes occurred in 3.8% and 16.2% patients with recurrent events (≥two episodes), respectively. The results indicate that secondary DKA and severe hypoglycaemia occur at high rates in Chinese patients with established T1DM and that recurrence is likely to occur in high-risk patients. Comprehensive management of T1DM should include recommendations to control modifiable risk factors. Copyright © 2014 John Wiley & Sons, Ltd.

Risk factors for chronic subdural haematoma formation do not account for the established male bias.

PubMed

Marshman, Laurence A G; Manickam, Appukutty; Carter, Danielle

2015-04-01

The 'subdural space' is an artefact of inner dural border layer disruption: it is not anatomical but always pathological. A male bias has long been accepted for chronic subdural haematomas (CSDH), and increased male frequencies of trauma and/or alcohol abuse are often cited as likely explanations: however, no study has validated this. We investigated to see which risk factors accounted for the male bias with CSDH. Retrospective review of prospectively collected data. A male bias (M:F 97:58) for CSDH was confirmed in n=155 patients. The largest risk factor for CSDH was cerebral atrophy (M:F 94% vs. 91%): whilst a male bias prevailed in mild-moderate cases (M:F 58% vs. 41%), a female bias prevailed for severe atrophy (F:M 50% vs. 36%) (χ(2)=3.88, P=0.14). Risk factors for atrophy also demonstrated a female bias, some approached statistical significance: atrial fibrillation (P=0.05), stroke/TIA (P=0.06) and diabetes mellitus (P=0.07). There was also a trend for older age in females (F:M 72±13 years vs. 68±15 years, P=0.09). The third largest risk factor, after atrophy and trauma (i.e. anti-coagulant and anti-platelet use) was statistically significantly biased towards females (F:M 50% vs. 33%, P=0.04). No risk factor accounted for the established male bias with CSDH. In particular, a history of trauma (head injury or fall [M:F 50% vs. 57%, P=0.37]), and alcohol abuse (M:F 17% vs. 16%, P=0.89) was remarkably similar between genders. No recognised risk factor for CSDH formation accounted for the established male bias: risk factor trends generally favoured females. In particular, and in contrast to popular belief, a male CSDH bias did not relate to increased male frequencies of trauma and/or alcohol abuse. Crown Copyright © 2015. Published by Elsevier B.V. All rights reserved.

Risk factors associated with post–kidney transplant malignancies: an article from the Cancer-Kidney International Network

PubMed Central

Nair, Vinay; Riella, Leonardo V; Jhaveri, Kenar D

2018-01-01

ABSTRACT In kidney transplant recipients, cancer is one of the leading causes of death with a functioning graft beyond the first year of kidney transplantation, and malignancies account for 8–10% of all deaths in the USA (2.6 deaths/1000 patient-years) and exceed 30% of deaths in Australia (5/1000 patient-years) in kidney transplant recipients. Patient-, transplant- and medication-related factors contribute to the increased cancer risk following kidney transplantation. While it is well established that the overall immunosuppressive dose is associated with an increased risk for cancer following transplantation, the contributive effect of different immunosuppressive agents is not well established. In this review we will discuss the different risk factors for malignancies after kidney transplantation. PMID:29942495

Job Hazard Analyses for Musculoskeletal Disorder Risk Factors in Pressing Operations of Dry-cleaning Establishments.

PubMed

Park, Jung-Keun

2016-12-01

Job hazard analyses were conducted to assess exposure to musculoskeletal disorder (MSD) risk factors in seven workers of three dry-cleaning establishments. In accordance with the Washington State Ergonomics Rule, the analyses were performed in two separate steps: (1) observation and checklist approaches were made to identify a "caution zone job" in the seven workers' pressing operations across the three shops; and (2) detailed posture and motion analyses were undertaken to determine a "MSD hazard" in one worker's operation using a video technique. One "caution zone job" was identified and it was the pressing operation job in which five physical risk factors were found in the pressing operations. The detailed analyses confirmed that one "MSD hazard", i.e., awkward posture in shoulders, was prevalent in the pressing operations of the three dry-cleaning facilities. It would be desirable to reduce MSD risk factors including awkward shoulder posture in the dry-cleaning industry.

Beyond Correlates: A Review of Risk and Protective Factors for Adolescent Dating Violence Perpetration

PubMed Central

Vagi, Kevin J.; Rothman, Emily; Latzman, Natasha E.; Tharp, Andra Teten; Hall, Diane M.; Breiding, Matthew J.

2013-01-01

Dating violence is a serious public health problem. In recent years, the U.S. Centers for Disease Control and Prevention (CDC) and other entities have made funding available to community based agencies for dating violence prevention. Practitioners who are tasked with developing dating violence prevention strategies should pay particular attention to risk and protective factors for dating violence perpetration that have been established in longitudinal studies. This has been challenging to date because the scientific literature on the etiology of dating violence is somewhat limited, and because there have been no comprehensive reviews of the literature that clearly distinguish correlates of dating violence perpetration from risk or protective factors that have been established through longitudinal research. This is problematic because prevention programs may then target factors that are merely correlated with dating violence perpetration, and have no causal influence, which could potentially limit the effectiveness of the programs. In this article, we review the literature on risk and protective factors for adolescent dating violence perpetration and highlight those factors for which temporal precedence has been established by one or more studies. This review is intended as a guide for researchers and practitioners as they formulate prevention programs. We reviewed articles published between 2000–2010 that reported on adolescent dating violence perpetration using samples from the United States or Canada. In total, 53 risk factors and six protective factors were identified from 20 studies. Next steps for etiological research in adolescent dating violence are discussed, as well as future directions for prevention program developers. PMID:23385616

[Paired kidneys in transplant].

PubMed

Regueiro López, Juan C; Leva Vallejo, Manuel; Prieto Castro, Rafael; Anglada Curado, Francisco; Vela Jiménez, Francisco; Ruiz García, Jesús

2009-02-01

Many factors affect the graft and patient survival on the renal transplant outcome. These factors depend so much of the recipient and donor. We accomplished a study trying to circumvent factors that depend on the donor. We checked the paired kidneys originating of a same donor cadaver. We examined the risk factors in the evolution and follow-up in 278 couples of kidney transplant. We describe their differences, significance, the graft and patient survival, their functionality in 3 and 5 years and the risk factors implicated in their function. We study immunogenic and no immunogenic variables, trying to explain the inferior results in the grafts that are established secondly. We regroup the paired kidneys in those that they did not show paired initial function within the same couple. The results yield a discreet deterioration in the graft and patient survival for second group establish, superior creatinina concentration, without obtaining statistical significance. The Cox regression study establishes the early rejection (inferior to three months) and DR incompatibility values like risk factors. This model of paired kidneys would be able to get close to best-suited form for risk factors analysis in kidney transplant from cadaver donors, if more patients examine themselves in the same way. The paired kidneys originating from the same donor do not show the same function in spite of sharing the same conditions of the donor and perioperative management.

Precautions for breast cancer-related lymphoedema: risk from air travel, ipsilateral arm blood pressure measurements, skin puncture, extreme temperatures, and cellulitis.

PubMed

Asdourian, Maria S; Skolny, Melissa N; Brunelle, Cheryl; Seward, Cara E; Salama, Laura; Taghian, Alphonse G

2016-09-01

Precautionary recommendations conveyed to survivors of cancer by health-care practitioners to reduce the risk of breast cancer-related lymphoedema are indispensable aspects of clinical care, yet remain unsubstantiated by high-level scientific evidence. By reviewing the literature, we identified 31 original research articles that examined whether lifestyle-associated risk factors (air travel, ipsilateral arm blood pressure measurements, skin puncture, extreme temperatures, and skin infections-eg, cellulitis) increase the risk of breast cancer-related lymphoedema. Among the few studies that lend support to precautionary guidelines, most provide low-level (levels 3-5) or inconclusive evidence of an association between lymphoedema and these risk factors, and only four level 2 studies show a significant association. Skin infections and previous infection or inflammation on the ipsilateral arm were among the most clearly defined and well established risk factors for lymphoedema. The paucity of high-level evidence and the conflicting nature of the existing literature make it difficult to establish definitive predictive factors for breast cancer-related lymphoedema, which could be a considerable source of patient distress and anxiety. Along with further research into these risk factors, continued discussion regarding modification of the guidelines and adoption of a risk-adjusted approach is needed. Copyright © 2016 Elsevier Ltd. All rights reserved.

NT-proBNP is associated with coronary heart disease risk in healthy older women but fails to enhance prediction beyond established risk factors: results from the British Women's Heart and Health Study.

PubMed

Sattar, Naveed; Welsh, Paul; Sarwar, Nadeem; Danesh, John; Di Angelantonio, Emanuele; Gudnason, Vilmundur; Davey Smith, George; Ebrahim, Shah; Lawlor, Debbie A

2010-03-01

Limited evidence suggests NT-proBNP improves prediction of coronary heart disease (CHD) events but further data are needed, especially in people without pre-existing CHD and in women. We measured NT-proBNP in serum from 162 women with incident CHD events and 1226 controls (60-79 years) in a case-control study nested within the prospective British Women's Heart and Health Study. All cases and controls were free from CHD at baseline. We related NT-proBNP to CHD event risk, and determined to what extent NT-proBNP enhanced CHD risk prediction beyond established risk factors. The odds ratio for CHD per 1 standard deviation increase in log(e)NT-proBNP was 1.37 (95% CI: 1.13-1.68) in analyses adjusted for established CHD risk factors, social class, CRP and insulin. However, addition of log(e)NT-proBNP did not improve the discrimination of a prediction model including age, social class, smoking, physical activity, lipids, fasting glucose, waist:hip ratio, hypertension, statin and aspirin use, nor a standard Framingham risk score model; area under the receiver operator curve for the former model increased from 0.676 to 0.687 on inclusion of NT-proBNP (p=0.3). Furthermore, adding NT-proBNP did not improve calibration of a prediction model containing established risk factors, nor did inclusion more appropriately re-classify participants in relation to their final outcome. Findings were similar (independent associations, but no prediction improvement) for fasting insulin and CRP. These results caution against use of NT-proBNP for CHD risk prediction in healthy women and suggest a need for larger studies in both genders to resolve outstanding uncertainties.

Correlates of overdose risk perception among illicit opioid users

PubMed Central

Rowe, Christopher; Santos, Glenn-Milo; Behar, Emily; Coffin, Philip O.

2016-01-01

Background Opioid-related mortality continues to increase in the United States. The current study assesses demographic and behavioral predictors of perceived overdose risk among individuals who use opioids illicitly. By examining these correlates in the context of established overdose risk factors, we aim to assess whether characteristics and behaviors that have been associated with actual overdose risk translate to higher perception of risk. Methods We conducted a cross-sectional survey of 172 adult illicit opioid users in San Francisco, CA and used multivariable logistic regression to identify predictors of perception of high risk for opioid overdose. Results Age (aOR=0.96, 95%CI=0.93-1.00) and number of injection days per month (0.91, 0.86-0.97) were associated with a lower odds of perceived high overdose risk. There was no independent association between use of opioid analgesics, concurrent use of opioids and benzodiazepines or cocaine, or HIV status and overdose risk perception. Conclusions Opioid users who injected more frequently and those who were older were less likely to perceive themselves as being at risk of overdose, notwithstanding that those who inject more are at higher risk of overdose and those who are older are at higher risk overdose mortality. In addition, despite being established overdose risk factors, there was no relationship between use of opioid analgesics, concurrent use of opioids and cocaine or benzodiazepines, or self-reported HIV status and overdose risk perception. These findings highlight key populations of opioid users and established risk factors that may merit focused attention as part of education-based overdose prevention and opioid management strategies. PMID:26754425

Differential diagnosis between benign and malignant soft tissue tumors utilizing ultrasound parameters.

PubMed

Morii, Takeshi; Kishino, Tomonori; Shimamori, Naoko; Motohashi, Mitsue; Ohnishi, Hiroaki; Honya, Keita; Aoyagi, Takayuki; Tajima, Takashi; Ichimura, Shoichi

2018-01-01

Preoperative discrimination between benign and malignant soft tissue tumors is critical for the prevention of excess application of magnetic resonance imaging and biopsy as well as unplanned resection. Although ultrasound, including power Doppler imaging, is an easy, noninvasive, and cost-effective modality for screening soft tissue tumors, few studies have investigated reliable discrimination between benign and malignant soft tissue tumors. To establish a modality for discrimination between benign and malignant soft tissue tumors using ultrasound, we extracted the significant risk factors for malignancy based on ultrasound information from 40 malignant and 56 benign pathologically diagnosed soft tissue tumors and established a scoring system based on these risk factors. The maximum size, tumor margin, and vascularity evaluated using ultrasound were extracted as significant risk factors. Using the odds ratio from a multivariate regression model, a scoring system was established. Receiver operating characteristic analyses revealed a high area under the curve value (0.85), confirming the accuracy of the scoring system. Ultrasound is a useful modality for establishing the differential diagnosis between benign and malignant soft tissue tumors.

Risk factors of hepatocellular carcinoma--current status and perspectives.

PubMed

Gao, Jing; Xie, Li; Yang, Wan-Shui; Zhang, Wei; Gao, Shan; Wang, Jing; Xiang, Yong-Bing

2012-01-01

Hepatocellular carcinoma is a common disorder worldwide which ranks 5th and 7th most common cancer among men and women. In recent years, different incidence trends have been observed in various regions, but the reasons are not completely understood. However, due to the great public efforts in HCC prevention and alternation of lifestyle, the roles of some well documented risk factors played in hepatocarcinogenesis might have changed. This paper summarizes both the environmental and host related risk factors of hepatocellular carcinoma including well established risk factors such as hepatitis virus infection, aflatoxin and alcohol, as well as possible risk factors such as coffee drinking and other dietary agents.

Establishing Adaptive Sports Programs for Youth with Moderate to Severe Disabilities

ERIC Educational Resources Information Center

Ryan, Joseph B.; Katsiyannis, Antonis; Cadorette, Deborah; Hodge, Janie; Markham, Michelle

2014-01-01

Children with disabilities are at increased risk of health risk factors including obesity, often because of low levels of physical activity and limited participation in sports. However, organized adaptive sports programs are increasingly available for individuals with disabilities. This article provides recommendations for establishing successful…

MET Receptor Tyrosine Kinase as an Autism Genetic Risk Factor

PubMed Central

Peng, Yun; Huentelman, Matthew; Smith, Christopher; Qiu, Shenfeng

2014-01-01

In this chapter, we will briefly discuss recent literature on the role of MET receptor tyrosine kinase (RTK) in brain development and how perturbation of MET signaling may alter normal neurodevelopmental outcomes. Recent human genetic studies have established MET as a risk factor for autism, and the molecular and cellular underpinnings of this genetic risk are only beginning to emerge from obscurity. Unlike many autism risk genes that encode synaptic proteins, the spatial and temporal expression pattern of MET RTK indicates this signaling system is ideally situated to regulate neuronal growth, functional maturation, and establishment of functional brain circuits, particularly in those brain structures involved in higher levels of cognition, social skills, and executive functions. PMID:24290385

Towards a New Explicative Model of Antisocial Behaviour

ERIC Educational Resources Information Center

Justicia, Fernando; Benitez, Juan Luis; Pichardo, Maria Carmen; Fernandez, Eduardo; Fernandez, Trinidad Garcia y Maria

2006-01-01

Antisocial behavior has been the object of investigation in many studies seeking to establish its etiological factors as well as risk factors which help to perpetuate such behavior over the course of the individual's life. In this paper, we seek to classify and clarify risk factors underlying the origin and development of antisocial behaviors from…

[Hyperlipidemias as a coronary risk factor in the newborn].

PubMed

Hernández, A; De Tejada, A L; Espinoza, M; Karchmer, S

1976-01-01

This article reviews the risk factors of the coronariopathy in the newborn. The authors state that the early diagnosis of the risk factors is an important step in the prevention of ateromatous plaques. Some people are now in the investigation of the normal levels of cholesterol and triglicerides in the blood of the umbilical cord. This values seems similar in different places all over the world and have served to establish the possible interrelation between the newborn hiperlipidemia and the coronary risk.

Associations between dietary and lifestyle risk factors and colorectal cancer in the Scottish population.

PubMed

Theodoratou, Evropi; Farrington, Susan M; Tenesa, Albert; McNeill, Geraldine; Cetnarskyj, Roseanne; Korakakis, Emmanouil; Din, Farhat V N; Porteous, Mary E; Dunlop, Malcolm G; Campbell, Harry

2014-01-01

Colorectal cancer (CRC) accounts for 9.7% of all cancer cases and for 8% of all cancer-related deaths. Established risk factors include personal or family history of CRC as well as lifestyle and dietary factors. We investigated the relationship between CRC and demographic, lifestyle, food and nutrient risk factors through a case-control study that included 2062 patients and 2776 controls from Scotland. Forward and backward stepwise regression was applied and the stability of the models was assessed in 1000 bootstrap samples. The variables that were automatically selected to be included by the forward or backward stepwise regression and whose selection was verified by bootstrap sampling in the current study were family history, dietary energy, 'high-energy snack foods', eggs, juice, sugar-sweetened beverages and white fish (associated with an increased CRC risk) and NSAIDs, coffee and magnesium (associated with a decreased CRC risk). Application of forward and backward stepwise regression in this CRC study identified some already established as well as some novel potential risk factors. Bootstrap findings suggest that examination of the stability of regression models by bootstrap sampling is useful in the interpretation of study findings. 'High-energy snack foods' and high-energy drinks (including sugar-sweetened beverages and fruit juices) as risk factors for CRC have not been reported previously and merit further investigation as such snacks and beverages are important contributors in European and North American diets.

Measuring and managing risk improves strategic financial planning.

PubMed

Kleinmuntz, D N; Kleinmuntz, C E; Stephen, R G; Nordlund, D S

1999-06-01

Strategic financial risk assessment is a practical technique that can enable healthcare strategic decision makers to perform quantitative analyses of the financial risks associated with a given strategic initiative. The technique comprises six steps: (1) list risk factors that might significantly influence the outcomes, (2) establish best-guess estimates for assumptions regarding how each risk factor will affect its financial outcomes, (3) identify risk factors that are likely to have the greatest impact, (4) assign probabilities to assumptions, (5) determine potential scenarios associated with combined assumptions, and (6) determine the probability-weighted average of the potential scenarios.

Are Attributes of Pregnancy and the Delivery Room Experience Related to Development of Autism? A Review of the Perinatal and Labor Risk Factors and Autism

PubMed Central

Dhawan, Naveen; Emerson, Blaze; Lin, Catherine; Rawji, Adam; Zeiden, Rita; Rashid, Leeda; Phyu, Pwint; Bahl, Jaya

2014-01-01

Autism is a neurodevelopmental disorder marked by severe deficits in social communication and interactions. It is a complex condition that lacks an established preventive method, warranting a need for research to identify possible environmental triggers. The identification of external factors particularly perinatal risk factors forms the initial critical step in preventing and alleviating risks. We conducted a literature review to assess evidence suggested in the worldwide literature. Perinatal risk factors that have a suggested association include β2 adrenergic receptor agonists, labor induction and augmentation, maternal infection and disease (i.e., antiphospholipid syndrome), antiepileptic drugs, cocaine use, and oral supplements. Smoking has not been found to have a direct association. Pollutants, selective serotonin reuptake inhibitors, artificial insemination, and fertility medications may have a link, but results are often conflicted. Factors related to the delivery room experience may be associated with meconium aspiration syndrome, birth weight, and labor time. Several risk factors during the pregnancy and labor periods have been associated with autism; yet further studies with large populations are needed to establish definitive associations. The fact that several risk factors during the prenatal and labor periods are implicated in autism should prompt the medical community to focus on the pregnancy and labor periods as preventive measures to curb the incidence of autism. PMID:27355027

Erectile dysfunction in patients with cardiovascular disease

PubMed Central

Ophuis, A.J.M. Oude; Nijeholt, A.A.B. Lycklama à

2006-01-01

Erectile dysfunction is a highly prevalent disease, especially in cardiovascular-compromised men. Many of the well-established risk factors for cardiovascular disease are also risk factors for erectile dysfunction. A correlation between erectile dysfunction and endothelial dysfunction is well established. It is postulated that erectile dysfunction with an arteriovascular aetiology can predate and be an indicator of potential coronary artery disease. In this paper we will attempt to increase awareness among cardiologists for the predictive value of erectile dysfunction for future cardiovascular disease in order to optimise cardiovascular risk management. The treatment of erectile dysfunction and cardiovascular interactions is also discussed in detail. ImagesFigure 1AFigure 1B PMID:25696612

Systematic Review of Falls in Older Adults with Cancer

PubMed Central

Wildes, Tanya M; Dua, Priya; Fowler, Susan A.; Miller, J. Philip; Carpenter, Christopher R.; Avidan, Michael S.; Stark, Susan

2014-01-01

Objectives lder adults frequently experience falls, at great cost to themselves and society. Older adults with cancer may be at greater risk for falls and have unique risk factors. Materials and Methods We undertook a systematic review of the available medical literature to examine the current evidence regarding factors associated with falls in older adults with cancer. PubMed, Embase, CINAHL, CENTRAL, DARE, Cochrane Database of Systematic Reviews and clinical trials.gov were searched using standardized terms for concepts of oncology/cancer, people 60 and older, screening, falls and diagnosis. Eligible studies included cohort or case-control studies or clinical trials in which all patients, or a subgroup of patients, had a diagnosis of cancer and in which falls were either the primary or secondary outcome. Results We identified 31 studies that met our inclusion criteria. Several studies suggest that falls are more common in older adults with a diagnosis of cancer than those without. Among the 11 studies that explored factors associated with outpatient falls, some risk factors for falls established in the general population were also associated with falls in older adults with cancer, including dependence in activities of daily living and prior falls. Other factors associated with falls in a general population, such as age, polypharmacy and opioid use, were not predictive of falls among oncology populations. Falls among older adults with cancer in the inpatient setting were associated with established risk factors for falls in people without cancer, but also with factors unique to an oncology population, such as brain metastases. Conclusions Falls in older adults with cancer are more common than in the general population, and are associated with risk factors unique to people with cancer. Further study is needed to establish methods of screening older adults with cancer for fall risk and ultimately implement interventions to reduce their risk of falls. Identifying which older adults with cancer are at greater risk for falls is a requisite step to ultimately intervene and prevent falls in this vulnerable population. PMID:25454770

MET receptor tyrosine kinase as an autism genetic risk factor.

PubMed

Peng, Yun; Huentelman, Matthew; Smith, Christopher; Qiu, Shenfeng

2013-01-01

In this chapter, we will briefly discuss recent literature on the role of MET receptor tyrosine kinase (RTK) in brain development and how perturbation of MET signaling may alter normal neurodevelopmental outcomes. Recent human genetic studies have established MET as a risk factor for autism, and the molecular and cellular underpinnings of this genetic risk are only beginning to emerge from obscurity. Unlike many autism risk genes that encode synaptic proteins, the spatial and temporal expression pattern of MET RTK indicates this signaling system is ideally situated to regulate neuronal growth, functional maturation, and establishment of functional brain circuits, particularly in those brain structures involved in higher levels of cognition, social skills, and executive functions. © 2013 Elsevier Inc. All rights reserved.

Predictors of Progression to High-Grade Dysplasia or Adenocarcinoma in Barrett’s Esophagus

PubMed Central

Whitson, Matthew J.; Falk, Gary W.

2015-01-01

Article Synopsis The prevalence of esophageal adenocarcinoma is increasing dramatically. Barrett’s esophagus remains the most well established risk factor for the development of esophageal adenocarcinoma. There are multiple clinical, endoscopic, and pathologic factors that increase the risk of neoplastic progression to high-grade dysplasia or esophageal adenocarcinoma in Barrett’s esophagus. This article will review both risk and protective factors for neoplastic progression in patients with Barrett’s esophagus. PMID:26021196

Bleeding complications with dual antiplatelet therapy among patients with stable vascular disease or risk factors for vascular disease: results from the Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management, and Avoidance (CHARISMA) trial.

PubMed

Berger, Peter B; Bhatt, Deepak L; Fuster, Valentin; Steg, P Gabriel; Fox, Keith A A; Shao, Mingyuan; Brennan, Danielle M; Hacke, Werner; Montalescot, Gilles; Steinhubl, Steven R; Topol, Eric J

2010-06-15

Uncertainty exists about the frequency, correlates, and clinical significance of bleeding with dual antiplatelet therapy (DAPT), particularly over an extended period in a stable population. We sought to determine the frequency and time course of bleeding with DAPT in patients with established vascular disease or risk factors only; identify correlates of bleeding; and determine whether bleeding is associated with mortality. We analyzed 15 603 patients enrolled in the Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management, and Avoidance (CHARISMA) trial, a double-blind, placebo-controlled, randomized trial comparing long-term clopidogrel 75 mg/d versus placebo; all patients received aspirin (75 to 162 mg) daily. Patients had either established stable vascular disease or multiple risk factors for vascular disease without established disease. Median follow-up was 28 months. Bleeding was assessed with the use of the Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries (GUSTO) criteria. Severe bleeding occurred in 1.7% of the clopidogrel group versus 1.3% on placebo (P=0.087); moderate bleeding occurred in 2.1% versus 1.3%, respectively (P<0.001). The risk of bleeding was greatest the first year. Patients without moderate or severe bleeding during the first year were no more likely than placebo-treated patients to have bleeding thereafter. The frequency of bleeding was similar in patients with established disease and risk factors only. In multivariable analysis, the relationship between moderate bleeding and all-cause mortality was strong (hazard ratio, 2.55; 95% confidence interval, 1.71 to 3.80; P<0.0001), along with myocardial infarction (hazard ratio, 2.92; 95% confidence interval, 2.04 to 4.18; P<0.0001) and stroke (hazard ratio, 4.20; 95% confidence interval, 3.05 to 5.77; P<0.0001). In CHARISMA, there was an increased risk of bleeding with long-term clopidogrel. The incremental risk of bleeding was greatest in the first year and similar thereafter. Moderate bleeding was strongly associated with mortality. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT00050817.

Do attributes of persons with chronic kidney disease differ in low-income and middle-income countries compared with high-income countries? Evidence from population-based data in six countries.

PubMed

Anand, Shuchi; Zheng, Yuanchao; Montez-Rath, Maria E; Wei, Wang Jin; Perico, Norberto; Carminati, Sergio; Narayan, Km Venkat; Tandon, Nikhil; Mohan, Viswanathan; Jha, Vivekanand; Zhang, Luxia; Remuzzi, Giuseppe; Prabahkaran, Dorairaj; Chertow, Glenn M

2017-01-01

Kidney biopsies to elucidate the cause of chronic kidney disease (CKD) are performed in a minority of persons with CKD living in high-income countries, since associated conditions-that is, diabetes mellitus, vascular disease or obesity with pre-diabetes, prehypertension or dyslipidaemia-can inform management targeted at slowing CKD progression in a majority. However, attributes of CKD may differ substantially among persons living in low-income and middle-income countries (LMICs). We used data from population or community-based studies from five LMICs (China, urban India, Moldova, Nepal and Nigeria) to determine what proportion of persons with CKD living in diverse regions fit one of the three major clinical profiles, with data from the US National Health Nutrition and Examination Survey as reference. In the USA, urban India and Moldova, 79.0%-83.9%; in China and Nepal, 62.4%-66.7% and in Nigeria, 51.6% persons with CKD fit one of three established risk profiles. Diabetes was most common in urban India and vascular disease in Moldova (50.7% and 33.2% of persons with CKD in urban India and Moldova, respectively). In Nigeria, 17.8% of persons with CKD without established risk factors had albuminuria ≥300 mg/g, the highest proportion in any country. While the majority of persons with CKD in LMICs fit into one of three established risk profiles, the proportion of persons who have CKD without established risk factors is higher than in the USA. These findings can inform tailored CKD detection and management systems and highlight the importance of studying potential causes and outcomes of CKD without established risk factors in LMICs.

Do attributes of persons with chronic kidney disease differ in low-income and middle-income countries compared with high-income countries? Evidence from population-based data in six countries

PubMed Central

Anand, Shuchi; Zheng, Yuanchao; Montez-Rath, Maria E; Wei, Wang Jin; Perico, Norberto; Carminati, Sergio; Narayan, KM Venkat; Tandon, Nikhil; Mohan, Viswanathan; Jha, Vivekanand; Zhang, Luxia; Remuzzi, Giuseppe; Prabahkaran, Dorairaj; Chertow, Glenn M

2017-01-01

Kidney biopsies to elucidate the cause of chronic kidney disease (CKD) are performed in a minority of persons with CKD living in high-income countries, since associated conditions—that is, diabetes mellitus, vascular disease or obesity with pre-diabetes, prehypertension or dyslipidaemia—can inform management targeted at slowing CKD progression in a majority. However, attributes of CKD may differ substantially among persons living in low-income and middle-income countries (LMICs). We used data from population or community-based studies from five LMICs (China, urban India, Moldova, Nepal and Nigeria) to determine what proportion of persons with CKD living in diverse regions fit one of the three major clinical profiles, with data from the US National Health Nutrition and Examination Survey as reference. In the USA, urban India and Moldova, 79.0%–83.9%; in China and Nepal, 62.4%–66.7% and in Nigeria, 51.6% persons with CKD fit one of three established risk profiles. Diabetes was most common in urban India and vascular disease in Moldova (50.7% and 33.2% of persons with CKD in urban India and Moldova, respectively). In Nigeria, 17.8% of persons with CKD without established risk factors had albuminuria ≥300 mg/g, the highest proportion in any country. While the majority of persons with CKD in LMICs fit into one of three established risk profiles, the proportion of persons who have CKD without established risk factors is higher than in the USA. These findings can inform tailored CKD detection and management systems and highlight the importance of studying potential causes and outcomes of CKD without established risk factors in LMICs. PMID:29071132

Aetiology of oral cancer in the Sudan.

PubMed

Ahmed, Hussain Gadelkarim

2013-07-01

To review the studied risk factors that linked to aetiology of oral cancer in the Sudan. There have been numerous reports in the increase in the incidence of oral cancer from various parts of the world. A recent trend for a rising incidence of oral cancer, with the absence of the well established risk factors, has raised concern. Although, there are inconsistent data on incidence and demographical factors, studies suggest that the physiologic response to risk factors by men and women vary in different populations. This review principally examines 33 publications devoted to aetiology of oral cancer in the Sudan, in addition to some risk factors that are commonly practiced in the Sudan. Several studies examining risk factors for oral cancer include tobacco use (Smoked and Smokeless), alcohol consumption, occupational risk, familial risk, immune deficits, virus infection and genetic factors. Toombak use and infection with high risk Human Papilloma Virus (HPV) were extensively investigated and linked to the aetiology of oral cancer in Sudan.

Aetiology of Oral Cancer in the Sudan

PubMed Central

2013-01-01

ABSTRACT Objectives To review the studied risk factors that linked to aetiology of oral cancer in the Sudan. There have been numerous reports in the increase in the incidence of oral cancer from various parts of the world. A recent trend for a rising incidence of oral cancer, with the absence of the well established risk factors, has raised concern. Although, there are inconsistent data on incidence and demographical factors, studies suggest that the physiologic response to risk factors by men and women vary in different populations. Material and Methods This review principally examines 33 publications devoted to aetiology of oral cancer in the Sudan, in addition to some risk factors that are commonly practiced in the Sudan. Results Several studies examining risk factors for oral cancer include tobacco use (Smoked and Smokeless), alcohol consumption, occupational risk, familial risk, immune deficits, virus infection and genetic factors. Conclusions Toombak use and infection with high risk Human Papilloma Virus (HPV) were extensively investigated and linked to the aetiology of oral cancer in Sudan. PMID:24422031

Percent Mammographic Density and Dense Area as Risk Factors for Breast Cancer.

PubMed

Rauh, C; Hack, C C; Häberle, L; Hein, A; Engel, A; Schrauder, M G; Fasching, P A; Jud, S M; Ekici, A B; Loehberg, C R; Meier-Meitinger, M; Ozan, S; Schulz-Wendtland, R; Uder, M; Hartmann, A; Wachter, D L; Beckmann, M W; Heusinger, K

2012-08-01

Purpose: Mammographic characteristics are known to be correlated to breast cancer risk. Percent mammographic density (PMD), as assessed by computer-assisted methods, is an established risk factor for breast cancer. Along with this assessment the absolute dense area (DA) of the breast is reported as well. Aim of this study was to assess the predictive value of DA concerning breast cancer risk in addition to other risk factors and in addition to PMD. Methods: We conducted a case control study with hospital-based patients with a diagnosis of invasive breast cancer and healthy women as controls. A total of 561 patients and 376 controls with available mammographic density were included into this study. We describe the differences concerning the common risk factors BMI, parital status, use of hormone replacement therapy (HRT) and menopause between cases and controls and estimate the odds ratios for PMD and DA, adjusted for the mentioned risk factors. Furthermore we compare the prediction models with each other to find out whether the addition of DA improves the model. Results: Mammographic density and DA were highly correlated with each other. Both variables were as well correlated to the commonly known risk factors with an expected direction and strength, however PMD (ρ = -0.56) was stronger correlated to BMI than DA (ρ = -0.11). The group of women within the highest quartil of PMD had an OR of 2.12 (95 % CI: 1.25-3.62). This could not be seen for the fourth quartile concerning DA. However the assessment of breast cancer risk could be improved by including DA in a prediction model in addition to common risk factors and PMD. Conclusions: The inclusion of the parameter DA into a prediction model for breast cancer in addition to established risk factors and PMD could improve the breast cancer risk assessment. As DA is measured together with PMD in the process of computer-assisted assessment of PMD it might be considered to include it as one additional breast cancer risk factor that is obtained from breast imaging.

[The risk factors and dangerous regimens of alcohol consumption in physicians' community].

PubMed

Savvina, I V; Grigor'ev, G I; Tulasynova, N Iu

2014-01-01

The study was carried out to determine percentage of hazardous, dangerous and possibly dependent alcohol consumption among physicians of Yakutsk. The relationship between social hygienic aspects accompanying hazardous and dangerous alcohol consumption was analyzed. The risk factors were established. The means of prevention of alcohol dependence among physicians were proposed.

Difference in Risk Factors for Breast Cancer by ER Status in an Indigenous African Population

PubMed Central

Galukande, M.; Wabinga, H.; Mirembe, F.; Karamagi, C.; Asea, A.

2013-01-01

Introduction. Breast cancer is the commonest cancer among women globally. In Uganda, it is on the rise, projected at a 4.5% annual ASR increase (age standardized incidence rate). The reasons for this steep increase are not fully established. In the recent past, gene profiling in tumor tissues suggests that breast cancers are divided into subtypes dependent on the presence or absence of oestrogen receptor, progesterone, and human epidermal growth factor receptor 2 (HER 2). These subtypes do have distinctive clinical outcomes and perhaps risk factors from past studies. There is paucity of data on hormonal receptor status and the traditionally known risk factors in sub-Saharan Africa. The purpose of this study therefore was to establish the differences between ER status and the traditionally known risk factors for breast cancer in Uganda. Methods. An observational analytical hospital, based study, carried out at Makerere University, College of Health Sciences. Formalin fixed and paraffin imbedded sections were prepared for haemotoxylin and eosin (H&E) stains and immunohistochemistry (IHC). Ethical approval was obtained. Results. A total of 113 women were recruited. Mean age was 45 years (SD14). There were no significant differences in selected risk factors (setting, age, contraceptive use, parity, breast feeding, or menarche) by ER status although ER negative tumors had significantly higher grade tumors (by a factor of two) compared to ER positive tumors. Conclusion. There were no significant differences among risk factors by ER status contrary to what several other studies suggest. The manifestation of breast cancer in Africa warrants further extensive inquiry. PMID:23936673

Difference in Risk Factors for Breast Cancer by ER Status in an Indigenous African Population.

PubMed

Galukande, M; Wabinga, H; Mirembe, F; Karamagi, C; Asea, A

2013-01-01

Introduction. Breast cancer is the commonest cancer among women globally. In Uganda, it is on the rise, projected at a 4.5% annual ASR increase (age standardized incidence rate). The reasons for this steep increase are not fully established. In the recent past, gene profiling in tumor tissues suggests that breast cancers are divided into subtypes dependent on the presence or absence of oestrogen receptor, progesterone, and human epidermal growth factor receptor 2 (HER 2). These subtypes do have distinctive clinical outcomes and perhaps risk factors from past studies. There is paucity of data on hormonal receptor status and the traditionally known risk factors in sub-Saharan Africa. The purpose of this study therefore was to establish the differences between ER status and the traditionally known risk factors for breast cancer in Uganda. Methods. An observational analytical hospital, based study, carried out at Makerere University, College of Health Sciences. Formalin fixed and paraffin imbedded sections were prepared for haemotoxylin and eosin (H&E) stains and immunohistochemistry (IHC). Ethical approval was obtained. Results. A total of 113 women were recruited. Mean age was 45 years (SD14). There were no significant differences in selected risk factors (setting, age, contraceptive use, parity, breast feeding, or menarche) by ER status although ER negative tumors had significantly higher grade tumors (by a factor of two) compared to ER positive tumors. Conclusion. There were no significant differences among risk factors by ER status contrary to what several other studies suggest. The manifestation of breast cancer in Africa warrants further extensive inquiry.

Deconstructing vulnerability for psychosis: Meta-analysis of environmental risk factors for psychosis in subjects at ultra high-risk.

PubMed

Fusar-Poli, P; Tantardini, M; De Simone, S; Ramella-Cravaro, V; Oliver, D; Kingdon, J; Kotlicka-Antczak, M; Valmaggia, L; Lee, J; Millan, M J; Galderisi, S; Balottin, U; Ricca, V; McGuire, P

2017-02-01

Subjects at ultra high-risk (UHR) for psychosis have an enhanced vulnerability to develop the disorder but the risk factors accounting for this accrued risk are undetermined. Systematic review of associations between genetic or environmental risk factors for psychosis that are widely established in the literature and UHR state, based on comparisons to controls. Forty-four studies encompassing 170 independent datasets and 54 risk factors were included. There were no studies on association between genetic or epigenetic risk factors and the UHR state that met the inclusion criteria. UHR subjects were more likely to show obstetric complications, tobacco use, physical inactivity, childhood trauma/emotional abuse/physical neglect, high perceived stress, childhood and adolescent low functioning, affective comorbidities, male gender, single status, unemployment and low educational level as compared to controls. The increased vulnerability of UHR subjects can be related to environmental risk factors like childhood trauma, adverse life events and affective dysfunction. The role of genetic and epigenetic risk factors awaits clarification. Copyright © 2016 The Authors. Published by Elsevier Masson SAS.. All rights reserved.

Overview of Current Concepts in Gastric Intestinal Metaplasia and Gastric Cancer

PubMed Central

Adam, Jason D.; Borum, Marie L.; Koh, Joyce M.; Stephen, Sindu

2018-01-01

Gastric intestinal metaplasia is a precancerous change of the mucosa of the stomach with intestinal epithelium, and is associated with an increased risk of dysplasia and cancer. The pathogenesis to gastric cancer is proposed by the Correa hypothesis as the transition from normal gastric epithelium to invasive cancer via inflammation followed by intramucosal cancer and invasion. Multiple risk factors have been associated with the development of gastric intestinal metaplasia interplay, including Helicobacter pylori infection and associated genomics, host genetic factors, environmental milieu, rheumatologic disorders, diet, and intestinal microbiota. Globally, screening guidelines have been established in countries with high incidence. In the United States, no such guidelines have been developed due to lower, albeit increasing, incidence. The American Society for Gastrointestinal Endoscopy recommends a case-by-case patient assessment based upon epidemiology, genetics, and environmental risk factors. Studies have examined the use of a serologic biopsy to stratify risk based upon factors such as H pylori status and virulence factors, along with serologic markers of chronic inflammation including pepsinogen I, pepsinogen II, and gastrin. High-risk patients may then be advised to undergo endoscopic evaluation with mapping biopsies from the antrum (greater curvature, lesser curvature), incisura angularis, and corpus (greater curvature, lesser curvature). Surveillance guidelines have not been firmly established for patients with known gastric intestinal metaplasia, but include repeat endoscopy at intervals according to the histologic risk for malignant transformation. PMID:29606921

Overview of Current Concepts in Gastric Intestinal Metaplasia and Gastric Cancer.

PubMed

Jencks, David S; Adam, Jason D; Borum, Marie L; Koh, Joyce M; Stephen, Sindu; Doman, David B

2018-02-01

Gastric intestinal metaplasia is a precancerous change of the mucosa of the stomach with intestinal epithelium, and is associated with an increased risk of dysplasia and cancer. The pathogenesis to gastric cancer is proposed by the Correa hypothesis as the transition from normal gastric epithelium to invasive cancer via inflammation followed by intramucosal cancer and invasion. Multiple risk factors have been associated with the development of gastric intestinal metaplasia interplay, including Helicobacter pylori infection and associated genomics, host genetic factors, environmental milieu, rheumatologic disorders, diet, and intestinal microbiota. Globally, screening guidelines have been established in countries with high incidence. In the United States, no such guidelines have been developed due to lower, albeit increasing, incidence. The American Society for Gastrointestinal Endoscopy recommends a case-by-case patient assessment based upon epidemiology, genetics, and environmental risk factors. Studies have examined the use of a serologic biopsy to stratify risk based upon factors such as H pylori status and virulence factors, along with serologic markers of chronic inflammation including pepsinogen I, pepsinogen II, and gastrin. High-risk patients may then be advised to undergo endoscopic evaluation with mapping biopsies from the antrum (greater curvature, lesser curvature), incisura angularis, and corpus (greater curvature, lesser curvature). Surveillance guidelines have not been firmly established for patients with known gastric intestinal metaplasia, but include repeat endoscopy at intervals according to the histologic risk for malignant transformation.

Regional Risk Evaluation of Flood Disasters for the Trunk-Highway in Shaanxi, China

PubMed Central

Qi, Hong-Liang; Tian, Wei-Ping; Li, Jia-Chun

2015-01-01

Due to the complicated environment there are various types of highway disasters in Shaanxi Province (China). The damages caused are severe, losses are heavy, and have rapidly increased over the years, especially those caused by flood disasters along the rivers in mountainous areas. Therefore, research on risk evaluations, which play important roles in the prevention and mitigation of highway disasters are very important. An evaluation model was established based on the superposition theory of regional influencing factors to highway flood disasters. Based on the formation mechanism and influencing factors of highway flood disasters, the main influencing factors were selected. These factors include rainstorms, terrain slopes, soil types, vegetation coverage and regional river density, which are based on evaluation indexes from climate conditions and underlying surface of the basin. A regional risk evaluation of highway flood disasters in Shaanxi was established using GIS. The risk index was divided into five levels using statistical methods, in accordance with the regional characteristics of highway flood disasters. Considering the difference in upfront investments, road grade, etc, between expressways and trunk-highways in China, a regional risk evaluation of trunk-highway flood disasters was completed. The evaluation results indicate that the risk evaluation is consistent with the actual situation. PMID:26528994

Regional Risk Evaluation of Flood Disasters for the Trunk-Highway in Shaanxi, China.

PubMed

Qi, Hong-Liang; Tian, Wei-Ping; Li, Jia-Chun

2015-10-29

Due to the complicated environment there are various types of highway disasters in Shaanxi Province (China). The damages caused are severe, losses are heavy, and have rapidly increased over the years, especially those caused by flood disasters along the rivers in mountainous areas. Therefore, research on risk evaluations, which play important roles in the prevention and mitigation of highway disasters are very important. An evaluation model was established based on the superposition theory of regional influencing factors to highway flood disasters. Based on the formation mechanism and influencing factors of highway flood disasters, the main influencing factors were selected. These factors include rainstorms, terrain slopes, soil types, vegetation coverage and regional river density, which are based on evaluation indexes from climate conditions and underlying surface of the basin. A regional risk evaluation of highway flood disasters in Shaanxi was established using GIS. The risk index was divided into five levels using statistical methods, in accordance with the regional characteristics of highway flood disasters. Considering the difference in upfront investments, road grade, etc, between expressways and trunk-highways in China, a regional risk evaluation of trunk-highway flood disasters was completed. The evaluation results indicate that the risk evaluation is consistent with the actual situation.

Molecular mechanisms of the genetic risk factors in pathogenesis of Alzheimer disease.

PubMed

Kanatsu, Kunihiko; Tomita, Taisuke

2017-01-01

Alzheimer disease (AD) is a neurodegenerative disease characterized by the extensive deposition of senile plaques and neurofibrillary tangles. Until recently, only the APOE gene had been known as a genetic risk factor for late-onset AD (LOAD), which accounts for more than 95% of all AD cases. However, in addition to this well-established genetic risk factor, genome-wide association studies have identified several single nucleotide polymorphisms as genetic risk factors of LOAD, such as PICALM and BIN1 . In addition, whole genome sequencing and exome sequencing have identified rare variants associated with LOAD, including TREM2 . We review the recent findings related to the molecular mechanisms by which these genetic risk factors contribute to AD, and our perspectives regarding the etiology of AD for the development of therapeutic agents.

Health and Social Factors Associated with Nutrition Risk: Results from Life and Living in Advanced Age: A Cohort Study in New Zealand (LiLACS NZ).

PubMed

Wham, C A; Teh, R; Moyes, S; Dyall, L; Kepa, M; Hayman, K; Kerse, N

2015-06-01

To establish the prevalence of high nutrition risk and associated health and social risk factors for New Zealand Māori and non-Māori in advanced age. A cross sectional analysis of inception cohorts to LiLACS NZ. Bay of Plenty and Lakes region of the North Island, New Zealand. 255 Māori and 400 non- Māori octogenarians. Nutrition risk was assessed using a validated questionnaire Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN II). Demographic, social, physical and health characteristics were established using an interviewer administered questionnaire. Health related quality of life (HRQOL) was assessed with the SF-12, depressive symptoms using the GDS-15. Half (49%) of Māori and 38% of non-Māori participants were at high nutrition risk (SCREEN II score <49). Independent risk factors were for Māori younger age (p=0.04), lower education (p=0.03), living alone (p<0.001), depressive symptoms (p=0.01). For non- Māori high nutrition risk was associated with female gender (p=0.005), living alone (p=0.002), a lower physical health related quality of life (p=0.02) and depressive symptoms (p=0.002). Traditional risk factors apply to both Māori and non-Māori whilst education as indicative of low socioeconomic status is an additional risk factor for Māori. High nutrition risk impacts health related quality of life for non-Māori. Interventions which socially facilitate eating are especially important for women and for Māori to maintain cultural practices and could be initiated by routine screening.

Adolescent self-harm: a school-based study in Northern Ireland.

PubMed

O'Connor, Rory C; Rasmussen, Susan; Hawton, Keith

2014-04-01

The prevalence of adolescent self-harm in Northern Ireland (NI) and its associated factors are unknown. Given the established relationship between conflict and mental health, and NI׳s recent history of conflict, it is important to investigate the factors associated with self-harm in NI. This study aimed to determine the prevalence of self-harm in NI adolescents and the factors associated with it, including exposure to the NI conflict. Observational study of 3596 school pupils employing an anonymous self-report survey. Information was obtained on demographic characteristics, lifestyle, life events and problems, exposure to the NI conflict, social and internet influences, and psychological variables. Self-harm was reported by 10% of respondents. In univariate analyses, exposure to the NI conflict was associated with self-harm alongside established risk factors. In multivariate analyses, bullying and exposure to self-harm were associated with lifetime self-harm in both girls and boys. Alcohol use, drug use, physical and sexual abuse, and self-esteem were also associated with self-harm in girls. In boys, absence of exercise, sexual orientation concerns, anxiety and impulsivity were additional risk factors. The internet/social media and the self-harm of others were also key influences. This is a cross-sectional study. The rate of self-harm was lower than elsewhere in the UK/Ireland. The study highlights the factors which should be considered in terms of risk assessment. In addition to established risk factors, the findings suggest that more research on the legacy of the NI conflict as well as the influence of new technologies warrant urgent attention. Copyright © 2014 Elsevier B.V. All rights reserved.

Impact of diet and exercise on lipid management in the modern era.

PubMed

Franklin, Barry A; Durstine, J Larry; Roberts, Christian K; Barnard, R James

2014-06-01

Unfortunately, many patients as well as the medical community, continue to rely on coronary revascularization procedures and cardioprotective medications as a first-line strategy to stabilize or favorably modify established risk factors and the course of coronary artery disease. However, these therapies do not address the root of the problem, that is, the most proximal risk factors for heart disease, including unhealthy dietary practices, physical inactivity, and cigarette smoking. We argue that more emphasis must be placed on novel approaches to embrace current primary and secondary prevention guidelines, which requires attacking conventional risk factors and their underlying environmental causes. The impact of lifestyle on the risk of cardiovascular disease has been well established in clinical trials, but these results are often overlooked and underemphasized. Considerable data also strongly support the role of lifestyle intervention to improve glucose and insulin homeostasis, as well as physical inactivity and/or low aerobic fitness. Accordingly, intensive diet and exercise interventions can be highly effective in facilitating coronary risk reduction, complementing and enhancing medications, and in some instances, even outperforming drug therapy. Copyright © 2014 Elsevier Ltd. All rights reserved.

Child Sexual Abuse and Negative Affect as Shared Risk Factors for Sexual Aggression and Sexual HIV Risk Behavior in Heterosexual Men.

PubMed

Peterson, Zoё D; Janssen, Erick; Goodrich, David; Fortenberry, J Dennis; Hensel, Devon J; Heiman, Julia R

2018-02-01

Previous research has suggested that sexually aggressive behavior and sexual HIV risk behavior are associated. Childhood sexual abuse (CSA) is a well-established risk factor for both types of problematic sexual behavior. Negative affect (i.e., anxiety, depression, and anger) is a less well-studied risk factor, but it has been theorized to relate to both sexual aggression and HIV risk behavior. Thus, this study sought to (1) confirm the relationship between sexual aggression and HIV risk behavior, (2) establish CSA and negative affect as shared risk factors for sexual aggression and HIV risk behavior, and (3) evaluate whether negative affect mediates the relationship between CSA and sexual aggression and between CSA and HIV sexual risk in a sample of heterosexual men. We recruited 18- to 30-year-old heterosexual men (N = 377) from urban sexually transmitted infection clinics. Men completed measures of sexual HIV risk history (number of partners and condom use), sexual aggression history, CSA history, and trait negative affect (anger, anxiety, and depression). Structural equation modeling was used to examine hypothesized direct and indirect relationships. In the final SEM model, sexual aggression history and sexual HIV risk behavior were correlated. CSA was associated with both types of problematic sexual behavior. Anxiety significantly mediated the relationship between CSA and sexual aggression and between CSA and sexual HIV risk behavior (χ 2 [1300] = 2121.79, p < .001; CFI = 0.905; RMSEA [90% CI] = .044 [.041-.047]). Sexual aggression appears to be part of a constellation of sexual risk behaviors; thus, it may be possible to develop prevention programs that target both sexual HIV risk and sexual aggression. CSA is a shared risk factor for sexual aggression and HIV risk behavior through the pathway of anxiety. Thus, anxiety might be one promising target for intervention.

Identifying individuals for primary cardiovascular disease prevention in UK general practice: priorities and resource implications

PubMed Central

Holt, Tim A; Thorogood, Margaret; Griffiths, Frances; Munday, Stephen; Stables, David

2008-01-01

Targeted cardiovascular disease prevention relies on risk-factor information held in primary care records. A risk algorithm, the ‘e-Nudge’, was applied to data from a population of ≥50-year-olds in 19 West Midlands practices, to identify those individuals at risk of cardiovascular disease. Altogether, 5.9% were identified aged 50–74 years at ≥20% 10-year risk based on existing data, and a further 26.4% were potentially at risk but had missing risk-factor information; 9.2% of patients aged over 50 years with established cardiovascular disease had at least one modifiable risk factor outside the audit target of the Quality and Outcomes Framework. Implications for resource allocation are discussed. PMID:18611316

Lifetime Risk for Sudden Cardiac Death in the Community.

PubMed

Bogle, Brittany M; Ning, Hongyan; Mehrotra, Sanjay; Goldberger, Jeffrey J; Lloyd-Jones, Donald M

2016-06-29

Sudden cardiac death (SCD) is a leading cause of death in the United States and often occurs without previous cardiac symptoms. Lifetime risk for SCD and the influence of established risk factors on lifetime risks for SCD have not been estimated previously. We followed Framingham Heart Study participants who were free of cardiovascular disease before their earliest examination. SCD was defined as death attributed to coronary heart disease within 1 hour of symptom onset without another probable cause of death, as adjudicated by a panel of 3 physicians. Lifetime risk for SCD was estimated to 85 years of age for men and women, with death attributed to other causes as the competing risk, and stratified by risk factor levels. We followed 2294 men and 2785 women for 160 396 person-years; 375 experienced SCD. At 45 years of age, lifetime risks were 10.9% (95% CI, 9.4-12.5) for men and 2.8% (95% CI, 2.1-3.5) for women. Greater aggregate burden of established risk factors was associated with a higher lifetime risk for SCD. Categorizing men and women solely by blood pressure levels resulted in a clear stratification of lifetime risk curves. We present the first lifetime risk estimates for SCD. Greater aggregate risk factor burden, or blood pressure level alone, is associated with higher lifetime risks for SCD. This high risk of premature death attributed to SCD (approximately 1 in 9 men and 1 in 30 women) should serve as a motivator of public health efforts in preventing and responding to SCD. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Multilevel Analysis of Trachomatous Trichiasis and Corneal Opacity in Nigeria: The Role of Environmental and Climatic Risk Factors on the Distribution of Disease.

PubMed

Smith, Jennifer L; Sivasubramaniam, Selvaraj; Rabiu, Mansur M; Kyari, Fatima; Solomon, Anthony W; Gilbert, Clare

2015-01-01

The distribution of trachoma in Nigeria is spatially heterogeneous, with large-scale trends observed across the country and more local variation within areas. Relative contributions of individual and cluster-level risk factors to the geographic distribution of disease remain largely unknown. The primary aim of this analysis is to assess the relationship between climatic factors and trachomatous trichiasis (TT) and/or corneal opacity (CO) due to trachoma in Nigeria, while accounting for the effects of individual risk factors and spatial correlation. In addition, we explore the relative importance of variation in the risk of trichiasis and/or corneal opacity (TT/CO) at different levels. Data from the 2007 National Blindness and Visual Impairment Survey were used for this analysis, which included a nationally representative sample of adults aged 40 years and above. Complete data were available from 304 clusters selected using a multi-stage stratified cluster-random sampling strategy. All participants (13,543 individuals) were interviewed and examined by an ophthalmologist for the presence or absence of TT and CO. In addition to field-collected data, remotely sensed climatic data were extracted for each cluster and used to fit Bayesian hierarchical logistic models to disease outcome. The risk of TT/CO was associated with factors at both the individual and cluster levels, with approximately 14% of the total variation attributed to the cluster level. Beyond established individual risk factors (age, gender and occupation), there was strong evidence that environmental/climatic factors at the cluster-level (lower precipitation, higher land surface temperature, higher mean annual temperature and rural classification) were also associated with a greater risk of TT/CO. This study establishes the importance of large-scale risk factors in the geographical distribution of TT/CO in Nigeria, supporting anecdotal evidence that environmental conditions are associated with increased risk in this context and highlighting their potential use in improving estimates of disease burden at large scales.

Is quality of life different between diabetic and non-diabetic people? The importance of cardiovascular risks

PubMed Central

Rodríguez-Sánchez, B.; Mata-Cases, M.; Rodríguez-Mañas, L.; Capel, M.; Oliva-Moreno, J.

2017-01-01

Background To analyse and compare the impact of cardiovascular risk factors and disease on health-related quality of life (HRQoL) in people with and without diabetes living in the community. Methods We used data of 1,905 people with diabetes and 19,031 people without diabetes from the last Spanish National Health Survey (years 2011–2012). The HRQoL instrument used was the EuroQol 5D-5L, based on time trade-off scores. Matching methods were used to assess any differences in the HRQoL in people with and without diabetes with the same characteristics (age, gender, education level, and healthy lifestyle), according to cardiovascular risk factors and diseases. Disparities were also analysed for every dimension of HRQoL: mobility, daily activities, personal care, pain/discomfort, and anxiety/depression. Results There were no significant differences in time trade-off scores between people with and without diabetes when cardiovascular risk factors or established cardiovascular disease were not present. However, when cardiovascular risk factors were present, the HRQoL score was significantly lower in people with diabetes than in those without. This difference was indeed greater when cardiovascular diseases were present. More precisely, people with diabetes and any of the cardiovascular risk factors, who have not yet developed any cardiovascular disease, report lower HRQoL, 0.046 TTO score points over 1 (7.93 over 100 in the VAS score) compared to those without diabetes, and 0.14 TTO score points of difference (14.61 over 100 in the VAS score) if cardiovascular diseases were present. In fact, when the three risk factors were present in people with diabetes, HRQoL was significantly lower (0.10 TTO score points over 1 and 10.86 points over 100 in VAS score), obesity being the most influential risk factor. Conclusions The presence of established cardiovascular disease and/or cardiovascular risk factors, specially obesity, account for impaired quality of life in people with diabetes. PMID:29240836

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…

Suboptimal management of cardiovascular risk factors in coronary heart disease patients in primary care occurs particularly in women.

PubMed

Driscoll, A; Beauchamp, A; Lyubomirsky, G; Demos, L; McNeil, J; Tonkin, A

2011-10-01

Patients with established coronary heart disease (CHD) are at the highest risk of further events. Despite proven therapies, secondary prevention is often suboptimal. General practitioners (GPs) are in an ideal position to improve secondary prevention. To contrast management of cardiovascular risk factors in patients with established CHD in primary care to those in clinical guidelines and according to gender. GPs throughout Australia were approached to participate in a programme incorporating a disease management software (mdCare) program. Participating practitioners (1258 GPs) recruited individual patients whose cardiovascular risk factor levels were measured. The mdCare programme included 12,509 patients (58% male) diagnosed with CHD. Their mean age was 71.7years (intra-quartile range 66-78) for men and 74years (intra-quartile range 68-80) for women. Low-density-lipoprotein cholesterol was above target levels in 69% (2032) of women compared with 58% (2487) in men (P < 0.0001). There was also a higher proportion of women with total cholesterol above target levels (76%, 3592) compared with men (57%, 3787) (P < 0.0001). In patients who were prescribed lipid-lowering medication, 53% (2504) of men and 72% (2285) of women continued to have a total cholesterol higher than recommended target levels (P < 0.0001). Overall, over half (52%, 6538) had at least five cardiovascular risk factors (55% (2914) in women and 50% (3624) in men, P < 0.0001). This study found less intensive management of cardiovascular risk factors in CHD patients, particularly among women, despite equivalent cardiovascular risk. This study has shown that these patients have multiple risk factors where gender also plays a role. © 2011 The Authors. Internal Medicine Journal © 2011 Royal Australasian College of Physicians.

[Multiple risk factors models of patients with acute coronary syndromes of different genders].

PubMed

Sun, Wanglexian; Hu, Tiemin; Huang, Xiansheng; Zhang, Ying; Guo, Jinrui; Wang, Wenfeng; Shi, Fei; Wang, Pengfei; Wang, Huarong; Sun, Jing; Li, Chunhua

2014-12-23

To establish the multiple risk factors models for patients with acute coronary syndromes (ACS) of different genders and quantitatively assess the pathopoiesis of all factors. A total of 2 308 consecutive ACS inpatients and a control group of 256 cases with normal coronary artery from January 2010 to December 2012 were enrolled and divided into 4 groups of female ACS (n = 970), male ACS (n = 1 338), female control (n = 136) and male control (n = 120). All demographic and clinical data were collected by the physicians and master degree candidates in the division of cardiology. The Logistic regression models of multiple risk factors were established for ACS by different genders. More than 45 years of age, dyslipidemia, type 2 diabetes mellitus, obesity and hypertension were all independent risk factors of ACS for different genders (P < 0.05). However, the same risk factors had different pathogenic effects on ACS between genders. The odds ratio (OR) was markedly different for females and males: per 5-year increase aged over 45 years (1.45 vs 1.13), dyslipidemia (3.45 vs 1.68), type 2 diabetes mellitus (4.06 vs 2.33), obesity (2.93 vs 1.91) and hypertension (1.78 vs 3.80) respectively (all P < 0.05). In addition, current smoking increased the risk of ACS attack in males by 5.49 (P < 0.05) while not statistically significant in females. Particularly cerebral ischemic stroke increased the risk of ACS attack by 5.49 folds in males other than females (P < 0.05). Type 2 diabetes mellitus, dyslipidemia and obesity may present higher risks of ACS attack for females than males. And smoking and hypertension are much more dangerous for males. Males with cerebral infarction are more susceptible for ACS than females.

Ethnic differences in the relationships of anthropometric measures to metabolic risk factors in Asian patients at risk of atherothrombosis: results from the REduction of Atherothrombosis for Continued Health (REACH) Registry.

PubMed

Wang, Tzung-Dau; Goto, Shinya; Bhatt, Deepak L; Steg, Philippe Gabriel; Chan, Juliana C N; Richard, Alain J; Liau, Chiau-Suong

2010-03-01

The aim of the study is to examine the relationships between 4 anthropometric indices and metabolic risk factors (hypertension, atherogenic dyslipidemia, and glucose intolerance) in different Asian ethnic groups of patients at risk of atherothrombosis. We analyzed the baseline data of 11 017 Asian patients with established atherothrombotic cardiovascular diseases or at least 3 atherothrombotic risk factors. In East and South Asians, the graded relationships of body mass index (BMI) with the presence of at least 2 metabolic risk factors remained significant after adjustment for waist circumference (top vs bottom quartile--East Asians: odds ratio, 2.02; 95% confidence interval, 1.67-2.45; South Asians: 3.24, 1.18-8.95), whereas the graded relationships of waist circumference decreased or became nonsignificant after adjustment for BMI (East Asians: 1.64, 1.35-1.99; South Asians: 0.68, 0.20-2.30). In Southeast Asian men, the graded relationship of waist circumference with metabolic risk factors (2.27, 1.42-3.63) was stronger than that of BMI (1.34, 0.84-2.12), whereas in Southeast Asian women, there was a trend toward a stronger association between BMI and metabolic risk factors. In East Asians and in Southeast Asian women, the waist-to-BMI ratio decreased with the number of metabolic risk factors. The optimal cutoff points for BMI and waist circumference with regard to the presence of at least 2 metabolic risk factors were lowest in East Asians (men: 24 kg/m(2) and 86 cm; women: 24 kg/m(2) and 82 cm). Our findings suggest that both BMI and waist circumference, rather than waist circumference alone, should be included in metabolic risk assessment in this high-risk multiethnic Asian population. Uniform anthropometric cutoff values for all Asian ethnic groups are not appropriate to assess obesity-related metabolic complications, even in patients with established atherothrombotic disease. (c) 2010 Elsevier Inc. All rights reserved.

International Patients' Travel Decision Making Process- A Conceptual Framework.

PubMed

Khan, Mohammad Jamal; Chelliah, Shankar; Haron, Mahmod Sabri

2016-02-01

Role of information source, perceived benefits and risks, and destination image has significantly been examined in travel and tourism literature; however, in medical tourism it is yet to be examined thoroughly. The concept discussed in this article is drawn form well established models in tourism literature. The purpose of this research was to identify the source of information, travel benefits and perceived risks related to movement of international patients and develop a conceptual model based on well-established theory. Thorough database search (Science Direct, utmj.org, nih.gov, nchu.edu.tw, palgrave-journals, medretreat, Biomedcentral) was performed to fulfill the objectives of the study. International patients always concern about benefits and risks related to travel. These benefits and risks form images of destination in the minds of international patients. Different sources of information make international patients acquaint about the associated benefits and risks, which later leads to development of intention to visit. This conceptual paper helps in establishing model for decision-making process of international patients in developing visit intention. Ample amount of literature is available detailing different factors involved in travel decision making of international patients; however literature explaining relationship between these factors is scarce.

International Patients’ Travel Decision Making Process- A Conceptual Framework

PubMed Central

KHAN, Mohammad Jamal; CHELLIAH, Shankar; HARON, Mahmod Sabri

2016-01-01

Background: Role of information source, perceived benefits and risks, and destination image has significantly been examined in travel and tourism literature; however, in medical tourism it is yet to be examined thoroughly. The concept discussed in this article is drawn form well established models in tourism literature. Methods: The purpose of this research was to identify the source of information, travel benefits and perceived risks related to movement of international patients and develop a conceptual model based on well-established theory. Thorough database search (Science Direct, utmj.org, nih.gov, nchu.edu.tw, palgrave-journals, medretreat, Biomedcentral) was performed to fulfill the objectives of the study. Results: International patients always concern about benefits and risks related to travel. These benefits and risks form images of destination in the minds of international patients. Different sources of information make international patients acquaint about the associated benefits and risks, which later leads to development of intention to visit. This conceptual paper helps in establishing model for decision-making process of international patients in developing visit intention. Conclusion: Ample amount of literature is available detailing different factors involved in travel decision making of international patients; however literature explaining relationship between these factors is scarce. PMID:27114978

Parental 'affectionless control' as an antecedent to adult depression: a risk factor refined.

PubMed

Mackinnon, A; Henderson, A S; Andrews, G

1993-02-01

It has been well established that individuals with a history of depression report their parents as being less caring and more overprotective of them than do controls. 'Affectionless control' in childhood has thus been proposed as a risk factor for depression. Evidence is presented from a logistic regression analysis of data from a volunteer community sample that lack of care rather than over-protection is the primary risk factor. No evidence for an interaction effect of low care and over-protection was found.

Mammographic breast density as a risk factor for breast cancer: awareness in a recently screened clinical sample.

PubMed

O'Neill, Suzanne C; Leventhal, Kara Grace; Scarles, Marie; Evans, Chalanda N; Makariou, Erini; Pien, Edward; Willey, Shawna

2014-01-01

Breast density is an established, independent risk factor for breast cancer. Despite this, density has not been included in standard risk models or routinely disclosed to patients. However, this is changing in the face of legal mandates and advocacy efforts. Little information exists regarding women's awareness of density as a risk factor, their personal risk, and risk management options. We assessed awareness of density as a risk factor and whether sociodemographic variables, breast cancer risk factors. and perceived breast cancer risk were associated with awareness in 344 women with a recent screening mammogram at a tertiary care center. Overall, 62% of women had heard about density as a risk factor and 33% had spoken to a provider about breast density. Of the sample, 18% reported that their provider indicated that they had high breast density. Awareness of density as a risk factor was greater among White women and those with other breast cancer risk factors. Our results suggest that although a growing number of women are aware of breast density as a risk factor, this awareness varies. Growing mandates for disclosure suggest the need for patient education interventions for women at increased risk for the disease and to ensure all women are equally aware of their risks. Copyright © 2014 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

Six-fold difference in the stomach cancer mortality rate between northern and southern Iran.

PubMed

Zendehdel, Kazem; Marzban, Maryam; Nahvijou, Azin; Jafari, Nahid

2012-12-01

Stomach cancer is the most common cancer in Iran. A multi-ethnic population and wide variation in the environmental risk factors may lead to variations in cancer risk within this country. We have designed an ecological study and evaluated geographical variation regarding mortality from stomach cancer and its established risk factors in Iran.  We used the Iranian National Causes of Death Registry and estimated the age-standardized mortality rates (ASMR) of stomach cancer in 29 Iranian provinces, stratified by sex and area of residence (rural/urban).  The average ASMR of stomach cancer among Iranian males was 15 per 100,000 and for females it was 8.1 per 100,000. The highest and lowest mortality rates were observed in Kurdistan with an ASMR of 29.1 per 100,000 in northwestern Iran and Hormozgan that had an ASMR of 5.0 per 100,000 in southern Iran. Males had approximately a two-fold higher ASMR compared to females, as did rural residents when compared with urban residents. The prevalence of H. pylori infection was about 90% in the province of Ardabil (a high-risk area) and 27% in the province of Sistan-Baluchistan (a low-risk area).  The wide geographical variation and high mortality rate of stomach cancer in Iran is likely due to differences in the exposure to the environmental risk factors among people living in the high- and low-risk areas, particularly H. pylori infection, a well-established risk factor of stomach cancer.

South Asian ethnicity is associated with a lower prevalence of atrial fibrillation despite greater prevalence of established risk factors: a population-based study in Bradford Metropolitan District.

PubMed

Gillott, Richard Geoffrey; Willan, Kathryn; Kain, Kirti; Sivananthan, Uduvil Mohanaraj; Tayebjee, Muzahir Hassan

2017-03-01

Previous studies indicate that South Asians (SAs) may have a reduced risk of developing atrial fibrillation (AF) despite having a higher prevalence of traditional cardiovascular risk factors. This observational study was designed to explore the relative differences between SAs and Whites in a well-defined, multi-ethnic population with careful consideration of traditional cardiovascular risk factors that are thought to contribute to the development of AF. Anonymized data from 417 575 adults were sourced from primary care records within Bradford Metropolitan District, UK. Atrial fibrillation diagnosis was indicated by the presence on the AF Quality Outcomes Framework register. Self-reported ethnicity was mapped to census ethnic codes. The age-standardized prevalence rates of AF were calculated for comparison between the White and SA populations; our study sample presented relative proportions of 2.39 and 0.4%. Multivariable logistic regression analysis was performed to estimate the odds of developing AF given SA ethnicity. Adjustment for age, sex, and established risk factors found a 71% reduction in odds of AF in SAs when compared with Whites [odds ratio (OR): 0.29, 95% confidence interval (CI): 0.26-0.32]. When stratified by ethnicity, analyses revealed significantly different odds of AF for patients with diabetes; diabetes was not associated with the development of AF in the SA population (0.81, 95% CI: 0.63-1.05). This study, in a multi-ethnic population, presents ethnicity as a predictor of AF in which prevalence is significantly lower in SAs when compared with Whites. This is despite SAs having a higher frequency of established risk factors for the development of AF, such as ischaemic heart disease, heart failure, hypertension, and type 2 diabetes. These findings are consistent with previous literature and add weight to the need for further investigation, although this is the first study to investigate the differential associations of individual risk factors with development of AF. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.

Long-term dietary sodium, potassium and fluid intake; exploring potential novel risk factors for renal cell cancer in the Netherlands Cohort Study on diet and cancer.

PubMed

Deckers, I A G; van den Brandt, P A; van Engeland, M; Soetekouw, P M M B; Baldewijns, M M L L; Goldbohm, R A; Schouten, L J

2014-02-04

As sodium, potassium and fluid intake are related to hypertension, an established risk factor for renal cell cancer (RCC), they may be independent risk factors for RCC. The Netherlands Cohort Study (NLCS) with case-cohort design included 120,852 participants aged 55-69 years. At baseline, diet and lifestyle were assessed with questionnaires. After 17.3 years of follow-up, 485 RCC cases and 4438 subcohort members were available for analyses. Sodium intake increased RCC risk (P-trend=0.03), whereas fluid and potassium intake did not. For high sodium and low fluid intake, the RCC risk additionally increased (P-interaction=0.02). Sodium intake is a potential risk factor for RCC, particularly if fluid consumption is low.

Homocystein as a Risk Factor for Developing Complications in Chronic Renal Failure

PubMed Central

Jakovljevic, Biljana; Gasic, Branislav; Kovacevic, Pedja; Rajkovaca, Zvezdana; Kovacevic, Tijana

2015-01-01

Aim: Cardiovascular diseases are leading cause of death in patients with chronic renal failure. The aim of our study was to establish connection between levels of homocysteine and traditional and nontraditional risk factors for developing cardiovascular diseases in dialysis and pre dialysis patients. Methods: We included 33 pre dialysis (23 in stage three and 10 in stage four of chronic kidney disease) and 43 patients receiving hemodialysis longer than six months. Besides standard laboratory parameters, levels of homocysteine and blood pressure were measured in all patients. Glomerular filtration rate was measured in pre dialysis patients and dialysis quality parameters in dialysis patients. Results: Homocysteine levels were elevated in all patients (19±5.42mmol/l). The connection between homocysteine levels and other cardiovascular diseases risk factors was not established in pre dialysis patients. In patients treated with hemodialysis we found negative correlation between homocysteine levels and patients’ age (p<0.05) and positive correlation between homocysteine levels and length of dialysis (p<0.01) as well as between homocysteine and anemia parameters (erythrocytes, hemoglobin), (p<0.01). Homocysteine and LDL (and total cholesterol) were in negative correlation (p<0.01). Conclusion: Homocysteine, as one of nontraditional cardiovascular diseases risk factors, is elevated in all patients with chronic renal failure and it’s positive correlation with some other risk factors was found. PMID:26005384

Management and Outcomes Among Chinese Hospitalized Patients With Established Cardiovascular Disease or Multiple Risk Factors.

PubMed

Yang, Jingang; Yang, Yuejin; Gu, Hongqiu; Li, Wei; Hu, Dayi

2016-02-01

We assessed the management and outcomes among hospitalized patients with coronary artery disease (CAD), stroke, peripheral artery disease (PAD), or with multiple (≥ 2) cardiovascular (CV) risk factors (multiple risk factors [MRFs]). We retrospectively studied 3732 hospitalized patients of either CV disease or ≥ 2 risk factors for atherothrombosis from October 2004 to January 2005. Outcomes included CV death, myocardial infarction (MI), stroke, and hospitalization for atherothrombotic events. About one-third had disease involving ≥ 1 vascular bed. Medication was more intense in patients with CAD than in others. The lowest use of statins and antiplatelet treatment was in the PAD-only group. Patients with PAD experienced a higher CV mortality (5.1%) than the patients with CAD (3.73%) or stroke (4.1%), P < .001. Cardiovascular death ranged from 1.2% for patients with MRFs, 2.8% for patients with 1-bed disease, 4.7% for patients with 2-bed disease to 6.4% for patients with 3-bed disease (P for trend <.001). For hospitalized patients with established atherosclerotic arterial disease, a substantial increase in CV event rates occurs with increasing numbers of affected arterial beds. Patients with PAD were at an especially high risk. © The Author(s) 2015.

Methods for establishing a surveillance system for cardiovascular diseases in Indian industrial populations.

PubMed Central

Reddy, K. S.; Prabhakaran, D.; Chaturvedi, V.; Jeemon, P.; Thankappan, K. R.; Ramakrishnan, L.; Mohan, B. V. M.; Pandav, C. S.; Ahmed, F. U.; Joshi, P. P.; Meera, R.; Amin, R. B.; Ahuja, R. C.; Das, M. S.; Jaison, T. M.

2006-01-01

OBJECTIVE: To establish a surveillance network for cardiovascular diseases (CVD) risk factors in industrial settings and estimate the risk factor burden using standardized tools. METHODS: We conducted a baseline cross-sectional survey (as part of a CVD surveillance programme) of industrial populations from 10 companies across India, situated in close proximity to medical colleges that served as study centres. The study subjects were employees (selected by age and sex stratified random sampling) and their family members. Information on behavioural, clinical and biochemical determinants was obtained through standardized methods (questionnaires, clinical measurements and biochemical analysis). Data collation and analyses were done at the national coordinating centre. FINDINGS: We report the prevalence of CVD risk factors among individuals aged 20-69 years (n = 19 973 for the questionnaire survey, n = 10 442 for biochemical investigations); mean age was 40 years. The overall prevalence of most risk factors was high, with 50.9% of men and 51.9% of women being overweight, central obesity was observed among 30.9% of men and 32.8% of women, and 40.2% of men and 14.9% of women reported current tobacco use. Self-reported prevalence of diabetes (5.3%) and hypertension (10.9%) was lower than when measured clinically and biochemically (10.1% and 27.7%, respectively). There was marked heterogeneity in the prevalence of risk factors among the study centres. CONCLUSION: There is a high burden of CVD risk factors among industrial populations across India. The surveillance system can be used as a model for replication in India as well as other developing countries. PMID:16799730

Clinical factors predicting risk for aspiration and respiratory aspiration among patients with Stroke1

PubMed Central

Oliveira, Ana Railka de Souza; Costa, Alice Gabrielle de Sousa; Morais, Huana Carolina Cândido; Cavalcante, Tahissa Frota; Lopes, Marcos Venícios de Oliveira; de Araujo, Thelma Leite

2015-01-01

Objective: to investigate the association of risk factors with the Risk for aspiration nursing diagnosis and respiratory aspiration. Method: cross-sectional study assessing 105 patients with stroke. The instrument used to collect data addressing sociodemographic information, clinical variables and risk factors for Risk for aspiration. The clinical judgments of three expert RNs were used to establish the diagnosis. The relationship between variables and strength of association using Odds Ratio (OR) was verified both in regard to Risk for aspiration and respiratory aspiration. Results: risk for aspiration was present in 34.3% of the patients and aspiration in 30.5%. The following stood out among the risk factors: Dysphagia, Impaired or absent gag reflex, Neurological disorders, and Impaired physical mobility, all of which were statistically associated with Risk for aspiration. Note that patients who develop such a diagnosis were seven times more likely to develop respiratory aspiration. Conclusion: dysphagia, Impaired or absent gag reflex were the best predictors both for Risk for aspiration and respiratory aspiration. PMID:26039291

Fire Interest and Antisociality as Risk Factors in the Severity and Persistence of Juvenile Firesetting

ERIC Educational Resources Information Center

MacKay, Sherri; Henderson, Joanna; Del Bove, Giannetta; Marton, Peter; Warling, Diane; Root, Carol

2006-01-01

Objective: In the DSM-IV-TR, firesetting is included as a criterion for the diagnoses of conduct disorder and pyromania. The link between firesetting and antisocial behavior is well established in the empirical literature. Although theoretical models of firesetting often include fire interest as a putative risk factor, there is little research on…

Epidemiology of testicular cancer: an overview.

PubMed

Garner, Michael J; Turner, Michelle C; Ghadirian, Parviz; Krewski, Daniel

2005-09-01

Testicular cancer is a rare disease, accounting for 1.1% of all malignant neoplasms in Canadian males. Despite the low overall incidence of testicular cancer, it is the most common malignancy among young men. The incidence rate of testicular cancer has been increasing since the middle of the 20th century in many western countries. However, the etiology of testicular cancer is not well understood. A search of the peer-reviewed literature was conducted to identify important articles for review and inclusion in this overview of the epidemiology of testicular cancer. Most of the established risk factors are related to early life events, including cryptorchidism, carcinoma in situ and in utero exposure to estrogens. Occupational, lifestyle, socioeconomic and other risk factors have demonstrated mixed associations with testicular cancer. Although there are few established risk factors for testicular cancer, some appear to be related to hormonal balance at various life stages. Lifestyle and occupational exposures occurring later in life may play a role in promoting the disease, although they are not likely involved in cancer initiation. In addition to summarizing the current epidemiologic evidence on risk factors for testicular cancer, we suggest future research directions that may elucidate the etiology of testicular cancer.

The Role of MicroRNAs in Environmental Risk Factors, Noise-Induced Hearing Loss, and Mental Stress.

PubMed

Miguel, Verónica; Cui, Julia Yue; Daimiel, Lidia; Espinosa-Díez, Cristina; Fernández-Hernando, Carlos; Kavanagh, Terrance J; Lamas, Santiago

2018-03-20

MicroRNAs (miRNAs) are important regulators of gene expression and define part of the epigenetic signature. Their influence on every realm of biomedicine is established and progressively increasing. The impact of environment on human health is enormous. Among environmental risk factors impinging on quality of life are those of chemical nature (toxic chemicals, heavy metals, pollutants, and pesticides) as well as those related to everyday life such as exposure to noise or mental and psychosocial stress. Recent Advances: This review elaborates on the relationship between miRNAs and these environmental risk factors. The most relevant facts underlying the role of miRNAs in the response to these environmental stressors, including redox regulatory changes and oxidative stress, are highlighted and discussed. In the cases wherein miRNA mutations are relevant for this response, the pertinent literature is also reviewed. We conclude that, even though in some cases important advances have been made regarding close correlations between specific miRNAs and biological responses to environmental risk factors, a need for prospective large-cohort studies is likely necessary to establish causative roles. Antioxid. Redox Signal. 28, 773-796.

Nutritional Health Considerations for Persons with Spinal Cord Injury.

PubMed

Bigford, Gregory; Nash, Mark S

2017-01-01

Chronic spinal cord injury (SCI) often results in morbidity and mortality due to all-cause cardiovascular disease (CVD) and comorbid endocrine disorders. Several component risk factors for CVD, described as the cardiometabolic syndrome (CMS), are prevalent in SCI, with the individual risks of obesity and insulin resistance known to advance the disease prognosis to a greater extent than other established risks. Notably, adiposity and insulin resistance are attributed in large part to a commonly observed maladaptive dietary/nutritional profile. Although there are no evidence-based nutritional guidelines to address the CMS risk in SCI, contemporary treatment strategies advocate more comprehensive lifestyle management that includes sustained nutritional guidance as a necessary component for overall health management. This monograph describes factors in SCI that contribute to CMS risks, the current nutritional profile and its contribution to CMS risks, and effective treatment strategies including the adaptability of the Diabetes Prevention Program (DPP) to SCI. Establishing appropriate nutritional guidelines and recommendations will play an important role in addressing the CMS risks in SCI and preserving optimal long-term health.

Respiratory Syncytial Virus Preterm (32-36 Completed Weeks of Gestation) Risk Estimation Measure for RSV Hospitalization in Ireland: A Prospective Study.

PubMed

Sheridan-Pereira, Margaret; Murphy, Joan; Sloan, Julie; Crispino, Gloria; Leahy, Anne; Corcoran, J David; Dempsey, Eugene; Elnazir, Basil; Gavin, Patrick; Sharif, Farhana; Gul, Rizwan; Satas, Salius; Murphy, John; Gormally, Siobhan; Shanaa, Issam; Waldron, David; Mc Mahon, Paul; Carson, John; Blanken, Maarten; Bont, Louis; Paes, Bosco

2016-01-01

In several countries, respiratory syncytial virus prophylaxis is offered to late preterm infants who are at escalated risk of respiratory syncytial virus hospitalization (RSVH). However, targeted prophylaxis should be informed by country-specific data. This study, which uniquely includes 36 weeks of gestational age (GA) infants, aims to establish the risk factors for RSVH in 32-36 weeks of GA infants in Ireland. A prospective observational study at 13 hospitals of laboratory-confirmed RSVH in nonprophylaxed 32-36 weeks of GA infants was conducted from July 2011 to February 2014. Baseline and first-year clinical data were analyzed by using SPSS software Version 22 (IBM Corp, Armonk, NY). Significant (P < 0.05) variables were entered into multiple logistic regression to determine the independent risk factors for RSVH. Sixty-three percent of eligible infants (1825 of 2877) were recruited. The RSVH rate was 3.6% (65 of 1807 analyzed infant records). There was no RSV-attributable mortality. Twelve infants required intensive care. Of the 15 variables correlating to RSVH, 5 independent risk factors were identified: older siblings [odds ratio (OR): 3.8; 95% confidence interval (CI): 1.97-7.41], being Caucasian (OR: 2.3; 95% CI: 1.04-5.29), neonatal respiratory morbidity (OR: 2.2; 95% CI: 1.28-3.94); birth July 15 to December 15 (OR: 2.1; 95% CI: 1.09-3.92) and family history of asthma (OR: 1.9; 95% CI: 1.01-3.39). Birth from 36 weeks to 36 + 6 days mitigated RSVH risk (relative risk: 0.58; 95% CI: 0.34-0.99); however, risk factors were similar to the 32-35 weeks of GA cohort. Neonatal respiratory morbidity or being Caucasian were the population-specific independent risk factors for RSVH in 32-36 weeks of GA in Ireland, whereas the other identified independent risk factors mirrored those established in previous studies.

Vertigo and dizziness in adolescents: Risk factors and their population attributable risk.

PubMed

Filippopulos, Filipp M; Albers, Lucia; Straube, Andreas; Gerstl, Lucia; Blum, Bernhard; Langhagen, Thyra; Jahn, Klaus; Heinen, Florian; von Kries, Rüdiger; Landgraf, Mirjam N

2017-01-01

To assess potential risk factors for vertigo and dizziness in adolescents and to evaluate their variability by different vertigo types. The role of possible risk factors for vertigo and dizziness in adolescents and their population relevance needs to be addressed in order to design preventive strategies. The study population consisted of 1482 school-children between the age of 12 and 19 years, who were instructed to fill out a questionnaire on different vertigo types and related potential risk factors. The questionnaire specifically asked for any vertigo, spinning vertigo, swaying vertigo, orthostatic dizziness, and unspecified dizziness. Further a wide range of potential risk factors were addressed including gender, stress, muscular pain in the neck and shoulder region, sleep duration, migraine, coffee and alcohol consumption, physical activity and smoking. Gender, stress, muscular pain in the neck and shoulder region, sleep duration and migraine were identified as independent risk factors following mutual adjustment: The relative risk was 1.17 [1.10-1.25] for female sex, 1.07 [1.02-1.13] for stress, 1.24 [1.17-1.32] for muscular pain, and 1.09 [1.03-1.14] for migraine. The population attributable risk explained by these risk factors was 26%, with muscular pain, stress, and migraine accounting for 11%, 4%, and 3% respectively. Several established risk factors in adults were also identified in adolescents. Risk factors amenable to prevention accounted for 17% of the total population risk. Therefore, interventions targeting these risk factors may be warranted.

Prevention of Infection in Orthopedic Prosthetic Surgery.

PubMed

Chirca, Ioana; Marculescu, Camelia

2017-06-01

Total joint arthroplasty is a generally safe orthopedic procedure; however, infection is a potentially devastating complication. Multiple risk factors have been identified for development of prosthetic joint infections. Identification of patients at risk and preoperative correction of known risk factors, such as smoking, diabetes mellitus, anemia, malnutrition, and decolonization of Staphylococcus carriers, represent well-established actions to decrease the infection risk. Careful operative technique, proper draping and skin preparation, and appropriate selection and dosing of antimicrobials for perioperative prophylaxis are also very important in prevention of infection. Published by Elsevier Inc.

Sex and Age Differences in the Risk Threshold for Delinquency

PubMed Central

Loeber, Rolf; Slotboom, Anne-Marie; Bijleveld, Catrien C. J. H.; Hipwell, Alison E.; Stepp, Stephanie D.; Koot, Hans M.

2015-01-01

This study examines sex differences in the risk threshold for adolescent delinquency. Analyses were based on longitudinal data from the Pittsburgh Youth Study (n = 503) and the Pittsburgh Girls Study (n = 856). The study identified risk factors, promotive factors, and accumulated levels of risks as predictors of delinquency and nondelinquency, respectively. The risk thresholds for boys and girls were established at two developmental stages (late childhood: ages 10–12 years, and adolescence: ages 13–16 years) and compared between boys and girls. Sex similarities as well as differences existed in risk and promotive factors for delinquency. ROC analyses revealed only small sex differences in delinquency thresholds, that varied by age. Accumulative risk level had a linear relationship with boys’ delinquency and a quadratic relationship with girls’ delinquency, indicating stronger effects for girls at higher levels of risk. PMID:23183920

Smoking is underrecognized as a risk factor for chronic pancreatitis.

PubMed

Yadav, Dhiraj; Slivka, Adam; Sherman, Stuart; Hawes, Robert H; Anderson, Michelle A; Burton, Frank R; Brand, Randall E; Lewis, Michele D; Gardner, Timothy B; Gelrud, Andres; Disario, James; Amann, Stephen T; Baillie, John; Lawrence, Christopher; O'Connell, Michael; Lowenfels, Albert B; Banks, Peter A; Whitcomb, David C

2010-01-01

Smoking is an established risk factor for chronic pancreatitis (CP). We sought to identify how often and in which CP patients physicians consider smoking to be a risk factor. We analyzed data on CP patients and controls prospectively enrolled from 19 US centers in the North American Pancreatitis Study-2. We noted each subject's self-reported smoking status and quantified the amount and duration of smoking. We noted whether the enrolling physician (gastroenterologist with specific interest in pancreatology) classified alcohol as the etiology for CP and selected smoking as a risk factor. Among 382/535 (71.4%) CP patients who were self-reported ever smokers, physicians cited smoking as a risk factor in only 173/382 (45.3%). Physicians cited smoking as a risk factor more often among current smokers, when classifying alcohol as CP etiology, and with higher amount and duration of smoking. We observed a wide variability in physician decision to cite smoking as a risk factor. Multivariable regression analysis however confirmed that the association of CP with smoking was independent of physician decision to cite smoking as a risk factor. Physicians often underrecognize smoking as a CP risk factor. Efforts are needed to raise awareness of the association between smoking and CP. and IAP. Copyright © 2011 S. Karger AG, Basel.

Genetics: Implications for Prevention and Management of Coronary Artery Disease.

PubMed

Assimes, Themistocles L; Roberts, Robert

2016-12-27

An exciting new era has dawned for the prevention and management of coronary artery disease (CAD) utilizing genetic risk variants. The recent identification of over 60 susceptibility loci for CAD confirms not only the importance of established risk factors, but also the existence of many novel causal pathways that are expected to improve our understanding of the genetic basis of CAD and facilitate the development of new therapeutic agents over time. Concurrently, Mendelian randomization studies have provided intriguing insights on the causal relationship between CAD-related traits, and highlight the potential benefits of long-term modifications of risk factors. Last, genetic risk scores of CAD may serve not only as prognostic, but also as predictive markers, and carry the potential to considerably improve the delivery of established prevention strategies. This review will summarize the evolution and discovery of genetic risk variants for CAD and their current and future clinical applications. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Factors affecting the ecology of tick-borne encephalitis in Slovenia.

PubMed

Knap, N; Avšič-Županc, T

2015-07-01

Recognition of factors that influence the formation of tick-borne encephalitis (TBE) foci is important for assessing the risk of humans acquiring the viral infection and for establishing what can be done (within reasonable boundaries) to minimize that risk. In Slovenia, the dynamics of the TBE vector, i.e. Ixodes ricinus, was studied over a 4-year period and the prevalence of infection in ticks was established. Two groups of tick hosts were investigated: deer and small mammals. Red deer have been confirmed as having a direct influence on the incidence of TBE and rodents have been recognized as important sentinels for TBE infections, although their role in the enzootic cycle of the virus still remains to be elucidated. Last, forest and agricultural areas, which are influenced by human activity, are suitable habitats for ticks, and important for TBEV transmission and establishment. Human behaviour is also therefore an important factor and should always be considered in studies of TBE ecology.

Study on quantitative risk assessment model of the third party damage for natural gas pipelines based on fuzzy comprehensive assessment

NASA Astrophysics Data System (ADS)

Qiu, Zeyang; Liang, Wei; Wang, Xue; Lin, Yang; Zhang, Meng

2017-05-01

As an important part of national energy supply system, transmission pipelines for natural gas are possible to cause serious environmental pollution, life and property loss in case of accident. The third party damage is one of the most significant causes for natural gas pipeline system accidents, and it is very important to establish an effective quantitative risk assessment model of the third party damage for reducing the number of gas pipelines operation accidents. Against the third party damage accident has the characteristics such as diversity, complexity and uncertainty, this paper establishes a quantitative risk assessment model of the third party damage based on Analytic Hierarchy Process (AHP) and Fuzzy Comprehensive Evaluation (FCE). Firstly, risk sources of third party damage should be identified exactly, and the weight of factors could be determined via improved AHP, finally the importance of each factor is calculated by fuzzy comprehensive evaluation model. The results show that the quantitative risk assessment model is suitable for the third party damage of natural gas pipelines and improvement measures could be put forward to avoid accidents based on the importance of each factor.

A macro environmental risk assessment methodology for establishing priorities among risks to human health and the environment in the Philippines

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

Gernhofer, S.; Oliver, T.J.; Vasquez, R.

1994-12-31

A macro environmental risk assessment (ERA) methodology was developed for the Philippine Department of Environment and Natural Resources (DENR) as part of the US Agency for International Development Industrial Environmental Management Project. The DENR allocates its limited resources to mitigate those environmental problems that pose the greatest threat to human health and the environment. The National Regional Industry Prioritization Strategy (NRIPS) methodology was developed as a risk assessment tool to establish a national ranking of industrial facilities. The ranking establishes regional and national priorities, based on risk factors, that DENR can use to determine the most effective allocation of itsmore » limited resources. NRIPS is a systematic framework that examines the potential risk to human health and the environment from hazardous substances released from a facility, and, in doing so, generates a relative numerical score that represents that risk. More than 3,300 facilities throughout the Philippines were evaluated successfully with the NRIPS.« less

The impact of level of education on vascular events and mortality in patients with type 2 diabetes mellitus: Results from the ADVANCE study.

PubMed

Blomster, J I; Zoungas, S; Woodward, M; Neal, B; Harrap, S; Poulter, N; Marre, M; Williams, B; Chalmers, J; Hillis, G S

2017-05-01

The relationship between educational level and the risk of all-cause mortality is well established, whereas the association with vascular events in individuals with type 2 diabetes is not well described. Any association may reflect a link with common cardiovascular or lifestyle-based risk factors. The relationships between the highest level of educational attainment and major cardiovascular events, microvascular complications and all-cause mortality were explored in a cohort of 11,140 individuals with type 2 diabetes. Completion of formal education before the age of 16 was categorized as a low level of education. Regional differences between Asia, East Europe and Established Market Economies were also assessed. During a median of 5years of follow up, 1031 (9%) patients died, 1147 (10%) experienced a major cardiovascular event and 1136 (10%) a microvascular event. After adjustment for baseline characteristics and risk factors, individuals with lower education had an increased risk of cardiovascular events (hazard ratio (HR) 1.31, 95% CI 1.16-1.48, p<0.0001), microvascular events (HR 1.23, 95% CI 1.08-1.39, p=0.0013) and all-cause mortality (HR 1.34, 95% CI 1.18-1.52, p<0.0001). In regional analyses the increased risk of studied outcomes associated with lower education was weakest in Established Market Economies and strongest in East Europe. A low level of education is associated with an increased risk of vascular events and death in patients with type 2 diabetes, independently of common lifestyle associated cardiovascular risk factors. The effect size varies between geographical regions. Copyright © 2017. Published by Elsevier B.V.

Cardiovascular disease, diabetes and established risk factors among populations of sub-Saharan African descent in Europe: a literature review

PubMed Central

Agyemang, Charles; Addo, Juliet; Bhopal, Raj; de Graft Aikins, Ama; Stronks, Karien

2009-01-01

Background Most European countries are ethnically and culturally diverse. Globally, cardiovascular disease (CVD) is the leading cause of death. The major risk factors for CVD have been well established. This picture holds true for all regions of the world and in different ethnic groups. However, the prevalence of CVD and related risk factors vary among ethnic groups. Methods This article provides a review of current understanding of the epidemiology of vascular disease, principally coronary heart disease (CHD), stroke and related risk factors among populations of Sub-Sahara African descent (henceforth, African descent) in comparison with the European populations in Europe. Results Compared with European populations, populations of African descent have an increased risk of stroke, whereas CHD is less common. They also have higher rates of hypertension and diabetes than European populations. Obesity is highly prevalent, but smoking rate is lower among African descent women. Older people of African descent have more favourable lipid profile and dietary habits than their European counterparts. Alcohol consumption is less common among populations of African descent. The rate of physical activity differs between European countries. Dutch African-Suriname men and women are less physically active than the White-Dutch whereas British African women are more physically active than women in the general population. Literature on psychosocial stress shows inconsistent results. Conclusion Hypertension and diabetes are highly prevalent among African populations, which may explain their high rate of stroke in Europe. The relatively low rate of CHD may be explained by the low rates of other risk factors including a more favourable lipid profile and the low prevalence of smoking. The risk factors are changing, and on the whole, getting worse especially among African women. Cohort studies and clinical trials are therefore needed among these groups to determine the relative contribution of vascular risk factors, and to help guide the prevention efforts. There is a clear need for intervention studies among these populations in Europe. PMID:19671137

Growth differentiation factor-15 level predicts major bleeding and cardiovascular events in patients with acute coronary syndromes: results from the PLATO study.

PubMed

Hagström, Emil; James, Stefan K; Bertilsson, Maria; Becker, Richard C; Himmelmann, Anders; Husted, Steen; Katus, Hugo A; Steg, Philippe Gabriel; Storey, Robert F; Siegbahn, Agneta; Wallentin, Lars

2016-04-21

Growth differentiation factor-15 (GDF-15) predicts death and composite cardiovascular (CV) events in patients with acute coronary syndrome (ACS). We investigated the independent associations between GDF-15 levels and major bleeding, the extent of coronary lesions and individual CV events in patients with ACS. Growth differentiation factor-15 was analysed at baseline ( ITALIC! n = 16 876) in patients with ACS randomized to ticagrelor or clopidogrel in the PLATO (PLATelet inhibition and patient Outcomes) trial. Growth differentiation factor-15 levels were related to extent of coronary artery disease (CAD) and to all types of non-coronary artery bypass grafting (CABG)-related major bleeding, spontaneous myocardial infarction (MI), stroke, and death during 12-month follow-up. In Cox proportional hazards models adjusting for established risk factors for CV disease and prognostic biomarkers (N-terminal pro B-type natriuretic peptide, cystatin C, high-sensitive C-reactive protein, and high-sensitive troponin T), 1 SD increase in ln GDF-15 was associated with increased risk of major bleeding with a hazard ratio (HR) 1.37 (95% confidence interval: 1.25-1.51) and with a similar increase in risk across different bleeding locations. For the same increase in ln GDF-15, the HR for the composite of CV death, spontaneous MI, and stroke was 1.29 (1.21-1.37), CV death 1.41 (1.30-1.53), all-cause death 1.41 (1.31-1.53), spontaneous MI 1.15 (1.05-1.26), and stroke 1.19 (1.01-1.42). The ITALIC! C-statistic improved for the prediction of CV death and non-CABG-related major bleeding when adding GDF-15 to established risk factors. In patients with ACS, higher levels of GDF-15 are associated with raised risks of all types of major non-CABG-related bleeding, spontaneous MI, and stroke as well as CV and total mortality and seem to improve risk stratification for CV-mortality and major bleeding beyond established risk factors. www.clinicaltrials.gov; NCT00391872. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

Reaction Time and Mortality from the Major Causes of Death: The NHANES-III Study

PubMed Central

Hagger-Johnson, Gareth; Deary, Ian J.; Davies, Carolyn A.; Weiss, Alexander; Batty, G. David

2014-01-01

Objective Studies examining the relation of information processing speed, as measured by reaction time, with mortality are scarce. We explored these associations in a representative sample of the US population. Methods Participants were 5,134 adults (2,342 men) aged 20–59 years from the Third National Health and Nutrition Examination Survey (NHANES III, 1988–94). Results Adjusted for age, sex, and ethnic minority status, a 1 SD slower reaction time was associated with a raised risk of mortality from all-causes (HR = 1.25, 95% CI 1.12, 1.39) and cardiovascular disease (CVD) (HR = 1.36, 95% CI 1.17, 1.58). Having 1 SD more variable reaction time was also associated with greater risk of all-cause (HR = 1.36, 95% CI 1.19, 1.55) and CVD (HR = 1.50, 95% CI 1.33, 1.70) mortality. No associations were observed for cancer mortality. The magnitude of the relationships was comparable in size to established risk factors in this dataset, such as smoking. Interpretation Alongside better-established risk factors, reaction time is associated with increased risk of premature death and cardiovascular disease. It is a candidate risk factor for all-cause and cause-specific mortality. PMID:24489645

Risk Factors for Dementia in People with Down Syndrome: Issues in Assessment and Diagnosis

ERIC Educational Resources Information Center

Bush, Alick; Beail, Nigel

2004-01-01

It has been clearly established that there is an increased incidence of early onset dementia of the Alzheimer type (DAT) in people who have Down syndrome. There are variations in the age of onset of the clinical signs of DAT, which may be accounted for by different risk factors. In this review we examined the evidence that different biological and…

QUANTITATIVE RISK ASSESSMENT FOR MICROBIAL AGENTS

EPA Science Inventory

Compared to chemical risk assessment, the process for microbial agents and infectious disease is more complex because of host factors and the variety of settings in which disease transmission can occur. While the National Academy of Science has established a paradigm for performi...

Alcohol's Effects on Women's Risk Detection in a Date-Rape Vignette

ERIC Educational Resources Information Center

Loiselle, Marci; Fuqua, Wayne R.

2007-01-01

Researchers have established that alcohol is a risk factor for date rape for both victims and perpetrators. Objective: The authors tried to experimentally address the link between alcohol consumption and women's risk detection abilities in a risky sexual vignette. Participants: The authors recruited 42 women from undergraduate classrooms at a…

Risk factors for stress fractures.

PubMed

Bennell, K; Matheson, G; Meeuwisse, W; Brukner, P

1999-08-01

Preventing stress fractures requires knowledge of the risk factors that predispose to this injury. The aetiology of stress fractures is multifactorial, but methodological limitations and expediency often lead to research study designs that evaluate individual risk factors. Intrinsic risk factors include mechanical factors such as bone density, skeletal alignment and body size and composition, physiological factors such as bone turnover rate, flexibility, and muscular strength and endurance, as well as hormonal and nutritional factors. Extrinsic risk factors include mechanical factors such as surface, footwear and external loading as well as physical training parameters. Psychological traits may also play a role in increasing stress fracture risk. Equally important to these types of analyses of individual risk factors is the integration of information to produce a composite picture of risk. The purpose of this paper is to critically appraise the existing literature by evaluating study design and quality, in order to provide a current synopsis of the known scientific information related to stress fracture risk factors. The literature is not fully complete with well conducted studies on this topic, but a great deal of information has accumulated over the past 20 years. Although stress fractures result from repeated loading, the exact contribution of training factors (volume, intensity, surface) has not been clearly established. From what we do know, menstrual disturbances, caloric restriction, lower bone density, muscle weakness and leg length differences are risk factors for stress fracture. Other time-honoured risk factors such as lower extremity alignment have not been shown to be causative even though anecdotal evidence indicates they are likely to play an important role in stress fracture pathogenesis.

Level of education and multiple sclerosis risk after adjustment for known risk factors: The EnvIMS study.

PubMed

Bjørnevik, Kjetil; Riise, Trond; Cortese, Marianna; Holmøy, Trygve; Kampman, Margitta T; Magalhaes, Sandra; Myhr, Kjell-Morten; Wolfson, Christina; Pugliatti, Maura

2016-01-01

Several recent studies have found a higher risk of multiple sclerosis (MS) among people with a low level of education. This has been suggested to reflect an effect of smoking and lower vitamin D status in the social class associated with lower levels of education. The objective of this paper is to investigate the association between level of education and MS risk adjusting for the known risk factors smoking, infectious mononucleosis, indicators of vitamin D levels and body size. Within the case-control study on Environmental Factors In MS (EnvIMS), 953 MS patients and 1717 healthy controls from Norway reported educational level and history of exposure to putative environmental risk factors. Higher level of education were associated with decreased MS risk (p trend = 0.001) with an OR of 0.53 (95% CI 0.41-0.68) when comparing those with the highest and lowest level of education. This association was only moderately reduced after adjusting for known risk factors (OR 0.61, 95% CI 0.44-0.83). The estimates remained similar when cases with disease onset before age 28 were excluded. These findings suggest that factors related to lower socioeconomic status other than established risk factors are associated with MS risk. © The Author(s), 2015.

Level of education and multiple sclerosis risk after adjustment for known risk factors: The EnvIMS study

PubMed Central

Bjørnevik, Kjetil; Riise, Trond; Cortese, Marianna; Holmøy, Trygve; Kampman, Margitta T; Magalhaes, Sandra; Myhr, Kjell-Morten; Wolfson, Christina; Pugliatti, Maura

2016-01-01

Background: Several recent studies have found a higher risk of multiple sclerosis (MS) among people with a low level of education. This has been suggested to reflect an effect of smoking and lower vitamin D status in the social class associated with lower levels of education. Objective: The objective of this paper is to investigate the association between level of education and MS risk adjusting for the known risk factors smoking, infectious mononucleosis, indicators of vitamin D levels and body size. Methods: Within the case-control study on Environmental Factors In MS (EnvIMS), 953 MS patients and 1717 healthy controls from Norway reported educational level and history of exposure to putative environmental risk factors. Results: Higher level of education were associated with decreased MS risk (p trend = 0.001) with an OR of 0.53 (95% CI 0.41–0.68) when comparing those with the highest and lowest level of education. This association was only moderately reduced after adjusting for known risk factors (OR 0.61, 95% CI 0.44–0.83). The estimates remained similar when cases with disease onset before age 28 were excluded. Conclusion: These findings suggest that factors related to lower socioeconomic status other than established risk factors are associated with MS risk. PMID:26014605

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

PubMed Central

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

2016-01-01

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

Characterizing cardiovascular risk in women with polycystic ovary syndrome: more than the sum of its parts?

PubMed

Chang, Alice Y; Wild, Robert A

2009-07-01

Polycystic ovary syndrome (PCOS), a condition of irregular menses and androgen excess, is the most common endocrinopathy of young women. Insulin resistance is a well-established feature among many women with PCOS, even in the nonobese. Therefore, it is not surprising that PCOS is frequently associated with cardiovascular risk factors and the metabolic syndrome. However, it is not known whether PCOS is an independent risk factor for atherosclerosis and cardiovascular (CV) events or whether CV risk is attributable to associated risk factors. We review previous studies on CV risk and disease in women with PCOS, describing the pitfalls and challenges in ascribing CV risk to PCOS. Women with PCOS might be partly reassured that their relative risk approximates that of the metabolic syndrome (RR 1.5) and also strongly counseled at the individual level about the greatest potential threat to their CV health, the development of type 2 diabetes.

Risk factors for injury in sport climbing and bouldering: a systematic review of the literature.

PubMed

Woollings, Kaikanani Y; McKay, Carly D; Emery, Carolyn A

2015-09-01

Rock climbing is an increasingly popular sport worldwide, as a recreational activity and a competitive sport. Several disciplines including sport climbing and bouldering have developed, each employing specific movements and techniques, leading to specific injuries. To examine risk factors and prevention measures for injury in sport climbing and bouldering, and to assess the methodological quality of existing studies. 12 electronic databases and several other sources were searched systematically using predetermined inclusion and exclusion criteria. Eligible articles were peer-reviewed, based on primary research using original data; outcome measures included injury, morbidity or mortality in rock climbing, and included one or more potential risk factor or injury prevention strategy. Two independent reviewers assessed the methodology of research in each study using the Downs and Black Quality Index. The data extracted is summarised, and appraisals of the articles are presented with respect to the quality of evidence presented. 19 studies met the inclusion criteria, and introduced 35 possible risk factors or injury prevention measures in climbing. Age, increasing years of climbing experience, highest climbing grade achieved (skill level), high climbing intensity score (CIS) and participating in lead climbing are potential risk factors. Results regarding injury prevention measures remain inconclusive. This field is relatively new and, as such, the data are not as robust as for more established sports with a larger research foundation. The key need is establishing modifiable risk factors using prospective studies and high quality methodology, such that injury prevention strategies can be developed. The CIS may be a useful measure in this field of research. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

[From "deadly quartet" to "metabolic syndrome". An analysis of its clinical relevance].

PubMed

Vancheri, Federico; Burgio, Antonio; Dovico, Rossana

2007-03-01

The metabolic syndrome denotes a clustering of specific risk factors for both cardiovascular disease and type 2 diabetes, whose underlying pathophysiology is believed to include insulin resistance. It has been widely reported that the syndrome is a simple clinical tool to identify people at high long term risk of cardiovascular disease and diabetes. However, its clinical importance is under debate. There are substantial uncertainties about the clinical definition of the syndrome, as to whether the risk factors clustering indicates a single unifying disorder, whether the risk conferred by the condition as a whole is higher risk than its individual components, and whether its predictive value of future cardiovascular events or diabetes is greater than established predicting models such as the Framingham Risk Score and the Diabetes Risk Score. We undertook an extensive review of the literature. Our analysis indicates that current definitions of the syndrome are incomplete or ambiguous, more than one pathophysiological process underlies the syndrome, although the combination of insulin resistance and hyperinsulinemia are related to most cases; the risk associated with the syndrome is no greater than that explained by the presence of its components, and the syndrome is less effective in predicting the future development of cardiovascular events and diabetes than established predicting models. Although the syndrome has some importance in understanding the pathophysiology of cardiovascular and diabetes risk factors clustering, its use as a clinical syndrome is not justified by current data.

Vertigo and dizziness in adolescents: Risk factors and their population attributable risk

PubMed Central

Albers, Lucia; Straube, Andreas; Gerstl, Lucia; Blum, Bernhard; Langhagen, Thyra; Jahn, Klaus; Heinen, Florian; von Kries, Rüdiger; Landgraf, Mirjam N.

2017-01-01

Objectives To assess potential risk factors for vertigo and dizziness in adolescents and to evaluate their variability by different vertigo types. The role of possible risk factors for vertigo and dizziness in adolescents and their population relevance needs to be addressed in order to design preventive strategies. Study design The study population consisted of 1482 school-children between the age of 12 and 19 years, who were instructed to fill out a questionnaire on different vertigo types and related potential risk factors. The questionnaire specifically asked for any vertigo, spinning vertigo, swaying vertigo, orthostatic dizziness, and unspecified dizziness. Further a wide range of potential risk factors were addressed including gender, stress, muscular pain in the neck and shoulder region, sleep duration, migraine, coffee and alcohol consumption, physical activity and smoking. Results Gender, stress, muscular pain in the neck and shoulder region, sleep duration and migraine were identified as independent risk factors following mutual adjustment: The relative risk was 1.17 [1.10–1.25] for female sex, 1.07 [1.02–1.13] for stress, 1.24 [1.17–1.32] for muscular pain, and 1.09 [1.03–1.14] for migraine. The population attributable risk explained by these risk factors was 26%, with muscular pain, stress, and migraine accounting for 11%, 4%, and 3% respectively. Conclusion Several established risk factors in adults were also identified in adolescents. Risk factors amenable to prevention accounted for 17% of the total population risk. Therefore, interventions targeting these risk factors may be warranted. PMID:29131843

[Detection of Toxoplasma gondii infection of sheep slaughtered in the governorate of Sousse on the occasion of the Muslim sacrifice feast (Eid Al-Adha) and analysis of risk factors].

PubMed

Khayeche, M; Mhadhbi, M; Gharbi, M; Nasfi, I; Darghouth, M A

2014-02-01

During the Muslim feast of Sacrifice (Eid Al-Adha), DNA of Toxoplasma gondii was screened in the heart apex of 70 sheep belonging to different households in Sousse region (North-East of Tunisia) by nested PCR.DNA of T. gondii was identified in 5.7% of the samples. To study different risk factors of Toxoplasma gondii transmission that can be present especially for this occasion, a questionnaire was established. It revealed that the majority of households (92.9%) slaughtered a sheep aged less than 1 year old. Moreover, 2% of the study population consumed undercooked meat. This study showed also that the majority of meat handlers did not respect the hygiene rules, since 91% of them did not wash their hands after handling and before preparing or consuming food. The presence of the definitive host (cats) is considered among the factors that increase the risk of Toxoplasma infection. It was recorded in 14% of the households with the presence of elements that increases the risk as defecating in the house and eating raw meat during Eid Al-Adha feast. Our results show that the risk factors of Toxoplasma infection increase during this occasion; it requires the establishment of a sanitary education programme during this feast.

Risk factors of Internet addiction and the health effect of internet addiction on adolescents: a systematic review of longitudinal and prospective studies.

PubMed

Lam, Lawrence T

2014-11-01

Internet gaming addiction was included in the latest version of the DSM-V as a possible disorder recently, while debate is still on-going as to whether the condition called "Internet Addiction" (IA) could be fully recognised as an established disorder. The major contention is how well IA could fulfil the validation criteria as a psychiatric disorder as in other well-established behavioural addictions. In addition to various proposed validation criteria, evidence of risk and protective factors as well as development of outcomes from longitudinal and prospective studies are suggested as important. A systematic review of available longitudinal and prospective studies was conducted to gather epidemiological evidence on risk and protective factors of IA and the health effect of IA on adolescents. Nine articles were identified after an extensive search of the literature in accordance to the PRISMA guidelines. Of these, eight provided data on risk or protective factors of IA and one focused solely on the effects of IA on mental health. Information was extracted and analysed systematically from each study and tabulated. Many exposure variables were studied and could be broadly classified into three main categories: psychopathologies of the participants, family and parenting factors, and others such as Internet usage, motivation, and academic performance. Some were found to be potential risk or protective factors of IA. It was also found that exposure to IA had a detrimental effect on the mental health of young people. These results were discussed in light of their implications to the fulfilment of the validation criteria.

Communicating with the public about risk

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

Wade, C R; Molony, S T; Durbin, M E

1992-01-01

Risk communication is a growing specialty field in communication that draws from well-established principles of sociology and psychology. It is a new way to communicate with potentially hostile audiences about sensitive environmental, safety, and health issues they face. This paper explains the most important principles of risk communication and discusses audience analyses, perceptions of risk (outrage factors), and risk comparisons. These principles are applied to a risk communication issue in Malhuevo, a fictitious Arizona community.

The epidemiology of endometriosis.

PubMed

Cramer, Daniel W; Missmer, Stacey A

2002-03-01

Advances in understanding the epidemiology of endometriosis have lagged behind other diseases because of methodologic problems related to disease definition and control selection. Nevertheless, a better picture of the epidemiology of endometriosis has emerged over the past few decades. Prevalence estimates of the disease in clinic populations vary from about a 4% occurrence of largely asymptomatic endometriosis found in women undergoing tubal ligation to 50% of teenagers with intractable dysmenorrhea. General population incidence during the 1970s in this country has been suggested to be 1.6 per 1000 white females aged 15-49, while a more current study based upon hospital discharges finds endometriosis as a first listed diagnosis in 1.3 per 1000 discharges in women aged 15-44. There is a clinical impression that blacks have lower rates of endometriosis and Orientals have higher rates than whites. A variety of personal risk factors for endometriosis have also been described. Women with endometriosis may be taller and thinner. Menstrual factors reported to increase risk include dysmenorrhea, early menarche, and shorter cycle lengths. There is support for the idea that lifestyle exposures that might raise or lower estrogen levels could affect risk, including a decreased risk associated with smoking and exercise and an increased risk associated with caffeine or alcohol use. These risk factors appear to be compatible with the central importance of retrograde menstruation influenced by outflow obstruction that might affect its amount, immune factors that might affect its ability to be cleared, or hormonal stimuli that might affect its growth. In this model, dysmenorrhea could be either a disease symptom or a manifestation of outflow obstruction. Nulliparity could be either a consequence of disease or a cause since nulliparous women would not have the benefit of cervical dilation associated with labor and delivery. Since there is evidence that family history is a risk factor for disease, a challenge is how to integrate genetic factors into the model. The genetics of endometriosis might be advanced if we could identify an "endometriosis phenotype". We propose that this may consist of early menarche, short cycles, painful periods, subfertility, and possibly tall stature that could be explained by genetic factors that predispose to poor endowment of germ cells and canalization defects of the cervix. The value of establishing an "endometriosis phenotype" is that, as candidates for genetic markers are identified, particular genotypes can be correlated with these factors even if a formal diagnosis of endometriosis has not been made. Additional well-designed case-control and cohort studies will be necessary to test theories related to pathogenesis, establish the precise relationship between reproductive morbidity and endometriosis, identify specific genetic factors, and establish long-term risks.

Community awareness of stroke in Accra, Ghana

PubMed Central

2014-01-01

Background Community awareness of stroke, especially the risk factors and warning signs is important in the control of the disease. In sub-Saharan Africa, little is known about community awareness of stroke though the brunt of stroke is currently borne in this region. The aim of the study was to evaluate stroke awareness in Accra (capital city of Ghana) particularly, the risk factors and warning signs. Methods This was a cross-sectional study involving systematic sampling of 63 households in each of the 11 sub metropolitan areas of Accra. A structured questionnaire was used to collect stroke awareness data from respondents randomly sampled in the selected households. Logistic regression analyses were done to identify predictors of the main outcome variables including recognition of stroke risk factors, stroke warning signs and the organ affected by stroke. Results Only 40% (n = 277) of the 693 respondents correctly identified the brain as the organ affected in stroke. Similarly, less than half of the respondents could recognize any of the established stroke risk factors as well as any of the established stroke warning signs. Over 70% (n > 485) of the respondents either believed that stroke is a preventable disease, or lifestyle alterations can be made to reduce the risk of stroke, or stroke requires emergency treatment. In multivariate analysis, predictors of stroke awareness were: age <50 years (OR = 0.56, CI = 0.35-0.92, p = 0.021), presence of a stroke risk factor (OR = 2.37, CI = 1.52-3.71, p < 0.001) and Christian Religion (OR = 14.86, CI = 1.37-161.01, p = 0.03). Conclusion Though stroke is perceived as a serious and preventable disease in Accra, community awareness of the risk factors and warning signs is sub-optimal. This indicates that community-based education programs to increase public awareness of stroke could contribute to decreasing the risk of stroke and to increasing the speed of hospital presentation after stroke onset. PMID:24559414

Cardiovascular risk

PubMed Central

Payne, Rupert A

2012-01-01

Cardiovascular disease is a major, growing, worldwide problem. It is important that individuals at risk of developing cardiovascular disease can be effectively identified and appropriately stratified according to risk. This review examines what we understand by the term risk, traditional and novel risk factors, clinical scoring systems, and the use of risk for informing prescribing decisions. Many different cardiovascular risk factors have been identified. Established, traditional factors such as ageing are powerful predictors of adverse outcome, and in the case of hypertension and dyslipidaemia are the major targets for therapeutic intervention. Numerous novel biomarkers have also been described, such as inflammatory and genetic markers. These have yet to be shown to be of value in improving risk prediction, but may represent potential therapeutic targets and facilitate more targeted use of existing therapies. Risk factors have been incorporated into several cardiovascular disease prediction algorithms, such as the Framingham equation, SCORE and QRISK. These have relatively poor predictive power, and uncertainties remain with regards to aspects such as choice of equation, different risk thresholds and the roles of relative risk, lifetime risk and reversible factors in identifying and treating at-risk individuals. Nonetheless, such scores provide objective and transparent means of quantifying risk and their integration into therapeutic guidelines enables equitable and cost-effective distribution of health service resources and improves the consistency and quality of clinical decision making. PMID:22348281

Predictors of stroke in patients with impaired glucose tolerance: results from the Nateglinide and Valsartan in Impaired Glucose Tolerance Outcomes Research trial.

PubMed

Preiss, David; Giles, Thomas D; Thomas, Laine E; Sun, Jie-Lena; Haffner, Steven M; Holman, Rury R; Standl, Eberhard; Mazzone, Theodore; Rutten, Guy E; Tognoni, Gianni; Chiang, Fu-Tien; McMurray, John J V; Califf, Robert M

2013-09-01

Risk factors for stroke are well-established in general populations but sparsely studied in individuals with impaired glucose tolerance. We identified predictors of stroke among participants with impaired glucose tolerance in the Nateglinide and Valsartan in Impaired Glucose Tolerance Outcomes Research (NAVIGATOR) trial. Cox proportional-hazard regression models were constructed using baseline variables, including the 2 medications studied, valsartan and nateglinide. Among 9306 participants, 237 experienced a stroke over 6.4 years. Predictors of stroke included classical risk factors such as existing cerebrovascular and coronary heart disease, higher pulse pressure, higher low-density lipoprotein cholesterol, older age, and atrial fibrillation. Other factors, including previous venous thromboembolism, higher waist circumference, lower estimated glomerular filtration rate, lower heart rate, and lower body mass index, provided additional important predictive information, yielding a C-index of 0.72. Glycemic measures were not predictive of stroke. Variables associated with stroke were similar in participants with no prior history of cerebrovascular disease at baseline. The most powerful predictors of stroke in patients with impaired glucose tolerance included a combination of established risk factors and novel variables, such as previous venous thromboembolism and elevated waist circumference, allowing moderately effective identification of high-risk individuals.

Incidence of oral cancer in relation to nickel and arsenic concentrations in farm soils of patients' residential areas in Taiwan.

PubMed

Su, Che-Chun; Lin, Yo-Yu; Chang, Tsun-Kuo; Chiang, Chi-Ting; Chung, Jian-An; Hsu, Yun-Ying; Lian, Ie-Bin

2010-02-12

To explore if exposures to specific heavy metals in the environment is a new risk factor of oral cancer, one of the fastest growing malignancies in Taiwan, in addition to the two established risk factors, cigarette smoking and betel quid chewing. This is an observational study utilized the age-standardized incidence rates of oral cancer in the 316 townships and precincts of Taiwan, local prevalence rates of cigarette smoking and betel quid chewing, demographic factors, socio-economic conditions, and concentrations in farm soils of the eight kinds of heavy metal. Spatial regression and GIS (Geographic Information System) were used. The registration contained 22,083 patients, who were diagnosed with oral cancer between 1982 and 2002. The concentrations of metal in the soils were retrieved from a nation-wide survey in the 1980s. The incidence rate of oral cancer is geographically related to the concentrations of arsenic and nickel in the patients' residential areas, with the prevalence of cigarette smoking and betel quid chewing as controlled variables. Beside the two established risk factors, cigarette smoking and betel quid chewing, arsenic and nickel in farm soils may be new risk factors for oral cancer. These two kinds of metal may involve in the development of oral cancer. Further studies are required to understand the pathways via which metal in the farm soils exerts its effects on human health.

Oestrogen exposure and breast cancer risk

PubMed Central

Travis, Ruth C; Key, Timothy J

2003-01-01

Epidemiological and experimental evidence implicates oestrogens in the aetiology of breast cancer. Most established risk factors for breast cancer in humans probably act through hormone-related pathways, and increased concentrations of circulating oestrogens have been found to be strongly associated with increased risk for breast cancer in postmenopausal women. This article explores the evidence for the hypothesis that oestrogen exposure is a major determinant of risk for breast cancer. We review recent data on oestrogens and breast cancer risk, consider oestrogen-related risk factors and examine possible mechanisms that might account for the effects of oestrogen. Finally, we discuss how these advances might influence strategies for reducing the incidence of breast cancer. PMID:12927032

A canine model of tracheal stenosis induced by cuffed endotracheal intubation

PubMed Central

Su, Zhuquan; Li, Shiyue; Zhou, Ziqing; Chen, Xiaobo; Gu, Yingying; Chen, Yu; Zhong, Changhao; Zhong, Minglu; Zhong, Nanshan

2017-01-01

Postintubation tracheal stenosis is a complication of endotracheal intubation. The pathological mechanism and risk factors for endotracheal intubation-induced tracheal stenosis remain not fully understood. We aimed to establish an animal model and to investigate risk factors for postintubation tracheal stenosis. Beagles were intubated with 4 sized tubes (internal diameter 6.5 to 8.0 mm) and cuff pressures of 100 to 200 mmHg for 24 hr. The status of tracheal wall was evaluated by bronchoscopic and histological examinations. The model was successfully established by cuffed endotracheal intubation using an 8.0 mm tube and an intra-cuff pressure of 200 mmHg for 24 hr. When the intra-cuff pressures were kept constant, a larger sized tube would induce a larger tracheal wall pressure and more severe injury to the tracheal wall. The degree of tracheal stenosis ranged from 78% to 91% at 2 weeks postextubation. Histological examination demonstrated submucosal infiltration of inflammatory cells, hyperplasia of granulation tissue and collapse of tracheal cartilage. In summary, a novel animal model of tracheal stenosis was established by cuffed endotracheal intubation, whose histopathological feathers are similar to those of clinical cases of postintubation tracheal stenosis. Excessive cuff pressure and over-sized tube are the risk factors for postintubation tracheal stenosis. PMID:28349955

Does fibrinogen add to prediction of cardiovascular disease? Results from the Scottish Heart Health Extended Cohort Study.

PubMed

Woodward, Mark; Tunstall-Pedoe, Hugh; Rumley, Ann; Lowe, Gordon D O

2009-08-01

Plasma fibrinogen is an established risk factor for cardiovascular disease (CVD), but it has not been established whether it adds predictive value to risk scores. In the Scottish Heart Health Extended Cohort Study, we measured plasma fibrinogen in 13 060 men and women, aged 30-74 years, initially free of CVD. After follow-up for a median of 19.2 years, 2626 subjects had at least one CVD event. After adjusting for classical CVD risk factors and socio-economic status, the hazard ratios (95% confidence interval) for a one unit (g/l) increase in plasma fibrinogen were 1.09 (1.02, 1.16) for men and 1.10 (1.02, 1.19) for women. Although fibrinogen added significantly to the discrimination of the Framingham risk score for women, it failed to do so for men. Fibrinogen did not add significantly to the ASSIGN risk score. Fibrinogen added between 1.3% and 3.2% to the classification of CVD status by the existing risk scores. We conclude that the added value of fibrinogen to two currently used risk scores is low; hence population screening with fibrinogen for this purpose is unlikely to be clinically useful or cost-effective.

Montana Youth Risk Behavior Survey Report, 2005 for Alternative Schools Students: Statewide Analysis of Selected Behavior Risk Factors

ERIC Educational Resources Information Center

Montana Office of Public Instruction, 2005

2005-01-01

The Youth Risk Behavior Surveillance System is an epidemiologic surveillance system that was established by the U.S. Centers for Disease Control and Prevention (CDC) to help monitor the prevalence of behaviors that not only influence youth health, but also put youth at risk for the most significant health and social problems that can occur during…

Montana Youth Risk Behavior Survey Report, 2005 for Students with Disabilities: Statewide Analysis of Selected Behavior Risk Factors

ERIC Educational Resources Information Center

Montana Office of Public Instruction, 2005

2005-01-01

The Youth Risk Behavior Surveillance System is an epidemiologic surveillance system that was established by the U.S. Centers for Disease Control and Prevention (CDC) to help monitor the prevalence of behaviors that not only influence youth health, but also put youth at risk for the most significant health and social problems that can occur during…

Montana Youth Risk Behavior Survey Report, 2005 for Grades 7-8: Statewide Analysis of Selected Behavior Risk Factors

ERIC Educational Resources Information Center

Montana Office of Public Instruction, 2005

2005-01-01

The Youth Risk Behavior Surveillance System is an epidemiologic surveillance system that was established by the U.S. Centers for Disease Control and Prevention (CDC) to help monitor the prevalence of behaviors that not only influence youth health, but also put youth at risk for the most significant health and social problems that can occur during…

Ethnic and cultural determinants influence risk assessment for hepatitis C acquisition.

PubMed

Dev, Anouk; Sundararajan, Vijaya; Sievert, William

2004-07-01

In the developed world hepatitis C virus (HCV) infection is predominantly associated with sharing contaminated equipment between injecting drug users (IDU). In developing countries inadequately sterilized medical equipment, transmission of infected blood and cultural practices have been implicated. Accurate risk factor assessment is essential for education targeted at risk reduction in culturally diverse populations. Ninety Australian-born Caucasians and 72 South-east Asian (SEA) HCV patients attending a Melbourne hospital liver clinic completed a questionnaire which assessed risk factor profile, perceived risk factors, knowledge of risk factors and methods to minimize transmission. Medical records were audited to identify doctor assessment of risk factors. Risk factors in Caucasians were IDU, body piercing and tattooing (89%, 47% and 32%, respectively). Risk factors in SEA patients were injection therapy, dental therapy and surgery (89%, 70% and 38%, respectively). Most Caucasian patients (94%) correctly identified their mode of acquisition compared with 33% of SEA patients (P < 0.0001). Accurate risk factor documentation in medical records was more common in Caucasians (96 vs 32%; P < 0.0001). The majority of patients identified blood-to-blood and sexual/vertical transmission as important modes of acquisition. However, 33% of SEA patients believed transmission occurred through food, water and poor hygiene and 80% did not identify therapeutic injection or traditional medical practices as risk factors. Education provided to SEA patients did not address less well established routes of transmission. Ethnicity influences perception and knowledge of risk factors. Improved assessment of risk factors in high-risk ethnic groups is needed. Education should be culturally appropriate and address the concerns of all populations with HCV. Copyright 2004 Blackwell Publishing Asia Pty Ltd

Risk factors for breast cancer in the breast cancer risk model study of Guam and Saipan.

PubMed

Leon Guerrero, Rachael T; Novotny, Rachel; Wilkens, Lynne R; Chong, Marie; White, Kami K; Shvetsov, Yurii B; Buyum, Arielle; Badowski, Grazyna; Blas-Laguaña, Michelle

2017-10-01

Chamorro Pacific Islanders in the Mariana Islands have breast cancer incidence rates similar to, but mortality rates higher than, those of U.S. women. As breast cancer risk factors of women of the Mariana Islands may be unique because of ethnic and cultural differences, we studied established and suspected risk factors for breast cancer in this unstudied population. From 2010-2013, we conducted retrospective case-control study of female breast cancer (104 cases and 185 controls) among women in the Mariana Islands. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for each of various lifestyle-related factors from logistic regression of breast cancer, in all women and in pre- and postmenopausal women separately. Tests for interaction of risk factors with ethnicity were based on the Wald statistics for cross-product terms. Of the medical and reproductive factors considered - age at menarche, breastfeeding, number of live births, age at first live birth, hormone use, and menopause - only age at first live birth was confirmed. Age at first live birth, among parous women, was higher among cases (mean 24.9 years) than controls (mean 23.2 years); with increased breast cancer risk (OR=2.53; 95% CI, 1.04-6.19 for age≥30y compared to <20y, P for trend=0.01). Of the lifestyle factors -body mass index, waist circumference, physical activity, alcohol and betel-nut intake, and education - only waist circumference (OR=1.65; 95% CI 0.87-3.14 for the highest tertile group compared to the lowest, P for trend=0.04) was significantly associated with breast cancer risk and only in Filipino women. The association with many other established risk factors, such as BMI, hormone use and physical activity, were in the expected direction but were not significant. Associations for family history of breast cancer and alcohol intake were not evident CONCLUSIONS: The results provide a basis for cancer prevention guidance for women in the Mariana Islands. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Effect of a Dissonance-Based Prevention Program on Risk for Eating Disorder Onset in the Context of Eating Disorder Risk Factors

PubMed Central

Rohde, Paul; Gau, Jeff; Shaw, Heather

2013-01-01

Test (a) whether a dissonance-based eating disorder prevention program that reduces thin-ideal internalization mitigates the effects of risk factors for eating disorder onset and (b) whether the risk factors moderate the effects of this intervention on risk for eating disorder onset, to place the effects of this intervention within the context of established risk factors. Female adolescents (N=481) with body image concerns were randomized to the dissonance-based program, healthy weight control program, expressive writing control condition, or assessment-only control condition. Denial of costs of pursuing the thin-ideal was the most potent risk factor for eating disorder onset during the 3-year follow-up (OR=5.0). The dissonance program mitigated the effect of this risk factor. For participants who did not deny costs of pursuing the thin-ideal, emotional eating and externalizing symptoms increased risk for eating disorder onset. Negative affect attenuated the effects of each of the active interventions in this trial. Results imply that this brief prevention program offsets the risk conveyed by the most potent risk factor for eating disorder onset in this sample, implicate three vulnerability pathways to eating pathology involving thin-ideal pursuit, emotional eating, and externalizing symptoms, and suggest that negative affect mitigates the effects of eating disorder prevention programs. PMID:21975593

High prevalence of cardiovascular disease in South Asians: Central role for brown adipose tissue?

PubMed

Boon, Mariëtte R; Bakker, Leontine E H; van der Linden, Rianne A D; van Ouwerkerk, Antoinette F; de Goeje, Pauline L; Counotte, Jacqueline; Jazet, Ingrid M; Rensen, Patrick C N

2015-01-01

Cardiovascular disease (CVD) is the leading cause of death in modern society. Interestingly, the risk of developing CVD varies between different ethnic groups. A particularly high risk is faced by South Asians, representing over one-fifth of the world's population. Here, we review potential factors contributing to the increased cardiovascular risk in the South Asian population and discuss novel therapeutic strategies based on recent insights. In South Asians, classical ('metabolic') risk factors associated with CVD are highly prevalent and include central obesity, insulin resistance, type 2 diabetes, and dyslipidemia. A contributing factor that may underlie the development of this disadvantageous metabolic phenotype is the presence of a lower amount of brown adipose tissue (BAT) in South Asian subjects, resulting in lower energy expenditure and lower lipid oxidation and glucose uptake. As it has been established that the increased prevalence of classical risk factors in South Asians cannot fully explain their increased risk for CVD, other non-classical risk factors must underlie this residual risk. In South Asians, the prevalence of "inflammatory" risk factors including visceral adipose tissue inflammation, endothelial dysfunction, and HDL dysfunction are higher compared with Caucasians. We conclude that a potential novel therapy to lower CVD risk in the South Asian population is to enhance BAT volume or its activity in order to diminish classical risk factors. Furthermore, anti-inflammatory therapy may lower non-classical risk factors in this population and the combination of both strategies may be especially effective.

Chronic pain, body mass index and cardiovascular disease risk factors: tests of moderation, unique and shared relationships in the Study of Women's Health Across the Nation (SWAN).

PubMed

Burns, John W; Quartana, Phillip J; Bruehl, Stephen; Janssen, Imke; Dugan, Sheila A; Appelhans, Bradley; Matthews, Karen A; Kravitz, Howard M

2015-04-01

Chronic pain may be related to cardiovascular disease (CVD) risk. The current study examined whether persistent bodily pain was related to cardiovascular disease risk factors, whether these effects were moderated by body mass index (BMI), and, if not, whether chronic pain accounted for unique variance in CVD risk factors. Participants were women (N = 2,135) in the Study of Women's Health Across the Nation. A high pain frequency variable (high pain in 0 through 4 assessments) was coded to reflect the frequency of high levels of bodily pain across the first 3 years of the study. Six CVD risk factors and BMI were measured at follow-up year 3. High pain frequency and BMI were correlated significantly with risk factors, although effects for the former were small. Hierarchical multiple regressions revealed high pain frequency × BMI interactions for 5 of 6 CVD risk factors. Dissecting the interactions revealed a similar pattern across 4 risk factors: for women with normal BMI, there was a "dose-response" in which increasing frequency of high pain revealed increasingly worse CVD risk factor levels, whereas for women with obese BMI, high pain frequency was unrelated to risk factors. For obese women, increasing frequency of high pain was associated with higher blood glucose. Although BMI is a well-established CVD risk factor, evaluation of CVD risk level may be improved by considering the incidence of persistent pain, particularly in normal weight women (BMI < 25 kg/m(2)) lower BMI.

NADiA ProsVue prostate-specific antigen slope is an independent prognostic marker for identifying men at reduced risk of clinical recurrence of prostate cancer after radical prostatectomy.

PubMed

Moul, Judd W; Lilja, Hans; Semmes, O John; Lance, Raymond S; Vessella, Robert L; Fleisher, Martin; Mazzola, Clarisse; Sarno, Mark J; Stevens, Barbara; Klem, Robert E; McDermed, Jonathan E; Triebell, Melissa T; Adams, Thomas H

2012-12-01

To validate the hypothesis that men displaying serum prostate-specific antigen (PSA) slopes ≤ 2.0 pg/mL/mo after prostatectomy, measured using a new immuno-polymerase chain reaction diagnostic test (NADiA ProsVue), have a reduced risk of clinical recurrence as determined by positive biopsy, imaging findings, or death from prostate cancer. From 4 clinical sites, we selected a cohort of 304 men who had been followed up for 17.6 years after prostatectomy for clinical recurrence. We assessed the prognostic value of a PSA slope cutpoint of 2.0 pg/mL/mo against established risk factors to identify men at low risk of clinical recurrence using uni- and multivariate Cox proportional hazards regression and Kaplan-Meier analyses. The univariate hazard ratio of a PSA slope >2.0 pg/mL/mo was 18.3 (95% confidence interval 10.6-31.8) compared with a slope ≤ 2.0 pg/mL/mo (P <.0001). The median disease-free survival interval was 4.8 years vs >10 years in the 2 groups (P <.0001). The multivariate hazard ratio for PSA slope with the covariates of preprostatectomy PSA, pathologic stage, and Gleason score was 9.8 (95% confidence interval 5.4-17.8), an 89.8% risk reduction for men with PSA slopes ≤ 2.0 pg/mL/mo (P <.0001). The Gleason score (<7 vs ≥ 7) was the only other significant predictor (hazard ratio 5.4, 95% confidence interval 2.1-13.8, P = .0004). Clinical recurrence after radical prostatectomy is difficult to predict using established risk factors. We have demonstrated that a NADiA ProsVue PSA slope of ≤ 2.0 pg/mL/mo after prostatectomy is prognostic for a reduced risk of prostate cancer recurrence and adds predictive power to the established risk factors. Copyright © 2012 Elsevier Inc. All rights reserved.

NADiA® ProsVue™ PSA Slope Is an Independent Prognostic Marker for Identifying Men at Reduced Risk for Clinical Recurrence of Prostate Cancer after Radical Prostatectomy

PubMed Central

Moul, Judd W.; Lilja, Hans; Semmes, O. John; Lance, Raymond S.; Vessella, Robert L.; Fleisher, Martin; Mazzola, Clarisse; Sarno, Mark J.; Stevens, Barbara; Klem, Robert E.; McDermed, Jonathan E.; Triebell, Melissa T.; Adams, Thomas H.

2015-01-01

Objectives To validate the hypothesis that men displaying serum PSA slopes ≤2.0 pg/mL/month postprostatectomy, measured with a new immuno-PCR diagnostic test (NADiA® ProsVue™) were at a reduced risk of clinical recurrence as determined by positive biopsy, imaging or death due to prostate cancer. Methods From 4 clinical sites, we selected a cohort of 304 men followed up to 17.6 years postprostatectomy for clinical recurrence. We assessed the prognostic value of a PSA slope cutpoint of 2.0 pg/mL/month against established risk factors to identify men at very low risk of clinical recurrence using uni- and multivariate Cox proportional hazards regression and Kaplan-Meier analysis. Results The univariate HR (95% CI) of a PSA slope >2.0 pg/mL/month was 18.3 (10.6–31.8), compared to a slope ≤2.0 pg/mL/month (P <0.0001). Median disease-free survival was 4.8 years versus >10 years in the 2 groups (P <0.0001). Multivariate HR for PSA slope with the covariates of preprostatectomy PSA, pathologic stage and Gleason score was 9.8 (5.4–17.8), an 89.8% risk reduction, for men with PSA slopes ≤2.0 pg/mL/month (P <0.0001). Gleason Score (<7 vs. ≥7) was the only other significant predictor (HR 5.4, 2.1–13.8, P = 0.0004). Conclusions Clinical recurrence following radical prostatectomy is often difficult to predict since established factors do not reliably stratify risk. We demonstrate that a NADiA ProsVue slope ≤2.0 pg/mL/month postprostatectomy is prognostic for reduced risk of prostate cancer recurrence and adds predictive power to established risk factors. PMID:23107099

Risk Factors for Acute Kidney Injury in Severe Rhabdomyolysis

PubMed Central

Rodríguez, Eva; Soler, María J.; Rap, Oana; Barrios, Clara; Orfila, María A.; Pascual, Julio

2013-01-01

Background Acute kidney injury (AKI) is a life-threatening complication of severe rhabdomyolysis. This study was conducted to assess risk factors for AKI and to develop a risk score for early prediction. Methods Retrospective observational cohort study with a 9-year follow-up, carried out in an acute-care teaching-affiliated hospital. A total of 126 patients with severe rhabdomyolysis defined as serum creatine kinase (CK) > 5,000 IU/L fulfilled the inclusion criteria. Univariate and logistic regression analyses were performed to determine risk factors for AKI. Based on the values obtained for each variable, a risk score and prognostic probabilities were estimated to establish the risk for developing AKI. Results The incidence of AKI was 58%. Death during hospitalization was significantly higher among patients with AKI, compared to patients without AKI (19.2% vs 3.6%, p = 0.008). The following variables were independently associated with AKI: peak CK (odds ratio [OR] 4.9, 95%CI 1.4-16.8), hypoalbuminemia (< 33 mg/dL, [OR 5.1, 95%CI 1.4-17-7]), metabolic acidosis (OR 5.3, 95%CI 1.4-20.3), and decreased prothrombin time (OR 4.4, 95% CI 1.3-14.5). A risk score for AKI was calculated for each patient, with an OR of 1.72 (95%CI 1.45-2.04). The discrimination value of the predictive model was established by means of a ROC curve, with the area under the curve of 0.871 (p<0.001). Conclusions The identification of independent factors associated with AKI and a risk score for early prediction of this complication in patients with severe rhabdomyolysis may be useful in clinical practice, particularly to implement early preventive measures. PMID:24367578

Common and Specific Factors Approaches to Home-Based Treatment: I-FAST and MST

ERIC Educational Resources Information Center

Lee, Mo Yee; Greene, Gilbert J.; Fraser, J. Scott; Edwards, Shivani G.; Grove, David; Solovey, Andrew D.; Scott, Pamela

2013-01-01

Objectives: This study examined the treatment outcomes of integrated families and systems treatment (I-FAST), a moderated common factors approach, in reference to multisystemic therapy (MST), an established specific factor approach, for treating at risk children and adolescents and their families in an intensive community-based setting. Method:…

[Life-style of medical personnel dwelling and working in agroindustrial area].

PubMed

Sorokina, M G; Kamaev, I A

2005-01-01

Results of sociological survey of medical personnel of typical agroindustrial area of Novgorod Oblast are presented. Data of self-registration of acute and chronic diseases and self-appraisal of one's health testify higher morbidity and health deterioration during last 3 years. Analysis of demographic characteristics, life-styles and labor conditions revealed complex of major factors impacting individual health and flow-out of professional medical personnel. Both amount of average monthly wage of physicians and paramedics, levels of their family income and welfare and as well degree of their inconsistence with cost of living of able-bodied population are established. Conditions of living and social maintenance, labor and off-labor activity, attitude to one's own health and spread of risk factors were analyzed. Management weaknesses of district and rural patient care institutions were established, including considerable exceeding of hygienic regulations established for medical personnel working load and higher spread of physical, chemical and biological risk factors of working environment harmful for health. Need in further enhancement of management of working process, occupational safety, labor remuneration and in increasing social safety, hygienic and curative activity of medical personnel is justified.

Alterations in cholesterol absorption and synthesis characterize Framingham offspring study participants with coronary heart disease

USDA-ARS?s Scientific Manuscript database

Data is limited on measures influencing cholesterol homeostasis in subjects at high risk of developing cardiovascular disease (CVD) relative to established risk factors. To address this, we quantified circulating indicators of cholesterol homeostasis (plasma phytosterols and cholesterol precursor co...

The emerging role of PET in Hodgkin lymphoma patients receiving autologous stem cell transplant.

PubMed

von Tresckow, Bastian; Engert, Andreas

2012-10-01

High-dose chemotherapy followed by autologous stem cell transplant (ASCT) is the standard therapy for patients with relapsed or refractory Hodgkin lymphoma. Several analyses have reported risk factors for a poor outcome after ASCT to allow for an individualized treatment, but there is no consensus on how the outcome in high-risk patients might be improved. A recent study by Cocorocchio et al. analyzes risk factors in 97 patients who received ASCT. Besides the established risk factor remission status after induction, result of positron emission tomography before and after transplant was the most important prognostic factor for progression-free survival and overall survival. This result is in line with other retrospective analyses and might allow for the selection of high-risk patients who should receive alternative treatment approaches, such as second-line salvage therapy, tandem ASCT, new drugs or maintenance therapy. Randomized trials characterizing the best therapeutic option for high-risk patients are highly warranted.

[Posterior reversible encephalopathy syndrome: Report of a fatal case and analysis of predictive factors of a poor prognosis].

PubMed

Torres, Moisés Ulises; Delgado, Ligia Victoria; Giraldo, Natalia; Urueña, Piedad; Franco, Sergio; Hernández, Olga Helena

2017-04-01

Posterior reversible encephalopathy syndrome is an illness with multiple causes and distinctive clinicalradiological characteristics that should be known by intensivists and emergency room physicians for a timely diagnosis and treatment. A fatal case of posterior reversible encephalopathy syndrome is presented, and the risk factors related to the outcome are identified.A 60-year-old man without a relevant medical history arrived at the emergency room presenting with depressed consciousness, seizures, and high blood pressure. Tomographic images revealed a posterior cerebellar hematoma. Resonance images showed ischemic zones, vasogenic edema from the thalamus to the brain stem, middle cerebellar peduncles, deep white matter of the cerebral hemispheres, and zones of hemorrhagic transformation. Despite medical-surgical management, the patient died. The risk factors described as the cause of the fatal outcome were identified. This case demonstrates that posterior reversible encephalopathy syndrome can occur without triggering risk factors and highlights the need for early recognition to establish an appropriate intervention to avoid injury or a fatal outcome. Cases of posterior reversible encephalopathy syndrome provide opportunities to investigate the susceptibility for the development of this condition and to establish appropriate preventive measures.

Factors associated with multidisciplinary case conference outcomes in children admitted to a regional hospital in Hong Kong with suspected child abuse: a retrospective case series with internal comparison.

PubMed

Lo, W C; Fung, G Pg; Cheung, P Ch

2017-10-01

In all cases of suspected child abuse, accurate risk assessment is vital to guide further management. This study examined the relationship between risk factors in a risk assessment matrix and child abuse case conference outcomes. Records of all children hospitalised at United Christian Hospital in Hong Kong for suspected child abuse from January 2012 to December 2014 were reviewed. Outcomes of the hospital abuse work-up as concluded in the Multi-Disciplinary Case Conference were categorised as 'established', 'high risk', or 'not established'. All cases of 'established' and 'high risk' were included in the positive case conference outcome group and all cases of 'not established' formed the comparison group. On the other hand, using the Risk Assessment Matrix developed by the California State University, Fresno in 1990, each case was allotted a matrix score of low, intermediate, or high risk in each of 15 matrix domains, and an aggregate matrix score was derived. The effect of individual matrix domain on case conference outcome was analysed. Receiver operating characteristic curve analysis was used to examine the relationship between case conference outcome and aggregate matrix score. In this study, 265 children suspected of being abused were included, with 198 in the positive case conference outcome group and 67 in the comparison group. Three matrix domains (severity and frequency of abuse, location of injuries, and strength of family support systems) were significantly associated with case conference outcome. An aggregate cut-off score of 23 yielded a sensitivity of 91.4% and specificity of 38.2% in relation to outcome of abuse categorisation. Risk assessment should be performed when handling suspected child abuse cases. A high aggregate score should arouse suspicion in all disciplines managing child abuse cases.

Montana Youth Risk Behavior Survey Report, 2005 for American Indian Students in Urban Schools: Statewide Analysis of Selected Behavior Risk Factors

ERIC Educational Resources Information Center

Montana Office of Public Instruction, 2005

2005-01-01

The Youth Risk Behavior Surveillance System is an epidemiologic surveillance system that was established by the U.S. Centers for Disease Control and Prevention (CDC) to help monitor the prevalence of behaviors that not only influence youth health, but also put youth at risk for the most significant health and social problems that can occur during…

Bio-psychosocial determinants of cardiovascular disease in a rural population on Crete, Greece: formulating a hypothesis and designing the SPILI-III study.

PubMed

Lionis, Christos; Anyfantakis, Dimitrios; Symvoulakis, Emmanouil K; Shea, Sue; Panagiotakos, Demosthenes; Castanas, Elias

2010-10-11

In 1988, the SPILI project was established in order to evaluate the cardiovascular disease (CVD) risk profile of the inhabitants of Spili, in rural Crete, Greece. The first reports from this project revealed that against the unfavourable risk factors' profile observed, only a few men with a previous myocardial infarction were encountered. A follow-up study (SPILI II) was performed twelve years after the initial examination, and the unfavourable cardiovascular risk profile was re-confirmed. This paper presents a hypothesis formulated on the basis of previous research to investigate if dynamic psycho-social determinants, including social coherence of the local community, religiosity and spirituality, are protective against the development of coronary heart disease in a well-defined population. A follow-up examination of this Cretan cohort is currently being performed to assess the link between psychosocial factors and CVD. Psychosocial factors including sense of control, religiosity and spirituality are assessed in together with conventional CVD risk factors. Smoking and alcohol consumption, as well as dietary habits and activity levels are recorded. Oxidative stress and inflammatory markers, as well as ultrasound measurement of carotid intima media thickness, a preclinical marker of atherosclerosis, will also be measured. IMPLICATIONS OF THE HYPOTHESIS TESTED: The issue of the cardio-protective effect of psycho-social factors would be revisited based on the results of this Cretan cohort; nevertheless, further research is needed across different sub-populations in order to establish a definite relationship. A comprehensive approach based on the aspects of bio-social life may result in more accurate CVD risk management.

A Profile of HIV Risk Factors in the Context of Sex Work Environments among Migrant Female Sex Workers in Beijing, China

PubMed Central

Yi, Huso; Mantell, Joanne E.; Wu, Rongrong; Lu, Zhao; Zeng, Jing; Wan, Yanhai

2010-01-01

Migrant female sex workers (FSWs) are one of the most at-risk populations for HIV in China. This study demonstrates how multiple risk factors are situated and vary by types of sex work environments in a sample of 348 migrant FSWs in Beijing. Participants reported high rates of clients' refusal to use condoms (76%), unsafe sex with both clients (32%), non-paid regular partners (e.g., boyfriend or husband) (76%), and a STI symptom (79%) last year. Only 22% of FSWs had been tested for HIV. Risk factors were compared by three types of sex work environments: (1) entertainment establishments, (2) personal services sectors, and (3) street-based venues, including roadside brothels. Street-based FSWs, compared to the other FSWs, were more likely to be older, married with children, migrate from rural areas, and be arrested by police, and less likely to be educated, have contact with prevention services, be knowledgeable about HIV, and be tested for HIV. The FSWs in entertainment establishments were more likely than street-based FSWs to have reported being physically, verbally, and/or sexually abused by clients. Multiple discriminant analysis distinguished a profile of two different groups of risk factors: (1) police arrest, lack of protection from violence, access to prevention and health care, and HIV knowledge, and (2) verbal and physical abuse and clients' refusal of condom use. In the massive internal migration in China, disadvantages in economic sectors drive women to become involved in sex work. HIV prevention strategies must target socio-structural factors embedded in sex work environments. PMID:20391235

Individual deprivation, regional deprivation, and risk for oral clefts in Argentina.

PubMed

Pawluk, Mariela Soledad; Campaña, Hebe; Rittler, Monica; Poletta, Fernando Adrián; Cosentino, Viviana R; Gili, Juan Antonio; Gimenez, Lucas Gabriel; López Camelo, Jorge Santiago

2018-02-19

The aim of this study was to analyze the effects of individual low socioeconomic status (SES) and deprived geographical area (GA) on the occurrence of isolated cleft lip with or without cleft palate (CL±P) in Argentina. This case-control study included 577 newborns with isolated CL±P and 13 344 healthy controls, born between 1992 and 2001, from a total population of 546 129 births in 39 hospitals in Argentina. Census data on unsatisfied basic needs were used to establish the degree of geographical area deprivation. An SES index for each individual was established, using maternal age, gravidity, low paternal and maternal education, and low-level paternal occupation. Logistic regression was used to assess the effects of low SES and of deprived GA on CL±P. A slightly increased risk of CL±P was observed in mothers with a low SES, while a deprived GA showed no effect. Native ancestry, acute maternal illnesses, and poor prenatal care were significant risk factors for CL±P for the mothers with low SES, after using propensity scores to adjust for the demographic characteristics in cases and controls. Low individual SES slightly increased the risk for CL±P, but a deprived GA did not have that effect. There was no interaction between individual SES and deprived GA. Factors related to low individual SES-including poor prenatal care, low parental education, lack of information, and lifestyle factors-should be primarily targeted as risk factors for CL±P rather than factors related to a deprived place of residence.

Nuclear risk analysis of the Ulysses mission

NASA Astrophysics Data System (ADS)

Bartram, Bart W.; Vaughan, Frank R.; Englehart, Richard W.

An account is given of the method used to quantify the risks accruing to the use of a radioisotope thermoelectric generator fueled by Pu-238 dioxide aboard the Space Shuttle-launched Ulysses mission. After using a Monte Carlo technique to develop probability distributions for the radiological consequences of a range of accident scenarios throughout the mission, factors affecting those consequences are identified in conjunction with their probability distributions. The functional relationship among all the factors is then established, and probability distributions for all factor effects are combined by means of a Monte Carlo technique.

Applicability of an established management algorithm for destructive colon injuries after abbreviated laparotomy: a 17-year experience.

PubMed

Sharpe, John P; Magnotti, Louis J; Weinberg, Jordan A; Shahan, Charles P; Cullinan, Darren R; Marino, Katy A; Fabian, Timothy C; Croce, Martin A

2014-04-01

For more than a decade, operative decisions (resection plus anastomosis vs diversion) for colon injuries, at our institution, have followed a defined management algorithm based on established risk factors (pre- or intraoperative transfusion requirements of more than 6 units packed RBCs and/or presence of significant comorbid diseases). However, this management algorithm was originally developed for patients managed with a single laparotomy. The purpose of this study was to evaluate the applicability of this algorithm to destructive colon injuries after abbreviated laparotomy (AL) and to determine whether additional risk factors should be considered. Consecutive patients over a 17-year period with colon injuries after AL were identified. Nondestructive injuries were managed with primary repair. Destructive wounds were resected at the initial laparotomy followed by either a staged diversion (SD) or a delayed anastomosis (DA) at the subsequent exploration. Outcomes were evaluated to identify additional risk factors in the setting of AL. We identified 149 patients: 33 (22%) patients underwent primary repair at initial exploration, 42 (28%) underwent DA, and 72 (49%) had SD. Two (1%) patients died before re-exploration. Of those undergoing DA, 23 (55%) patients were managed according to the algorithm and 19 (45%) were not. Adherence to the algorithm resulted in lower rates of suture line failure (4% vs 32%, p = 0.03) and colon-related morbidity (22% vs 58%, p = 0.03) for patients undergoing DA. No additional specific risk factors for suture line failure after DA were identified. Adherence to an established algorithm, originally defined for destructive colon injuries after single laparotomy, is likewise efficacious for the management of these injuries in the setting of AL. Copyright © 2014 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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

USGS Publications Warehouse

Reed, Robert N.; Rodda, Gordon H.

2009-01-01

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

Health in police officers: Role of risk factor clusters and police divisions.

PubMed

Habersaat, Stephanie A; Geiger, Ashley M; Abdellaoui, Sid; Wolf, Jutta M

2015-10-01

Law enforcement is a stressful occupation associated with significant health problems. To date, most studies have focused on one specific factor or one domain of risk factors (e.g., organizational, personal). However, it is more likely that specific combinations of risk factors are differentially health relevant and further, depend on the area of police work. A self-selected group of officers from the criminal, community, and emergency division (N = 84) of a Swiss state police department answered questionnaires assessing personal and organizational risk factors as well as mental and physical health indicators. In general, few differences were observed across divisions in terms of risk factors or health indicators. Cluster analysis of all risk factors established a high-risk and a low-risk cluster with significant links to all mental health outcomes. Risk cluster-by-division interactions revealed that, in the high-risk cluster, Emergency officers reported fewer physical symptoms, while community officers reported more posttraumatic stress symptoms. Criminal officers in the high-risk cluster tended to perceived more stress. Finally, perceived stress did not mediate the relationship between risk clusters and posttraumatic stress symptoms. In summary, our results support the notion that police officers are a heterogeneous population in terms of processes linking risk factors and health indicators. This heterogeneity thereby appeared to be more dependent on personal factors and individuals' perception of their own work conditions than division-specific work environments. Our findings further suggest that stress-reduction interventions that do not target job-relevant sources of stress may only show limited effectiveness in reducing health risks associated with police work. Copyright © 2015 Elsevier Ltd. All rights reserved.

Health in police officers: Role of risk factor clusters and police divisions

PubMed Central

Habersaat, Stephanie A.; Geiger, Ashley M.; Abdellaoui, Sid; Wolf, Jutta M.

2015-01-01

Objective Law enforcement is a stressful occupation associated with significant health problems. To date, most studies have focused on one specific factor or one domain of risk factors (e.g., organizational, personal). However, it is more likely that specific combinations of risk factors are differentially health relevant and further, depend on the area of police work. Methods A self-selected group of officers from the criminal, community, and emergency division (N = 84) of a Swiss state police department answered questionnaires assessing personal and organizational risk factors as well as mental and physical health indicators. Results In general, few differences were observed across divisions in terms of risk factors or health indicators. Cluster analysis of all risk factors established a high-risk and a low-risk cluster with significant links to all mental health outcomes. Risk cluster-by-division interactions revealed that, in the high-risk cluster, Emergency officers reported fewer physical symptoms, while community officers reported more posttraumatic stress symptoms. Criminal officers in the high-risk cluster tended to perceived more stress. Finally, perceived stress did not mediate the relationship between risk clusters and posttraumatic stress symptoms. Conclusion In summary, our results support the notion that police officers are a heterogeneous population in terms of processes linking risk factors and health indicators. This heterogeneity thereby appeared to be more dependent on personal factors and individuals' perception of their own work conditions than division-specific work environments. Our findings further suggest that stress-reduction interventions that do not target job-relevant sources of stress may only show limited effectiveness in reducing health risks associated with police work. PMID:26364008

Awareness and Misconceptions of Breast Cancer Risk Factors Among Laypersons and Physicians.

PubMed

Morère, Jean-François; Viguier, Jérôme; Couraud, Sébastien; Brignoli-Guibaudet, Lysel; Lhomel, Christine; Pivot, Xavier B; Eisinger, François

2018-03-05

Primary prevention of cancer relies on awareness of and consequent identification of risk factors. We investigated knowledge of breast cancer risk factors not only among laywomen but also among female physicians. The EDIFICE 4 nationwide observational survey was conducted by phone interviews of a representative female population (737 laywomen and 105 female physicians) aged 40-75 years, using the quota method. This analysis focuses on spontaneous replies to the question "In your opinion, what are the five main risk factors that increase the risk of breast cancer?". Heredity/Family history of breast cancer was the most widely recognized risk factor in both study populations (98.1% physicians vs. 54.2% laywomen; P ≤ 0.01). Smoking (19.0 and 17.5%) and alcohol consumption (3.8 and 5.5%) were among the lifestyle risk factors that were cited by similar proportions of physicians and laywomen, respectively. Other established risk factors were however very rarely cited by either physicians or laywomen, e.g., Exposure to medical radiation (4.8 vs. 0.4%, respectively; P ≤ 0.05) or not cited at all, i.e., Benign mastopathy and Personal history of breast cancer. This survey highlights a number of misconceptions relating to behavioral risk factors for breast cancer, including the relative impact of alcohol and tobacco consumption and the importance of menopausal status. The limited awareness of the risk related to Exposure to medical radiation, Benign mastopathy, or Personal history raises concern regarding compliance with national screening recommendations.

A Risk Prediction Model for In-hospital Mortality in Patients with Suspected Myocarditis

PubMed Central

Xu, Duo; Zhao, Ruo-Chi; Gao, Wen-Hui; Cui, Han-Bin

2017-01-01

Background: Myocarditis is an inflammatory disease of the myocardium that may lead to cardiac death in some patients. However, little is known about the predictors of in-hospital mortality in patients with suspected myocarditis. Thus, the aim of this study was to identify the independent risk factors for in-hospital mortality in patients with suspected myocarditis by establishing a risk prediction model. Methods: A retrospective study was performed to analyze the clinical medical records of 403 consecutive patients with suspected myocarditis who were admitted to Ningbo First Hospital between January 2003 and December 2013. A total of 238 males (59%) and 165 females (41%) were enrolled in this study. We divided the above patients into two subgroups (survival and nonsurvival), according to their clinical in-hospital outcomes. To maximize the effectiveness of the prediction model, we first identified the potential risk factors for in-hospital mortality among patients with suspected myocarditis, based on data pertaining to previously established risk factors and basic patient characteristics. We subsequently established a regression model for predicting in-hospital mortality using univariate and multivariate logistic regression analyses. Finally, we identified the independent risk factors for in-hospital mortality using our risk prediction model. Results: The following prediction model for in-hospital mortality in patients with suspected myocarditis, including creatinine clearance rate (Ccr), age, ventricular tachycardia (VT), New York Heart Association (NYHA) classification, gender and cardiac troponin T (cTnT), was established in the study: P = ea/(1 + ea) (where e is the exponential function, P is the probability of in-hospital death, and a = −7.34 + 2.99 × [Ccr <60 ml/min = 1, Ccr ≥60 ml/min = 0] + 2.01 × [age ≥50 years = 1, age <50 years = 0] + 1.93 × [VT = 1, no VT = 0] + 1.39 × [NYHA ≥3 = 1, NYHA <3 = 0] + 1.25 × [male = 1, female = 0] + 1.13 × [cTnT ≥50 μg/L = 1, cTnT <50 μg/L = 0]). The area under the receiver operating characteristic curve was 0.96 (standard error = 0.015, 95% confidence interval [CI]: 0.93-0.99). The model demonstrated that a Ccr <60 ml/min (odds ratio [OR] = 19.94, 95% CI: 5.66–70.26), an age ≥50 years (OR = 7.43, 95% CI: 2.18–25.34), VT (OR = 6.89, 95% CI: 1.86–25.44), a NYHA classification ≥3 (OR = 4.03, 95% CI: 1.13–14.32), male gender (OR = 3.48, 95% CI: 0.99–12.20), and a cTnT level ≥50 μg/L (OR = 3.10, 95% CI: 0.91–10.62) were the independent risk factors for in-hospital mortality. Conclusions: A Ccr <60 ml/min, an age ≥50 years, VT, an NYHA classification ≥3, male gender, and a cTnT level ≥50 μg/L were the independent risk factors resulting from the prediction model for in-hospital mortality in patients with suspected myocarditis. In addition, sufficient life support during the early stage of the disease might improve the prognoses of patients with suspected myocarditis with multiple risk factors for in-hospital mortality. PMID:28345541

Radiation epidemiology: old and new challenges.

PubMed Central

Shore, R E

1989-01-01

Over the last 40 years the amount of knowledge about human radiation effects has increased dramatically. During that interval, radiation epidemiologists have documented a number of additional types of radiation-induced cancer and have established rough estimates of the magnitude of cancer risks. Nevertheless, we currently have inadequate knowledge about a number of factors that help define the magnitude of radiation risks. These include questions of estimating risk over the lifetime, shapes of dose-effect curves, magnitude of risks at low doses, potentiation between radiation and other agents, and the nature and role of host susceptibility factors. Data from various studies are used to illustrate these questions. PMID:2759057

And now, from the company that brought you the seven-eyed trout: Risk communication in action

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

Durbin, M.E.; Klein, S.H.; Molony, S.T.

1992-01-01

Risk communication is a growing specialty field in communication that draws from well-established principles of sociology and psychology. It is a way to communicate with potentially hostile audiences about sensitive environmental, safety, and health issues they face. This paper explains the most important principles of risk communication and discusses audience analyses, perceptions of risk (outrage factors), and risk comparisons. These principles are applied to a risk communication issue in a fictitious community.

Environmental Exposure and Risk of Childhood Leukemia: An Overview.

PubMed

Schüz, Joachim; Erdmann, Friederike

2016-11-01

Childhood leukemia is the most common cancer diagnosed in children worldwide. However, only a few causes have been established so far, mainly some genetic syndromes and high doses of ionizing radiation. Major efforts have been undertaken to study the relationship between environmental factors and the risk of childhood leukemia, inspired by geographical variation in incidence rates. Some evidence has emerged for parental occupational exposures to pesticides, whereas there is less evidence for an association with postnatal pesticide exposure. Diagnostic radiation and radon exposure have been suggested but there remains a lack of convincing studies. Extremely low-frequency magnetic fields consistently showed a small increase in risk in numerous studies, but bias and confounding cannot be ruled out as possible explanations. From among factors other than environmental and radiation-related, the most promising candidate is abnormal patterns to common infections, but which children are most at risk and the pathways are not fully understood. In conclusion, although childhood leukemia shows some distinct incidence patterns by sex, age, and geography suggesting a role of the environment in its etiology, no major environmental risk factors including radiation have been established as major contributors to the global childhood leukemia burden. Due to the young age at diagnosis and evidence of chromosomal damage before birth in many of the affected children, parental exposures remain of high interest. Although cure rates of childhood leukemia are high in economically developed countries, because of the adverse late effects of the disease and its treatment, identification of modifiable risk factors for implementing primary prevention remains the ultimate goal. Copyright © 2016 IMSS. Published by Elsevier Inc. All rights reserved.

Quantifying links between stroke and risk factors: a study on individual health risk appraisal of stroke in a community of Chongqing.

PubMed

Wu, Yazhou; Zhang, Ling; Yuan, Xiaoyan; Wu, Yamin; Yi, Dong

2011-04-01

The objective of this study is to investigate the risk factors of stroke in a community in Chongqing by setting quantitative criteria for determining the risk factors of stroke. Thus, high-risk individuals can be identified and laid a foundation for predicting individual risk of stroke. 1,034 cases with 1:2 matched controls (2,068) were chosen from five communities in Chongqing including Shapingba, Xiaolongkan, Tianxingqiao, Yubei Road and Ciqikou. Participants were interviewed with a uniform questionnaire. The risk factors of stroke and the odds ratios of risk factors were analyzed with a logistic regression model, and risk exposure factors of different levels were converted into risk scores using statistical models. For men, ten risk factors including hypertension (5.728), family history of stroke (4.599), and coronary heart disease (5.404), among others, were entered into the main effect model. For women, 11 risk factors included hypertension (5.270), family history of stroke (4.866), hyperlipidemia (4.346), among others. The related risk scores were added to obtain a combined risk score to predict the individual's risk of stoke in the future. An individual health risk appraisal model of stroke, which was applicable to individuals of different gender, age, health behavior, disease and family history, was established. In conclusion, personal diseases including hypertension, diabetes mellitus, etc., were very important to the prevalence of stoke. The prevalence of stroke can be effectively reduced by changing unhealthy lifestyles and curing the positive individual disease. The study lays a foundation for health education to persuade people to change their unhealthy lifestyles or behaviors, and could be used in community health services.

VERTICAL PROFILING OF VOCS IN GROUNDWATER AND SOIL VAPORS TO EVALUATE THE RISK OF VAPOR INTRUSION

EPA Science Inventory

The Draft EPA Subsurface Vapor Intrusion Guidance Document was established to address the incremental increases in exposures and risks from subsurface contaminants that may be intruding into indoor air@. The document utilizes attenuation factors based on indoor air/soil gas or i...

Extreme Weight-Control Behaviors and Suicide Risk among High School Students

ERIC Educational Resources Information Center

Johnson, Emily R.; Weiler, Robert M.; Barnett, Tracey E.; Pealer, Lisa N.

2016-01-01

Background: Suicide is the third leading cause of death for people ages 15-19. Research has established an association across numerous risk factors and suicide, including depression, substance abuse, bullying victimization, and feelings of alienation. However, the connection between disordered eating as manifested in extreme weight-control…

ARAC--The Montreal Jewish General Hospital Alzheimer Risk Assessment Clinic.

PubMed

Schipper, Hyman M; Liberman, Adrienne; Kelner, Nora; Babins, Lennie; Fried, Lynda; Bilbul, Melanie; Goodman, Rachel

2011-07-01

In parallel with robust efforts world-wide to develop effective neuroprotection for established disease, resources are being mobilized to delineate risk factors and implement preventive measures in a concerted effort to forestall the anticipated Alzheimer disease (AD) epidemic. A review of heritable and 'acquired' dementia risk factors, many operating at midlife, is presented in a companion paper. In 2009, an Alzheimer Risk Assessment Clinic (ARAC) was established at the Jewish General Hospital (Montreal) to address the concerns increasingly being voiced by active middle-aged individuals at risk for AD. A positive family history of AD and/or perceived changes in personal cognitive function (predominantly short-term memory) are main reasons for referral. The primary objectives of ARAC are to (i) ascertain, inform and mitigate the risks of developing AD in cognitively-healthy persons aged 40-65 based on best available medical and epidemiological evidence, (ii) conduct scientific research on midlife dementia risk and prevention in this population and (iii) provide instruction in dementia risk assessment and management to health professionals, clinical/research fellows, medical residents and students. ARAC infrastructure, evaluation protocol, risk profile classification scheme, interventions, knowledge dissemination program, case vignettes, and seminal research projects are described. It is hoped that ARAC and similar initiatives will help prevent or delay dementia by innovating effective interventions based on increasingly nuanced estimation of modifiable AD risk in presymptomatic persons.

The extent of evidence-based information about child maltreatment fatalities in social science textbooks.

PubMed

Douglas, Emily M; Serino, Patricia J

2013-10-01

Previous research has established that child welfare workers lack important information about child maltreatment fatalities and risk factors leading to death. Further, training has not been associated with improvements in knowledge. The authors assessed the presence of evidence-based information about child maltreatment fatalities and risk factors for death in 24 social science textbooks about child abuse and neglect or child welfare. The results indicate that basic information, such as definitions and incidence rates of child maltreatment fatalities are routinely included in social science textbooks, but information about child, parent, and household risk factors are not, and that inaccurate information is often included. Implications of the findings are discussed.

[Maternal and perinatal risk factors for neonatal morbidity: a narrative literature review].

PubMed

Hernández Núñez, Jónathan; Valdés Yong, Magel; Suñol Vázquez, Yoanca de la Caridad; López Quintana, Marelene de la Caridad

2015-07-14

Newborn diseases increase neonatal mortality rates, so a literature review was conducted to establish the risk factors related to maternal and peripartum morbidity affecting the newborn. We searched the following electronic databases: Cumed, EBSCO, LILACS, IBECS and PubMed/MEDLINE. We used specific terms and Boolean operators in Spanish, Portuguese and English. We included longitudinal and cross-sectional descriptive studies, as well as case-control and cohort studies, systematic reviews and meta-analysis, spanning from 2010 to 2015 that responded the topic of interest. The included studies show that multiple maternal and perinatal conditions are risk factors for significant increase of neonatal morbidity, which are described in this narrative review.

Life Satisfaction and Risk of Chronic Diseases in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Germany Study

PubMed Central

Feller, Silke; Teucher, Birgit; Kaaks, Rudolf; Boeing, Heiner; Vigl, Matthaeus

2013-01-01

Objective The aim of the study was to examine the prospective association between life satisfaction and risk of type 2 diabetes mellitus, myocardial infarction, stroke, and cancer. Previous studies suggested that psychosocial factors may affect the development of chronic diseases but the impact of positive attitudes, in particular life satisfaction, is yet to be determined. Methods The analysis included 50,358 participants of the European Prospective Investigation into Cancer and Nutrition (EPIC)-Germany study in Potsdam and Heidelberg. Life satisfaction was assessed in a baseline interview and incident cases of chronic diseases were identified and verified during follow-up. Hazard ratios were calculated using Cox proportional hazards regression models that were systematically multivariable-adjusted for established risk factors and prevalent diseases. Results During an average of 8 years of follow-up 2,293 cases of cancer, 1,840 cases of type 2 diabetes mellitus, 440 cases of stroke, and 562 cases of myocardial infarction were observed. Women who were unsatisfied with life at baseline showed in all models a significantly increased risk of cancer (HR: 1.45; 95% CI: 1.18-1.78) and stroke (HR: 1.69; 95% CI: 1.05-2.73) as well as an increased risk of type 2 diabetes mellitus by trend across categories (p-trend=0.04) compared to women very satisfied with life. In men, a relationship between life satisfaction and stroke was found but did not persist after consideration of lifestyle factors and prevalent diseases. No significant association was observed between life satisfaction and risk of myocardial infarction. Conclusions The results of this study suggest that reduced life satisfaction is related to the development of chronic diseases—particularly in women and partly mediated by established risk factors. PMID:23977388

Epidemiologic characteristics and risk factors for renal cell cancer

PubMed Central

Lipworth, Loren; Tarone, Robert E; Lund, Lars; McLaughlin, Joseph K

2009-01-01

Incidence rates of renal cell cancer, which accounts for 85% of kidney cancers, have been rising in the United States and in most European countries for several decades. Family history is associated with a two- to four-fold increase in risk, but the major forms of inherited predisposition together account for less than 4% of renal cell cancers. Cigarette smoking, obesity, and hypertension are the most consistently established risk factors. Analgesics have not been convincingly linked with renal cell cancer risk. A reduced risk of renal cell cancer among statin users has been hypothesized but has not been adequately studied. A possible protective effect of fruit and vegetable consumption is the only moderately consistently reported dietary finding, and, with the exception of a positive association with parity, evidence for a role of hormonal or reproductive factors in the etiology of renal cell cancer in humans is limited. A recent hypothesis that moderate levels of alcohol consumption may be protective for renal cell cancer is not strongly supported by epidemiologic results, which are inconsistent with respect to the categories of alcohol consumption and the amount of alcohol intake reportedly associated with decreased risk. For occupational factors, the weight of the evidence does not provide consistent support for the hypotheses that renal cell cancer may be caused by asbestos, gasoline, or trichloroethylene exposure. The established determinants of renal cell cancer, cigarette smoking, obesity, and hypertension, account for less than half of these cancers. Novel epidemiologic approaches, including evaluation of gene–environment interactions and epigenetic mechanisms of inherited and acquired increased risk, are needed to explain the increasing incidence of renal cell cancer. PMID:20865085

Molecular epidemiology, and possible real-world applications in breast cancer.

PubMed

Ito, Hidemi; Matsuo, Keitaro

2016-01-01

Gene-environment interaction, a key idea in molecular epidemiology, has enabled the development of personalized medicine. This concept includes personalized prevention. While genome-wide association studies have identified a number of genetic susceptibility loci in breast cancer risk, however, the application of this knowledge to practical prevention is still underway. Here, we briefly review the history of molecular epidemiology and its progress in breast cancer epidemiology. We then introduce our experience with the trial combination of GWAS-identified loci and well-established lifestyle and reproductive risk factors in the risk prediction of breast cancer. Finally, we report our exploration of the cumulative risk of breast cancer based on this risk prediction model as a potential tool for individual risk communication, including genetic risk factors and gene-environment interaction with obesity.

Incidence of oral cancer in relation to nickel and arsenic concentrations in farm soils of patients' residential areas in Taiwan

PubMed Central

2010-01-01

Background To explore if exposures to specific heavy metals in the environment is a new risk factor of oral cancer, one of the fastest growing malignancies in Taiwan, in addition to the two established risk factors, cigarette smoking and betel quid chewing. Methods This is an observational study utilized the age-standardized incidence rates of oral cancer in the 316 townships and precincts of Taiwan, local prevalence rates of cigarette smoking and betel quid chewing, demographic factors, socio-economic conditions, and concentrations in farm soils of the eight kinds of heavy metal. Spatial regression and GIS (Geographic Information System) were used. The registration contained 22,083 patients, who were diagnosed with oral cancer between 1982 and 2002. The concentrations of metal in the soils were retrieved from a nation-wide survey in the 1980s. Results The incidence rate of oral cancer is geographically related to the concentrations of arsenic and nickel in the patients' residential areas, with the prevalence of cigarette smoking and betel quid chewing as controlled variables. Conclusions Beside the two established risk factors, cigarette smoking and betel quid chewing, arsenic and nickel in farm soils may be new risk factors for oral cancer. These two kinds of metal may involve in the development of oral cancer. Further studies are required to understand the pathways via which metal in the farm soils exerts its effects on human health. PMID:20152030

[Obesity in children: Risk factors and strategies for its prevention in Peru].

PubMed

Villar, Carlos M Del Águila

2017-01-01

The prevalence of overweight and obesity in children and adolescents represents an emerging public health problem in Peru, so it is necessary to be aware of the different risk factors in order to establish suitable and efficient prevention measures. These should contribute to health strategies such as promoting physical activity and a healthy diet to ensure that the infant population reaches adulthood without chronic diseases and with an adequate quality of life.

Multivariate logistic regression analysis of postoperative complications and risk model establishment of gastrectomy for gastric cancer: A single-center cohort report.

PubMed

Zhou, Jinzhe; Zhou, Yanbing; Cao, Shougen; Li, Shikuan; Wang, Hao; Niu, Zhaojian; Chen, Dong; Wang, Dongsheng; Lv, Liang; Zhang, Jian; Li, Yu; Jiao, Xuelong; Tan, Xiaojie; Zhang, Jianli; Wang, Haibo; Zhang, Bingyuan; Lu, Yun; Sun, Zhenqing

2016-01-01

Reporting of surgical complications is common, but few provide information about the severity and estimate risk factors of complications. If have, but lack of specificity. We retrospectively analyzed data on 2795 gastric cancer patients underwent surgical procedure at the Affiliated Hospital of Qingdao University between June 2007 and June 2012, established multivariate logistic regression model to predictive risk factors related to the postoperative complications according to the Clavien-Dindo classification system. Twenty-four out of 86 variables were identified statistically significant in univariate logistic regression analysis, 11 significant variables entered multivariate analysis were employed to produce the risk model. Liver cirrhosis, diabetes mellitus, Child classification, invasion of neighboring organs, combined resection, introperative transfusion, Billroth II anastomosis of reconstruction, malnutrition, surgical volume of surgeons, operating time and age were independent risk factors for postoperative complications after gastrectomy. Based on logistic regression equation, p=Exp∑BiXi / (1+Exp∑BiXi), multivariate logistic regression predictive model that calculated the risk of postoperative morbidity was developed, p = 1/(1 + e((4.810-1.287X1-0.504X2-0.500X3-0.474X4-0.405X5-0.318X6-0.316X7-0.305X8-0.278X9-0.255X10-0.138X11))). The accuracy, sensitivity and specificity of the model to predict the postoperative complications were 86.7%, 76.2% and 88.6%, respectively. This risk model based on Clavien-Dindo grading severity of complications system and logistic regression analysis can predict severe morbidity specific to an individual patient's risk factors, estimate patients' risks and benefits of gastric surgery as an accurate decision-making tool and may serve as a template for the development of risk models for other surgical groups.

Development and evaluation of the McKnight Risk Factor Survey for assessing potential risk and protective factors for disordered eating in preadolescent and adolescent girls.

PubMed

Shisslak, C M; Renger, R; Sharpe, T; Crago, M; McKnight, K M; Gray, N; Bryson, S; Estes, L S; Parnaby, O G; Killen, J; Taylor, C B

1999-03-01

To describe the development, test-retest reliability, internal consistency, and convergent validity of the McKnight Risk Factor Survey-III (MRFS-III). The MRFS-III was designed to assess a number of potential risk and protective factors for the development of disordered eating in preadolescent and adolescent girls. Several versions of the MRFS were pilot tested before the MRFS-III was administered to a sample of 651 4th through 12th- grade girls to establish its psychometric properties. Most of the test-retest reliability coefficients of individual items on the MRFS-III were r > .40. Alpha coefficients for each risk and protective factor domain on the MRFS-III were also computed. The majority of these coefficients were r > .60. High convergent validity coefficients were obtained for specific items on the MRFS-III and measures of self-esteem (Rosenberg Self-Esteem Scale) and weight concerns (Weight Concerns Scale). The test-retest reliability, internal consistency, and convergent validity of the MRFS-III suggest that it is a useful new instrument to assess potential risk and protective factors for the development of disordered eating in preadolescent and adolescent girls.

[Risk for the development of upper gastrointestinal bleeding in children in an intensive care unit].

PubMed

Gutiérrez-Gutiérrez, Glenda Karina; Villasís-Keever, Miguel Angel; González-Ortiz, Beatriz; Troconis-Trens, Germán; Tapia-Monge, Dora María; Flores-Calderón, Judith

2014-01-01

Although gastrointestinal tract bleeding can occur at any age, most studies trying to establish causes or risk factors for its development have been conducted in adults. The aim of this study was to determine risk factors in children admitted in a pediatric intensive care unit. A retrospective case-control study was conducted. Children who developed upper gastrointestinal bleeding children during their stay at the intensive care unit were considered the cases. Variables were obtained from medical records including age, sex, nutritional status, mechanical ventilation, use of nasogastric tube, development of complications, presence of coagulopathy, use of prophylaxis for upper gastrointestinal tract bleeding, fasting and use of steroids. Using a multivariate analysis, risk factors were identified, with odds ratios (OR) and 95 % confidence intervals (95 % CI) calculations. Out of 165 patients, 58 had upper gastrointestinal bleeding (35 %). Risk factors identified were prolonged clotting times (OR = 3.35), thrombocytopenia (OR = 2.39), development of sepsis (OR = 6.74) or pneumonia (OR = 4.37). Prophylaxis for upper gastrointestinal bleeding was not a protective factor. Upper gastrointestinal bleeding frequency in children hospitalized in an intensive care unit was high. Identifying risk factors should help to reduce upper gastrointestinal bleeding frequency.

Introduction of risk size in the determination of uncertainty factor UFL in risk assessment

NASA Astrophysics Data System (ADS)

Xue, Jinling; Lu, Yun; Velasquez, Natalia; Yu, Ruozhen; Hu, Hongying; Liu, Zhengtao; Meng, Wei

2012-09-01

The methodology for using uncertainty factors in health risk assessment has been developed for several decades. A default value is usually applied for the uncertainty factor UFL, which is used to extrapolate from LOAEL (lowest observed adverse effect level) to NAEL (no adverse effect level). Here, we have developed a new method that establishes a linear relationship between UFL and the additional risk level at LOAEL based on the dose-response information, which represents a very important factor that should be carefully considered. This linear formula makes it possible to select UFL properly in the additional risk range from 5.3% to 16.2%. Also the results remind us that the default value 10 may not be conservative enough when the additional risk level at LOAEL exceeds 16.2%. Furthermore, this novel method not only provides a flexible UFL instead of the traditional default value, but also can ensure a conservative estimation of the UFL with fewer errors, and avoid the benchmark response selection involved in the benchmark dose method. These advantages can improve the estimation of the extrapolation starting point in the risk assessment.

Intrinsic factors associated with pregnancy falls.

PubMed

Wu, Xuefang; Yeoh, Han T

2014-10-01

Approximately 25% to 27% of women sustain a fall during pregnancy, and falls are associated with serious injuries and can affect pregnancy outcomes. The objective of the current study was to identify intrinsic factors associated with pregnancy that may contribute to women's increased risk of falls. A literature search (Medline and Pubmed) identified articles published between January 1980 and June 2013 that measured associations between pregnancy and fall risks, using an existing fall accident investigation framework. The results indicated that physiological, biomechanical, and psychological changes associated with pregnancy may influence the initiation, detection, and recovery phases of falls and increase the risk of falls in this population. Considering the logistic difficulties and ethnic concerns in recruiting pregnant women to participate in this investigation of fall risk factors, identification of these factors could establish effective fall prevention and intervention programs for pregnant women and improve birth outcomes. [Workplace Health Saf 2014;62(10):403-408.]. Copyright 2014, SLACK Incorporated.

Cardiovascular disease in women.

PubMed

Lee, L Veronica; Foody, Joanne Micale

2008-08-01

The rates of cardiovascular disease (CVD) have decreased significantly for men over the past few decades, but similar reductions have not occurred in women. Consequently, CVD remains the leading killer of women in the United States. Men usually develop heart disease earlier than women, but women develop heart disease more rapidly once menopause has occurred. A review of risk factors that are common between men and women demonstrates some notable sex-dependent differences. Many of these changes appear related to the hormonal changes that occur in menopause, such as the development of hypertension, changes in lipid concentrations, and central adiposity. In addition, diabetes is a more significant risk factor for CVD in women than men. Sociologic and physiologic factors need to be considered in treatment of risk factors, such as smoking, lack of exercise, obesity, and depression. Prevention is known to significantly reduce CVD risk, but new goals are being established for women as the sex-dependent differences have become apparent.

Informing aetiologic research priorities for squamous cell oesophageal cancer in Africa: A review of setting-specific exposures to known and putative risk factors

PubMed Central

McCormack, V; Menya, D; Munishi, MO; Dzamalala, C; Gasmelseed, N; Roux, M Leon; Assefa, M; Odipo, O; Watts, M; Mwasamwaja, AO; Mmbaga, BT; Murphy, G; Abnet, CC; Dawsey, SM; Schüz, J

2018-01-01

Oesophageal squamous cell carcinoma (ESCC) is one of the most common cancers in most Eastern and Southern African countries, but its aetiology has been understudied to date. To inform its research agenda, we undertook a review to identify, of the ESCC risk factors that have been established or strongly suggested worldwide, those with a high prevalence or high exposure levels in any ESCC-affected African setting and the sources thereof. We found that for almost all ESCC risk factors known to date, including tobacco, alcohol, hot beverage consumption, nitrosamines and both inhaled and ingested PAHs, there is evidence of population groups with raised exposures, the sources of which vary greatly between cultures across the ESCC corridor. Research encompassing these risk factors is warranted and is likely to identify primary prevention strategies. PMID:27466161

Coronary artery disease: the role of lipids, hypertension and smoking.

PubMed

Keil, U

2000-01-01

Pioneering epidemiological projects such as the Seven Countries study, and the Framingham Heart study established the classical risk factor concept for coronary heart disease (CAD). These landmark studies showed that a raised serum total cholesterol, high blood pressure (systolic and diastolic) and smoking increase the risk of developing CHD in men and women in a graded fashion. Women develop CHD about 10 years later than men and women's risk is smaller. In the years and decades following these early studies many more prospective cohort studies primarily in the US and Europe have confirmed the early findings. In Germany two occupational and one population based cohort studies have contributed further information on this topic. In addition interactions between the three classical risk factors have been quantified, demonstrating for example that smoking carries a much higher risk for CHD in persons with high cholesterol values. Most cohort studies have confirmed that the relative risks for the classical risk factors are very similar. However, the respective absolute risks can differ tremendously, indicating that many more factors such as socio-economic conditions, nutrition, physical activity and others are of importance for the development of CHD. The scientific community, however, did not accept the consistent findings from the many observational studies as proof of causality. They required evidence that the risk for CHD could be reduced when the respective risk factor(s) was (were) diminished or eliminated. The late 1960s early 1970s thus saw the beginning of the era of randomized controlled trials (RCTs) following the advice of Archibald Cochrane who once wrote "we have to find that point on the distribution curve where therapy does more good than harm". We now know from meta-analyses of RCTs that a 1% reduction in serum cholesterol produces a 2-3% decline in risk for CHD and we can achieve reductions in total cholesterol of 20% or more. Regarding treatment of high blood pressure, meta-analyses of RCTs have shown that a reduction of 1 mmHg in diastolic blood pressure (DBP) produces a 2-3% decline in risk of CHD, and we can achieve reductions in DBP on average of 5-6 mmHg. With regard to smoking cessation, observational studies have shown that within 1-5 years of cessation those who stop smoking have a 50-70% lower risk than current smokers. Thus the findings from observational studies, RCTs and studies on mechanisms have clearly established the importance of the three classical risk factors for CHD. The successful treatment of these risk factors will not only lower the burden of CHD in the population but promises to be the most effective way of improving the health of the whole population.

[Environmental risk factors for schizophrenia: a review].

PubMed

Vilain, J; Galliot, A-M; Durand-Roger, J; Leboyer, M; Llorca, P-M; Schürhoff, F; Szöke, A

2013-02-01

Evidence of variations in schizophrenia incidence rates has been found in genetically homogenous populations, depending on changes within time or space of certain environmental characteristics. The consideration of the impact of environmental risk factors in etiopathogenic studies has put the environment in the forefront of research regarding psychotic illnesses. Various environmental factors such as urbanicity, migration, cannabis, childhood traumas, infectious agents, obstetrical complications and psychosocial factors have been associated with the risk of developing schizophrenia. These risk factors can be biological, physical, psychological as well as social and may operate at different times in an individual's life (fetal period, childhood, adolescence and early adulthood). Whilst some of these factors act on an individual level, others act on a populational level, modulating the individual risk. These factors can have a direct action on the development of schizophrenia, or on the other hand act as markers for directly implicated factors that have not yet been identified. This article summarizes the current knowledge on this subject. An extensive literature search was conducted via the search engine Pubmed. Eight risk factors were selected and developed in the following paper: urbanicity (or living in an urban area), cannabis, migration (and ethnic density), obstetrical complications, seasonality of birth, infectious agents (and inflammatory responses), socio-demographic factors and childhood traumas. For each of these factors, we provide information on the importance of the risk, the vulnerability period, hypotheses made on the possible mechanisms behind the factors and the level of proof the current research offers (good, medium, or insufficient) according to the amount, type, quality and concordance of the studies at hand. Some factors, such as cannabis, are "unique" in their influence on the development of schizophrenia since it labels only one risk factor. Others, such as obstetrical complications, are grouped (or "composed") in that they include various sub-factors that can influence the development of schizophrenia. The data reviewed clearly demonstrates that environmental factors have an influence on the risk of developing schizophrenia. For certain factors - cannabis, migration, urbanicity, obstetrical complications, seasonality - there is enough evidence to establish an association with the risk of schizophrenia. This association, however, remains weak (especially for seasonality). With the exception of cannabis, no direct link can yet be established. Concerning the three remaining factors - childhood traumas, infectious agents, socio-demographic factors - the available proof is insufficient. One main limitation concerning all environmental factors is the generalization of results due to the fact that the studies were conducted on geographically limited populations. The current state of knowledge does not allow us to determine the mechanisms by which these factors may act. Further research is needed to fill the gaps in our understanding of the subject. In response to this need, a collaborative European project (European Study of Gene-Environment Interactions [EU GEI]) was set-up. This study proposes the analysis of those environmental factors that influence the incidence of schizophrenia in various European countries, in both rural and urban settings, migrant and native populations, as well as their interaction with genetic factors. Copyright © 2011 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

Bayesian-network-based safety risk assessment for steel construction projects.

PubMed

Leu, Sou-Sen; Chang, Ching-Miao

2013-05-01

There are four primary accident types at steel building construction (SC) projects: falls (tumbles), object falls, object collapse, and electrocution. Several systematic safety risk assessment approaches, such as fault tree analysis (FTA) and failure mode and effect criticality analysis (FMECA), have been used to evaluate safety risks at SC projects. However, these traditional methods ineffectively address dependencies among safety factors at various levels that fail to provide early warnings to prevent occupational accidents. To overcome the limitations of traditional approaches, this study addresses the development of a safety risk-assessment model for SC projects by establishing the Bayesian networks (BN) based on fault tree (FT) transformation. The BN-based safety risk-assessment model was validated against the safety inspection records of six SC building projects and nine projects in which site accidents occurred. The ranks of posterior probabilities from the BN model were highly consistent with the accidents that occurred at each project site. The model accurately provides site safety-management abilities by calculating the probabilities of safety risks and further analyzing the causes of accidents based on their relationships in BNs. In practice, based on the analysis of accident risks and significant safety factors, proper preventive safety management strategies can be established to reduce the occurrence of accidents on SC sites. Copyright © 2013 Elsevier Ltd. All rights reserved.

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

PubMed

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

2017-01-11

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

Prediction and Informative Risk Factor Selection of Bone Diseases.

PubMed

Li, Hui; Li, Xiaoyi; Ramanathan, Murali; Zhang, Aidong

2015-01-01

With the booming of healthcare industry and the overwhelming amount of electronic health records (EHRs) shared by healthcare institutions and practitioners, we take advantage of EHR data to develop an effective disease risk management model that not only models the progression of the disease, but also predicts the risk of the disease for early disease control or prevention. Existing models for answering these questions usually fall into two categories: the expert knowledge based model or the handcrafted feature set based model. To fully utilize the whole EHR data, we will build a framework to construct an integrated representation of features from all available risk factors in the EHR data and use these integrated features to effectively predict osteoporosis and bone fractures. We will also develop a framework for informative risk factor selection of bone diseases. A pair of models for two contrast cohorts (e.g., diseased patients versus non-diseased patients) will be established to discriminate their characteristics and find the most informative risk factors. Several empirical results on a real bone disease data set show that the proposed framework can successfully predict bone diseases and select informative risk factors that are beneficial and useful to guide clinical decisions.

Genetic and non-iodine-related factors in the aetiology of nodular goitre.

PubMed

Knudsen, Nils; Brix, Thomas Heiberg

2014-08-01

Genetic and a large number of environmental non-iodine-related factors play a role in the cause of nodular goitre. Most evidence for the influence of genetic and environmental factors in the cause of goitre is from cross-sectional, population-based studies. Only a few studies have included prospective data on risk factors for nodular goitre, although few prospective data are available on the effect of iodine and tobacco smoking on goitre development. Goitre is not one single phenotype. Many epidemiological studies do not distinguish diffuse from nodular goitre, as the investigated parameter is often thyroid volume or frequency with increased thyroid volume. Moreover, information on the presence and effect of gene-environment, gene-gene, and environment-environment effect modifications is limited. Thus, firm conclusions about the relative contributions and causality of the investigated risk factors should be made with caution. Smoking seems to be an established risk factor for nodular goitre, possibly with effect modification from iodine intake, as the risk associated with smoking is smaller or absent in areas with sufficient iodine intake. The use of oral contraceptives might have protective effects against goitre, and childbirth is an increased risk factor for goitre in areas with non-optimal iodine intake. Insulin resistance is a recently investigated risk factor, and the risk of goitre may be reversible with metformin treatment. Iodine remains the major environmental risk factor for nodular goitre. Copyright © 2014 Elsevier Ltd. All rights reserved.

Cohort study of risk factors for breast cancer in post menopausal women.

PubMed

Hartz, Arthur J; He, Tao

2013-01-01

The present study assessed more than 800 potential risk factors to identify new predictors of breast cancer and compare the independence and relative importance of established risk factors. Data were collected by the Women's Health Initiative and included 147,202 women ages 50 to 79 who were enrolled from 1993 to 1998 and followed for 8 years. Analyses performed in 2011 and 2012 used the Cox proportional hazard regression to test the association between more than 800 baseline risk factors and incident breast cancer. Baseline factors independently associated with subsequent breast cancer at the p<0.001 level (in decreasing order of statistical significance) were breast aspiration, family history, age, weight, history of breast biopsies, estrogen and progestin use, fewer live births, greater age at menopause, history of thyroid cancer, breast tenderness, digitalis use, alcohol intake, white race, not restless, no vaginal dryness, relative with prostate cancer, colon polyps, smoking, no breast augmentation, and no osteoporosis. Risk factors previously reported that were not independently associated with breast cancer in the present study included socioeconomic status, months of breast feeding, age at first birth, adiposity measures, adult weight gain, timing of initiation of hormone therapy, and several dietary, psychological, and exercise variables. Family history was not found to alter the risk associated with other factors. These results suggest that some risk factors not commonly studied may be important for breast cancer and some frequently cited risk factors may be relatively unimportant or secondary.

Contemporary epidemiology of renal cell carcinoma: perspectives of primary prevention.

PubMed

Weikert, Steffen; Ljungberg, Börje

2010-06-01

Epidemiological research of recent years has produced evidence for a role of lifestyle-associated risk factors in the etiology of renal cell carcinoma (RCC), the most common renal tumor. In this review, we give an overview of recent trends in incidence and mortality and summarize the current knowledge on risk factors of RCC. Data on incidence and mortality in the literature were reviewed. Global incidence data were derived from the Globocan database. A literature review of epidemiological studies on risk factors of kidney cancer was performed, with special emphasis on recent studies with high level of evidence, i.e., meta-analyses and prospective cohort studies. The incidence of renal malignancies has increased over recent decades in the context of the more widespread use of diagnostic imaging. However, time trends and geographic variations in incidence and mortality may also relate to changes in the prevalence of risk factors. Cigarette smoking, excess body weight and uncontrolled blood pressure are the most important and modifiable risk factors for RCC with a high prevalence in the general population. Moreover, dietary habits associated with a Western lifestyle were proposed as potential risk factors, but no food or food group has consistently been related to RCC risk. Based on the current evidence, reductions in the prevalence of cigarette smoking, overweight and hypertension are preventive strategies for RCC. More research is needed to establish the underlying mechanisms linking these risk factors and renal carcinogenesis.

Drought Risk Assessment based on Natural and Social Factors

NASA Astrophysics Data System (ADS)

Huang, Jing; Wang, Huimin; Han, Dawei

2015-04-01

In many parts of the world, drought hazard is becoming more frequent and severe due to climate change and human activities. It is crucial to monitor and assess drought conditions, especially for decision making support in agriculture sector. The vegetation index (VI) decreases, and the land surface temperature (LST) increases when the vegetation is under drought stress. Therefore both of these remotely sensed indices are widely used in drought monitoring and assessment. Temperature-Vegetation Dryness Index (TVDI) is obtained by establishing the feature space of the normalized difference vegetation index (NDVI) and LST, which reflects agriculture dry situation by inverting soil moisture. However, these indices only concern the natural hazard-causing factors. Our society is a complex large-scale system with various natural and social elements. The drought risk is the joint consequence of hazard-causing factors and hazard-affected bodies. For example, as the population increases, the exposure of the hazard-affected bodies also tends to increase. The high GDP enhances the response ability of government, and the irrigation and water conservancy reduces the vulnerability. Such characteristics of hazard-affected bodies should be coupled with natural factors. In this study, the 16-day moderate-resolution imaging spectroradiometer (MODIS) NDVI and LST data are combined to establish NDVI-Ts space according to different land use types in Yunnan Province, China. And then, TVDIs are calculated through dry and wet edges modeled as a linear fit to data for each land cover type. Next, the efforts are turned to establish an integrated drought assessment index of social factors and TVDI through ascertaining attribute weight based on rough sets theory. Thus, the new CDI (comprehensive drought index) recorded during spring of 2010 and the spatial variations in drought are analyzed and compared with TVDI dataset. Moreover, actual drought risk situation in the study area is given to verify the effectiveness of the CDI. In addition, GIS is applied to provide geographically referenced information, i.e. information involving location, elevation, land use, water resources distance and so on, which are essential inputs for spatial analysis in drought risk assessment. On the whole, this study has proposed a new idea on drought risk assessment integrating natural factors with social factors, as well as providing a real-time drought monitoring method in a social context.

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

PubMed

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

2005-10-01

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

Environmental risk factors for chronic pancreatitis and pancreatic cancer.

PubMed

Nitsche, Claudia; Simon, Peter; Weiss, F Ulrich; Fluhr, Gabriele; Weber, Eckhard; Gärtner, Simone; Behn, Claas O; Kraft, Matthias; Ringel, Jörg; Aghdassi, Ali; Mayerle, Julia; Lerch, Markus M

2011-01-01

Chronic pancreatitis has long been thought to be mainly associated with immoderate alcohol consumption. The observation that only ∼10% of heavy drinkers develop chronic pancreatitis not only suggests that other environmental factors, such as tobacco smoke, are potent additional risk factors, but also that the genetic component of pancreatitis is more common than previously presumed. Either disease-causing or protective traits have been indentified for mutations in different trypsinogen genes, the gene for the trypsin inhibitor SPINK1, chymotrypsinogen C, and the cystic fibrosis transmembane conductance regulator (CFTR). Other factors that have been proposed to contribute to pancreatitis are obesity, diets high in animal protein and fat, as well as antioxidant deficiencies. For the development of pancreatic cancer, preexisting chronic pancreatitis, more prominently hereditary pancreatitis, is a risk factor. The data on environmental risk factors for pancreatic cancer are, with the notable exception of tobacco smoke, either sparse, unconfirmed or controversial. Obesity appears to increase the risk of pancreatic cancer in the West but not in Japan. Diets high in processed or red meat, diets low in fruits and vegetables, phytochemicals such as lycopene and flavonols, have been proposed and refuted as risk or protective factors in different trials. The best established and single most important risk factor for cancer as well as pancreatitis and the one to clearly avoid is tobacco smoke. Copyright © 2011 S. Karger AG, Basel.

Prevalence and Risk Factors for Self-Reported Violence of Osaka and Seattle Male Youths

PubMed Central

Bui, Laura; Farrington, David P.; Ueda, Mitsuaki; Hill, Karl G.

2013-01-01

Traditionally, Japan has been regarded as a country with low crime. Comparative research has given insights into the extent of similarities and differences in crime between America and Japan. The importance of these studies is the examination of whether Western-established criminological knowledge is applicable to non- Western societies like Japan. Unfortunately, comparative self-report studies involving Japan and investigating youth offending are scarce. The current study investigates risk factors and self-reports of violence from Osaka and Seattle male youths. The findings reveal that Japanese male youths self-report a higher prevalence of violence than Seattle male youths. Risk factors for violence, issues of comparability, and prevalence versus strength of relationships of risk factors are examined. It is concluded that the higher prevalence of violence in Osaka is primarily a function of the higher prevalence of troubled peers and risk taking. The findings call for replication of this type of comparative research. PMID:24013769

To examine the effectiveness of a hospital-based nurse-led secondary prevention clinic.

PubMed

Mainie, Paula M; Moore, Gillian; Riddell, John W; Adgey, A A Jennifer

2005-12-01

Modification of cardiovascular risk factors can reduce the incidence of myocardial infarction (MI), effectively extend survival, decrease the need for interventional procedures, and improve quality of life in persons with known cardiovascular disease. Pharmacological treatments and important lifestyle changes reduce people's risks substantially (by 1/3 to 2/3) and can slow and perhaps reverse progression of established coronary disease. When used appropriately, these interventions are more cost-effective than many other treatments, currently provided by the National Health Service [Department of Health National Service Frameworks: coronary heart disease. Preventing coronary heart disease in high risk patients. 2000. HMSO.] Secondary prevention clinics are effective means by which to ensure targets are achieved and assist primary care in long-term maintenance of lifestyle change and drug optimisation. A 2-year hospital-based pilot project was established at the Royal Hospitals, April 2001-April 2003. The aim of the project was to target patients with coronary heart disease, post-MI and/or coronary artery bypass grafting and/or percutaneous coronary intervention, 6 months following their cardiac event. The plan was to assess patient risk factors and medication a minimum of 6 months following their cardiac event to ascertain if government targets were being achieved; secondly, to examine the effectiveness of a hospital-based nurse-led secondary prevention clinic on modifying risk factors and optimising drug therapies.

Work-related musculoskeletal disorders (WMDs) risk assessment at core assembly production of electronic components manufacturing company

NASA Astrophysics Data System (ADS)

Yahya, N. M.; Zahid, M. N. O.

2018-03-01

This study conducted to assess the work-related musculoskeletal disorders (WMDs) among the workers at core assembly production in an electronic components manufacturing company located in Pekan, Pahang, Malaysia. The study is to identify the WMDs risk factor and risk level. A set of questionnaires survey based on modified Nordic Musculoskeletal Disorder Questionnaires have been distributed to respective workers to acquire the WMDs risk factor identification. Then, postural analysis was conducted in order to measure the respective WMDs risk level. The analysis were based on two ergonomics assessment tools; Rapid Upper Limb Assessment (RULA) and Rapid Entire Body Assessment (REBA). The study found that 30 respondents out of 36 respondents suffered from WMDs especially at shoulder, wrists and lower back. The WMDs risk have been identified from unloading process, pressing process and winding process. In term of the WMDs risk level, REBA and RULA assessment tools have indicated high risk level to unloading and pressing process. Thus, this study had established the WMDs risk factor and risk level of core assembly production in an electronic components manufacturing company at Malaysia environment.

Explanatory risk factors in the relations between schizotypy and indicators of suicide risk.

PubMed

Jahn, Danielle R; DeVylder, Jordan E; Hilimire, Matthew R

2016-04-30

Schizotypy has been linked to suicide risk, but it is not known whether established suicide-related risk factors mediate this relation. The aim of this study was to assess the mediating effects of depressive symptoms, social anxiety, self-esteem, and intimate disclosure in peer relationships in the relation between interpersonal schizotypy and suicide ideation or lifetime suicide attempts. This aim was tested in 590 young adults using a nonparametric bootstrapping procedure. After inclusion of the mediators, interpersonal schizotypy was no longer directly associated with either suicide ideation or lifetime suicide attempts. Depression and self-esteem mediated the relation between interpersonal schizotypy and suicide ideation. No variables mediated the relation between interpersonal schizotypy and lifetime suicide attempts, and there were no significant direct relations when mediators were included. Schizotypy appears to be a distal risk factor for suicidal behavior; assessing depressive symptoms and self-esteem may provide more proximal information about suicide risk, and may be targets for mitigating suicide risk in individuals with schizotypy. Published by Elsevier Ireland Ltd.

Defining Risk Groups to Yellow Fever Vaccine-Associated Viscerotropic Disease in the Absence of Denominator Data

PubMed Central

Seligman, Stephen J.; Cohen, Joel E.; Itan, Yuval; Casanova, Jean-Laurent; Pezzullo, John C.

2014-01-01

Several risk groups are known for the rare but serious, frequently fatal, viscerotropic reactions following live yellow fever virus vaccine (YEL-AVD). Establishing additional risk groups is hampered by ignorance of the numbers of vaccinees in factor-specific risk groups thus preventing their use as denominators in odds ratios (ORs). Here, we use an equation to calculate ORs using the prevalence of the factor-specific risk group in the population who remain well. The 95% confidence limits and P values can also be calculated. Moreover, if the estimate of the prevalence is imprecise, discrimination analysis can indicate the prevalence at which the confidence interval results in an OR of ∼1 revealing if the prevalence might be higher without yielding a non-significant result. These methods confirm some potential risk groups for YEL-AVD and cast doubt on another. They should prove useful in situations in which factor-specific risk group denominator data are not available. PMID:24394480

Managing mixed dyslipidemia in special populations.

PubMed

Miller, Michael

2010-01-01

Controlling low-density lipoprotein cholesterol is one of the major focuses of cardiovascular care. However, the twin global pandemics of obesity and diabetes are promoting an increased prevalence of associated cardiometabolic risk factors. These factors include mixed dyslipidemia, which is prevalent among several important subgroups of the overall population. Cardiovascular risk increases as women reach and extend beyond menopause, partly reflective of dyslipidemia. In addition, women with polycystic ovary syndrome display a cluster of risk factors reminiscent of the metabolic syndrome. Certain ethnic groups are also at increased risk for type 2 diabetes or the metabolic syndrome. Dyslipidemia contributes significantly to overall cardiovascular risk in the elderly, and the frequency of children and adolescents presenting with type 2 diabetes or metabolic syndrome is increasing worldwide. Physicians should be aware of the possibility of mixed dyslipidemia in patients at elevated cardiometabolic risk. However, while combination therapy may successfully correct the associated dyslipidemia, it remains to be established whether the addition of a second agent improves coronary risk beyond statin monotherapy.

Defining risk groups to yellow fever vaccine-associated viscerotropic disease in the absence of denominator data.

PubMed

Seligman, Stephen J; Cohen, Joel E; Itan, Yuval; Casanova, Jean-Laurent; Pezzullo, John C

2014-02-01

Several risk groups are known for the rare but serious, frequently fatal, viscerotropic reactions following live yellow fever virus vaccine (YEL-AVD). Establishing additional risk groups is hampered by ignorance of the numbers of vaccinees in factor-specific risk groups thus preventing their use as denominators in odds ratios (ORs). Here, we use an equation to calculate ORs using the prevalence of the factor-specific risk group in the population who remain well. The 95% confidence limits and P values can also be calculated. Moreover, if the estimate of the prevalence is imprecise, discrimination analysis can indicate the prevalence at which the confidence interval results in an OR of ∼1 revealing if the prevalence might be higher without yielding a non-significant result. These methods confirm some potential risk groups for YEL-AVD and cast doubt on another. They should prove useful in situations in which factor-specific risk group denominator data are not available.

Risk factors for anal HPV infection and anal precancer in HIV-infected men who have sex with men.

PubMed

Schwartz, Lauren M; Castle, Philip E; Follansbee, Stephen; Borgonovo, Sylvia; Fetterman, Barbara; Tokugawa, Diane; Lorey, Thomas S; Sahasrabuddhe, Vikrant V; Luhn, Patricia; Gage, Julia C; Darragh, Teresa M; Wentzensen, Nicolas

2013-12-01

Carcinogenic human papillomaviruses (HPVs) cause a large proportion of anal cancers. Human immunodeficiency virus (HIV)-infected men who have sex with men (MSM) are at increased risk of HPV infection and anal cancer compared with HIV-negative men. We evaluated risk factors for HPV infection and anal precancer in a population of HIV-infected MSM. Our study included 305 MSM at an HIV/AIDS clinic in the Kaiser Permanente Northern California Health Maintenance Organization. Logistic regression was used to estimate associations of risk factors comparing men without anal HPV infection; men with anal HPV infection, but no precancer; and men with anal precancer. Low CD4 count (<350 cells/mm(3)) and previous chlamydia infection were associated with an increased risk of carcinogenic HPV infection (odds ratio [OR], 3.65; 95% confidence interval [CI], 1.28-10.40 and OR, 4.24; 95% CI, 1.16-15.51, respectively). History of smoking (OR, 2.71 95% CI, 1.43-5.14), duration, recency, and dose of smoking increased the risk of anal precancer among carcinogenic HPV-positive men but had no association with HPV infection. We found distinct risk factors for anal HPV infection and anal precancer. Risk factors for HPV infection and anal precancer are similar to established risk factors for cervical cancer progression.

Factors associated with over-serving at drinking establishments.

PubMed

Buvik, Kristin; Rossow, Ingeborg

2015-04-01

To address characteristics of drinking establishments, bartenders and patrons that may affect the likelihood of over-serving. A systematic examination of 425 purchase attempts with pseudo-intoxicated patrons enacting scripts that, according to the law, should lead to the denial of alcohol sales. Drinking establishments in the three largest cities in Norway (Trondheim, Bergen and Oslo) were visited by male and female actors aged 20-30 years on weekend nights, with a total of 425 purchase items. Over-serving was recorded when the pseudo-intoxicated patron was served alcohol. Characteristics of the drinking establishment, the bartender and the pseudo-intoxicated patron were recorded systematically. Pseudo-intoxicated patrons were served in 347 of 425 purchase attempts (82%). In bivariate analyses, the over-serving rate increased with venue characteristics, music/noise level and intoxication level among patrons. These factors were intercorrelated and correlated with poor lighting. The over-serving rate was also higher when the pseudo-intoxicated patron was female and when the purchase attempt occurred after midnight. In multi-variate analyses, two factors increased the likelihood of over-serving significantly: a high problematic bar indicator score (poor lighting, high music/noise level and high intoxication level among patrons) [adjusted odds ratio (OR) = 3.5, 95% confidence interval (CI) = 1.9, 6.4] and female gender of pseudo-intoxicated patrons (adjusted OR = 2.6, 95% CI = 1.4, 4.7). The rate of over-serving was 95% when both risk factors were present and 67% when both factors were absent. In urban settings in Norway, it is likely that over-serving occurs frequently, and is increased by the risk factors of poor lighting, loud music and high intoxication level among patrons. © 2015 Society for the Study of Addiction.

Metabolic Syndrome and Breast Cancer Risk.

PubMed

Wani, Burhan; Aziz, Shiekh Aejaz; Ganaie, Mohammad Ashraf; Mir, Mohammad Hussain

2017-01-01

The study was meant to estimate the prevalence of metabolic syndrome in patients with breast cancer and to establish its role as an independent risk factor on occurrence of breast cancer. Fifty women aged between 40 and 80 years with breast cancer and fifty controls of similar age were assessed for metabolic syndrome prevalence and breast cancer risk factors, including age at menarche, reproductive status, live births, breastfeeding, and family history of breast cancer, age at diagnosis of breast cancer, body mass index, and metabolic syndrome parameters. Metabolic syndrome prevalence was found in 40.0% of breast cancer patients, and 18.0% of those in control group ( P = 0.02). An independent and positive association was seen between metabolic syndrome and breast cancer risk (odds ratio = 3.037; 95% confidence interval 1.214-7.597). Metabolic syndrome is more prevalent in breast cancer patients and is an independent risk factor for breast cancer.

Dissection of the aorta in Turner syndrome: two cases and review of 85 cases in the literature

PubMed Central

Carlson, M; Silberbach, M

2009-01-01

Patients with Turner syndrome (TS) are at risk for aortic dissection, but the clinical profile for those at risk is not well described. In addition to reporting two new cases, we performed an electronic search to identify all reported cases of aortic dissection associated with TS. In total, 85 cases of aortic dissection in TS were reported between 1961 and 2006. Dissection occurred at a young age, 30.7 (range 4–64) years, which is significantly earlier than its occurrence in the general female population (68 years). Importantly, in 11% of the cases, neither hypertension nor congenital heart disease were identified, suggesting that TS alone is an independent risk factor for aortic dissection; however, the cases where no risk factors were identified were very poorly documented. A TS aortic dissection registry has been established to determine the natural history and risk factors better (http://www.turnersyndrome.org/). PMID:21731587

[Logistic regression model of noninvasive prediction for portal hypertensive gastropathy in patients with hepatitis B associated cirrhosis].

PubMed

Wang, Qingliang; Li, Xiaojie; Hu, Kunpeng; Zhao, Kun; Yang, Peisheng; Liu, Bo

2015-05-12

To explore the risk factors of portal hypertensive gastropathy (PHG) in patients with hepatitis B associated cirrhosis and establish a Logistic regression model of noninvasive prediction. The clinical data of 234 hospitalized patients with hepatitis B associated cirrhosis from March 2012 to March 2014 were analyzed retrospectively. The dependent variable was the occurrence of PHG while the independent variables were screened by binary Logistic analysis. Multivariate Logistic regression was used for further analysis of significant noninvasive independent variables. Logistic regression model was established and odds ratio was calculated for each factor. The accuracy, sensitivity and specificity of model were evaluated by the curve of receiver operating characteristic (ROC). According to univariate Logistic regression, the risk factors included hepatic dysfunction, albumin (ALB), bilirubin (TB), prothrombin time (PT), platelet (PLT), white blood cell (WBC), portal vein diameter, spleen index, splenic vein diameter, diameter ratio, PLT to spleen volume ratio, esophageal varices (EV) and gastric varices (GV). Multivariate analysis showed that hepatic dysfunction (X1), TB (X2), PLT (X3) and splenic vein diameter (X4) were the major occurring factors for PHG. The established regression model was Logit P=-2.667+2.186X1-2.167X2+0.725X3+0.976X4. The accuracy of model for PHG was 79.1% with a sensitivity of 77.2% and a specificity of 80.8%. Hepatic dysfunction, TB, PLT and splenic vein diameter are risk factors for PHG and the noninvasive predicted Logistic regression model was Logit P=-2.667+2.186X1-2.167X2+0.725X3+0.976X4.

Selective Methicillin-Resistant Staphylococcus Aureus (MRSA) screening of a high risk population does not adequately detect MRSA carriers within a country with low MRSA prevalence.

PubMed

de Wouters, Solange; Daxhelet, Jérémy; Kaminski, Ludovic; Thienpont, Emmanuel; Cornu, Olivier; Yombi, Jean Cyr

2015-12-01

Methicillin-Resistant Staphylococcus Aureus (MRSA) has been widely recognized as a serious problem in hospital settings. The purpose of this study is to evaluate the predictive value of MRSA colonization factors in the detection of MRSA carriers in an orthopedic ward. A systematic MRSA detection strategy was set up to assess the predictive value of MRSA colonization factors among 554 patients undergoing elective knee arthroplasty. In total 116 patients were found positive for Staphylococcus Aureus; among those 110/116 patients were found positive for Methicillin-Sensitive Staphylococcus Aureus (MSSA) and 6/116 for MRSA. Only one patient out of six presented two risk factors according to MRSA risk factors. In this study, no correlation was found between the remaining conventional risk factors, according to Belgian guidelines, defined to target high-risk populations and to identify MRSA carriers. Established criteria for selective MRSA screening do not allow detecting MRSA carriers. The objective of detecting MRSA carriers is not correctly met by the actual applied criteria (Belgian consensus) for a selective screening policy. Future studies should aim at identifying the right risk factors, depending of the country's prevalence of MRSA, to improve the ability to predict the risk of MRSA carriage at hospital admission.

Association of Circulating Biomarkers (Adrenomedullin, TNFR1, and NT-proBNP) With Renal Function Decline in Patients With Type 2 Diabetes: A French Prospective Cohort.

PubMed

Saulnier, Pierre-Jean; Gand, Elise; Velho, Gilberto; Mohammedi, Kamel; Zaoui, Philippe; Fraty, Mathilde; Halimi, Jean Michel; Roussel, Ronan; Ragot, Stéphanie; Hadjadj, Samy

2017-03-01

We explored the prognostic value of three circulating candidate biomarkers-midregional-proadrenomedullin (MR-proADM), soluble tumor necrosis factor receptor 1 (sTNFR1), and N-terminal prohormone brain natriuretic peptide (NT-proBNP)-for change in renal function in patients with type 2 diabetes. Outcomes were defined as renal function loss (RFL), ≥40% decline of estimated glomerular filtration rate (eGFR) from baseline, and rapid renal function decline (RRFD), absolute annual eGFR slope <-5 mL/min/year. We used a proportional hazard model for RFL and a logistic model for RRFD. Adjustments were performed for established risk factors (age, sex, diabetes duration, HbA 1c , blood pressure, baseline eGFR, and urinary albumin-to-creatinine ratio [uACR]). C-statistics were used to assess the incremental predictive value of the biomarkers to these risk factors. Among 1,135 participants (mean eGFR 76 mL/min, median uACR 2.6 mg/mmol, and median GFR slope -1.6 mL/min/year), RFL occurred in 397, RRFD developed in 233, and 292 died during follow-up. Each biomarker predicted RFL and RRFD. When combined, MR-proADM, sTNFR1, and NT-proBNP predicted RFL independently from the established risk factors (adjusted hazard ratio 1.59 [95% CI 1.34-1.89], P < 0.0001; 1.33 [1.14-1.55], P = 0.0003; and 1.22 [1.07-1.40], P = 0.004, respectively) and RRFD (adjusted odds ratio 1.56 [95% CI 1.7-2.09], P = 0.003; 1.72 [1.33-2.22], P < 0.0001; and 1.28 [1.03-1.59], P = 0.02, respectively). The combination of the three biomarkers yielded the highest discrimination (difference in C-statistic = 0.054, P < 0.0001; 0.067, P < 0.0001 for RFL; and 0.027, P < 0.0001 for RRFD). In addition to established risk factors, MR-proADM, sTNFR1, and NT-proBNP improve risk prediction of loss of renal function in patients with type 2 diabetes. © 2017 by the American Diabetes Association.

Association of Genetic Markers in the BCL-2 Family of Apoptosis-Related Genes with Endometrial Cancer Risk in a Chinese Population

PubMed Central

Dorjgochoo, Tsogzolmaa; Xiang, Yong-Bing; Long, Jirong; Shi, Jiajun; Deming, Sandra; Xu, Wang-Hong; Cai, Hui; Cheng, Jiarong; Cai, Qiuyin; Zheng, Wei; Shu, Xiao-Ou

2013-01-01

Background In vitro studies have demonstrated the role of the BCL-2 family of genes in endometrial carcinogenesis. The role of genetic variants in BCL-2 genes and their interactions with non-genetic factors in the development of endometrial cancer has not been investigated in epidemiological studies. Patients and Methods We examined the relationship between BCL-2 gene family variants and endometrial cancer risk among 1,028 patients and 1,922 age-matched community controls from Shanghai, China. We also investigated possible interactions between genetic variants and established risk factors (demographic, lifestyle and clinical). Individuals were genotyped for 86 tagging single nucleotide polymorphisms (SNPs) in the BCL2, BAX, BAD and BAK1 genes. Results Significant associations with endometrial cancer risk were found for 9 SNPs in the BCL2 gene (P trend<0.05 for all). For SNPs rs17759659 and rs7243091 (minor allele for both: G), the associations were independent. The odds ratio was 1.27 (95% CI: 1.04–1.53) for women with AG genotype for the SNP rs17759659 and 1.82 (95% CI: 1.21–2.73) for women with the GG genotype for the SNP rs7243091. No interaction between these two SNPs and established non-genetic risk factors of endometrial cancer was noticed. Conclusion Genetic polymorphisms in the BCL2 gene may be associated with the risk of endometrial cancer in Chinese women. PMID:23637776

Management Status of Cardiovascular Disease Risk Factors for Dyslipidemia among Korean Adults.

PubMed

Lee, Jongseok; Son, Heejeong; Ryu, Ohk Hyun

2017-03-01

Dyslipidemia, hypertension, and diabetes are well-established risk factors for cardiovascular disease (CVD). This study investigated the prevalence and management status of these factors for dyslipidemia among Korean adults aged 30 years old and older. The prevalence and management status of dyslipidemia, hypertension, and diabetes were analyzed among 12229 subjects (≥30 years) participating in the Korea National Health and Nutrition Survey 2010-2012. Dyslipidemia was defined according to treatment criteria rather than diagnostic criteria in Korea. Therefore, hyper-low-density lipoprotein (LDL) cholesterolemia was defined if LDL cholesterol levels exceeded the appropriate risk-based threshold established by the National Cholesterol Education Program Adult Treatment Panel III. The age-standardized prevalence was highest for dyslipidemia (39.6%), followed by hypertension (32.8%) and diabetes (9.8%). The lowest patient awareness was found for dyslipidemia (27.9%). The treatment rate was 66.5% for diabetes and 57.3% for hypertension, but only 15.7% for dyslipidemia. The control rate among those undergoing treatment was highest for hypertension (64.2%), followed by dyslipidemia (59.2%) and diabetes (22.1%). The higher the risk levels of CVD were, the lower the control rate of dyslipidemia. While the prevalence of dyslipidemia was higher than hypertension and diabetes, awareness and treatment rates thereof were lower. Higher CVD-risk categories showed lower control rates of dyslipidemia. In order to improve awareness and control rates of dyslipidemia, diagnostic criteria should be reconciled with treatment targets based on cardiovascular risk in Korean populations.

METHOD AND LOCATION OF GROUND WATER SAMPLING: IMPACT ON ATTENUATION FACTORS FOR ASSESSING IMPACT ON VAPOR INTRUSION

EPA Science Inventory

The Draft EPA Subsurface Vapor Intrusion Guidance Document was established to "address the incremental increases in exposures and risks from subsurface contaminants that my be intruding into indoor air". The document utilizes attenuation factors based on indoor air/soil gas or i...

Preschool Children with and without Developmental Delay: Risk, Parenting, and Child Demandingness

ERIC Educational Resources Information Center

Brown, Mallory A.; McIntyre, Laura Lee; Crnic, Keith A.; Baker, Bruce L.; Blacher, Jan

2011-01-01

Although past literature has established relations between early child risk factors, negative parenting, and problematic child behavior, the nature of these interrelations and pathways of influence over time remains largely unknown, especially in children with developmental delays or disabilities. In the current study, data were drawn from the…

Risk Assessment on Constructors during Over-water Riprap Based on Entropy Weight and FAHP

NASA Astrophysics Data System (ADS)

Wu, Tongqing; Li, Liang; Liang, Zelong; Mao, Tian; Shao, Weifeng

2017-07-01

Being aimed at waterway regulation engineering, there exist risks of over-water riprap for constructors which keeps uncertainty and complexity. For the purpose of evaluating the possibility and consequence, this paper utilizes fuzzy analytic hierarchy process with abbreviation of FAHP to do empowerment on the related risk indicators, constructs FAHP under entropy weight and establishes relevant evaluation factor set and evaluation language for constructors during over-water riprap construction process. Through doing risk probability estimation and risk consequence size evaluation on the factor of constructors, this paper introduces this model into risk analysis on constructors during over-water riprap of Ching River waterway regulation project. Results show that evaluation of this method is so credible that it could be utilized in practical engineering.

Using Simulation to Compare Established and Emerging Interventions to Reduce Cardiovascular Disease Risk in the United States

PubMed Central

Homer, Jack; Wile, Kristina; Trogdon, Justin G.; Hirsch, Gary; Cooper, Lawton; Soler, Robin; Orenstein, Diane

2014-01-01

Introduction Computer simulation offers the ability to compare diverse interventions for reducing cardiovascular disease risks in a controlled and systematic way that cannot be done in the real world. Methods We used the Prevention Impacts Simulation Model (PRISM) to analyze the effect of 50 intervention levers, grouped into 6 (2 x 3) clusters on the basis of whether they were established or emerging and whether they acted in the policy domains of care (clinical, mental health, and behavioral services), air (smoking, secondhand smoke, and air pollution), or lifestyle (nutrition and physical activity). Uncertainty ranges were established through probabilistic sensitivity analysis. Results Results indicate that by 2040, all 6 intervention clusters combined could result in cumulative reductions of 49% to 54% in the cardiovascular risk-related death rate and of 13% to 21% in risk factor-attributable costs. A majority of the death reduction would come from Established interventions, but Emerging interventions would also contribute strongly. A slim majority of the cost reduction would come from Emerging interventions. Conclusion PRISM allows public health officials to examine the potential influence of different types of interventions — both established and emerging — for reducing cardiovascular risks. Our modeling suggests that established interventions could still contribute much to reducing deaths and costs, especially through greater use of well-known approaches to preventive and acute clinical care, whereas emerging interventions have the potential to contribute significantly, especially through certain types of preventive care and improved nutrition. PMID:25376017

Evaluation of new and established age-related macular degeneration susceptibility genes in the Women's Health Initiative Sight Exam (WHI-SE) Study

USDA-ARS?s Scientific Manuscript database

To assess whether established and newly reported genetic variants, independent of known lifestyle factors, are associated with the risk of age-related macular degeneration (AMD) among women participating in the Women's Health Initiative Sight Exam (WHI-SE) Genetic Ancillary Study. This is a multice...

A discriminant analysis prediction model of non-syndromic cleft lip with or without cleft palate based on risk factors.

PubMed

Li, Huixia; Luo, Miyang; Luo, Jiayou; Zheng, Jianfei; Zeng, Rong; Du, Qiyun; Fang, Junqun; Ouyang, Na

2016-11-23

A risk prediction model of non-syndromic cleft lip with or without cleft palate (NSCL/P) was established by a discriminant analysis to predict the individual risk of NSCL/P in pregnant women. A hospital-based case-control study was conducted with 113 cases of NSCL/P and 226 controls without NSCL/P. The cases and the controls were obtained from 52 birth defects' surveillance hospitals in Hunan Province, China. A questionnaire was administered in person to collect the variables relevant to NSCL/P by face to face interviews. Logistic regression models were used to analyze the influencing factors of NSCL/P, and a stepwise Fisher discriminant analysis was subsequently used to construct the prediction model. In the univariate analysis, 13 influencing factors were related to NSCL/P, of which the following 8 influencing factors as predictors determined the discriminant prediction model: family income, maternal occupational hazards exposure, premarital medical examination, housing renovation, milk/soymilk intake in the first trimester of pregnancy, paternal occupational hazards exposure, paternal strong tea drinking, and family history of NSCL/P. The model had statistical significance (lambda = 0.772, chi-square = 86.044, df = 8, P < 0.001). Self-verification showed that 83.8 % of the participants were correctly predicted to be NSCL/P cases or controls with a sensitivity of 74.3 % and a specificity of 88.5 %. The area under the receiver operating characteristic curve (AUC) was 0.846. The prediction model that was established using the risk factors of NSCL/P can be useful for predicting the risk of NSCL/P. Further research is needed to improve the model, and confirm the validity and reliability of the model.

Serum IGF-1 linking visceral obesity with esophageal adenocarcinoma: unconvincing evidence.

PubMed

McColl, K E L

2012-02-01

There is a strong positive association between body mass index (BMI) and risk of esophageal adenocarcinoma. This is likely to be largely or entirely explained by the established association between central obesity and gastroesophageal reflux and between the latter and risk of esophageal adenocarcinoma. Visceral fat is also metabolically active and there is interest in the possibility that humoral factors released by this fat might promote esophageal carcinogenesis. Insulin growth factor I (IGF-1) has been studied but current data do not support circulating total IGF-1 as a humoral factor linking BMI and esophageal carcinogenesis.

[Sudden Cardiac Death of Young Persons: Risk Factors, Causes, Morphological Equivalents].

PubMed

Shilova, M A; Mamedov, M N

2015-01-01

The article contains literature review on the problem of causes of sudden cardiac death (SCD) among young people as well as results of author's own retrospective study of deaths of persons before 39 years based on forensic autopsies performed during 10 year period. The study of structure and dynamics of causes of death, its risk factors and the role of connective tissue dysplasia in development of terminal symptomocomlexes allowed to establish that main mechanism of SCD in young people was arrhythmogenic developing as a response to provoking factors--physical effort, psychoemotional stress, consumption of light alcoholic beverages.

Risk factors for diabetes, but not for cardiovascular disease, are associated with family history of Type 2 diabetes in subjects from central Mexico.

PubMed

Zamora-Ginez, Irma; Pérez-Fuentes, Ricardo; Baez-Duarte, Blanca G; Revilla-Monsalve, Cristina; Brambila, Eduardo

2012-03-01

Independent of obesity, family history of type 2 diabetes mellitus (FHT2DM) is another important risk factor for developing diabetes. To establish the association among FHT2DM, risk factors for diabetes and cardiovascular disease in subjects from central Mexico. Clinical and biochemical studies were performed in 383 first-degree relatives of patients with type 2 diabetes and 270 subjects unrelated to patients with type 2 diabetes-all subjects were from the city of Puebla in central Mexico. Logistic regressions were used to assess the association between FHT2DM and metabolic parameters. Cardiovascular risk was classified by dyslipidemia and the Framingham Risk Score (FRS). FHT2DM was associated with risk factors for diabetes, such as increased fasting insulin levels (OR = 1.731, 95% CI = 1.041-2.877), decreased insulin sensitivity (OR = 1.951, 95% CI = 1.236-3.080) and pre-diabetes (OR = 1.63, 95% CI = 1.14-2.33). FHT2DH was not associated with risk factors for cardiovascular disease, such as dyslipidemia (OR = 1.12, 95% CI = 0.70-1.79) and FRS (OR = 0.74, 95% CI = 0.40-1.36) when adjusted for gender, age, smoking and obesity. Diabetic risk factors, but not cardiovascular disease risk factors, are associated with a positive family history of diabetes in subjects from central Mexico, independent of the presence of obesity.

Effectiveness of a web-based personalized rheumatoid arthritis risk tool with or without a health educator for knowledge of RA risk factors.

PubMed

Prado, Maria G; Iversen, Maura D; Yu, Zhi; Miller Kroouze, Rachel; Triedman, Nellie A; Kalia, Sarah S; Lu, Bing; Green, Robert C; Karlson, Elizabeth W; Sparks, Jeffrey A

2018-01-05

To assess knowledge of rheumatoid arthritis (RA) risk factors among unaffected first-degree relatives (FDRs) and to study whether a personalized RA education tool increases risk factor knowledge. We performed a randomized controlled trial assessing RA educational interventions among 238 FDRs. The web-based Personalized Risk Estimator for RA (PRE-RA) tool displayed personalized RA risk results (genetics, autoantibodies, demographics, and behaviors) and educated about risk factors. Subjects were randomly assigned to: Comparison arm (standard RA education, n=80), PRE-RA arm (PRE-RA alone, n=78), or PRE-RA Plus arm (PRE-RA and a one-on-one session with a trained health educator, n=80). The RA Knowledge Score (RAKS, the number of 8 established RA risk factors identified as related to RA) was calculated at baseline and post-education (immediate/6 weeks/6 months/12 months). We compared RAKS and its components at each post-education point by randomization arm. At baseline before education, few FDRs identified behavioral RA risk factors (15.9% for dental health, 31.9% for smoking, 47.5% for overweight/obesity, and 54.2% for diet). After education, RAKS increased in all arms, higher in PRE-RA and PRE-RA Plus than Comparison at all post-education points (p<0.05). PRE-RA were more likely to identify risk factors than those that received standard education (proportion agreeing smoking is a risk factor at 6 weeks: 83.1% in PRE-RA Plus arm, 71.8% in PRE-RA, and 43.1% in Comparison arms, p<0.05 for PRE-RA vs. Comparison). Despite being both familiar with RA and at increased risk, FDRs had low knowledge about RA risk factors. A web-based personalized RA education tool successfully increased RA risk factor knowledge. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

The use of a logistic regression model to develop a risk assessment of intraoperatively acquired pressure ulcer.

PubMed

Gao, Ling; Yang, Lina; Li, Xiaoqin; Chen, Jin; Du, Juan; Bai, Xiaoxia; Yang, Xianjun

2018-04-20

To screen the factors of intraoperatively acquired pressure ulcer and establish a new risk assessment model of intraoperatively acquired pressure ulcer. This is a prospective study. A total of 1,963 patients who received neurosurgery, orthopaedics, paediatric surgery and cardiac surgery therapy in Sichuan Academy of Medical Science and Provincial People's Hospital in China from October 2015-October 2016 were enrolled in the study, and their clinical parameters were collected. Multivariable logistic regression analysis and decision tree analysis were used to analyse and screen the factors of intraoperatively acquired pressure ulcer and establish the risk assessment model of intraoperatively acquired pressure ulcer. The risk factors for intraoperatively acquired pressure ulcer included the application of external force during operation (β = 1.10, OR = 3.20), lean body mass (β = 1.08, OR = 2.95), time of operation ≥6 hr (β = 2.66, OR = 14.30), prone position operation (β = 1.13, OR = 3.10), cardiopulmonary bypass during operation (β = 1.72, OR = 5.59) and intraoperative blood loss (β = 0.67, OR = 1.95). The new risk assessment model showed that the AUC of ROC curve was 0.897 (p < .001). According to the maximum principle of Youden's index, the sensitivity, specificity and Youden's index J of the model were 0.81, 0.88 and 0.69, respectively, when the cut-off point was set at π = 0.025. A new and relatively reliable assessment model for intraoperatively acquired pressure ulcer is established. Pressure ulcers remain a challenge in clinical nursing. A new risk assessment model of pressure ulcers that is applicable to surgical patients is highly recommended. © 2018 John Wiley & Sons Ltd.

Protein Biomarkers of New-Onset Cardiovascular Disease: A Prospective Study from the Systems Approach to Biomarker Research in Cardiovascular Disease (SABRe CVD) Initiative

PubMed Central

Yin, Xiaoyan; Subramanian, Subha; Hwang, Shih-Jen; O’Donnell, Christopher J.; Fox, Caroline S.; Courchesne, Paul; Muntendam, Pieter; Adourian, Aram; Juhasz, Peter; Larson, Martin G.; Levy, Daniel

2014-01-01

Objective Incorporation of novel plasma protein biomarkers may improve current models for prediction of atherosclerotic cardiovascular disease (ASCVD) risk. Approach and Results We utilized discovery mass spectrometry (MS) to determine plasma concentrations of 861 proteins in 135 myocardial infarction (MI) cases and 135 matched controls. We then measured 59markers by targeted MS in 336 ASCVD case-control pairs. Associations with MI or ASCVD were tested in single marker and multimarker analyses adjusted for established ASCVD risk factors. Twelve single markers from discovery MS were associated with MI incidence (at p<0.01) adjusting for clinical risk factors. Seven proteins in aggregate (cyclophilin A, CD5 antigen-like, cell surface glycoprotein MUC18, collagen-alpha 1 [XVIII] chain, salivary alpha-amylase 1, C-reactive protein, and multimerin-2) were highly associated with MI (p<0.0001) and significantly improved its prediction compared to a model with clinical risk factors alone (C-statistic of 0.71 vs. 0.84). Through targeted MS, twelve single proteins were predictors of ASCVD (at p<0.05) after adjusting for established risk factors. In multimarker analyses, four proteins in combination (alpha-1-acid glycoprotein 1, paraoxonase 1, tetranectin, and CD5 antigen-like, predicted incident ASCVD (p<0.0001) and moderately improved the C-statistic from the model with clinical covariates alone (C-statistic of 0.69 vs. 0.73). Conclusions Proteomics profiling identified single and multimarker protein panels that are associated with new onset ASCVD and may lead to a better understanding of underlying disease mechanisms. Our findings include many novel protein biomarkers that, if externally validated, may improve risk assessment for MI and ASCVD. PMID:24526693

Analysis of Unplanned Intensive Care Unit Admissions in Postoperative Pediatric Patients.

PubMed

Landry, Elizabeth K; Gabriel, Rodney A; Beutler, Sascha; Dutton, Richard P; Urman, Richard D

2017-03-01

Currently, there are only a few retrospective, single-institution studies that have addressed the prevalence and risk factors associated with unplanned admissions to the pediatric intensive care unit (ICU) after surgery. Based on the limited amount of studies, it appears that airway and respiratory complications put a child at increased risk for unplanned ICU admission. A more extensive and diverse analysis of unplanned postoperative admissions to the ICU is needed to address risk factors that have yet to be revealed by the current literature. To establish a rate of unplanned postoperative ICU admissions in pediatric patients using a large, multi-institution data set and to further characterize the associated risk factors. Data from the National Anesthesia Clinical Outcomes Registry were analyzed. We recorded the overall risk of unplanned postoperative ICU admission in patients younger than 18 years and performed univariate and multivariate logistic regression analysis to identify the associated patient, surgical, and anesthetic-related characteristics. Of the 324 818 cases analyzed, 211 reported an unexpected ICU admission. There was an increased likelihood of unplanned postoperative ICU in infants (age <1 year) and children who were classified as American Society of Anesthesiologists physical status classification of III or IV. Likewise, longer case duration and cases requiring general anesthesia were also associated with unplanned ICU admissions. This study establishes a rate of unplanned ICU admission following surgery in the heterogeneous pediatric population. This is the first study to utilize such a large data set encompassing a wide range of practice environments to identify risk factors leading to unplanned postoperative ICU admissions. Our study revealed that patient, surgical, and anesthetic complexity each contributed to an increased number of unplanned ICU admissions in the pediatric population.

Active case finding for carbapenemase-producing Enterobacteriaceae in a teaching hospital: prevalence and risk factors for colonization.

PubMed

Poole, K; George, R; Decraene, V; Shankar, K; Cawthorne, J; Savage, N; Welfare, W; Dodgson, A

2016-10-01

Over the past decade, the prevalence of carbapenemase-producing Enterobacteriaceae (CPE) has increased. Whilst basic infection prevention and control practices reduce the risk of transmission, cases of unrecognized carriage pose a potential risk of transmission. To estimate the prevalence of CPE and explore risk factors associated with colonization within a large teaching hospital with an established CPE outbreak. All inpatients that had not previously tested positive for CPE were offered testing. Demographic and hospital episode data were also collected, together with antibiotic and proton pump inhibitor (PPI) use in the preceding 24h. This study identified 70 CPE-positive cases (26 newly identified and 44 previously known) and 592 CPE-negative cases, giving a combined prevalence of 11% [95% confidence interval (CI) 8-13]. Medication (antibiotic and PPI use), previous admission, ethnicity and length of stay were assessed as risk factors for colonization, and none were found to be independently associated with CPE colonization. Using logistic regression, age [odds ratio (OR) 1.03, 95% CI 1.01-1.07] and antibiotic use (OR 2.55, 95% CI 1.08-6.03) were the only risk factors significantly associated with CPE colonization. This study has added to the evidence base by estimating the prevalence of CPE among inpatients in an acute hospital with an established CPE outbreak. A case-finding exercise was feasible and identified a number of new cases. Despite a small sample size, increasing age and prescription of an antibiotic on the day of testing were significantly associated with CPE colonization. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

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

PubMed

Samady, Waheeda; Pong, Alice; Fisher, Erin

2014-10-01

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

Posttraumatic stress disorder in adults: impact, comorbidity, risk factors, and treatment.

PubMed

Sareen, Jitender

2014-09-01

During the last 30 years, there has been a substantial increase in the study of posttraumatic stress disorder (PTSD). Several high-profile traumatic events, such as the wars in Afghanistan and Iraq, and the terrorist attacks of September 11 on the World Trade Center, have led to a greater public interest in the risk and protective factors for PTSD. In this In Review paper, I discuss some of the important advances in PTSD. The paper provides a concise review of the evolution of PTSD diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, impact of PTSD in the community, an overview of the established risk factors for developing PTSD, and assessment and treatment. Throughout the paper, controversies and clinical implications are discussed.

Identifying Links Between Sexual Violence and Youth Violence Perpetration: New Opportunities for Sexual Violence Prevention

PubMed Central

DeGue, Sarah; Massetti, Greta M.; Holt, Melissa K.; Tharp, Andra Teten; Valle, Linda Anne; Matjasko, Jennifer L.; Lippy, Caroline

2018-01-01

Objective One promising opportunity for advancing sexual violence (SV) research and identifying new avenues for prevention involves examining other forms of violence that may share risk factors with SV. Youth violence (YV) is ideal for consideration given evidence of overlap in SV and YV risk factors, a large set of established YV risk factors across the social ecology, and the number of evidence-based YV prevention strategies available. The current paper identifies shared and unique risk factors for SV and YV and highlights evidence-based YV prevention strategies that impact these shared risk factors. Conclusions Researchers and program developers should consider adapting and evaluating evidence-based YV prevention strategies to prevent SV. Modifying these programs to address SV’s unique risk factors may maximize their potential effectiveness. In addition, expanding SV research at the outer levels of the social ecology is critical to developing community-level prevention strategies. The YV literature suggests several potential risk factors at these levels in need of research for SV, including school connectedness, social disorganization, and availability of alcohol and drugs. Using the YV literature as a starting point for expanding SV research leverages prior investments in YV research, may help identify new SV prevention strategies at a limited cost, and moves the field more quickly toward implementation of cost-effective, multidomain violence prevention strategies in communities. PMID:29644117

[Prevalence of the Diabetic Retinopathy and Genetic Factors Significance in the Development of Diabetic Retinopathy in Patients with Diabetes Mellitus type I and II in Slovakia (DIARET SK study). Overview of Actual Findings and Design of the Epidemiological DIARET SK Study].

PubMed

Krásnik, V; Štefaničková, J; Fabková, J; Bucková, D; Helbich, M

2015-09-01

Diabetic retinopathy (DR) is the second most common microvascular complication and the most common cause of blindness in patients with diabetes mellitus (DM). Despite the ongoing research, the findings of diabetic retinopathy epidemiological and risk factors are, until now, not consistent. More finding may be revealed by epidemiological studies, consistently mapping DR epidemiology under the current possibilities of investigations and treatment of the DM. DIARET SK Study, with 5 000 enrolled patients with diabetes mellitus in the Slovak Republic, is, until now, the largest epidemiological study to set the prevalence of diabetic retinopathy. The primary aim is to establish the prevalence of diabetic retinopathy in patients with diabetes mellitus type I and II, according to the duration of the disease. The secondary aim is to establish prevalence of the different stages of the DR and diabetic macular edema (DME) and analysis of the risk factors influence. Included are patients with DM type I and II regardless to the ocular complications history and the period of DM duration. Each enrolled patient has both complex diabetic and ophthalmic examinations.Projects to establish DR prevalence: Tens of projects concerned with diabetic retinopathy epidemiology with different approaches to establish the prevalence and with different patients population. Results from different studies vary significantly (from 12.3 % to 66.9 %). The results depend on the design of the study and the patients recruitment, used examination methods, specific patients population with regard to the geography, prevalence of risk factors, period of diabetes duration, glycated hemoglobin (HbA1C) level, blood pressure, and is higher in type I diabetic patients. The most accurate results are from population epidemiological studies with well-controlled patient recruitment and uniform complex examination that are similar to the DIARET SK study. The DIARET SK study represents the largest epidemiological study to establish the prevalence of the diabetic retinopathy in patients with DM type I and II. Thanks to the quality design, similar to the already published studies, but with larger number of patients and newest examinations methods, the DIARET SK study has the aspiration to obtain the most accurate up to date data of diabetic retinopathy prevalence and risk factors influence to its outbreak. The patients recruitment started in February 2015. The expected date of patients recruitment termination is in the end of the year 2015, and the data analysis in 2016.

Alcohol consumption and PSA-detected prostate cancer risk—A case-control nested in the ProtecT study

PubMed Central

Zuccolo, Luisa; Lewis, Sarah J; Donovan, Jenny L; Hamdy, Freddie C; Neal, David E; Smith, George Davey

2013-01-01

Alcohol is an established carcinogen but not an established risk factor for prostate cancer, despite some recent prospective studies suggesting increased risk among heavy drinkers. The aim of this study was to investigate the role of alcohol on prostate-specific antigen (PSA) levels and prostate cancer risk. Two thousand four hundred PSA detected prostate cancer cases and 12,700 controls matched on age and general practice were identified through a case-control study nested in the PSA-testing phase of a large UK-based randomized controlled trial for prostate cancer treatment (ProtecT). Linear and multinomial logistic regression models were used to estimate ratios of geometric means (RGMs) of PSA and relative risk ratios (RRRs) of prostate cancer by stage and grade, with 95% confidence intervals (CIs), associated with weekly alcohol intake and drinking patterns. We found evidence of lower PSA (RGM 0.98, 95% CI: 0.98–0.99) and decreased risk of low Gleason-grade (RRR 0.96; 95%CI 0.93–0.99) but increased risk of high-grade prostate cancer (RRR 1.04; 95%CI 0.99–1.08; pdifference=0.004) per 10 units/week increase in alcohol consumption, not explained by current BMI, blood pressure, comorbidities, or reverse causation. This is the first large population-based study to find evidence of lower PSA levels for increasing alcohol consumption, with potential public health implications for the detection of prostate cancer. Our results also support a modestly higher risk of high-grade disease for heavy drinkers, but require independent replication to establish the nature of the association of alcohol with low-grade disease, preferably in cohorts with a heterogeneous case-mix. What's new? Alcohol is not an established risk factor for prostate cancer; however, the current work suggests that heavy drinking could cause a small increase in risk of the more aggressive forms. If the results are confirmed to be causal, prostate cancer risk will be added to the many long-term health risks of heavy drinking, and public health strategies will then also reduce high-risk, poorer prognosis prostate cancer. The authors also found that heavy drinkers have lower PSA levels, suggesting that heavy alcohol consumption could be used as a marker to identify men in whom some cancers might be missed. PMID:23024014

Population heterogeneity in the salience of multiple risk factors for adolescent delinquency.

PubMed

Lanza, Stephanie T; Cooper, Brittany R; Bray, Bethany C

2014-03-01

To present mixture regression analysis as an alternative to more standard regression analysis for predicting adolescent delinquency. We demonstrate how mixture regression analysis allows for the identification of population subgroups defined by the salience of multiple risk factors. We identified population subgroups (i.e., latent classes) of individuals based on their coefficients in a regression model predicting adolescent delinquency from eight previously established risk indices drawn from the community, school, family, peer, and individual levels. The study included N = 37,763 10th-grade adolescents who participated in the Communities That Care Youth Survey. Standard, zero-inflated, and mixture Poisson and negative binomial regression models were considered. Standard and mixture negative binomial regression models were selected as optimal. The five-class regression model was interpreted based on the class-specific regression coefficients, indicating that risk factors had varying salience across classes of adolescents. Standard regression showed that all risk factors were significantly associated with delinquency. Mixture regression provided more nuanced information, suggesting a unique set of risk factors that were salient for different subgroups of adolescents. Implications for the design of subgroup-specific interventions are discussed. Copyright © 2014 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Compassion satisfaction, compassion fatigue, anxiety, depression and stress in registered nurses in Australia: study 1 results.

PubMed

Hegney, Desley G; Craigie, Mark; Hemsworth, David; Osseiran-Moisson, Rebecca; Aoun, Samar; Francis, Karen; Drury, Vicki

2014-05-01

To explore compassion fatigue and compassion satisfaction with the potential contributing factors of anxiety, depression and stress. To date, no studies have connected the quality of work-life with other contributing and co-existing factors such as depression, anxiety and stress. A self-report exploratory cross sectional survey of 132 nurses working in a tertiary hospital. The reflective assessment risk profile model provides an excellent framework for examining the relationships between the professional quality of work factors and contributing factors within the established risk profiles. The results show a definite pattern of risk progression for the six factors examined for each risk profile. Additionally, burnout and secondary traumatic stress were significantly related to higher anxiety and depression levels. Higher anxiety levels were correlated with nurses who were younger, worked full-time and without a postgraduate qualification. Twenty percent had elevated levels of compassion fatigue: 7.6% having a very distressed profile. At-risk nurses' stress and depression scores were significantly higher than nurses with higher compassion satisfaction scores. The employed nurse workforce would benefit from a psychosocial capacity building intervention that reduces a nurse's risk profile, thus enhancing retention. © 2013 John Wiley & Sons Ltd.

Increased Growth of a Newly Established Mouse Epithelial Cell Line Transformed with HPV-16 E7 in Diabetic Mice.

PubMed

He, Lan; Law, Priscilla T Y; Boon, Siaw Shi; Zhang, Chuqing; Ho, Wendy C S; Banks, Lawrence; Wong, C K; Chan, Juliana C N; Chan, Paul K S

2016-01-01

Epidemiological evidence supports that infection with high-risk types of human papillomavirus (HPV) can interact with host and environmental risk factors to contribute to the development of cervical, oropharyngeal, and other anogenital cancers. In this study, we established a mouse epithelial cancer cell line, designated as Chinese University Papillomavirus-1 (CUP-1), from C57BL/KsJ mice through persistent expression of HPV-16 E7 oncogene. After continuous culturing of up to 200 days with over 60 passages, we showed that CUP-1 became an immortalized and transformed epithelial cell line with continuous E7 expression and persistent reduction of retinoblastoma protein (a known target of E7). This model allowed in-vivo study of interaction between HPV and co-factors of tumorigenesis in syngeneic mice. Diabetes has been shown to increase HPV pathogenicity in different pathological context. Herein, with this newly-established cell line, we uncovered that diabetes promoted CUP-1 xenograft growth in syngeneic db/db mice. In sum, we successfully established a HPV-16 E7 transformed mouse epithelial cell line, which allowed subsequent studies of co-factors in multistep HPV carcinogenesis in an immunocompetent host. More importantly, this study is the very first to demonstrate the promoting effect of diabetes on HPV-associated carcinogenesis in vivo, implicating the importance of cancer surveillance in diabetic environment.

Individual and areal risk factors for road traffic injury deaths: nationwide study in South Korea.

PubMed

Park, Kunhee; Hwang, Seung-Sik; Lee, Jin-Seok; Kim, Yoon; Kwon, Soonman

2010-07-01

This study determines the individual and areal risk factors for road traffic injury deaths in South Korea. The risk factors that influence road traffic injury deaths are defined by multilevel Poisson regression analysis. It is seen that not only demographic factors but also individual educational level, which represents socioeconomic status, influences road traffic injury deaths. The material deprivation index, which represents areal socioeconomic status, and W statistics, as a measure of the quality of the emergency medical system in an area, also influence road traffic injury deaths. Based on this study, the most vulnerable group for road traffic injury deaths is elderly men with a low level of education who live in the most deprived areas.Therefore, preventive policies focusing on both these areas and this population demographic should be established.

III: Use of biomarkers as Risk Indicators in Environmental Risk Assessment of oil based discharges offshore.

PubMed

Sanni, Steinar; Lyng, Emily; Pampanin, Daniela M

2017-06-01

Offshore oil and gas activities are required not to cause adverse environmental effects, and risk based management has been established to meet environmental standards. In some risk assessment schemes, Risk Indicators (RIs) are parameters to monitor the development of risk affecting factors. RIs have not yet been established in the Environmental Risk Assessment procedures for management of oil based discharges offshore. This paper evaluates the usefulness of biomarkers as RIs, based on their properties, existing laboratory biomarker data and assessment methods. Data shows several correlations between oil concentrations and biomarker responses, and assessment principles exist that qualify biomarkers for integration into risk procedures. Different ways that these existing biomarkers and methods can be applied as RIs in a probabilistic risk assessment system when linked with whole organism responses are discussed. This can be a useful approach to integrate biomarkers into probabilistic risk assessment related to oil based discharges, representing a potential supplement to information that biomarkers already provide about environmental impact and risk related to these kind of discharges. Copyright © 2016 Elsevier Ltd. All rights reserved.

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

Munganahalli, D.

Sedco Forex is a drilling contractor that operates approximately 80 rigs on land and offshore worldwide. The HSE management system developed by Sedco Forex is an effort to prevent accidents and minimize losses. An integral part of the HSE management system is establishing risk profiles and thereby minimizing risk and reducing loss exposures. Risk profiles are established based on accident reports, potential accident reports and other risk identification reports (RIR) like the Du Pont STOP system. A rig could fill in as many as 30 accident reports, 30 potential accident reports and 500 STOP cards each year. Statistics are importantmore » for an HSE management system, since they are indicators of success or failure of HSE systems. It is however difficult to establish risk profiles based on statistical information, unless tools are available at the rig site to aid with the analysis. Risk profiles are then used to identify important areas in the operation that may require specific attention to minimize the loss exposure. Programs to address the loss exposure can then be identified and implemented with either a local or corporate approach. In January 1995, Sedco Forex implemented a uniform HSE Database on all the rigs worldwide. In one year companywide, the HSE database would contain information on approximately 500 accident and potential accident reports, and 10,000 STOP cards. This paper demonstrates the salient features of the database and describes how it has helped in establishing key risk profiles. It also shows a recent example of how risk profiles have been established at the corporate level and used to identify the key contributing factors to hands and finger injuries. Based on this information, a campaign was launched to minimize the frequency of occurrence and associated loss attributed to hands and fingers accidents.« less

Falls in patients with chronic obstructive pulmonary disease: a call for further research

PubMed Central

Roig, M; Eng, JJ; MacIntyre, DL; Road, JD; Reid, WD.

2012-01-01

Summary Chronic obstructive pulmonary disease (COPD) is a respiratory disease that results in airflow limitation and respiratory distress. The effects of COPD, however, are not exclusively limited to respiratory function and people with COPD face many non-respiratory manifestations that affect both function and mobility. Deficits in function and mobility have been associated with an increased risk for falling in older adults. The purpose of this study was to provide a theoretical framework to identify risks factors for falls in people with COPD. We have analyzed the literature to identify possible relationships between pathophysiological changes observed in COPD and common risk factors for falls. Well-established fall risk factors in people with COPD include lower limb muscle weakness and impaired activities of daily living. Other intrinsic risk factors such as gait and balance deficits, nutritional depletion, malnutrition, depression, cognitive impairments and medications are possible risk factors that need to be confirmed with more studies. There is no evidence that visual deficits are common in COPD. The role that precipitating factors such as syncope and postural hypotension may have on fall risk is unclear. Exacerbations and dyspnea do not have a precipitating effect on fall risk but they contribute to the progressive physical deterioration that may theoretically increase the risk for falls. While these results suggest that people with COPD might have an increased susceptibility to fall compared to their healthy peers, further research is needed to determine the prevalence of falls and specific risk factors for falls in people living with COPD. PMID:19419852

Social cure, what social cure? The propensity to underestimate the importance of social factors for health.

PubMed

Haslam, S Alexander; McMahon, Charlotte; Cruwys, Tegan; Haslam, Catherine; Jetten, Jolanda; Steffens, Niklas K

2018-02-01

Recent meta-analytic research indicates that social support and social integration are highly protective against mortality, and that their importance is comparable to, or exceeds, that of many established behavioural risks such as smoking, high alcohol consumption, lack of exercise, and obesity that are the traditional focus of medical research (Holt-Lunstad et al., 2010). The present study examines perceptions of the contribution of these various factors to life expectancy within the community at large. American and British community respondents (N = 502) completed an on-line survey assessing the perceived importance of social and behavioural risk factors for mortality. As hypothesized, while respondents' perceptions of the importance of established behavioural risks was positively and highly correlated with their actual importance, social factors were seen to be far less important for health than they actually are. As a result, overall, there was a small but significant negative correlation between the perceived benefits and the actual benefits of different social and behavioural factors. Men, younger participants, and participants with a lower level of education were more likely to underestimate the importance of social factors for health. There was also evidence that underestimation was predicted by a cluster of ideological factors, the most significant of which was respondents' respect for prevailing convention and authorities as captured by Right-Wing Authoritarianism. Findings suggest that while people generally underestimate the importance of social factors for health this also varies as a function of demographic and ideological factors. They point to a range of challenges confronting those who seek to promote greater awareness of the importance of social factors for health. Copyright © 2017 Elsevier Ltd. All rights reserved.

Correlation of Lipid Profile and Risk of Developing Type 2 Diabetes Mellitus in 10-14 Year Old Children.

PubMed

Habiba, Nusrath M; Fulda, Kimberly G; Basha, Riyaz; Shah, Deep; Fernando, Shane; Nguyen, Bao; Xiong, Yi; Franks, Susan F; Matches, Sarah J; Magie, Richard D; Bowman, W Paul

2016-01-01

The role of lipid profile in predicting the risk of Type 2 diabetes mellitus (T2DM) in children is not clearly established. Our aim is to screen non-diabetic children aged 10-14 years for risk of developing T2DM and evaluate the association of abnormal lipids and socioeconomic status (SES). Data on race/ethnicity, family history, body mass index percentile, blood pressure and presence of neck pigmentation (acanthosis nigricans) were collected from 149 non-diabetic children. Using these factors, children were classified into low risk (<3 risk factors) and high risk (>3 risk factors) groups. Logistic regression model and chi-square tests were used to evaluate the association of blood lipid profile and demographic variables. Independent t-test was used to compare the ratio of Total Cholesterol (TC) and High Density Lipids (HDL) with T2DM risk. 60% of children were at high risk for developing T2DM. HDL (p<0.001), triglycerides (p=0.02) and TC/HDL ratio (p<.001) were significantly abnormal in high risk group. Low SES showed a marginal association with high risk group. There were no gender or age differences between high and low risk groups. The significant determinants associated with high risk group were modifiable factors providing an opportunity for early intervention and prevention. © 2016 The Author(s) Published by S. Karger AG, Basel.

Awareness of lifestyle risk factors for cancer and heart disease among adults in the UK.

PubMed

Sanderson, Saskia C; Waller, Jo; Jarvis, Martin J; Humphries, Steve E; Wardle, Jane

2009-02-01

To examine and compare awareness of lifestyle risk factors for cancer and heart disease in a single UK representative sample. Two open-ended questions about cancer and heart disease risk factors were included in a population-based survey of 1747 adults. Responses were coded for four lifestyles with established links to both diseases: smoking, eating an unhealthy diet, drinking excessive alcohol and physical inactivity. Awareness of lifestyle risk factors was low for both diseases, although higher for heart disease than cancer. The average number identified by respondents was 2.1 (heart disease) and 1.4 (cancer). The strongest predictor was education (both p<0.001). Awareness that physical inactivity is a cancer risk factor was particularly low at 7%. These findings suggest that public awareness of the impact of lifestyle on commonly feared diseases, especially cancer, is low. Unhealthy lifestyles make a significant contribution to ill health and mortality. Increased public awareness of the links between lifestyles and commonly feared diseases might help people understand the potential health consequences of their actions and encourage them to make much-needed lifestyle changes. Efforts are needed to improve public health messages about how lifestyle risk factors impact on the chances of developing these important diseases.

Impact of acculturation on cardiovascular risk factors among elderly Mexican Americans.

PubMed

López, Lenny; Peralta, Carmen A; Lee, Anne; Zeki Al Hazzouri, Adina; Haan, Mary N

2014-10-01

Higher levels of acculturation among Latinos have been shown to be associated with a higher prevalence of cardiovascular (CV) risk factors in some studies of middle-age persons. The association of acculturation and prevalence of CV risk factors in elderly Latinos is less well established. Acculturation was measured using the validated bidimensional Acculturation Rating Scale for Mexican Americans-II. We conducted a cross-sectional analysis of the association of acculturation with prevalence of CV risk factors among 1789 elderly men and women from the Sacramento Area Latino Study on Aging using multivariate linear and logistic regression. We tested for the interaction of acculturation with risk factors by nativity status. Median age was 69.8 years. Higher acculturation was associated with lower systolic blood pressure, lower low-density lipoprotein, higher high-density lipoprotein, and lower prevalence of CV disease after age and sex adjustment. Higher acculturation remained associated with lower level of low-density lipoprotein and higher level of high-density lipoprotein after full adjustment. Nativity status did not affect these results. Contrary to other reports in middle-aged persons, higher levels of acculturation were associated with better lipid profiles and no significant differences in other CV risk factors by acculturation level in elderly Latinos. Copyright © 2014 Elsevier Inc. All rights reserved.

Prevalence and risk factors of work-related musculoskeletal disorders in the catering industry: a systematic review.

PubMed

Xu, Yan-Wen; Cheng, Andy S K; Li-Tsang, Cecilia W P

2013-01-01

This paper aims to systematically explore the prevalence and risk factors of Work-related Musculoskeletal Disorders (WMSDs) in the catering industry by reviewing relevant published literature with the goal of developing future prevention strategies. The systematic review was carried out in nine English medical databases, two Chinese-dominated full-text databases and seven web sites with the designated search strategies. Studies were included if they met the defined inclusion criteria hierarchically to investigate prevalence and or risk factors associated with WMSDs in the catering industry with appropriate epidemiological methodology. Nine English databases yielded 634 citations, and two Chinese databases yielded 401 citations, although only five English and three Chinese studies passed the inclusion criteria. Three-fourths of the studies were cross-sectional. The prevalence of WMSDs varied from 3% to 86% depending on the type of establishment and positions. The most important risk factors were physical job demands, such as work posture, force applied, and repeated movement. The lack of epidemiological information about WMSDs in the catering industry is apparent. Further studies are needed to investigate the relation among prevalence, risk factors and forms of WMSDs, in particular the interaction of risk factors in psychosocial aspects of the catering industry.

Can They Succeed? Exploring At-Risk Students' Study Habits in College General Chemistry

ERIC Educational Resources Information Center

Ye, Li; Shuniak, Constantine; Oueini, Razanne; Robert, Jenay; Lewis, Scott

2016-01-01

A well-established literature base identifies a portion of students enrolled in post-secondary General Chemistry as at-risk of failing the course based on incoming metrics. Learning about the experiences and factors that lead to this higher failure rate is essential toward improving retention in this course. This study examines the relationship…

Gender differences in the relationships between psychosocial factors and hypertension.

PubMed

Di Pilla, Marina; Bruno, Rosa Maria; Taddei, Stefano; Virdis, Agostino

2016-11-01

Gender differences in the epidemiology, pathophysiology, clinical manifestations and outcomes of cardiovascular disease are well established but there is still a lack of awareness of this both in the general population and among healthcare providers. In addition to the traditionally recognized cardiovascular risk factors, more recently psychosocial risk factors such as stress, mood disorders, low socioeconomic status and sleep disorders have been linked to cardiovascular diseases and hypertension. Psychosocial factors may have different cardiovascular consequences in men and women; thus further efforts are required to explore pathophysiological mechanisms, to obtain gender-specific data from clinical trials and to translate this knowledge into everyday clinical practice. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Association of Fibroblast Growth Factor 23 With Recurrent Cardiovascular Events in Patients After an Acute Coronary Syndrome: A Secondary Analysis of a Randomized Clinical Trial.

PubMed

Bergmark, Brian A; Udell, Jacob A; Morrow, David A; Cannon, Christopher P; Steen, Dylan L; Jarolim, Petr; Budaj, Andrzej; Hamm, Christian; Guo, Jianping; Im, KyungAh; Kuder, Julia F; Braunwald, Eugene; Sabatine, Marc S; O'Donoghue, Michelle L

2018-04-18

Elevated fibroblast growth factor 23 (FGF-23) concentrations are associated with myocardial fibrosis and renin-angiotensin system upregulation, potentially providing prognostic information distinct from standard cardiovascular (CV) biomarkers. To evaluate the association of FGF-23 with recurrent CV events in patients after an acute coronary syndrome (ACS). C-terminal FGF-23 was measured in plasma samples using an established enzyme-linked immunosorbent assay system for 4947 patients within 30 days of ACS (median, 14 days) and with 1 additional CV risk factor in the Stabilization of Plaques Using Darapladib-Thrombolysis in Myocardial Infarction 52 (SOLID-TIMI 52) trial of the lipoprotein-associated phospholipase A2 inhibitor darapladib vs placebo performed from December 1, 2009, to April 24, 2014 (median follow-up, 2.5 years). Analyses were adjusted for clinical risk factors, renal function, and established cardiorenal biomarkers. This secondary analysis was performed from September 25, 2014, to October 1, 2017. The FGF-23 concentration at baseline. The primary end point for this post hoc analysis was the composite of CV death or hospitalization for heart failure. In this study, baseline FGF-23 concentrations were available for 4947 patients (median age, 64.0 years; interquartile range, 59.0-71.0 years; 1276 [25.8%] female). Patients with higher FGF-23 concentrations were older and more likely female, with a greater proportion of hypertension, diabetes, and previous myocardial infarction. After multivariable adjustment for baseline clinical characteristics and established biomarkers (high-sensitivity troponin I, brain-type natriuretic peptide, and high-sensitivity C-reactive protein), FGF-23 concentration in the top quartile was independently associated with an increased risk of CV death or heart failure hospitalization (adjusted hazard ratio [HR], 2.35; 95% CI, 1.82-3.02; P < .001) and its individual components. Elevated FGF-23 concentration was also associated with an increased risk of all-cause mortality (adjusted HR, 2.27; 95% CI, 1.73-2.97; P < .001) and CV death, myocardial infarction, or stroke (adjusted HR, 1.42; 95% CI, 1.17-1.71; P < .001). When analyses were stratified by patient sex, the association between FGF-23 and CV risk, including CV death or heart failure, appeared to be attenuated in women (adjusted HR, 1.11; 95% CI, 0.70-1.76; P = .67) compared with men (HR, 3.11; 95% CI, 2.29-4.22; P < .001; P < .001 for interaction). In patients stabilized after ACS, elevated FGF-23 concentrations may be associated with recurrent major CV events and all-cause mortality, providing information independent of established clinical risk factors and cardiorenal biomarkers. A potential sex difference in these findings deserves further study.

Environmental cancer risks

NASA Astrophysics Data System (ADS)

Bell, Peter M.

In a long-awaited report (‘Assessment of Technologies for Determining Cancer Risks From the Environment’), the U.S. Office of Technology Assessment (OTA) has evaluated the role of environmental factors in cancer diseases. Environment is interpreted broadly as encompassing anything that interacts with humans, including the natural environment, food, radiation, the workplace, etc. Geologic factors range from geographic location to radiation and specific minerals. The report, however, is based on an inadequate data base in most instances, and its major recommendations are related to the establishment of a national cancer registry to record cancer statistics, as is done for many other diseases. Presently, hard statistics are lacking in the establishment of some association between the cause-effect relationship of most environmental factors and most carcinogens. Of particular interest, but unfortunately based on unreliable data, are the effects of mineral substances such as ‘asbestos.’ USGS mineralogist Malcolm Ross will review asbestos and its effects on human health in the forthcoming Mineralogical Society of America's Short Course on the Amphiboles (Reviews in Mineralogy, 9, in press, 1981).

The Role of Prospective Memory in Medication Adherence: A Review of an Emerging Literature

PubMed Central

Zogg, Jennifer B.; Woods, Steven Paul; Sauceda, John A.; Wiebe, John S.; Simoni, Jane M.

2013-01-01

Although neurocognitive impairment is an established risk factor for medication non-adherence, standard neurocognitive tests developed for clinical purposes may not fully capture the complexities of non-adherence behavior or effectively inform theory-driven interventions. Prospective memory, an innovative cognitive construct describing one’s ability to remember to do something at a later time, is an understudied factor in the detection and remediation of medication non-adherence. This review orients researchers to the construct of prospective memory, summarizes empirical evidence for prospective memory as a risk factor for non-adherence, discusses the relative merits of current measurement techniques, and highlights potential prospective memory-focused intervention strategies. A comprehensive literature review was conducted of published empirical studies investigating prospective memory and medication adherence. Overall, reviewed studies suggest that prospective memory is an important component of medication adherence, providing incremental ecological validity over established predictors. Findings indicate that prospective memory-based interventions might be an effective means of improving adherence. PMID:21487722

Improving risk assessments for manufactured gas plant soils by measuring PAH availability.

PubMed

Stroo, Hans F; Nakles, David V; Kreitinger, Joseph P; Loehr, Raymond C; Hawthorne, Steven B; Luthy, Richard G; Holman, Hoi-Ying; LaPierre, Adrienne

2005-07-01

Remediation of soils at oil-gas manufactured gas plant (MGP) sites is driven primarily by the human health risks posed by the carcinogenic polycyclic aromatic hydrocarbons (PAHs), particularly benzo[a]pyrene (BaP), that are associated with lampblack residues. Although PAHs on lampblack are tightly sorbed, risk assessments do not account for this reduced availability. A multi-investigator study of 7 oil-gas MGP site soil samples demonstrated that the dermal and ingestion absorption factors are far lower than current default assumptions used in risk assessments. Using these sample-specific absorption factors in standard risk assessment equations increased risk-based cleanup levels by a factor of 72 on average (with a range from 23 to 142 times the default level). The rapidly released fraction of the BaP in each sample, as measured by supercritical fluid extraction, was closely correlated (r2 = 0.96) to these calculated cleanup levels. The weight of evidence developed during this research indicates that the risks posed by PAHs on lampblack are far less than assumed when using default absorption factors and that a tiered evaluation protocol employing chemical analyses, chemical release data, and in vitro bioassays can be used to establish more realistic site-specific criteria.

Ethnicity-related variation in breast cancer risk factors.

PubMed

Bernstein, Leslie; Teal, Cayla R; Joslyn, Sue; Wilson, Jerome

2003-01-01

A variety of factors are predictors of breast cancer risk. However, the studies conducted to establish these risk factors have rarely included African American women. The few studies with sufficient numbers of African-American women suggest that risk factors for breast cancer among African-American women are similar to those of white women. Although risk factors may be similar for African-American and white women, differences in the prevalence of risk factors may explain the differences in patterns of incidence. The authors reviewed the epidemiologic studies of breast cancer among African-American women and identified resources with information regarding the prevalence of risk factors among African American and white women. Considerable variation exists in the studies of breast cancer risk factors among African American women. Because few studies have included sufficient numbers of African-American women, no firm conclusions can be drawn regarding whether risk estimates for African American women differ from those of white women. Estimates of the prevalence of breast cancer risk factors indicate that African American and white women differ in terms of their ages at menarche, menstrual cycle patterns, birth rates, lactation histories, patterns of oral contraceptive use, levels of obesity, frequency of menopausal hormone use, physical activity patterns, and alcohol intake. The risk factor profile of African-American women appears to differ from that of white women. This may explain in part, the higher incidence rates for African Americans before age 45 years and the lower incidence rates at older ages. Discussions of these data at a workshop highlighted the need for future research on breast cancer risk among African Americans. This research should acknowledge the heterogeneous heritage, cultural beliefs, and cultural knowledge of African-American women. Studies conducted in collaboration with the African-American community of women and with the breast cancer advocacy community can benefit from assistance in the design of questionnaires and recruitment of participants.

Radiation and breast cancer: a review of current evidence

PubMed Central

Ronckers, Cécile M; Erdmann, Christine A; Land, Charles E

2005-01-01

This paper summarizes current knowledge on ionizing radiation-associated breast cancer in the context of established breast cancer risk factors, the radiation dose–response relationship, and modifiers of dose response, taking into account epidemiological studies and animal experiments. Available epidemiological data support a linear dose–response relationship down to doses as low as about 100 mSv. However, the magnitude of risk per unit dose depends strongly on when radiation exposure occurs: exposure before the age of 20 years carries the greatest risk. Other characteristics that may influence the magnitude of dose-specific risk include attained age (that is, age at observation for risk), age at first full-term birth, parity, and possibly a history of benign breast disease, exposure to radiation while pregnant, and genetic factors. PMID:15642178

Health factors in the everyday life and work of public sector employees in Sweden.

PubMed

Erlandsson, Lena-Karin; Carlsson, Gunilla; Horstmann, Vibeke; Gard, Gunvor; Holmström, Eva

2012-01-01

The aim was to explore aspects of everyday life in addition to established risk factors and their relationship to subjective health and well-being among public sector employees in Sweden. Gainful employment impact on employees' health and well-being, but work is only one part of everyday life and a broader perspective is essential in order to identify health-related factors. Data were obtained from employees at six Social Insurance Offices in Sweden, 250 women and 50 men. A questionnaire based on established instruments and questions specifically designed for this study was used. Relationships between five factors of everyday life, subjective health and well-being were investigated by means of multivariate logistic regression analysis. The final model revealed a limited importance of certain work-related factors. A general satisfaction with everyday activities, a stress-free environment and general control in addition to not having monotonous movements at work were found to be factors explaining 46.3% of subjective good health and well-being. A person's entire activity pattern, including work, is important, and strategies for promoting health should take into account the person's situation as a whole. The interplay between risk and health factors is not clear and further research is warranted.

Cholera in pregnancy: outcomes from a specialized cholera treatment unit for pregnant women in Léogâne, Haiti.

PubMed

Ciglenecki, Iza; Bichet, Mathieu; Tena, Javier; Mondesir, Erneau; Bastard, Mathieu; Tran, Nguyen-Toan; Antierens, Annick; Staderini, Nelly

2013-01-01

The association between cholera in pregnancy and negative fetal outcome has been described since the 19(th) century. However, there is limited published literature on the subject. We describe pregnancy outcomes from a specialized multidisciplinary hospital unit at the onset of a large cholera outbreak in Haiti in 2010 and 2011. Pregnant women with cholera were hospitalized in a specialized unit within the MSF hospital compound in Léogâne and treated using standard cholera treatment guidelines but with earlier, more intense fluid replacement. All women had intravenous access established at admission regardless of their hydration status, and all received antibiotic treatment. Data were collected on patient demographics, pregnancy and cholera status, and pregnancy outcome. In this analysis we calculated risk ratios for fetal death and performed logistic regression analysis to control for confounding factors. 263 pregnant women with cholera were hospitalized between December 2010 and July 2011. None died during hospitalization, 226 (86%) were discharged with a preserved pregnancy and 16 (6%) had live fullterm singleton births, of whom 2 died within the first 5 days postpartum. The remaining 21 pregnancies (8%) resulted in intrauterine fetal death. The risk of fetal death was associated with factors reflecting severity of the cholera episode: after adjusting for confounding factors, the strongest risk factor for fetal death was severe maternal dehydration (adjusted risk ratio for severe vs. mild dehydration was 9.4, 95% CI 2.5-35.3, p = 0.005), followed by severe vomiting (adjusted risk ratio 5.1, 95% 1.1-23.8, p = 0.041). This is the largest cohort of pregnant women with cholera described to date. The main risk factor identified for fetal death was severity of dehydration. Our experience suggests that establishing specialized multidisciplinary units which facilitate close follow-up of both pregnancy and dehydration status due to cholera could be beneficial for patients, especially in large epidemics.

Risk factors for burnout among caregivers working in nursing homes.

PubMed

Kandelman, Nadia; Mazars, Thierry; Levy, Antonin

2018-01-01

(i) To assess the level of burnout in nursing home caregivers within a unique healthcare network in France and (ii) to evaluate potential risk factors in this population. Burnout syndrome occurs frequently among nursing home caregivers and has strong detrimental effects on the quality of health care for residents. We used an observational survey to study burnout in nursing home caregivers. The survey was used to quantify burnout level (Maslach Burnout Inventory) and potential risk factors and was implemented from October 2013-April 2014. A logistic regression was used to explore the association between burnout and its risk factors. Three hundred and sixty questionnaires were delivered to caregivers in 14 nursing homes within a unique healthcare network. The response rate was 37% (132/360), and 124/132 (94%) surveys were analysed. Caregiver burnout rate was 40% (49/124). Median age was 41 years (range, 20-70) and most caregivers were female. The most common profession (n = 54; 44%) was nurse caregiver and 90% (n = 112) had an antecedent of bullying by a resident. Risk factors identified were as follows: the presence of institutional protocols (death announcement [OR: 3.7] and pain assessment [OR: 2.8]), working in a profit-making establishment (OR: 2.6) and the antecedent of bullying by a resident (OR: 6.2). Factors most negatively associated with burnout included: practising pastimes (OR: 0.4) and working as a nurse (OR: 0.3). The only significant risk factor in the multivariate analysis was the antecedent of bullying by a resident (OR: 5.3). Several specific risk factors for burnout in nursing home caregivers were identified. In high-risk populations of healthcare professionals, screening and management of risk factors is crucial for preventing burnout. © 2017 John Wiley & Sons Ltd.

Risk Factor Detection as a Metric of STARHS Performance for HIV Incidence Surveillance Among Female Sex Workers in Kigali, Rwanda

PubMed Central

Braunstein, Sarah L; van de Wijgert, Janneke H; Vyankandondera, Joseph; Kestelyn, Evelyne; Ntirushwa, Justin; Nash, Denis

2012-01-01

Background: The epidemiologic utility of STARHS hinges not only on producing accurate estimates of HIV incidence, but also on identifying risk factors for recent HIV infection. Methods: As part of an HIV seroincidence study, 800 Rwandan female sex workers (FSW) were HIV tested, with those testing positive further tested by BED-CEIA (BED) and AxSYM Avidity Index (Ax-AI) assays. A sample of HIV-negative (N=397) FSW were followed prospectively for HIV seroconversion. We compared estimates of risk factors for: 1) prevalent HIV infection; 2) recently acquired HIV infection (RI) based on three different STARHS classifications (BED alone, Ax-AI alone, BED/Ax-AI combined); and 3) prospectively observed seroconversion. Results: There was mixed agreement in risk factors between methods. HSV-2 coinfection and recent STI treatment were associated with both prevalent HIV infection and all three measures of recent infection. A number of risk factors were associated only with prevalent infection, including widowhood, history of forced sex, regular alcohol consumption, prior imprisonment, and current breastfeeding. Number of sex partners in the last 3 months was associated with recent infection based on BED/Ax-AI combined, but not other STARHS-based recent infection outcomes or prevalent infection. Risk factor estimates for prospectively observed seroconversion differed in magnitude and direction from those for recent infection via STARHS. Conclusions: Differences in risk factor estimates by each method could reflect true differences in risk factors between the prevalent, recently, or newly infected populations, the effect of study interventions (among those followed prospectively), or assay misclassification. Similar investigations in other populations/settings are needed to further establish the epidemiologic utility of STARHS for identifying risk factors, in addition to incidence rate estimation. PMID:23056162

Evaluation critique of state of the art dyslipidemia management in general and with a special emphasis on the Indian population.

PubMed

Whayne, Thomas F

2007-01-01

Classically, there have been three well established major cardiovascular risk factors, hypercholesterolemia, hypertension and tobacco abuse. With accumulating clinical evidence, diabetes can now be added as a fourth major risk factor. Much interest in various other risk factors and possible causative factors has been generated, but it should be remembered that of all these, low density lipoproteins (LDL) remains the gold standard for evaluating risk. The common perception is that only caucasians in the western world have significant cardiovascular (CV) risk. However, much clinical information to the contrary has accumulated and now it is realized that many other ethnic groups also have significant CV disease, such as in India, especially in the urban population. Dyslipidemias of specific lipoproteins and their treatment is an important part of understanding and managing CV disease and risk. Various plasma factors such as homocysteine and lipoprotein (a) [(a)] have been considered to have definite associations with CV disease, but any treatment benefit remains in doubt. In addition, inflammatory risk factors are considered to be of significant clinical interest, especially high sensitivity C-Reactive protein (hsCRP). Where do these factors fit into routine clinical practice still awaits clarification. Only two of these inflammatory risk (Lp-factors can be tested commercially on a routine clinical basis and these are hsCRP and Lipoprotein-associated Phospholipase A2 Lp-PLA2). Their clinical utillity is not established and acceptance is limited: some third party health coverage organizations refuse to pay for such analyses. In the past, women have been looked upon as not having significant CV disease. More recently, evidence suggests that women may have more CV disease than men, and that physicians may have failed to realize this and act accordingly. The true situation is that women have less CV disease than men prior to menopause and then they slowly catch up. However, some women under age 50 have an especially malignant form of CV disease and in these cases, myocardial infarction mortality is twice that of men. The explanation and management is the subject of much clinical investigation. In both India and the western world, perhaps the most important medical problem is the metabolic syndrome (MS) and this combination of CV risk factors multiplies the significance of each. For the difficult patient not tolerant of or sufficiently responsive to conventional therapy, alternative diets and medications can frequently offer just enough benefit in lowering LDL to allow the patient to attain their target level. Future treatments undoubtedly will involve genetics, but for now, aggressive medication use can favorably modify risk although not eliminate it.

[Study on building index system of risk assessment of post-marketing Chinese patent medicine based on AHP-fuzzy neural network].

PubMed

Li, Yuanyuan; Xie, Yanming; Fu, Yingkun

2011-10-01

Currently massive researches have been launched about the safety, efficiency and economy of post-marketing Chinese patent medicine (CPM) proprietary Chinese medicine, but it was lack of a comprehensive interpretation. Establishing the risk evaluation index system and risk assessment model of CPM is the key to solve drug safety problems and protect people's health. The clinical risk factors of CPM exist similarities with the Western medicine, can draw lessons from foreign experience, but also have itself multi-factor multivariate multi-level complex features. Drug safety risk assessment for the uncertainty and complexity, using analytic hierarchy process (AHP) to empower the index weights, AHP-based fuzzy neural network to build post-marketing CPM risk evaluation index system and risk assessment model and constantly improving the application of traditional Chinese medicine characteristic is accord with the road and feasible beneficial exploration.

Potential risk factors associated with contact dermatitis, lameness, negative emotional state, and fear of humans in broiler chicken flocks.

PubMed

Bassler, A W; Arnould, C; Butterworth, A; Colin, L; De Jong, I C; Ferrante, V; Ferrari, P; Haslam, S; Wemelsfelder, F; Blokhuis, H J

2013-11-01

The objectives of this study were to 1) identify determinants of poor welfare in commercial broiler chicken flocks by studying the associations between selected resource-based measures (RBM, potential risk factors), such as litter quality and dark period, and animal-based welfare indicators (ABM), such as foot pad dermatitis and lameness, and 2) establish the breadth of effect of a risk factor by determining the range of animal welfare indicators associated with each of the risk factors (i.e., the number of ABM related to a specific RBM). Eighty-nine broiler flocks were inspected in 4 European countries (France, Italy, the United Kingdom, and the Netherlands) in a cross-sectional study. The ABM were contact dermatitis (measured using scores of foot-pad dermatitis and hock burn, respectively), lameness (measured as gait score), fear of humans (measured by the avoidance distance test and the touch test), and negative emotional state (measured using qualitative behavior assessment, QBA). In a first step, risk factors were identified by building a multiple linear regression model for each ABM. Litter quality was identified as a risk factor for contact dermatitis. Length of dark period at 3 wk old (DARK3) was a risk factor for the touch test result. DARK3 and flock age were risk factors for lameness, and the number of different stockmen and DARK3 were risk factors for QBA results. Next, the ABM were grouped according to risk factor and counted. Then, in a second step, associations between the ABM were investigated using common factor analysis. The breadth of a risk factor's effect was judged by combining the number (count) of ABM related to this factor and the strength of association between these ABM. Flock age and DARK3 appeared to affect several weakly correlated ABM, thus indicating a broad range of effects. Our findings suggest that manipulation of the predominant risk factors identified in this study (DARK3, litter quality, and slaughter age) could generate improvements in the related ABM and thereby enhance the birds' overall welfare status.

European Scientific Notes. Volume 34, Number 11,

DTIC Science & Technology

1980-11-30

assumed risk factor of 2 x 10-4 1 reason for the risk to the public from man-rem, coal and oil stems from the assumedwhich includes cancers plus genetic ... genetic make-up, increasing rate of mor- types would lead to indirect risks tality, formation of extremist groups, (police state, etc.), but were...biology and reproduction of echinoderms In 1957, the University of Paris and siphonophores , (5) The physiology established a second laboratory, the Sta

Musculoskeletal pain in Europe: role of personal, occupational and social risk factors

PubMed Central

Farioli, Andrea; Mattioli, Stefano; Quaglieri, Anna; Curti, Stefania; Violante, Francesco S; Coggon, David

2014-01-01

Objectives Prevalence of musculoskeletal pain in European countries varies considerably. We analyzed data from the fifth European Working Conditions Survey (EWCS) to explore the role of personal, occupational, and social risk factors in determining the national prevalence of musculoskeletal pain. Methods During 2010, 43,816 subjects from 34 countries were interviewed. We analyzed the one-year prevalence of back and neck/upper limb pain. Personal risk factors studied were: sex; age; educational level; socio-economic status; housework or cooking; gardening and repairs; somatising tendency; job demand-control; six physical occupational exposures; and occupational group. Data on national socio-economic risk factors were obtained from eurostat and were available for 29 countries. We fitted Poisson regression models with random intercept on country. Results 35,550 workers entered the main analysis. Among personal risk factors, somatising tendency was the strongest predictor of the symptoms. Major differences were observed by country with back pain more than twice as common in Portugal (63.8%) as Ireland (25.7%), and prevalence rates of neck/upper limb pain ranging from 26.6% in Ireland to 67.7% in Finland. Adjustment by personal risk factors slightly reduced the large variation of prevalence between countries. For back pain, the rates were more homogenous after adjustment for social risk factors. Conclusions Our analysis indicates substantial variation between European countries in the prevalence of back and neck/upper limb pain. This variation is unexplained by established individual risk factors. It may be attributable in part to socio-economic differences between countries, with higher prevalence where there is less poverty and more social support. PMID:24009006

The elaboration likelihood model and communication about food risks.

PubMed

Frewer, L J; Howard, C; Hedderley, D; Shepherd, R

1997-12-01

Factors such as hazard type and source credibility have been identified as important in the establishment of effective strategies for risk communication. The elaboration likelihood model was adapted to investigate the potential impact of hazard type, information source, and persuasive content of information on individual engagement in elaborative, or thoughtful, cognitions about risk messages. One hundred sixty respondents were allocated to one of eight experimental groups, and the effects of source credibility, persuasive content of information and hazard type were systematically varied. The impact of the different factors on beliefs about the information and elaborative processing examined. Low credibility was particularly important in reducing risk perceptions, although persuasive content and hazard type were also influential in determining whether elaborative processing occurred.

Management Status of Cardiovascular Disease Risk Factors for Dyslipidemia among Korean Adults

PubMed Central

Lee, Jongseok

2017-01-01

Purpose Dyslipidemia, hypertension, and diabetes are well-established risk factors for cardiovascular disease (CVD). This study investigated the prevalence and management status of these factors for dyslipidemia among Korean adults aged 30 years old and older. Materials and Methods The prevalence and management status of dyslipidemia, hypertension, and diabetes were analyzed among 12229 subjects (≥30 years) participating in the Korea National Health and Nutrition Survey 2010–2012. Dyslipidemia was defined according to treatment criteria rather than diagnostic criteria in Korea. Therefore, hyper-low-density lipoprotein (LDL) cholesterolemia was defined if LDL cholesterol levels exceeded the appropriate risk-based threshold established by the National Cholesterol Education Program Adult Treatment Panel III. Results The age-standardized prevalence was highest for dyslipidemia (39.6%), followed by hypertension (32.8%) and diabetes (9.8%). The lowest patient awareness was found for dyslipidemia (27.9%). The treatment rate was 66.5% for diabetes and 57.3% for hypertension, but only 15.7% for dyslipidemia. The control rate among those undergoing treatment was highest for hypertension (64.2%), followed by dyslipidemia (59.2%) and diabetes (22.1%). The higher the risk levels of CVD were, the lower the control rate of dyslipidemia. Conclusion While the prevalence of dyslipidemia was higher than hypertension and diabetes, awareness and treatment rates thereof were lower. Higher CVD-risk categories showed lower control rates of dyslipidemia. In order to improve awareness and control rates of dyslipidemia, diagnostic criteria should be reconciled with treatment targets based on cardiovascular risk in Korean populations. PMID:28120563

Food safety in raw milk production: risk factors associated to bacterial DNA contamination.

PubMed

Cerva, Cristine; Bremm, Carolina; Reis, Emily Marques dos; Bezerra, André Vinícius Andrade; Loiko, Márcia Regina; Cruz, Cláudio Estêvão Farias da; Cenci, Alexander; Mayer, Fabiana Quoos

2014-06-01

While human illness from milkborne pathogens may be linked to contamination of the product after pasteurization or improper pasteurization, such diseases are usually associated with consumption of raw milk or its by-products. Molecular biology tools were applied to investigate contamination by Listeria monocytogenes, Salmonella spp., some pathogenic strains of Escherichia coli, and Campylobacter jejuni in 548 raw milk samples from 125 dairy farms established in two regions from southern Brazil. Moreover, 15 variables were evaluated for their association with raw milk contamination levels, and the risk factors were determined by multiple regression analysis. Salmonella spp. were more frequently detected, followed by pathogenic E. coli. There was difference in contamination index between the regions, in which risk factors such as temporary cattle confinement, low milk production, low milking machine cleaning frequency, and milk storage area without tile walls were identified. The risk factors were specific to each region studied. Nevertheless, the data can be used to improve milk quality of dairy farms/herds with similar management practices.

Do adolescent delinquency and problem drinking share psychosocial risk factors? A literature review.

PubMed

Curcio, Angela L; Mak, Anita S; George, Amanda M

2013-04-01

Despite the prevalence and damaging effects of adolescent problem drinking, relative to delinquency, far less research has focused on drinking using an integrated theoretical approach. The aim of the current research was to review existing literature on psychosocial risk factors for delinquency and problem drinking, and explore whether integrating elements of social learning theory with an established psychosocial control theory of delinquency could explain adolescent problem drinking. We reviewed 71 studies published post-1990 with particular focus on articles that empirically researched risk factors for adolescent problem drinking and delinquency in separate and concurrent studies and meta-analytic reviews. We found shared risk factors for adolescent delinquency and problem drinking that are encompassed by an extension of psychosocial control theory. The potential of an extended psychosocial control theory providing a parsimonious theoretical approach to explaining delinquency, problem drinking and other adolescent problem behaviours, along with suggestions for future investigations, is discussed. Copyright © 2012 Elsevier Ltd. All rights reserved.

Worksite-based cardiovascular risk screening and management: a feasibility study.

PubMed

Padwal, Raj; Rashead, Mohammad; Snider, Jonathan; Morrin, Louise; Lehman, Agnes; Campbell, Norm Rc

2017-01-01

Established cardiovascular risk factors are highly prevalent and contribute substantially to cardiovascular morbidity and mortality because they remain uncontrolled in many Canadians. Worksite-based cardiovascular risk factor screening and management represent a largely untapped strategy for optimizing risk factor control. In a 2-phase collaborative demonstration project between Alberta Health Services (AHS) and the Alberta Newsprint Company (ANC), ANC employees were offered cardiovascular risk factor screening and management. Screening was performed at the worksite by AHS nurses, who collected baseline history, performed automated blood pressure measurement and point-of-care testing for lipids and A1c, and calculated 10-year Framingham risk. Employees with a Framingham risk score of ≥10% and uncontrolled blood pressure, dyslipidemia, or smoking were offered 6 months of pharmacist case management to optimize their risk factor control. In total, 87 of 190 (46%) employees volunteered to undergo cardiovascular risk factor screening. Mean age was 44.5±11.9 years, 73 (83.9%) were male, 14 (16.1%) had hypertension, 4 (4.6%) had diabetes, 12 (13.8%) were current smokers, and 9 (10%) had dyslipidemia. Of 36 employees with an estimated Framingham risk score of ≥10%, 21 (58%) agreed to receive case management and 15 (42%) attended baseline and 6-month follow-up case management visits. Statistically significant reductions in left arm systolic blood pressure (-8.0±12.4 mmHg; p =0.03) and triglyceride levels (-0.8±1.4 mmol/L; p =0.04) occurred following case management. These findings demonstrate the feasibility and usefulness of collaborative, worksite-based cardiovascular risk factor screening and management. Expansion of this type of partnership in a cost-effective manner is warranted.

Identity Formation, Outness and Sexual Risk among Gay and Bisexual Men

PubMed Central

White, Darcy; Stephenson, Rob

2014-01-01

Research on HIV among men who have sex with men (MSM) has focused on individual behavioral and biomedical factors driving transmission risks, but these cannot be fully understood without also understanding the social context within which sexual minorities live. Using data from 703 gay and bisexual men in Atlanta, this study explores the factors associated with homosexual identity formation and disclosure (“outness”) and examines how these constructs are associated with sexual risk taking. In multivariable regression models, sexual identity and outness were associated with age, race, education, employment, and experience of discrimination. Independent of these factors, having a more established and open homosexual identity was associated with lower sexual risk behaviors. These results highlight the need to address discriminatory policies and values in society and call for programs to provide support and promote healthy identity development among vulnerable groups. PMID:23690365

Potential benefits of weight loss in coronary heart disease.

PubMed

Ades, Philip A; Savage, Patrick D

2014-01-01

The prevalence of overweight, obesity and insulin resistance in patients with coronary heart disease (CHD) exceeds that of the general population. Obesity is associated with a constellation of coronary risk factors that predispose to the development and progression of CHD. Intentional weight loss, accomplished through behavioral weight loss and exercise, improves insulin sensitivity and associated cardio-metabolic risk factors such as lipid measures, blood pressure, measures of inflammation and vascular function both in healthy individuals and patients with CHD. Additionally, physical fitness, physical function and quality of life all improve. There is evidence that intentional weight loss prevents the onset of CHD in high risk overweight individuals. While weight loss associated improvements in insulin resistance, fitness and related risk factors strongly supports favorable prognostic effects in individuals with established CHD, further study is needed to determine if long-term clinical outcomes are improved. © 2014.

[Zoonosis transmission risk factors according to population habits inIlha Solteira city, Brazil].

PubMed

Sánchez-Ortiz, Iván A; Leite, Maurício A

2011-06-01

Determining conditions regarding possible zoonosis transmission risk based on Ilha Solteira-São Paulo citizens' habits aimed at establishing concrete recommendations for the corresponding local authorities to reduce some risk factors. 100 focalized interviews were held on Ilha Solteira's urban perimeter during April 2008. The people interviewed were adults who lived or worked in houses in the study area. This research found a significant number of cat and/or dog owners who allowed their pets to stay in internal areas of their houses. They did not define a specific place for animals to defecate and/or urinate or did not arrange appropriate final disposal of such waste. Local authorities must make greater efforts at educating Ilha Solteira pets' owners and providing them with information and encouraging greater citizen commitment and awareness to improve habits related to caring for pets/animal sand reducing zoonosis transmission risk factors.

[Birds, mosquitoes and West Nile virus: little risk of West Nile fever in the Netherlands].

PubMed

Duijster, Janneke W; Stroo, C J Arjan; Braks, Marieta A H

2016-01-01

Due to increased incidence of West Nile fever (WNF) in Europe and the rapid spread of West Nile virus (WNV) in the US, it is commonly thought that it will only be a matter of time before WNV reaches the Netherlands. However, assessing whether WNV is really a threat to the Dutch population is challenging, due to the numerous factors affecting transmission of the virus. Some of these factors are known to limit the risk of WNF in the Netherlands. This risk is determined by the interaction between the pathogen (WNV), the vectors (Culex mosquitoes), the reservoirs (birds) and the exposure of humans to infected mosquitoes. In this paper, we discuss the factors influencing introduction, establishment and spread of WNV in the Netherlands. The probability that each of these three phases will occur in the Netherlands is currently relatively small, as is the risk of WNF infection in humans in the Netherlands.

Risk factors of major noncommunicable diseases in Bahrain. The need for a surveillance system.

PubMed

Hamadeh, Randah R

2004-09-01

Noncommunicable diseases NCDs are the major cause of morbidity and mortality in Bahrain. The review examines the prevalence of risk factors of major NCDs from the available literature and determines the impact of the rapid socio economic changes on their burden. It further recommends ways of improving their reporting and monitoring. Smoking, obesity, diabetes, hypertension, hyperlipidemia, physical activity and nutrition are considered. The review points out that data on some of the factors is available but deficient for others. The call for the establishment of an integrated surveillance system using the World Health Organization STEPwise approach is stressed.

Retinopathy of prematurity - from recognition of risk factors to treatment recommendations.

PubMed

Fagerholm, Reija; Vesti, Eija

Retinopathy of prematurity is a proliferative retinal disorder diagnosed exclusively in prematurely born infants. In retinopathy of prematurity, growth of the retinal vasculature is disturbed, leading to hypoxia-induced pathological changes typical of retinopathy of prematurity, in the worst case resulting in retinal detachment. The most typical risk factors predisposing to the disease include hyperoxemia, low levels of insulin-like growth factor 1 (IGF-I), and low birth weight in relation to weeks of pregnancy. Laser therapy of peripheral retina is the currently established form of treatment. Screening is applied in order to recognize the pathological changes in retinopathy of prematurity early enough.

Management of severe asthma: targeting the airways, comorbidities and risk factors.

PubMed

Gibson, Peter G; McDonald, Vanessa M

2017-06-01

Severe asthma is a complex heterogeneous disease that is refractory to standard treatment and is complicated by multiple comorbidities and risk factors. In mild to moderate asthma, the burden of disease can be minimised by inhaled corticosteroids, bronchodilators and self-management education. In severe asthma, however, management is more complex. When patients with asthma continue to experience symptoms and exacerbations despite optimal management, severe refractory asthma (SRA) should be suspected and confirmed, and other aetiologies ruled out. Once a diagnosis of SRA is established, patients should undergo a systematic and multidimensional assessment to identify inflammatory endotypes, risk factors and comorbidities, with targeted and individualised management initiated. We describe a practical approach to assessment and management of patients with SRA. © 2017 Royal Australasian College of Physicians.

Lifetime risk of stroke in young-aged and middle-aged Chinese population: the Chinese Multi-Provincial Cohort Study

PubMed Central

Wang, Ying; Liu, Jing; Wang, Wei; Wang, Miao; Qi, Yue; Xie, Wuxiang; Li, Yan; Sun, Jiayi; Liu, Jun; Zhao, Dong

2016-01-01

Objective: Stroke is a major cause of premature death in China. Early prevention of stroke requires a more effective method to differentiate the stroke risk among young-aged and middle-aged individuals than the 10-year risk of cardiovascular disease. This study aimed to establish a lifetime stroke risk model and risk charts for the young-aged and middle-aged population in China. Methods: The Chinese Multi-Provincial Cohort Study participants (n = 21 953) aged 35–84 years without cardiovascular disease at baseline were followed for 18 years (263 016 person-years). Modified Kaplan–Meier method was used to estimate the mean lifetime stroke risk up to age of 80 years and the lifetime stroke risk according to major stroke risk factors for the population aged 35–60 years. Results: A total of 917 participants developed first-ever strokes. For the participants aged 35–40 years (98 stroke cases), the lifetime stroke risk was 18.0 and 14.7% in men and women, respectively. Blood pressure most effectively discriminated the lifetime stroke risk. The lifetime risk of stroke for the individuals with all risk factors optimal was 8–10 times lower compared with those with two or more high risk factors at age 35–60 years at baseline. Conclusion: In young-aged and middle-aged population, the lifetime stroke risk will keep very low if major risk factors especially blood pressure level is at optimal levels, but the risk substantially increases even with a slight elevation of major risk factors, which could not be identified using 10-year risk estimation. PMID:27512963

The role of exogenous risk factors of antituberculosis treatment failure.

PubMed

Lesnic, Evelina; Ustian, Aurelia; Pop, Carmen Monica

2016-01-01

The Republic of Moldova reports the highest incidence of tuberculosis and the lowest treatment success rate among European region countries. In most of the patients the antituberculosis treatment failure is correlated with social risk factors (low socio-economical state, epidemiological danger characteristics) and biological factors (young age, male sex, physiological conditions, associated diseases). Clinical factors (advanced forms of tuberculosis, chronic evolution, immune disturbances), therapeutic factors (treatment errors and interruptions, individualized regimens) and administrative factors (drug interruption in supply, suboptimal treatment quality) prevail in regions with defficient in health care delivery. The association of risk factors has a higher impact than the severity of one risk factor. The risk factor assessment is very important before initiation of the treatment, for establishing the plan of risk reduction measures for increasing the success rate. The aim of the study was to determine the impact of exogenous risk factors on antituberculosis treatment failure. The study was conducted on 201 patients with pulmonary tuberculosis and treatment failure and 105 patients with pulmonary tuberculosis who successfully finished the antituberculosis treatment. Selected cases were investigated according national standards. The treatment failure occurred in patients belonging to socially disadvantaged groups, patients with harmful habits (alcohol abuse, drug use, active smoking), patients from infectious clusters. Migration, homelessness and detention releasing imperil the quality of treatment, thus predisposing to the treatment failure. Social, educational support and the substitutive therapy and withdrawal techniques (tobacco, alcohol, psycho-active substances) must be implemented in the high risk groups in order to diminish the risk of treatment failure and to increase the treatment success rate. The study of exogenous risk factors in vulnerable groups will contribute to the precocious detection of patients predisposed to failing the tuberculosis treatment and will permit the initiation of measures centered on patient that will favor the increase of treatment quality and success rate.

The role of exogenous risk factors of antituberculosis treatment failure

PubMed Central

LESNIC, EVELINA; USTIAN, AURELIA; POP, CARMEN MONICA

2016-01-01

Background and aim The Republic of Moldova reports the highest incidence of tuberculosis and the lowest treatment success rate among European region countries. In most of the patients the antituberculosis treatment failure is correlated with social risk factors (low socio-economical state, epidemiological danger characteristics) and biological factors (young age, male sex, physiological conditions, associated diseases). Clinical factors (advanced forms of tuberculosis, chronic evolution, immune disturbances), therapeutic factors (treatment errors and interruptions, individualized regimens) and administrative factors (drug interruption in supply, suboptimal treatment quality) prevail in regions with defficient in health care delivery. The association of risk factors has a higher impact than the severity of one risk factor. The risk factor assessment is very important before initiation of the treatment, for establishing the plan of risk reduction measures for increasing the success rate. The aim of the study was to determine the impact of exogenous risk factors on antituberculosis treatment failure. Methods The study was conducted on 201 patients with pulmonary tuberculosis and treatment failure and 105 patients with pulmonary tuberculosis who successfully finished the antituberculosis treatment. Selected cases were investigated according national standards. Results The treatment failure occurred in patients belonging to socially disadvantaged groups, patients with harmful habits (alcohol abuse, drug use, active smoking), patients from infectious clusters. Migration, homelessness and detention releasing imperil the quality of treatment, thus predisposing to the treatment failure. Social, educational support and the substitutive therapy and withdrawal techniques (tobacco, alcohol, psycho-active substances) must be implemented in the high risk groups in order to diminish the risk of treatment failure and to increase the treatment success rate. Conclusions The study of exogenous risk factors in vulnerable groups will contribute to the precocious detection of patients predisposed to failing the tuberculosis treatment and will permit the initiation of measures centered on patient that will favor the increase of treatment quality and success rate. PMID:27547060

Development and validation of a risk assessment tool for gastric cancer in a general Japanese population.

PubMed

Iida, Masahiro; Ikeda, Fumie; Hata, Jun; Hirakawa, Yoichiro; Ohara, Tomoyuki; Mukai, Naoko; Yoshida, Daigo; Yonemoto, Koji; Esaki, Motohiro; Kitazono, Takanari; Kiyohara, Yutaka; Ninomiya, Toshiharu

2018-05-01

There have been very few reports of risk score models for the development of gastric cancer. The aim of this study was to develop and validate a risk assessment tool for discerning future gastric cancer risk in Japanese. A total of 2444 subjects aged 40 years or over were followed up for 14 years from 1988 (derivation cohort), and 3204 subjects of the same age group were followed up for 5 years from 2002 (validation cohort). The weighting (risk score) of each risk factor for predicting future gastric cancer in the risk assessment tool was determined based on the coefficients of a Cox proportional hazards model in the derivation cohort. The goodness of fit of the established risk assessment tool was assessed using the c-statistic and the Hosmer-Lemeshow test in the validation cohort. During the follow-up, gastric cancer developed in 90 subjects in the derivation cohort and 35 subjects in the validation cohort. In the derivation cohort, the risk prediction model for gastric cancer was established using significant risk factors: age, sex, the combination of Helicobacter pylori antibody and pepsinogen status, hemoglobin A1c level, and smoking status. The incidence of gastric cancer increased significantly as the sum of risk scores increased (P trend < 0.001). The risk assessment tool was validated internally and showed good discrimination (c-statistic = 0.76) and calibration (Hosmer-Lemeshow test P = 0.43) in the validation cohort. We developed a risk assessment tool for gastric cancer that provides a useful guide for stratifying an individual's risk of future gastric cancer.

Current Understanding of Lifestyle and Environmental Factors and Risk of Non-Hodgkin Lymphoma: An Epidemiological Update

PubMed Central

Bassig, Bryan A.; Lan, Qing; Rothman, Nathaniel; Zhang, Yawei; Zheng, Tongzhang

2012-01-01

The incidence rates of non-Hodgkin lymphoma (NHL) have steadily increased over the last several decades in the United States, and the temporal trends in incidence can only be partially explained by the HIV epidemic. In 1992, an international workshop sponsored by the United States National Cancer Institute concluded that there was an “emerging epidemic” of NHL and emphasized the need to investigate the factors responsible for the increasing incidence of this disease. Over the past two decades, numerous epidemiological studies have examined the risk factors for NHL, particularly for putative environmental and lifestyle risk factors, and international consortia have been established in order to investigate rare exposures and NHL subtype-specific associations. While few consistent risk factors for NHL aside from immunosuppression and certain infectious agents have emerged, suggestive associations with several lifestyle and environmental factors have been reported in epidemiologic studies. Further, increasing evidence has suggested that the effects of these and other exposures may be limited to or stronger for particular NHL subtypes. This paper examines the progress that has been made over the last twenty years in elucidating the etiology of NHL, with a primary emphasis on lifestyle factors and environmental exposures. PMID:23008714

Normally Expected Aberrations in the 8-hour Dynamic EKG

NASA Technical Reports Server (NTRS)

Fleck, R. L.; Arnoldi, L. B.; Townsend, J. C.; Tonesk, X.

1970-01-01

The establishment of norms for interpreting long term dynamic electrocardiograms is attempted by correlating a completely disease symptom and cardiac risk factor free sample with a non-pure sample in the direction of normality on various variables. Out of a population of 362 subjects exposed to dynamic electrocardiogram testing, a discrimination between normals and abnormals in terms of traditional risk factors was observed. The two groups differed significantly on the following variables: cholesterol, smoking, systolic blood pressure, white blood count, fasting blood sugar, uric acid, resting EKG, year of birth, and coronary insufficiency.

A simulation model to investigate the impact of cardiovascular risk in renal transplantation.

PubMed

McLean, D R; Jardine, A G

2005-06-01

Premature cardiovascular (CV) disease is the leading cause of death following renal transplantation and, as a consequence of death with a functioning graft, it is a major cause of graft loss. Renal transplant recipients have a high prevalence of CV risk factors that influence both patient and graft survival. We used data on the relationship between CV risk factors and graft and patient survivals to develop a discrete event simulation model to study the possible impact of CV risk factor reduction on transplant outcome. The simulation was based on a renal unit in a population that has the risk factor profile of patients from the West of Scotland. We studied the dynamic between patient numbers on the waiting list compared to the transplanted list. After establishing results pertinent to the renal unit, we investigated in what way potential changes to transplant policy affected patient numbers. These perturbations included changing the number of transplants performed, changing the incidence of acute rejection, and interventional policies where patients on the waiting list were selectively transplanted taking into account their CV risk factor profiles. Overall, the model predicts that reducing CV risk in the population with end-stage renal failure awaiting kidney transplantation will have comparable benefits to foreseeable developments in immunosuppression or attainable increases in transplant numbers. Moreover, addressing CV risk has benefits for all patients regardless of whether or not they ultimately receive a kidney transplant.

Risk assessment and adaptive runoff utilization in water resource system considering the complex relationship among water supply, electricity generation and environment

NASA Astrophysics Data System (ADS)

Zhou, J.; Zeng, X.; Mo, L.; Chen, L.; Jiang, Z.; Feng, Z.; Yuan, L.; He, Z.

2017-12-01

Generally, the adaptive utilization and regulation of runoff in the source region of China's southwest rivers is classified as a typical multi-objective collaborative optimization problem. There are grim competitions and incidence relation in the subsystems of water supply, electricity generation and environment, which leads to a series of complex problems represented by hydrological process variation, blocked electricity output and water environment risk. Mathematically, the difficulties of multi-objective collaborative optimization focus on the description of reciprocal relationships and the establishment of evolving model of adaptive systems. Thus, based on the theory of complex systems science, this project tries to carry out the research from the following aspects: the changing trend of coupled water resource, the covariant factor and driving mechanism, the dynamic evolution law of mutual feedback dynamic process in the supply-generation-environment coupled system, the environmental response and influence mechanism of coupled mutual feedback water resource system, the relationship between leading risk factor and multiple risk based on evolutionary stability and dynamic balance, the transfer mechanism of multiple risk response with the variation of the leading risk factor, the multidimensional coupled feedback system of multiple risk assessment index system and optimized decision theory. Based on the above-mentioned research results, the dynamic method balancing the efficiency of multiple objectives in the coupled feedback system and optimized regulation model of water resources is proposed, and the adaptive scheduling mode considering the internal characteristics and external response of coupled mutual feedback system of water resource is established. In this way, the project can make a contribution to the optimal scheduling theory and methodology of water resource management under uncertainty in the source region of Southwest River.

NEDD9, an independent good prognostic factor in intermediate-risk acute myeloid leukemia patients

PubMed Central

Pallarès, Victor; Hoyos, Montserrat; Chillón, M. Carmen; Barragán, Eva; Conde, M. Isabel Prieto; Llop, Marta; Céspedes, María Virtudes; Nomdedeu, Josep F.; Brunet, Salut; Sanz, Miguel Ángel; González-Díaz, Marcos; Sierra, Jorge; Casanova, Isolda; Mangues, Ramon

2017-01-01

Intermediate-risk acute myeloid leukemia (IR-AML) is the largest subgroup of AML patients and is highly heterogeneous. Whereas adverse and favourable risk patients have well-established treatment protocols, IR-AML patients have not. It is, therefore, crucial to find novel factors that stratify this subgroup to implement risk-adapted strategies. The CAS (Crk-associated substrate) adaptor protein family regulates cell proliferation, survival, migration and adhesion. Despite its association with metastatic dissemination and prognosis of different solid tumors, the role of these proteins in hematological malignancies has been scarcely evaluated. Nevertheless, previous work has established an important role for the CAS family members NEDD9 or BCAR1 in the migratory and dissemination capacities of myeloid cells. On this basis, we hypothesized that NEDD9 or BCAR1 expression levels could associate with survival in IR-AML patients and become new prognostic markers. To that purpose, we assessed BCAR1 and NEDD9 gene expression in a cohort of 73 adult AML patients validating the results in an independent cohort (n = 206). We have identified NEDD9, but not BCAR1, as a new a marker for longer overall and disease-free survival, and for lower cumulative incidence of relapse. In summary, NEDD9 gene expression is an independent prognostic factor for favourable prognosis in IR-AML patients. PMID:29100287

[The influence of Sudden Infant Death Syndrome (SIDS) risk factors on health, growth and development in the first year of life. A preliminary report].

PubMed

Zakrzewski, Maciej; Wojtak, Jerzy; Mazurkiewicz, Hanna; Grygalewicz, Jacek

2005-01-01

To establish the occurrence of SIDS risk factors (including 'removable' ones) and the incidence of the ecg long QT interval (accepted as a risk factor) and their influence upon infants development and morbidity. A group of 98 infants from normal birth at term to the end of first year of life was observed. The data sources were as follows: 1) a questionnaire filled by mothers before discharge front maternity ward, 2) records of four consecutive medical examinations (including ecg records) performed on 3rd day and 3rd, 6th and 12th month of life. Chi-Square test and Fisher test were used. The most often identified risk factors were: prone sleeping position of infant (60.2%), environmental and maternal tobacco smoking (40.8%) and bed sharing practices (32.6%). A significant but transient signs of delay in psychomotor development (in motor zone) as well as more frequent respiratory tract infections in infants sleeping prone were noted. There were no deaths in the observed group neither cases of long QT interval. 1) the most frequently occurring SIDS risk factors are: environmental tobacco smoking, infant prone sleeping and bed sharing, 2) these inappropriate nursing practices and improper habits of adult family members known as a 'removable' SIDS risk factors have a bad effect on infant health and development, 3) identification of SIDS risk factors in an infant does not predict crib death.

Clinical correlates of vitamin D deficiency in established psychosis.

PubMed

Lally, J; Gardner-Sood, P; Firdosi, M; Iyegbe, C; Stubbs, B; Greenwood, K; Murray, R; Smith, S; Howes, O; Gaughran, F

2016-03-22

Suboptimal vitamin D levels have been identified in populations with psychotic disorders. We sought to explore the relationship between vitamin D deficiency, clinical characteristics and cardiovascular disease risk factors among people with established psychosis. Vitamin D levels were measured in 324 community dwelling individuals in England with established psychotic disorders, along with measures of mental health, cardiovascular risk and lifestyle choices. Vitamin D deficiency was defined as serum 25-hydroxyvitamin D (25-OHD) levels below 10 ng/ml (equivalent to <25 nmol/L) and "sufficient" Vitamin D as above 30 ng/ml (>50 nmol/L). The mean 25-OHD serum level was 12.4 (SD 7.3) ng/ml, (range 4.0-51.7 ng/ml). Forty nine percent (n = 158) were vitamin D deficient, with only 14 % (n = 45) meeting criteria for sufficiency. Accounting for age, gender, ethnicity and season of sampling, serum 25-OHD levels were negatively correlated with waist circumference (r = -0.220, p < 0.002), triglycerides (r = -0.160, p = 0.024), total cholesterol (r = -0.144, p = 0.043), fasting glucose (r = -0.191, p = 0.007), HbA1c (r = -0.183, p = 0.01), and serum CRP levels (r = -0.211, p = 0.003) and were linked to the presence of metabolic syndrome. This is the largest cross sectional study of serum 25-OHD levels in community dwelling individuals with established psychosis, indicating a high level of vitamin D deficiency. Lower vitamin D levels are associated with increased cardiovascular disease risk factors and in particular metabolic syndrome. Further research is needed to define appropriate protocols for vitamin D testing and supplementation in practice to see if this can improve cardiovascular disease risk. ISRCTN number is ISRCTN58667926 Date of registration: 23/04/2010.

Epidemiology of ovarian cancer.

PubMed

Permuth-Wey, Jennifer; Sellers, Thomas A

2009-01-01

Ovarian cancer represents the sixth most commonly diagnosed cancer among women in the world, and causes more deaths per year than any other cancer of the female reproductive system. Despite the high incidence and mortality rates, the etiology of this disease is poorly understood. Established risk factors for ovarian cancer include age and having a family history of the disease, while protective factors include increasing parity, oral contraceptive use, and oophorectomy. Lactation, incomplete pregnancies, and surgeries such as hysterectomy and tubal ligation may confer a weak protective effect against ovarian cancer. Infertility may contribute to ovarian cancer risk among nulliparous women. Other possible risk factors for ovarian cancer include postmenopausal hormone-replacement therapy and lifestyle factors such as cigarette smoking and alcohol consumption. Many of the causes of ovarian cancer are yet to be identified. Additional research is needed to better understand the etiology of this deadly disease.

Traditional and emerging cardiovascular and renal risk factors: an epidemiologic perspective.

PubMed

Zoccali, C

2006-07-01

Patients with chronic kidney disease (CKD) represent an important segment of the population (7-10%) and, mostly because of the high risk of cardiovascular complications associated with renal insufficiency, detection and treatment of CKD is now a public health priority. Traditional risk factors can incite renal dysfunction and cardiovascular damage as well. As renal function deteriorates, non-traditional risk factors play an increasing role both in glomerular filtration rate (GFR) loss and cardiovascular damage. Secondary analyses of controlled clinical trials suggest that inflammation may be a modifiable risk factor both for cardiac ischemia and renal disease progression in patients with or at risk of coronary heart disease. Homocysteine predicts renal function loss in the general population and cardiovascular events in end-stage renal disease (ESRD), but evidence that this sulfur amino acid is directly implicated in the progression of renal disease and in the high cardiovascular mortality of uremic patients is still lacking. High sympathetic activity and raised plasma concentration of asymmetric dimethylarginine (ADMA) have been associated to reduced GFR in patients with CKD and to cardiovascular complications in those with ESRD but again we still lack clinical trials targeting these risk factors. Presently, the clinical management of CKD patients remains largely unsatisfactory because only a minority of these attain the treatment goals recommended by current guidelines. Thus, in addition to research into new and established risk factors, it is important that nephrologists make the best use of knowledge already available to optimize the follow-up of these patients.

Cardiovascular risk assessment in low-resource settings: a consensus document of the European Society of Hypertension Working Group on Hypertension and Cardiovascular Risk in Low Resource Settings

PubMed Central

Modesti, Pietro A.; Agostoni, Piergiuseppe; Agyemang, Charles; Basu, Sanjay; Benetos, Athanase; Cappuccio, Francesco P.; Ceriello, Antonio; Del Prato, Stefano; Kalyesubula, Robert; O’Brien, Eoin; Kilama, Michael O.; Perlini, Stefano; Picano, Eugenio; Reboldi, Gianpaolo; Remuzzi, Giuseppe; Stuckler, David; Twagirumukiza, Marc; Van Bortel, Luc M.; Watfa, Ghassan; Zhao, Dong; Parati, Gianfranco

2014-01-01

The Global Burden of Diseases, Injuries, and Risk Factors Study 2010 confirms ischemic heart disease and stroke as the leading cause of death and that hypertension is the main associated risk factor worldwide. How best to respond to the rising prevalence of hypertension in resource-deprived settings is a topic of ongoing public-health debate and discussion. In low-income and middle-income countries, socioeconomic inequality and cultural factors play a role both in the development of risk factors and in the access to care. In Europe, cultural barriers and poor communication between health systems and migrants may limit migrants from receiving appropriate prevention, diagnosis, and treatment. To use more efficiently resources available and to make treatment cost-effective at the patient level, cardiovascular risk approach is now recommended. In 2011, The European Society of Hypertension established a Working Group on ‘Hypertension and Cardiovascular risk in low resource settings’, which brought together cardiologists, diabetologists, nephrologists, clinical trialists, epidemiologists, economists, and other stakeholders to review current strategies for cardiovascular risk assessment in population studies in low-income and middle-income countries, their limitations, possible improvements, and future interests in screening programs. This report summarizes current evidence and presents highlights of unmet needs. PMID:24577410

Using Generic Data to Establish Dormancy Failure Rates

NASA Technical Reports Server (NTRS)

Reistle, Bruce

2014-01-01

Many hardware items are dormant prior to being operated. The dormant period might be especially long, for example during missions to the moon or Mars. In missions with long dormant periods the risk incurred during dormancy can exceed the active risk contribution. Probabilistic Risk Assessments (PRAs) need to account for the dormant risk contribution as well as the active contribution. A typical method for calculating a dormant failure rate is to multiply the active failure rate by a constant, the dormancy factor. For example, some practitioners use a heuristic and divide the active failure rate by 30 to obtain an estimate of the dormant failure rate. To obtain a more empirical estimate of the dormancy factor, this paper uses the recently updated database NPRD-2011 [1] to arrive at a set of distributions for the dormancy factor. The resulting dormancy factor distributions are significantly different depending on whether the item is electrical, mechanical, or electro-mechanical. Additionally, this paper will show that using a heuristic constant fails to capture the uncertainty of the possible dormancy factors.

Mild to moderate cognitive impairment is a major risk factor for mortality and nursing home admission in the first year after hip fracture

USDA-ARS?s Scientific Manuscript database

It is not well established if and to what extent mild to moderate cognitive impairment predicts mortality and risk of nursing home admission after hip fracture. To investigate prospectively whether and to what extent mild to moderate cognitive impairment, contributes to mortality and admission to nu...

An Irish Cohort Study of Risk and Protective Factors for Infant Language Development at 9?Months

ERIC Educational Resources Information Center

McNally, Sinéad; Quigley, Jean

2014-01-01

This nationally representative study of Irish infants explores whether the set of child and environmental factors established as predicting language outcomes aged 3?years would also predict language and communication development as early as age 9?months. Associations between infant and environmental characteristics and infant language outcomes at…

Novel risk score of contrast-induced nephropathy after percutaneous coronary intervention.

PubMed

Ji, Ling; Su, XiaoFeng; Qin, Wei; Mi, XuHua; Liu, Fei; Tang, XiaoHong; Li, Zi; Yang, LiChuan

2015-08-01

Contrast-induced nephropathy (CIN) post-percutaneous coronary intervention (PCI) is a major cause of acute kidney injury. In this study, we established a comprehensive risk score model to assess risk of CIN after PCI procedure, which could be easily used in a clinical environment. A total of 805 PCI patients, divided into analysis cohort (70%) and validation cohort (30%), were enrolled retrospectively in this study. Risk factors for CIN were identified using univariate analysis and multivariate logistic regression in the analysis cohort. Risk score model was developed based on multiple regression coefficients. Sensitivity and specificity of the new risk score system was validated in the validation cohort. Comparisons between the new risk score model and previous reported models were applied. The incidence of post-PCI CIN in the analysis cohort (n = 565) was 12%. Considerably high CIN incidence (50%) was observed in patients with chronic kidney disease (CKD). Age >75, body mass index (BMI) >25, myoglobin level, cardiac function level, hypoalbuminaemia, history of chronic kidney disease (CKD), Intra-aortic balloon pump (IABP) and peripheral vascular disease (PVD) were identified as independent risk factors of post-PCI CIN. A novel risk score model was established using multivariate regression coefficients, which showed highest sensitivity and specificity (0.917, 95%CI 0.877-0.957) compared with previous models. A new post-PCI CIN risk score model was developed based on a retrospective study of 805 patients. Application of this model might be helpful to predict CIN in patients undergoing PCI procedure. © 2015 Asian Pacific Society of Nephrology.

Impact of sex and traditional cardiovascular risk factors on the risk of recurrent venous thromboembolism: results from the German MAISTHRO Registry.

PubMed

Linnemann, Birgit; Zgouras, Dimitrios; Schindewolf, Marc; Schwonberg, Jan; Jarosch-Preusche, Marie; Lindhoff-Last, Edelgard

2008-03-01

As arterial and venous thrombosis share common risk factors, a link between arterial and venous thrombosis has been suggested recently. Therefore, we aimed to investigate the impact of established cardiovascular risk factors on the risk of recurrent venous thromboembolism (VTE). With a cross-sectional study design, we analyzed the data of 1006 patients (582 F, 424 M) consecutively treated in our outpatient department for VTE (i.e. lower extremity deep vein thrombosis and/or pulmonary embolism) and registered in the MAISTHRO (MAin-ISar-THROmbosis) database. Of the total cohort, 324 (32.2%) patients suffered a recurrent VTE. Compared with the patients with a single thromboembolic event, patients with recurrent VTE were more frequently male (39.4 vs. 27.0%, P < 0.001). In univariate analysis, the relative risk of recurrent VTE was 1.9 [95% confidence interval (CI) 1.53-2.39] for male sex and 1.6 (1.25-1.95) for age over 50 years (PAOD). After adjustments for age, sex, thrombophilia and other common VTE risk factors, male sex [hazard ratio (HR) = 1.7 (1.38-21.9)] and arterial hypertension [HR = 1.4 (1.05-1.78)] were independent risk factors of recurrent VTE. The higher risk in men than in women persisted even after the exclusion of women with transient hormonal risk factors [HR = 1.57 (1.19-2.07)]. In contrast, no association between the presence of diabetes, obesity, hypercholesterolemia or smoking and the risk of VTE recurrence was observed. Male sex and arterial hypertension are independently associated with an increased risk of recurrent VTE after termination of anticoagulant therapy for the first VTE event.

Development and evaluation of an office ergonomic risk checklist: ROSA--rapid office strain assessment.

PubMed

Sonne, Michael; Villalta, Dino L; Andrews, David M

2012-01-01

The Rapid Office Strain Assessment (ROSA) was designed to quickly quantify risks associated with computer work and to establish an action level for change based on reports of worker discomfort. Computer use risk factors were identified in previous research and standards on office design for the chair, monitor, telephone, keyboard and mouse. The risk factors were diagrammed and coded as increasing scores from 1 to 3. ROSA final scores ranged in magnitude from 1 to 10, with each successive score representing an increased presence of risk factors. Total body discomfort and ROSA final scores for 72 office workstations were significantly correlated (R = 0.384). ROSA final scores exhibited high inter- and intra-observer reliability (ICCs of 0.88 and 0.91, respectively). Mean discomfort increased with increasing ROSA scores, with a significant difference occurring between scores of 3 and 5 (out of 10). A ROSA final score of 5 might therefore be useful as an action level indicating when immediate change is necessary. ROSA proved to be an effective and reliable method for identifying computer use risk factors related to discomfort. Copyright © 2011 Elsevier Ltd and The Ergonomics Society. All rights reserved.

Identification of risk factors for post-endoscopic retrograde cholangiopancreatography pancreatitis in a high volume center.

PubMed

Phillip, Veit; Schwab, Miriam; Haf, David; Algül, Hana

2017-01-01

Pancreatitis is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP). Several patients´ or procedure related risk factors for post-ERCP pancreatitis (PEP) have been suggested. The aim of this study was to validate the risk factors for PEP in a high-volume center. All patients undergoing first time ERCP at a tertiary referral center between December 2010 and October 2013 were retrospectively included. PEP was defined according to the Atlanta Classification. 344 patients were included in the final analysis. The risk to develop PEP was increased in patients with chronic pancreatitis (odds ratio 3.7) and after inadvertent cannulation of the pancreatic duct (odds ratio 2.2), which occurred in 26.5% of the patients. Inadvertent cannulation occurred significantly more frequently in patients with difficult cannulation of the papilla duodeni major (odds ratio 12.7; p<0.001). ERCP on call was associated with an increased risk for difficult cannulation (odds ratio 3.0). Inadvertent cannulation of the pancreatic duct is a procedure related risk factor for PEP. Measurements on preventing inadvertent cannulation of the pancreatic duct should be established and studies on prophylactic measurements should focus particularly on patients with inadvertent cannulation of the pancreatic duct.

Pancreatic thickness as a predictive factor for postoperative pancreatic fistula after distal pancreatectomy using an endopath stapler.

PubMed

Okano, Keiichi; Oshima, Minoru; Kakinoki, Keitaro; Yamamoto, Naoki; Akamoto, Shintaro; Yachida, Shinichi; Hagiike, Masanobu; Kamada, Hideki; Masaki, Tsutomu; Suzuki, Yasuyuki

2013-02-01

No consistent risk factor has yet been established for the development of pancreatic fistula (PF) after distal pancreatectomy (DP) with a stapler. A total of 31 consecutive patients underwent DP with an endopath stapler between June 2006 and December 2010 using a slow parenchymal flattening technique. The risk factors for PF after DP with an endopath stapler were identified based on univariate and multivariate analyses. Clinical PF developed in 7 of 31 (22 %) patients who underwent DP with a stapler. The pancreata were significantly thicker at the transection line in patients with PF (19.4 ± 1.47 mm) in comparison to patients without PF (12.6 ± 0.79 mm; p = 0.0003). A 16-mm cut-off for pancreatic thickness was established based on the receiver operating characteristic (ROC) curve; the area under the ROC curve was 0.875 (p = 0.0215). Pancreatic thickness (p = 0.0006) and blood transfusion (p = 0.028) were associated with postoperative PF in a univariate analysis. Pancreatic thickness was the only significant independent factor (odds ratio 9.99; p = 0.036) according to a multivariate analysis with a specificity of 72 %, and a sensitivity of 85 %. Pancreatic thickness is a significant independent risk factor for PF development after DP with an endopath stapler. The stapler technique is thus considered to be an appropriate modality in patients with a pancreatic thicknesses of <16 mm.

Risk Assessment of Groundwater Contamination: A Multilevel Fuzzy Comprehensive Evaluation Approach Based on DRASTIC Model

PubMed Central

Zhang, Yan; Zhong, Ming

2013-01-01

Groundwater contamination is a serious threat to water supply. Risk assessment of groundwater contamination is an effective way to protect the safety of groundwater resource. Groundwater is a complex and fuzzy system with many uncertainties, which is impacted by different geological and hydrological factors. In order to deal with the uncertainty in the risk assessment of groundwater contamination, we propose an approach with analysis hierarchy process and fuzzy comprehensive evaluation integrated together. Firstly, the risk factors of groundwater contamination are identified by the sources-pathway-receptor-consequence method, and a corresponding index system of risk assessment based on DRASTIC model is established. Due to the complexity in the process of transitions between the possible pollution risks and the uncertainties of factors, the method of analysis hierarchy process is applied to determine the weights of each factor, and the fuzzy sets theory is adopted to calculate the membership degrees of each factor. Finally, a case study is presented to illustrate and test this methodology. It is concluded that the proposed approach integrates the advantages of both analysis hierarchy process and fuzzy comprehensive evaluation, which provides a more flexible and reliable way to deal with the linguistic uncertainty and mechanism uncertainty in groundwater contamination without losing important information. PMID:24453883

Awareness of risk factors for cancer: a comparative study of Sweden and Denmark.

PubMed

Lagerlund, Magdalena; Hvidberg, Line; Hajdarevic, Senada; Fischer Pedersen, Anette; Runesdotter, Sara; Vedsted, Peter; Tishelman, Carol

2015-11-23

Sweden and Denmark are neighbouring countries with similarities in culture, healthcare, and economics, yet notable differences in cancer statistics. A crucial component of primary prevention is high awareness of risk factors in the general public. We aimed to determine and compare awareness of risk factors for cancer between a Danish and a Swedish population sample, and to examine whether there are differences in awareness across age groups. Data derive from Module 2 of the International Cancer Benchmarking Partnership. Telephone interviews were conducted with 3000 adults in Denmark and 3070 in Sweden using the Awareness and Beliefs about Cancer measure. Data reported here relate to awareness of 13 prompted risk factors for cancer. Prevalence ratios with 95 % confidence intervals were calculated to examine associations between country, age, and awareness of risk factors. Over 90 % of respondents in both countries recognized smoking, use of sunbeds and ionizing radiation as risk factors for cancer. Lowest awareness (<50 %) was found for HPV-infection, low fruit and vegetable intake and alcohol intake. Swedish respondents reported higher awareness than Danish respondents for ten of the 13 risk factors studied. Respondents from Denmark reported higher awareness only regarding low fruit and vegetable intake and use of sunbeds. Low physical activity was the only risk factor for which there was no difference in awareness between the countries. A decline in awareness was generally seen with increasing age in both countries, but deviating patterns were seen for alcohol intake, red/processed meat, obesity and age 70+. This study supports findings from other European studies that generally demonstrate modest public awareness of many established cancer risk factors. Efforts should be made to improve awareness of the cancer risk factors HPV-infection, low fruit and vegetable intake and alcohol intake, which showed particularly low awareness in both countries. Previous studies indicate that repeated, broad campaigns are successful, and suggest that a multimedia approach is used.

Description of Various Factors Contributing to Traffic Accidents in Youth and Measures Proposed to Alleviate Recurrence.

PubMed

Gicquel, Ludovic; Ordonneau, Pauline; Blot, Emilie; Toillon, Charlotte; Ingrand, Pierre; Romo, Lucia

2017-01-01

Traffic accidents are the leading cause of hospitalization in adolescence, with the 18-24-year-old age group accounting for 23% of deaths by traffic accidents. Recurrence rate is also high. One in four teenagers will have a relapse within the year following the first accident. Cognitive impairments known in adolescence could cause risky behaviors, defined as repetitive engagement in dangerous situations such as road accidents. Two categories of factors seem to be associated with traffic accidents: (1) factors specific to the traffic environment and (2) "human" factors, which seem to be the most influential. Moreover, the establishment of a stronger relation to high speed driving increases traffic accident risks and can also be intensified by sensation seeking. Other factors such as substance use (alcohol, drugs, and "binge drinking") are also identified as risk factors. Furthermore, cell phone use while driving and attention deficit disorder with or without hyperactivity also seem to be important risk factors for car accidents. The family environment strongly influences a young person's driving behavior. Some interventional driving strategies and preventive measures have reduced the risk of traffic accidents among young people, such as the graduated driver licensing program and advertising campaigns. So far, few therapeutic approaches have been implemented. Reason why, we decided to set up an innovative strategy consisting of a therapeutic postaccident group intervention, entitled the ECARR2 protocol, to prevent recurrence among adolescents and young adults identified at risk, taking into account the multiple risk factors.

Difference in Risk Behaviors and STD Prevalence Between Street-Based and Establishment-Based FSWs in Guangdong Province, China

PubMed Central

Li, Yan; Lin, Peng; Fu, Xiaobing; Deng, Zhongming; Liu, Yongying; Huang, Guohua; Li, Jie; Tan, Yihe

2012-01-01

The major mode of HIV/AIDS transmission in China is now heterosexual activities, but risk for HIV and sexually transmitted diseases (STDs) may differ among different strata of female sex workers (FSWs). Respondent-driven sampling was used to recruit 320 FSWs in Guangdong Province, China. The respondents were interviewed using a structured questionnaire, and tested for HIV, syphilis, gonorrhea, and Chlamydia. The street-based FSWs had lower education levels, a higher proportion supporting their families, charged less for their services, and had engaged in commercial sex for a longer period of time than establishment-based FSWs. The proportion consistently using condoms with clients and with regular non-paying partners was also lower. The prevalence of syphilis, gonorrhea, and Chlamydia was higher among street-based sex workers. Being a street-based sex worker, having regular non-paying sex partners, and having non-regular non-paying partners were independent risk factors for inconsistent condom. Street-based FSWs had more risk behaviors than establishment-based FSWs, and should therefore be specifically targeted for HIV as well as STD intervention programs. PMID:22228068

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

PubMed

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

2016-10-01

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

Neighborhood and community factors: effects on deviant behavior and social competence.

PubMed

Fariña, Francisca; Arce, Ramón; Novo, Mercedes

2008-05-01

Socialization in a neighborhood and community at risk, defined in terms of violence, social alienation, school failure, and disruptive behavior, is a risk factor for the acquisition of antisocial and delinquent behavior. In order to test this hypothesis and examine the underlying mechanisms involved, 346 participants, 155 high-risk and 191 low-risk, aged 11 to 13, that is, under the age of criminal responsibility as established by the Spanish Law 5/2000 were selected. The results reveal that high-risk youngsters had higher rates of antisocial behavior and lower levels of social skills (i.e., greater tendency to externalize attribution of responsibility, fewer conflict resolution strategies, lower self esteem, and a lower degrees of emotional intelligence) in comparison to the lower-risk group. Finally, the results and implications of the study are discussed in the light of designing prevention programs.

The safety experience of New Zealand adventure tourism operators.

PubMed

Bentley, Tim A; Page, Stephen; Walker, Linda

2004-01-01

This survey examined parameters of the New Zealand adventure tourism industry client injury risk. The research also sought to establish priorities for intervention to reduce adventure tourism risk, and identify client injury control measures currently in place (or absent) in the New Zealand adventure tourism industry, with a view to establishing guidelines for the development of effective adventure tourism safety management systems. This 2003 survey builds upon an exploratory study of New Zealand adventure tourism safety conducted by us during 1999. A postal questionnaire was used to survey all identifiable New Zealand adventure tourism operators. The questionnaire asked respondents about their recorded client injury experience, perceptions of client injury risk factors, safety management practices, and barriers to safety. Some 27 adventure tourism activities were represented among the responding sample (n=96). The highest client injury risk was reported in the snow sports, bungee jumping and horse riding sectors, although serious underreporting of minor injuries was evident across the industry. Slips, trips and falls (STF) were the major client injury mechanisms, and a range of risk factors for client injuries were identified. Safety management measures were inconsistently applied across the industry. The industry should consider the implications of poor injury reporting standards and safety management practices generally. Specifically, the industry should consider risk management that focuses on minor (e.g., STF) as well as catastrophic events.

Spatially-Correlated Risk in Nature Reserve Site Selection

PubMed Central

Albers, Heidi J.; Busby, Gwenlyn M.; Hamaide, Bertrand; Ando, Amy W.; Polasky, Stephen

2016-01-01

Establishing nature reserves protects species from land cover conversion and the resulting loss of habitat. Even within a reserve, however, many factors such as fires and defoliating insects still threaten habitat and the survival of species. To address the risk to species survival after reserve establishment, reserve networks can be created that allow some redundancy of species coverage to maximize the expected number of species that survive in the presence of threats. In some regions, however, the threats to species within a reserve may be spatially correlated. As examples, fires, diseases, and pest infestations can spread from a starting point and threaten neighboring parcels’ habitats, in addition to damage caused at the initial location. This paper develops a reserve site selection optimization framework that compares the optimal reserve networks in cases where risks do and do not reflect spatial correlation. By exploring the impact of spatially-correlated risk on reserve networks on a stylized landscape and on an Oregon landscape, this analysis demonstrates an appropriate and feasible method for incorporating such post-reserve establishment risks in the reserve site selection literature as an additional tool to be further developed for future conservation planning. PMID:26789127

Impact of age on cardiovascular risk: implications for cardiovascular disease management.

PubMed

Tuomilehto, Jaakko

2004-05-01

Cardiovascular disease (CVD) represents a major global healthcare problem. The prevalence of this condition increases with age. As many countries around the world are experiencing an increase in the proportion of elderly people in the population, this raises serious issues for cardiac and cerebrovascular disease prevention and management. A wealth of data has established smoking, dyslipidemia, hypertension and type 2 diabetes as major risk factors for cardiac and cerebrovascular events. This article reviews the evidence that links these metabolic risk factors with an increased risk of complications, and assesses the data concerning how risk changes with age. This review also focuses on how these conditions can be optimally managed and whether treatment outcomes are affected by age. The current status of research is assessed and issues which remain to be resolved are highlighted.

Allergen avoidance.

PubMed

Woodcock, A; Custovic, A

2000-12-09

Allergen exposure is a risk factor for sensitisation, prevalence and severity of allergic disease. Effective allergen avoidance strategies have been devised. The cost-benefit in public health terms should be established by prospective controlled studies that are under way around the world.

The occurrence of high-risk factors for hearing loss in very-low-birth-weight neonates: a retrospective exploratory study of targeted hearing screening.

PubMed

Kanji, Amisha; Khoza-Shangase, Katijah

2012-12-01

The current study aimed at determining the type and frequency of high-risk factors for hearing loss in a group of very-low-birth-weight (VLBW) neonates in a tertiary hospital in South Africa with the objective of collating evidence that could be used in arguing for or against revisiting targeted hearing screening in developing countries. Furthermore, the study aimed at investigating the relationship between the identified high-risk factors and hearing screening results. In a retrospective data review design, data were collated from files from the VLBW project; this included hearing screening records, as well as records from participant medical and audiology files. Records of 86 neonates with birth weights ranging between 680 g and 1500 g were reviewed. Findings indicated that neonatal jaundice, exposure to human immunodeficiency virus (HIV), mechanical or assisted ventilation, and neonatal intensive care unit stay greater than 48 hours were the most frequently occurring high-risk factors for hearing loss in the current sample. These factors are consistent with those listed in the high-risk register of the Health Professions Council of South Africa for the South African context. Findings confirm the complexity of risk factors, and the influence that a variety of factors such as poor follow-up or return rate might have on the implementation of early hearing detection and intervention. The importance of establishing context-specific risk factors for effective implementation of targeted screening protocols where niversal newborn hearing screening is not yet a reality was highlighted by the current study.

[Risk factors on the recurrence of ischemic stroke and the establishment of a Cox's regression model].

PubMed

An, Ya-chen; Chen, Yun-xia; Wang, Yu-xun; Zhao, Xiao-jing; Wang, Yan; Zhang, Jiang; Li, Chun-ling; Peng, Yan-bo; Gao, Su-ling; Chang, Li-sha; Zhang, Li; Xue, Xin-hong; Chen, Rui-ying; Wang, Da-li

2011-08-01

To investigate the risk factors and establish the Cox's regression model on the recurrence of ischemic stroke. We retrospectively reviewed consecutive patients with ischemic stroke admitted to the Neurology Department of the Hebei United University Affiliated Hospital between January 1, 2008 and December 31, 2009. Cases had been followed since the onset of ischemic stroke. The follow-up program was finished in June 30, 2010. Kaplan-Meier methods were used to describe the recurrence rate. Monovariant and multivariate Cox's proportional hazard regression model were used to analyze the risk factors associated to the episodes of recurrence. And then, a recurrence model was set up. During the period of follow-up program, 79 cases were relapsed, with the recurrence rates as 12.75% in one year and 18.87% in two years. Monovariant and multivariate Cox's proportional hazard regression model showed that the independent risk factors that were associated with the recurrence appeared to be age (X₁) (RR = 1.025, 95%CI: 1.003 - 1.048), history of hypertension (X₂) (RR = 1.976, 95%CI: 1.014 - 3.851), history of family strokes (X₃) (RR = 2.647, 95%CI: 1.175 - 5.961), total cholesterol amount (X₄) (RR = 1.485, 95%CI: 1.214 - 1.817), ESRS total scores (X₅) (RR = 1.327, 95%CI: 1.057 - 1.666) and progression of the disease (X₆) (RR = 1.889, 95%CI: 1.123 - 3.178). Personal prognosis index (PI) of the recurrence model was as follows: PI = 0.025X₁ + 0.681X₂ + 0.973X₃ + 0.395X₄ + 0.283X₅ + 0.636X₆. The smaller the personal prognosis index was, the lower the recurrence risk appeared, while the bigger the personal prognosis index was, the higher the recurrence risk appeared. Age, history of hypertension, total cholesterol amount, total scores of ESRS, together with the disease progression were the independent risk factors associated with the recurrence episodes of ischemic stroke. Both recurrence model and the personal prognosis index equation were successful constructed.

Impact of sickle cell trait on the thrombotic risk associated with non-O blood groups in northern Nigeria.

PubMed

Ahmed, Sagir G; Kagu, Modu B; Ibrahim, Umma A; Bukar, Audu A

2015-10-01

The non-O blood group is an established risk factor for deep vein thrombosis (DVT), while controversy surrounds the role of sickle cell trait (SCT) as a risk factor for DVT. We hypothesised that if SCT is a risk factor for DVT, individuals with non-O blood groups and SCT (Hb AS) would have a higher risk of DVT than their counterparts with non-O blood groups and normal haemoglobin phenotype (Hb AA). We retrospectively analysed the prevalence of SCT and non-O blood groups among 148 DVT patients with control subjects in order to determine the role of SCT as a risk factor for DVT and its impact on the risk of DVT among patients with non-O blood groups. In comparison with control subjects, DVT patients had significantly higher prevalences of SCT (35.1% vs 27.7%, p=0.04) and non-O blood groups (68.9% vs 45.9%, p=0.02). The odds ratios for DVT due to SCT, non-O blood groups with normal Hb phenotype (Hb AA) and non-O blood groups with SCT (Hb AS) were 1.3, 2.4 and 3.5, respectively. These results suggest that SCT by itself is a weak risk factor for DVT but it has the potential of escalating the DVT risk among patients with non-O blood groups. The combined effects of elevated clotting factors (non-O group effect) and increased clotting factor activation (SCT effect) were responsible for the escalated DVT risk among patients with co-inheritance of non-O blood groups and SCT. Co-inheritance of SCT and non-O blood group is, therefore, an important mixed risk factor for DVT. This should be taken into account when assessing DVT risk profiles of patients in Africa and other parts of the world where the SCT is prevalent.

A new method to quantify the health risks from sources of perfluoroalkyl substances, combined with positive matrix factorization and risk assessment models.

PubMed

Xu, Jiao; Shi, Guo-Liang; Guo, Chang-Sheng; Wang, Hai-Ting; Tian, Ying-Ze; Huangfu, Yan-Qi; Zhang, Yuan; Feng, Yin-Chang; Xu, Jian

2018-01-01

A hybrid model based on the positive matrix factorization (PMF) model and the health risk assessment model for assessing risks associated with sources of perfluoroalkyl substances (PFASs) in water was established and applied at Dianchi Lake to test its applicability. The new method contains 2 stages: 1) the sources of PFASs were apportioned by the PMF model and 2) the contribution of health risks from each source was calculated by the new hybrid model. Two factors were extracted by PMF, with factor 1 identified as aqueous fire-fighting foams source and factor 2 as fluoropolymer manufacturing and processing and perfluorooctanoic acid production source. The health risk of PFASs in the water assessed by the health risk assessment model was 9.54 × 10 -7  a -1 on average, showing no obvious adverse effects to human health. The 2 sources' risks estimated by the new hybrid model ranged from 2.95 × 10 -10 to 6.60 × 10 -6  a -1 and from 1.64 × 10 -7 to 1.62 × 10 -6  a -1 , respectively. The new hybrid model can provide useful information on the health risks of PFAS sources, which is helpful for pollution control and environmental management. Environ Toxicol Chem 2018;37:107-115. © 2017 SETAC. © 2017 SETAC.

Are current UK National Institute for Health and Clinical Excellence (NICE) obesity risk guidelines useful? Cross-sectional associations with cardiovascular disease risk factors in a large, representative English population.

PubMed

Tabassum, Faiza; Batty, G David

2013-01-01

The National Institute for Health and Clinical Excellence (NICE) has recently released obesity guidelines for health risk. For the first time in the UK, we estimate the utility of these guidelines by relating them to the established cardiovascular disease (CVD) risk factors. Health Survey for England (HSE) 2006, a population-based cross-sectional study in England was used with a sample size of 7225 men and women aged ≥35 years (age range: 35-97 years). The following CVD risk factor outcomes were used: hypertension, diabetes, total and high density lipoprotein cholesterol, glycated haemoglobin, fibrinogen, C-reactive protein and Framingham risk score. Four NICE categories of obesity were created based on body mass index (BMI) and waist circumference (WC): no risk (up to normal BMI and low/high WC); increased risk (normal BMI & very high WC, or obese & low WC); high risk (overweight & very high WC, or obese & high WC); and very high risk (obese I & very high WC or obese II/III with any levels of WC. Men and women in the very high risk category had the highest odds ratios (OR) of having unfavourable CVD risk factors compared to those in the no risk category. For example, the OR of having hypertension for those in the very high risk category of the NICE obesity groupings was 2.57 (95% confidence interval 2.06 to 3.21) in men, and 2.15 (1.75 to 2.64) in women. Moreover, a dose-response association between the adiposity groups and most of the CVD risk factors was observed except total cholesterol in men and low HDL in women. Similar results were apparent when the Framingham risk score was the outcome of interest. In conclusion, the current NICE definitions of obesity show utility for a range of CVD risk factors and CVD risk in both men and women.

Are Current UK National Institute for Health and Clinical Excellence (NICE) Obesity Risk Guidelines Useful? Cross-Sectional Associations with Cardiovascular Disease Risk Factors in a Large, Representative English Population

PubMed Central

Tabassum, Faiza; Batty, G. David

2013-01-01

The National Institute for Health and Clinical Excellence (NICE) has recently released obesity guidelines for health risk. For the first time in the UK, we estimate the utility of these guidelines by relating them to the established cardiovascular disease (CVD) risk factors. Health Survey for England (HSE) 2006, a population-based cross-sectional study in England was used with a sample size of 7225 men and women aged ≥35 years (age range: 35–97 years). The following CVD risk factor outcomes were used: hypertension, diabetes, total and high density lipoprotein cholesterol, glycated haemoglobin, fibrinogen, C-reactive protein and Framingham risk score. Four NICE categories of obesity were created based on body mass index (BMI) and waist circumference (WC): no risk (up to normal BMI and low/high WC); increased risk (normal BMI & very high WC, or obese & low WC); high risk (overweight & very high WC, or obese & high WC); and very high risk (obese I & very high WC or obese II/III with any levels of WC. Men and women in the very high risk category had the highest odds ratios (OR) of having unfavourable CVD risk factors compared to those in the no risk category. For example, the OR of having hypertension for those in the very high risk category of the NICE obesity groupings was 2.57 (95% confidence interval 2.06 to 3.21) in men, and 2.15 (1.75 to 2.64) in women. Moreover, a dose-response association between the adiposity groups and most of the CVD risk factors was observed except total cholesterol in men and low HDL in women. Similar results were apparent when the Framingham risk score was the outcome of interest. In conclusion, the current NICE definitions of obesity show utility for a range of CVD risk factors and CVD risk in both men and women. PMID:23844088

Left Ventricular Mass and Geometry and the Risk of Ischemic Stroke

PubMed Central

Di Tullio, Marco R.; Zwas, Donna R.; Sacco, Ralph L.; Sciacca, Robert R.; Homma, Shunichi

2009-01-01

Background and Purpose Left ventricular hypertrophy (LVH) is a risk factor for cardiovascular events, but its effect on ischemic stroke risk is established mainly in whites. The effect of LV geometry on stroke risk has not been defined. The aim of the present study was to evaluate whether LVH and LV geometry are independently associated with increased ischemic stroke risk in a multiethnic population. Methods A population-based case-control study was conducted on 394 patients with first ischemic stroke and 413 age-, sex-, and race-ethnicity–matched community control subjects. LV mass was measured by transthoracic echocardiography. LV geometric patterns (normal, concentric remodeling, concentric or eccentric hypertrophy) were identified. Stroke risk associated with LVH and different LV geometric patterns was assessed by conditional logistic regression analysis in the overall group and age, sex, and race-ethnic strata, with adjustment for established stroke risk factors. Results Concentric hypertrophy carried the greatest stroke risk (adjusted odds ratio [OR], 3.5; 95% confidence interval [CI], 2.0 to 6.2), followed by eccentric hypertrophy (adjusted OR, 2.4; 95% CI, 2.0 to 4.3). Concentric remodeling carried slightly increased stroke risk (adjusted OR, 1.7; 95% CI, 1.0 to 2.9). Increased LV relative wall thickness was independently associated with stroke after adjustment for LV mass (OR, 1.6; 95% CI, 1.1 to 2.3). Conclusions LVH and abnormal LV geometry are independently associated with increased stroke risk. LVH is strongly associated with ischemic stroke in all age, sex, and race-ethnic subgroups. Increased LV relative wall thickness imparts an increased stroke risk after adjustment for LV mass and is of additional value in stroke risk prediction. PMID:12958319

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

PubMed

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

2014-01-01

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

Is systemic lupus erithematosus a new risk factor for atherosclerosis?

PubMed

Freire, Beatriz Funayama Alvarenga; da Silva, Rogério Cardoso; Fabro, Alexandre Todorovic; dos Santos, Daniela Cristina

2006-09-01

To evaluate the prevalence of cardiovascular events (CVE) secondary to atherosclerosis in lupus patients and correlate them to the traditional risk factors, disease duration and drug therapy used. A retrospective study was carried out based on data obtained from patients charts. Patients included were those who had a lupus diagnosis confirmed at least two years before inclusion in the study and had been followed since 1992. CVE were characterized as MI, angina pectoris and stroke non-related to lupus activity. Risk factors and drugs used for treatment were recorded. Seventy-one charts were analyzed. Patients mean age was 34.2+/-12.7 years; 68 were women and three were men; 58 were Caucasian (81.6%). Ten (14.08%) presented CVE. Patients in whom CVE were observed were older (42.7 vs. 32.8 years p=0.0021) and presented longer disease duration (10.8 vs. 7.2 years p=0.011). The traditional risk factors, daily and cumulative doses of steroids, immunosuppressive drugs and antimalarial drugs were not significant when patients with and without CVE were compared. The prevalence of CVE secondary to atherosclerosis in systemic lupus erythematosus (SLE) was 14.08%. The traditional risk factors were not associated with the development of CVE in lupus patients. Patients that presented cardiovascular events were older and presented longer disease duration. It is a premature conclusion to establish SLE as an independent risk factor for atherosclerosis development.

Are patients with thrombophilia and previous venous thromboembolism at higher risk to arterial thrombosis?

PubMed

Linnemann, Birgit; Schindewolf, Marc; Zgouras, Dimitrios; Erbe, Matthias; Jarosch-Preusche, Marie; Lindhoff-Last, Edelgard

2008-01-01

Whether thrombophilic disorders, which are established risk factors for venous thromboembolism (VTE), also increase the risk of arterial thrombosis is still unknown. We analyzed data from 1081 consecutive patients (649 F/432 M, 16-93 years of age) with previous VTE registered in the MAISTHRO (MAin-ISar-THROmbosis) database with regard to arterial thrombotic events and contributing risk factors. Screening for thrombophilia included testing for factor V Leiden and prothrombin G20210A mutation, antiphospholipid antibodies and activities of factor VIII, protein C, protein S and antithrombin. Of the entire study cohort, 40 patients (3.7%) had a prior myocardial infarction (MI), and 41 (3.8%) suffered a stroke. Other arterial thrombotic events were rare. Elevated factor VIII levels were more prevalent in MI patients than in controls (44.4 vs. 25.9%, p=0.044), but after adjusting for the traditional cardiovascular risk factors, this relationship was no longer significant. We observed a higher rate of lupus anticoagulant in MI patients with an adjusted odds ratio of 3.3 (95%CI 0.84-12.8, p=0.090). No difference in any other tested thrombophilia was observed in patients with MI or stroke relative to those without. The cumulative incidence of arterial thrombotic events in VTE patients is low, and the inherited thrombophilias do not seem to substantially increase the risk of arterial thrombosis.

The relationship of autonomic imbalance, heart rate variability and cardiovascular disease risk factors.

PubMed

Thayer, Julian F; Yamamoto, Shelby S; Brosschot, Jos F

2010-05-28

Cardiovascular disease (CVD) is the leading cause of death and disability worldwide. The understanding of the risk factors for CVD may yield important insights into the prevention, etiology, course, and treatment of this major public health concern. Autonomic imbalance, characterized by a hyperactive sympathetic system and a hypoactive parasympathetic system, is associated with various pathological conditions. Over time, excessive energy demands on the system can lead to premature aging and diseases. Therefore, autonomic imbalance may be a final common pathway to increased morbidity and mortality from a host of conditions and diseases, including cardiovascular disease. Heart rate variability (HRV) may be used to assess autonomic imbalances, diseases and mortality. Parasympathetic activity and HRV have been associated with a wide range of conditions including CVD. Here we review the evidence linking HRV to established and emerging modifiable and non-modifiable CVD risk factors such as hypertension, obesity, family history and work stress. Substantial evidence exists to support the notion that decreased HRV precedes the development of a number of risk factors and that lowering risk profiles is associated with increased HRV. We close with a suggestion that a model of autonomic imbalance may provide a unifying framework within which to investigate the impact of risk factors, including psychosocial factors and work stress, on cardiovascular disease. Copyright 2009 Elsevier Ireland Ltd. All rights reserved.

Exploring divergent trajectories: Disorder-specific moderators of the association between negative urgency and dysregulated eating.

PubMed

Racine, Sarah E; Martin, Shelby J

2016-08-01

Negative urgency (i.e., the tendency to act impulsively when experiencing negative emotions) is a well-established risk factor for dysregulated eating (e.g., binge eating, loss of control eating, emotional eating). However, negative urgency is transdiagnostic, in that it is associated with multiple forms of psychopathology. It is currently unclear why some individuals with high negative urgency develop dysregulated eating while others experience depressive symptoms or problematic alcohol use. Investigating disorder-specific moderators of the association between negative urgency and psychopathology may help elucidate these divergent trajectories. The current study examined interactions among negative urgency and eating disorder-specific risk factors specified in the well-established dual-pathway model of bulimic pathology (i.e., appearance pressures, thin-ideal internalization, body dissatisfaction, dietary restraint). We hypothesized that these interactions would predict dysregulated eating, but not depressive symptoms or problematic alcohol use. Latent moderated structural equation modeling was used to test this hypothesis in a large (N = 313) sample of female college students. Negative urgency was significantly associated with dysregulated eating, depressive symptoms, and problematic alcohol use. However, interactions among negative urgency and dual-pathway model variables were specific to dysregulated eating and accounted for an additional 3-5% of the variance beyond main effects. Findings suggest that eating disorder-specific risk factors may shape negative urgency into manifesting as dysregulated eating versus another form of psychopathology. Future research should use longitudinal designs to further test the impact of interactions among disorder-specific risk factors and negative urgency on divergent psychopathology trajectories. Copyright © 2016 Elsevier Ltd. All rights reserved.

Risk Profiles for Injurious Falls in People Over 60: A Population-Based Cohort Study

PubMed Central

Ek, Stina; Rizzuto, Debora; Fratiglioni, Laura; Johnell, Kristina; Xu, Weili

2018-01-01

Abstract Background Although falls in older adults are related to multiple risk factors, these factors have commonly been studied individually. We aimed to identify risk profiles for injurious falls in older adults by detecting clusters of established risk factors and quantifying their impact on fall risk. Methods Participants were 2,566 people, aged 60 years and older, from the population-based Swedish National Study on Aging and Care in Kungsholmen. Injurious falls was defined as hospitalization for or receipt of outpatient care because a fall. Cluster analysis was used to identify aggregation of possible risk factors including chronic diseases, fall-risk increasing drugs (FRIDs), physical and cognitive impairments, and lifestyle-related factors. Associations between the clusters and injurious falls over 3, 5, and 10 years were estimated using flexible parametric survival models. Results Five clusters were identified including: a “healthy”, a “well-functioning with multimorbidity”, a “well-functioning, with multimorbidity and high FRID consumption”, a “physically and cognitively impaired”, and a “disabled” cluster. The risk of injurious falls for all groups was significantly higher than for the first cluster of healthy individuals in the reference category. Hazard ratios (95% confidence intervals) ranged from 1.71 (1.02–2.66) for the second cluster to 12.67 (7.38–21.75) for the last cluster over 3 years of follow-up. The highest risk was observed in the last two clusters with high burden of physical and cognitive impairments. Conclusion Risk factors for injurious fall tend to aggregate, representing different levels of risk for falls. Our findings can be useful to tailor and prioritize clinical and public health interventions. PMID:28605455

Prognostic factors for acute myeloid leukaemia in adults--biological significance and clinical use.

PubMed

Liersch, Ruediger; Müller-Tidow, Carsten; Berdel, Wolfgang E; Krug, Utz

2014-04-01

Acute myeloid leukaemia (AML) is a heterogeneous disease. Prognosis of AML is influenced both by patient-specific as well as disease-specific factors. Age is the most prominent patient-specific risk factor, while chromosomal aberrations are the strongest disease-specific risk factors. For patients with cytogenetically normal AML, prognosis can be specified by mutational status of the genes NPM1, FLT3 and CEBPA. A growing number of recurrent mutations in additional genes have recently been identified, for which the prognostic effect yet has to be determined. Performance status, geriatric assessment, secondary leukaemia following myelodysplastic syndrome or cytotoxic treatment, common laboratory parameters, leukaemic stem cell frequency, bone marrow microenvironment, gene expression levels, epigenetic changes, micro-RNA's as well as kinetics and depth of response to treatment influence prognosis of AML patients. Despite the high number of established risk factors, only few predictive markers exist which can truly aid therapy decisions in patients with AML. © 2014 John Wiley & Sons Ltd.

Environmental Exposures and Hepatocellular Carcinoma

PubMed Central

Wu, Hui-Chen

2013-01-01

Infection with hepatitis B and/or hepatitis C virus is a well-established risk factor for the development of hepatocellular carcinoma (HCC). However, it is now clear that certain occupational, environmental, and lifestyle factors also play a role in cancer development. Among these factors are smoking, alcohol consumption, workplace exposure to vinyl chloride, and exposure to polycylic aromatic hydrocarbons and aflatoxins. There is also evidence that several other chemical and infectious agents have a role in inducing HCC in humans. Epidemiologic studies and the use of biomarkers have provided essential data to demonstrate the importance of some of these factors in human risk, while animal studies have suggested that other chemicals may also play a role. Although immunization against hepatitis B virus infection remains the primary method of preventing HCC in regions of the world where this virus is a primary etiologic agent, there is currently no vaccine for hepatitis C virus. Thus, limiting exposure to other known risk factors remains an important mechanism in preventing HCC. PMID:26357611

Recent development of risk-prediction models for incident hypertension: An updated systematic review

PubMed Central

Xiao, Lei; Liu, Ya; Wang, Zuoguang; Li, Chuang; Jin, Yongxin; Zhao, Qiong

2017-01-01

Background Hypertension is a leading global health threat and a major cardiovascular disease. Since clinical interventions are effective in delaying the disease progression from prehypertension to hypertension, diagnostic prediction models to identify patient populations at high risk for hypertension are imperative. Methods Both PubMed and Embase databases were searched for eligible reports of either prediction models or risk scores of hypertension. The study data were collected, including risk factors, statistic methods, characteristics of study design and participants, performance measurement, etc. Results From the searched literature, 26 studies reporting 48 prediction models were selected. Among them, 20 reports studied the established models using traditional risk factors, such as body mass index (BMI), age, smoking, blood pressure (BP) level, parental history of hypertension, and biochemical factors, whereas 6 reports used genetic risk score (GRS) as the prediction factor. AUC ranged from 0.64 to 0.97, and C-statistic ranged from 60% to 90%. Conclusions The traditional models are still the predominant risk prediction models for hypertension, but recently, more models have begun to incorporate genetic factors as part of their model predictors. However, these genetic predictors need to be well selected. The current reported models have acceptable to good discrimination and calibration ability, but whether the models can be applied in clinical practice still needs more validation and adjustment. PMID:29084293

Analysis of risk factors for schizophrenia with two different case definitions: a nationwide register-based external validation study.

PubMed

Sørensen, Holger J; Larsen, Janne T; Mors, Ole; Nordentoft, Merete; Mortensen, Preben B; Petersen, Liselotte

2015-03-01

Different case definitions of schizophrenia have been used in register based research. However, no previous study has externally validated two different case definitions of schizophrenia against a wide range of risk factors for schizophrenia. We investigated hazard ratios (HRs) for a wide range of risk factors for ICD-10 DCR schizophrenia using a nationwide Danish sample of 2,772,144 residents born in 1955-1997. We compared one contact only (OCO) (the case definition of schizophrenia used in Danish register based studies) with two or more contacts (TMC) (a case definition of at least 2 inpatient contacts with schizophrenia). During the follow-up, the OCO definition included 15,074 and the TMC 7562 cases; i.e. half as many. The TMC case definition appeared to select for a worse illness course. A wide range of risk factors were uniformly associated with both case definitions and only slightly higher risk estimates were found for the TMC definition. Choosing at least 2 inpatient contacts with schizophrenia (TMC) instead of the currently used case definition would result in almost similar risk estimates for many well-established risk factors. However, this would also introduce selection and include considerably fewer cases and reduce power of e.g. genetic studies based on register-diagnosed cases only. Copyright © 2015 Elsevier B.V. All rights reserved.

Application of the risk assessment paradigm to the induction of allergic contact dermatitis.

PubMed

Felter, Susan P; Ryan, Cindy A; Basketter, David A; Gilmour, Nicola J; Gerberick, G Frank

2003-02-01

The National Academy of Science (NAS) risk assessment paradigm has been widely accepted as a framework for estimating risk from exposure to environmental chemicals (NAS, 1983). Within this framework, quantitative risk assessments (QRAs) serve as the cornerstone of health-based exposure limits, and have been used routinely for both cancer and noncancer endpoints. These methods have focused primarily on the extrapolation of data from laboratory animals to establish acceptable levels of exposure for humans. For health effects associated with a threshold, uncertainty and variability inherent in the extrapolation process is generally dealt with by the application of "uncertainty factors (UFs)." The adaptation of QRA methods to address skin sensitization is a natural and desirable extension of current practices. Based on our chemical, cellular and molecular understanding of the induction of allergic contact dermatitis, one can conduct a QRA using established methods of identifying a NOAEL (No Observed Adverse Effect Level) or other point of departure, and applying appropriate UFs. This paper describes the application of the NAS paradigm to characterize risks from human exposure to skin sensitizers; consequently, this method can also be used to establish an exposure level for skin allergens that does not present an appreciable risk of sensitization. Copyright 2003 Elsevier Science (USA)

Prevention and treatment of college student drug use: A review of the literature.

PubMed

Dennhardt, Ashley A; Murphy, James G

2013-10-01

Drug use during the college years is a significant public health concern. The primary goal of this paper is to provide a comprehensive review of prevention and treatment studies of college student drug use in order to guide college prevention efforts and to inform and stimulate new research in this area. First, established risk factors for drug use were reviewed. High levels of personality traits including, impulsivity, sensation-seeking, negative emotionality, emotional dysregulation, and personality disorder symptoms increase risk for drug use. Drug use has also been linked to overestimating normative levels of drug use and experiencing negative life events, and specific motives for drug use are linked to more problematic patterns. There have been very few studies examining prevention and treatment, but parent-based and in-person brief motivational interventions appear to be promising. Longitudinal studies of the development and course of drug use among college students, as well as clinical trials to evaluate novel theoretically-based intervention and prevention programs that take into account established risk factors for drug abuse are needed. Copyright © 2013 Elsevier Ltd. All rights reserved.

Pregnancy failure in patients with obstetric antiphospholipid syndrome with conventional treatment: the influence of a triple positive antibody profile.

PubMed

Latino, J O; Udry, S; Aranda, F M; Perés Wingeyer, S D A; Fernández Romero, D S; de Larrañaga, G F

2017-08-01

Conventional treatment of obstetric antiphospholipid syndrome fails in approximately 20-30% of pregnant women without any clearly identified risk factor. It is important to identify risk factors that are associated with these treatment failures. This study aimed to assess the impact of risk factors on pregnancy outcomes in women with obstetric antiphospholipid syndrome treated with conventional treatment. We carefully retrospectively selected 106 pregnancies in women with obstetric antiphospholipid syndrome treated with heparin + aspirin. Pregnancy outcomes were evaluated according to the following associated risk factors: triple positivity profile, double positivity profile, single positivity profile, history of thrombosis, autoimmune disease, more than four pregnancy losses, and high titers of anticardiolipin antibodies and/or anti-βeta-2-glycoprotein-I (aβ2GPI) antibodies. To establish the association between pregnancy outcomes and risk factors, a single binary logistic regressions analysis was performed. Risk factors associated with pregnancy loss with conventional treatment were: the presence of triple positivity (OR = 5.0, CI = 1.4-16.9, p = 0.01), high titers of aβ2GPI (OR = 4.4, CI = 1.2-16.1, p = 0.023) and a history of more than four pregnancy losses (OR = 3.5, CI = 1.2-10.0, p = 0.018). The presence of triple positivity was an independent risk factor associated with gestational complications (OR = 4.1, CI = 1.2-13.9, p = 0.02). Our findings reinforce the idea that triple positivity is a categorical risk factor for poor response to conventional treatment.

Did it fall or was it pushed? The contribution of trends in established risk factors to the decline in premature coronary heart disease mortality in New Zealand.

PubMed

Tobias, Martin; Taylor, Richard; Yeh, Li-Chia; Huang, Ken; Mann, Stewart; Sharpe, Norman

2008-04-01

To estimate the contribution of trends in three risk factors--systolic blood pressure (SBP), total blood cholesterol (TBC) and cigarette smoking--to the decline in premature coronary heart disease (CHD) mortality in New Zealand from 1980-2004. Risk factor prevalence data by 10-year age group (35-64 years) and sex was sourced from six national or Auckland regional health surveys and three population censuses (the latter only for smoking). The data were smoothed using two-point moving averages, then further smoothed by fitting quadratic regression equations (SBP and TBC) or splines (smoking). Risk factor/CHD mortality hazard ratios estimated by expert working groups for the World Health Organization Global Burden of Disease Study 2001 were used to translate average annual changes in risk factor prevalences to the corresponding percentage changes in premature CHD mortality. The expected trends in CHD mortality were then compared with the observed trend to estimate the contribution of each risk factor to the decline. Approximately 80% (73% for males, 87% for females) of the decline in premature CHD mortality from 1980 to 2004 is estimated to have resulted from the joint trends in population SBP and TBC distributions and smoking prevalence. Overall, approximately 42%, 36% and 22% of the joint risk factor effect was contributed by trends in SBP, TBC and smoking respectively. Our estimate for the joint risk factor contribution to the CHD mortality decline of 80% exceeds those of two earlier New Zealand studies, but agrees closely with a similar Australian study. This provides an indicator of the scope that still remains for further reduction in CHD mortality through primary and secondary prevention.

Risk assessment and psychosocial interventions for suicidal patients

PubMed Central

Chesin, Megan; Stanley, Barbara

2013-01-01

Objectives Suicide is a leading cause of death in the US. Although factors elevating long-term risk for suicide are known and include bipolar disorder, signs of imminent suicide risk are difficult to study and not well-specified. Acute risk determinations must be made to determine the appropriate level of care to safeguard patients. To increase safety among at-risk patients in the short term and to decrease risk over time, psychosocial interventions to prevent suicide have been developed and tested in acute care and outpatient settings. Methods A narrative review of studies of imminent risk factors for suicide, suicide risk decision making, and psychosocial suicide prevention interventions was conducted. Results While some long-term risk factors of suicide have been established, accurate identification of individuals at imminent risk for suicide is difficult. Therefore, prevention efforts targeting individuals at high suicide behavior risk discharging from acute care settings tend to be generic and focus on psychoeducation and supportive follow-up contact. Data regarding the effectiveness of brief interventions (i.e., those not requiring more than one individualized treatment session) is mixed, showing better outcomes in the shorter term and when incidence of suicidal behavior or ideation is the outcome. With respect to longer term suicide prevention interventions (i.e., those with a minimum of 10 sessions), Dialectical Behavior Therapy has the largest evidence base. Conclusions To improve suicide prevention efforts, more rigorous study of imminent risk factors and psychosocial interventions is needed. Adaptations specific to individuals with bipolar disorder are possible and needed. PMID:23782460

Epidemics after Natural Disasters

PubMed Central

Gayer, Michelle; Connolly, Maire A.

2007-01-01

The relationship between natural disasters and communicable diseases is frequently misconstrued. The risk for outbreaks is often presumed to be very high in the chaos that follows natural disasters, a fear likely derived from a perceived association between dead bodies and epidemics. However, the risk factors for outbreaks after disasters are associated primarily with population displacement. The availability of safe water and sanitation facilities, the degree of crowding, the underlying health status of the population, and the availability of healthcare services all interact within the context of the local disease ecology to influence the risk for communicable diseases and death in the affected population. We outline the risk factors for outbreaks after a disaster, review the communicable diseases likely to be important, and establish priorities to address communicable diseases in disaster settings. PMID:17370508

A narrative review of alcohol consumption as a risk factor for global burden of disease.

PubMed

Rehm, Jürgen; Imtiaz, Sameer

2016-10-28

Since the original Comparative Risk Assessment (CRA) for alcohol consumption as part of the Global Burden of Disease Study for 1990, there had been regular updates of CRAs for alcohol from the World Health Organization and/or the Institute for Health Metrics and Evaluation. These studies have become more and more refined with respect to establishing causality between dimensions of alcohol consumption and different disease and mortality (cause of death) outcomes, refining risk relations, and improving the methodology for estimating exposure and alcohol-attributable burden. The present review will give an overview on the main results of the CRAs with respect to alcohol consumption as a risk factor, sketch out new trends and developments, and draw implications for future research and policy.

Multiplex proteomics for prediction of major cardiovascular events in type 2 diabetes.

PubMed

Nowak, Christoph; Carlsson, Axel C; Östgren, Carl Johan; Nyström, Fredrik H; Alam, Moudud; Feldreich, Tobias; Sundström, Johan; Carrero, Juan-Jesus; Leppert, Jerzy; Hedberg, Pär; Henriksen, Egil; Cordeiro, Antonio C; Giedraitis, Vilmantas; Lind, Lars; Ingelsson, Erik; Fall, Tove; Ärnlöv, Johan

2018-05-24

Multiplex proteomics could improve understanding and risk prediction of major adverse cardiovascular events (MACE) in type 2 diabetes. This study assessed 80 cardiovascular and inflammatory proteins for biomarker discovery and prediction of MACE in type 2 diabetes. We combined data from six prospective epidemiological studies of 30-77-year-old individuals with type 2 diabetes in whom 80 circulating proteins were measured by proximity extension assay. Multivariable-adjusted Cox regression was used in a discovery/replication design to identify biomarkers for incident MACE. We used gradient-boosted machine learning and lasso regularised Cox regression in a random 75% training subsample to assess whether adding proteins to risk factors included in the Swedish National Diabetes Register risk model would improve the prediction of MACE in the separate 25% test subsample. Of 1211 adults with type 2 diabetes (32% women), 211 experienced a MACE over a mean (±SD) of 6.4 ± 2.3 years. We replicated associations (<5% false discovery rate) between risk of MACE and eight proteins: matrix metalloproteinase (MMP)-12, IL-27 subunit α (IL-27a), kidney injury molecule (KIM)-1, fibroblast growth factor (FGF)-23, protein S100-A12, TNF receptor (TNFR)-1, TNFR-2 and TNF-related apoptosis-inducing ligand receptor (TRAIL-R)2. Addition of the 80-protein assay to established risk factors improved discrimination in the separate test sample from 0.686 (95% CI 0.682, 0.689) to 0.748 (95% CI 0.746, 0.751). A sparse model of 20 added proteins achieved a C statistic of 0.747 (95% CI 0.653, 0.842) in the test sample. We identified eight protein biomarkers, four of which are novel, for risk of MACE in community residents with type 2 diabetes, and found improved risk prediction by combining multiplex proteomics with an established risk model. Multiprotein arrays could be useful in identifying individuals with type 2 diabetes who are at highest risk of a cardiovascular event.

Novel coronary heart disease risk factors at 60–64 years and life course socioeconomic position: The 1946 British birth cohort

PubMed Central

Jones, Rebecca; Hardy, Rebecca; Sattar, Naveed; Deanfield, John E.; Hughes, Alun; Kuh, Diana; Murray, Emily T.; Whincup, Peter H.; Thomas, Claudia

2015-01-01

Social disadvantage across the life course is associated with a greater risk of coronary heart disease (CHD) and with established CHD risk factors, but less is known about whether novel CHD risk factors show the same patterns. The Medical Research Council National Survey of Health and Development was used to investigate associations between occupational socioeconomic position during childhood, early adulthood and middle age and markers of inflammation (C-reactive protein, interleukin-6), endothelial function (E-selectin, tissue-plasminogen activator), adipocyte function (leptin, adiponectin) and pancreatic beta cell function (proinsulin) measured at 60–64 years. Life course models representing sensitive periods, accumulation of risk and social mobility were compared with a saturated model to ascertain the nature of the relationship between social class across the life course and each of these novel CHD risk factors. For interleukin-6 and leptin, low childhood socioeconomic position alone was associated with high risk factor levels at 60–64 years, while for C-reactive protein and proinsulin, cumulative effects of low socioeconomic position in both childhood and early adulthood were associated with higher (adverse) risk factor levels at 60–64 years. No associations were observed between socioeconomic position at any life period with either endothelial marker or adiponectin. Associations for C-reactive protein, interleukin-6, leptin and proinsulin were reduced considerably by adjustment for body mass index and, to a lesser extent, cigarette smoking. In conclusion, socioeconomic position in early life is an important determinant of several novel CHD risk factors. Body mass index may be an important mediator of these relationships. PMID:25437893

Cardiovascular risk in women with polycystic ovary syndrome.

PubMed

Cho, L W; Atkin, S L

2007-12-01

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

Lifestyle and stroke risk: a review.

PubMed

Galimanis, Aekaterini; Mono, Marie-Luise; Arnold, Marcel; Nedeltchev, Krassen; Mattle, Heinrich P

2009-02-01

In recent years, many epidemiological studies have given new insights into old and new lifestyle factors that influence the risk of cerebrovascular events. In this review, we refer to the most important articles to highlight recent advances, especially those important for stroke prevention. This review focuses on the most recent studies that show the association of environmental factors, nutrition, alcohol, tobacco, education, lifestyle and behavior with the risk of vascular disease, including ischemic stroke and cerebral hemorrhage. The link between air pollution and stroke risk has become evident. Low education levels and depression are established as risk factors. This is also true for heavy alcohol consumption, although moderate drinking may be protective. Active and passive smoking are independent risk factors, and a smoking ban in public places has already reduced cardiovascular events in the short term. Physical activity reduces stroke risk; overweight increases it. However, clinical trials to assess the effect of weight reduction on stroke risk are still lacking. Fruits, vegetables, fish, fibers, low-fat dairy products, potassium and low sodium consumption are known and recommended to reduce cardiovascular risk. Data on omega 3 fatty acid, folic acid and B vitamins are inconsistent, and antioxidants are not recommended. Stroke can be substantially reduced by an active lifestyle, cessation of smoking and a healthy diet. Both public and professional education should promote the awareness that a healthy lifestyle and nutrition have the potential to reduce the burden of stroke.

Exaggerated blood pressure response during the exercise treadmill test as a risk factor for hypertension.

PubMed

Lima, S G; Albuquerque, M F P M; Oliveira, J R M; Ayres, C F J; Cunha, J E G; Oliveira, D F; Lemos, R R; Souza, M B R; Barbosa e Silva, O

2013-04-01

Exaggerated blood pressure response (EBPR) during the exercise treadmill test (ETT) has been considered to be a risk factor for hypertension. The relationship of polymorphisms of the renin-angiotensin system gene with hypertension has not been established. Our objective was to evaluate whether EBPR during exercise is a clinical marker for hypertension. The study concerned a historical cohort of normotensive individuals. The exposed individuals were those who presented EBPR. At the end of the observation period (41.7 months = 3.5 years), the development of hypertension was analyzed within the two groups. Genetic polymorphisms and blood pressure behavior were assessed as independent variables, together with the classical risk factors for hypertension. The I/D gene polymorphism of the angiotensin-converting enzyme and M235T of angiotensinogen were ruled out as risk factors for hypertension. EBPR during ETT is not an independent influence on the chances of developing hypertension. No differences were observed between the hypertensive and normotensive individuals regarding gender (P = 0.655), skin color (P = 0.636), family history of hypertension (P = 0.225), diabetes mellitus (P = 0.285), or hypertriglyceridemia (P = 0.734). The risk of developing hypertension increased with increasing body mass index (BMI) and advancing age. The risk factors, which independently influenced the development of hypertension, were age and BMI. EBPR did not constitute an independent risk factor for hypertension and is probably a preclinical phase in the spectrum of normotension and hypertension.

[Prevention and control of nosocomial and health-care facilities associated infections caused by species of Candida and other yeasts].

PubMed

Pemán, Javier; Zaragoza, Rafael; Salavert, Miguel

2013-12-01

Knowledge of the epidemiology of invasive fungal diseases caused by yeasts (Candida spp., especially) in health care settings allows the establishment of the levels necessary for its prevention. A first step is to identify groups of patients at high risk of nosocomial invasive fungal infections, establish accurate risk factors, observing the periods of greatest risk, and analyze the epidemiological profile in genera and species as well as the patterns of antifungal resistance. Secondly, mechanisms to avoid persistent exposure to potential fungal pathogens must be programed, protecting areas and recommending measures such as the control of the quality of the air and water, inside and outside the hospital, and other products or substances able to cause outbreaks. Finally, apart from the correct implementation of these measures, in selected patients at very high risk, the use of antifungal prophylaxis should be considered following the guidelines published.

Risk of Human Papillomavirus Infection in Cancer-Prone Individuals: What We Know

PubMed Central

Khoury, Ruby; Sauter, Sharon; Butsch Kovacic, Melinda; Nelson, Adam S.; Myers, Kasiani C.; Mehta, Parinda A.; Davies, Stella M.; Wells, Susanne I.

2018-01-01

Human papillomavirus (HPV) infections cause a significant proportion of cancers worldwide, predominantly squamous cell carcinomas (SCC) of the mucosas and skin. High-risk HPV types are associated with SCCs of the anogenital and oropharyngeal tract. HPV oncogene activities and the biology of SCCs have been intensely studied in laboratory models and humans. What remains largely unknown are host tissue and immune-related factors that determine an individual’s susceptibility to infection and/or carcinogenesis. Such susceptibility factors could serve to identify those at greatest risk and spark individually tailored HPV and SCC prevention efforts. Fanconi anemia (FA) is an inherited DNA repair disorder that is in part characterized by extreme susceptibility to SCCs. An increased prevalence of HPV has been reported in affected individuals, and molecular and functional connections between FA, SCC, and HPV were established in laboratory models. However, the presence of HPV in some human FA tumors is controversial, and the extent of the etiological connections remains to be established. Herein, we discuss cellular, immunological, and phenotypic features of FA, placed into the context of HPV pathogenesis. The goal is to highlight this orphan disease as a unique model system to uncover host genetic and molecular HPV features, as well as SCC susceptibility factors. PMID:29361695

[Hygienic education in pupils from general educational establishments].

PubMed

Mirskaia, N B

2009-01-01

The high prevalence of the major behavioral factors of a risk to health: violation of the study leisure regimen, violation of dietary pattern and quality, low motor activity, smoking, frequent alcohol abuse, drug taste, and deteriorated family microclimate, was revealed in middle and senior schoolchildren from Moscow, Kaliningrad, and Murmansk. Proposals are given to mold healthy lifestyle in adolescents and to optimize their hygienic education at general educational establishments.

[Epidemiological health factors and their relationship with academic performance during the first year of medical school. Study of two generations].

PubMed

López-Bárcena, Joaquin; González-de Cossío Ortiz, Marcela; Avila-Martínez, Isidro; Teos-Aguilar, Oswaldo

2009-01-01

Academic drop outs at the university level is a serious problem. At the School of Medicine of the UNAM, over 50% of students enrolled in their first year do not graduate. In order to solve this problem, the UNAM has tutoring and financial aids to help students. One area of enquiry is to analyze factors such as health status (physical and mental), lifestyle and environmental factors that may influence student's performance. The objective in the present study was to identify risk factors for overall health and establish a scholastic performance forecasting profile. Health variables included in the Examen Médico Automatizado (EMA) were correlated with the academic performance in a sample of students from two generations. Four groups were conformed and the variables that were analyzed included traditional academic program (TRAD), high academic demand and having a status as regular or irregular student. 1,848 students were included in the study. The risk factors that characterized students in the TRAD program and had an irregular status were: signs of depression, anxiety, suicidal ideation and suicidal intent, prior pregnancy, poor interpersonal relationships, public school education, low income, parents with less than college education and long commutes from home to school. Students with an irregular status belonging to the high academic demand, reported the strongest protective factors against school failure. The EMA test identifies risk and protective factors that have an influence on student's academic performance. A forecasting failure profile was established among first year of students enrolled in the TRAD program. We suggest strategies that should be implemented and to continue studying cohorts of graduating students.

Greater absolute risk for all subtypes of breast cancer in the US than Malaysia.

PubMed

Horne, Hisani N; Beena Devi, C R; Sung, Hyuna; Tang, Tieng Swee; Rosenberg, Philip S; Hewitt, Stephen M; Sherman, Mark E; Anderson, William F; Yang, Xiaohong R

2015-01-01

Hormone receptor (HR) negative breast cancers are relatively more common in low-risk than high-risk countries and/or populations. However, the absolute variations between these different populations are not well established given the limited number of cancer registries with incidence rate data by breast cancer subtype. We, therefore, used two unique population-based resources with molecular data to compare incidence rates for the 'intrinsic' breast cancer subtypes between a low-risk Asian population in Malaysia and high-risk non-Hispanic white population in the National Cancer Institute's surveillance, epidemiology, and end results 18 registries database (SEER 18). The intrinsic breast cancer subtypes were recapitulated with the joint expression of the HRs (estrogen receptor and progesterone receptor) and human epidermal growth factor receptor-2 (HER2). Invasive breast cancer incidence rates overall were fivefold greater in SEER 18 than in Malaysia. The majority of breast cancers were HR-positive in SEER 18 and HR-negative in Malaysia. Notwithstanding the greater relative distribution for HR-negative cancers in Malaysia, there was a greater absolute risk for all subtypes in SEER 18; incidence rates were nearly 7-fold higher for HR-positive and 2-fold higher for HR-negative cancers in SEER 18. Despite the well-established relative breast cancer differences between low-risk and high-risk countries and/or populations, there was a greater absolute risk for HR-positive and HR-negative subtypes in the US than Malaysia. Additional analytical studies are sorely needed to determine the factors responsible for the elevated risk of all subtypes of breast cancer in high-risk countries like the United States.

We Don't Need Any Stinking AFSRB!

NASA Technical Reports Server (NTRS)

Henwood, Barton

2008-01-01

Flight Test supports four needs: a) Management approval to proceed; b) Establish a record of accountability; c) Inject expert insight into the risk management process; and d) Mitigate the human factors vulnerabilities associated with small group teaming and project ownership.

SURF - SUrvey of Risk Factor management: first report of an international audit.

PubMed

Cooney, Mt; Reiner, Z; Sheu, W; Ryden, L; Sutter, J de; De Bacquer, D; DeBacker, G; Mithal, A; Chung, N; Lim, Yt; Dudina, A; Reynolds, A; Dunney, K; Graham, I

2014-07-01

Despite the fact that subjects with established coronary heart disease (CHD) are at high risk of further events and deserve meticulous secondary prevention, current audits such as EUROASPIRE show poor control of major risk factors. Ongoing monitoring is required. We present a new risk factor audit system, SURF (Survey of Risk Factor management), that can be conducted much more quickly and easily than existing audit systems and has the potential to allow hospitals of all sizes to participate in a unified international audit system that will complement EUROASPIRE. Initial experience indicates that SURF is truly simple to undertake in an international setting, and this is illustrated with the results of a substantive pilot project conducted in Europe and Asia. The data collection system was designed to allow rapid and easy data collection as part of routine clinic work. Consecutive patients (aged 18 and over) with established CHD attending outpatient cardiology clinics were included. Information on demographics, previous coronary medical history, smoking history, history of hypertension, dyslipidaemia or diabetes, physical activity, attendance at cardiac rehabilitation, cardiac medications, lipid and glucose levels (and HbA1c in diabetics) if available within the last year, blood pressure, heart rate, body mass index, and waist circumference were collected using a one-page data collection sheet. Years spent in full time education was added as an additional question during the pilot phase. Three European countries - Ireland (n = 251), Belgium (n = 122), and Croatia (n = 124) - and four Asian countries - Singapore (n = 142), Taiwan (n = 334), India (n = 97), and Korea (n = 45) - were included in the pilot study. The results of initial field testing were confirmed in that it proved possible to collect data within 60-90 seconds per subject. There was poor control of several risk factors including high levels of physical inactivity (41-45%), overweight and obesity (59-78%), and ongoing smoking (15%). There were lower levels of individuals attending cardiac rehabilitation in Asia. More Europeans than Asians reached the low-density lipoprotein cholesterol target of <2.5 mmol/l (66 vs. 59%) reflecting differences in medication usage. However, blood pressure control was superior in Asia, with 71% <140/90 compared with 66% of Europeans (NS). This phase of SURF has confirmed its ease of use which should allow wide participation and the collection of representative risk factor data in subjects with CHD as well as ongoing data collection to monitor secular trends in risk factor control. Notwithstanding that this is a pilot study, the results suggest that risk factor control, particularly for lifestyle-related measures, is poor in both Europe and Asia. © The European Society of Cardiology 2012.

Prognostic significance of smoking in addition to established risk factors in patients with Dukes B and C colorectal cancer: a retrospective analysis.

PubMed

Diamantis, N; Xynos, I D; Amptulah, S; Karadima, M; Skopelitis, H; Tsavaris, N

2013-01-01

To investigate the prognostic significance of smoking in addition to established risk factors in patients with Dukes stage B and C colorectal cancer (CRC). 291 consecutive non-selected CRC patients were studied retrospectively. Twenty-three variables were examined using a regression statistical model to identify relevant prognostic factors related to disease free survival (DFS) and overall survival (OS). On multivariate analysis DFS was found to be negatively affected in patients with a smoking history of ≤10 pack-years vs. non-smokers (p<0.016). Additionally, performance status (PS)<90 (p<0.001), Dukes stage C (p<0.001) and elevated tumor markers (p<0.001) at the time of diagnosis were found to adversely affect DFS. Smoking also had a significant association with relapse. Patients with a smoking history of ≤10 pack-years had 2.45 (p<0.018) higher risk of recurrence compared to patients with no smoking history. OS was influenced by Karnofsky performance status (PS), Dukes stage, and elevated tumor markers. In particular patients with PS< 90 had a 4.69-fold higher risk of death (p<0.001) than patients with better PS. Stage C disease was associated with 2.27-fold higher risk of death (p<0.001) than stage B disease, and patients with elevated tumor markers at the time of diagnosis had 2.74-fold higher risk of death (p<0.014) when compared to those whose tumor markers were normal at presentation. Our study associates smoking and relapse incidence in non-clinical- trial CRC patients and reiterates the prognostic significance of PS, stage and tumor markers at the time of diagnosis.

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 of neglectful mothers to help break the intergenerational neglect transmission cycle. It is also important to develop government policies and ensure that efforts among the various response networks are concerted since in-depth changes to neglect situations can only come about when all interested parties become involved. Copyright 2010 Elsevier Ltd. All rights reserved.

Establishment of the Fox Chase Network Breast Cancer Risk Registry.

DTIC Science & Technology

1995-10-01

Howe, G.R., Hirohata, T., Hislop , T.G., et al. "Dietary factors and risk of breast cancer: Combined analysis of 12 case-control studies," J Natl...1993. 15. King MC, Rowell S, Love SM: Inherited breast and ovarian cancer. What are the risks? What are the choices? JAMA 269(15):1975- 1980 , 1993. 16...3):118-124, 1980 . Kelly, Patricia T. Dealing with Dilemma. A Manual for Genetic Counselors. Springer-Verlag, New York, NY pp. 1-143, 1977. Kelly

Disentangling the risk assessment and intimate partner violence relation: Estimating mediating and moderating effects.

PubMed

Williams, Kirk R; Stansfield, Richard

2017-08-01

To manage intimate partner violence (IPV), the criminal justice system has turned to risk assessment instruments to predict if a perpetrator will reoffend. Empirically determining whether offenders assessed as high risk are those who recidivate is critical for establishing the predictive validity of IPV risk assessment instruments and for guiding the supervision of perpetrators. But by focusing solely on the relation between calculated risk scores and subsequent IPV recidivism, previous studies of the predictive validity of risk assessment instruments omitted mediating factors intended to mitigate the risk of this behavioral recidivism. The purpose of this study was to examine the mediating effects of such factors and the moderating effects of risk assessment on the relation between assessed risk (using the Domestic Violence Screening Instrument-Revised [DVSI-R]) and recidivistic IPV. Using a sample of 2,520 perpetrators of IPV, results revealed that time sentenced to jail and time sentenced to probation each significantly mediated the relation between DVSI-R risk level and frequency of reoffending. The results also revealed that assessed risk moderated the relation between these mediating factors and IPV recidivism, with reduced recidivism (negative estimated effects) for high-risk perpetrators but increased recidivism (positive estimate effects) for low-risk perpetrators. The implication is to assign interventions to the level of risk so that no harm is done. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

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.

Association of Anxiety and Depression With All‐Cause Mortality in Individuals With Coronary Heart Disease

PubMed Central

Watkins, Lana L.; Koch, Gary G.; Sherwood, Andrew; Blumenthal, James A.; Davidson, Jonathan R.T.; O'Connor, Christopher; Sketch, Michael H.

2013-01-01

Background Depression has been related to mortality in coronary heart disease (CHD) patients, but few studies have evaluated the role of anxiety or the role of the co‐occurrence of depression and anxiety. We examined whether anxiety is associated with increased risk of mortality after accounting for depression in individuals with established CHD. Methods and Results The cohort was composed of 934 men and women with confirmed CHD (mean age, 62±11 years) who completed the Hospital Anxiety and Depression scale (HADS) during hospitalization for coronary angiography. Over the 3‐year follow‐up period, there were 133 deaths. Elevated scores on the HADS anxiety subscale (HADS‐A≥8) were associated with increased risk of mortality after accounting for established risk factors including age, congestive heart failure, left ventricular ejection fraction, 3‐vessel disease, and renal disease (hazard ratio [HR], 2.27; 95% CI, 1.55 to 3.33; P<0.001). Elevated scores on the HADS depression subscale (HADS‐D≥8) were also associated with increased risk of mortality (HR, 2.18; 95% CI, 1.47 to 3.22; P<0.001). When both psychosocial factors were included in the model, each maintained an association with mortality (anxiety, HR, 1.83; 95% CI, 1.18 to 2.83; P=0.006; depression, HR, 1.66; 95% CI, 1.06 to 2.58; P=0.025). Estimation of the HR for patients with both anxiety and depression versus those with neither revealed a larger HR than for patients with either factor alone (HR, 3.10; 95% CI, 1.95 to 4.94; P<0.001). Conclusions Anxiety is associated with increased risk of mortality in CHD patients, particularly when comorbid with depression. Future studies should focus on the co‐occurrence of these psychosocial factors as markers of increased mortality risk. PMID:23537805

Race/Ethnic Differences in the Associations of the Framingham Risk Factors with Carotid IMT and Cardiovascular Events

PubMed Central

Hoefer, Imo E.; Eijkemans, Marinus J. C.; Asselbergs, Folkert W.; Anderson, Todd J.; Britton, Annie R.; Dekker, Jacqueline M.; Engström, Gunnar; Evans, Greg W.; de Graaf, Jacqueline; Grobbee, Diederick E.; Hedblad, Bo; Holewijn, Suzanne; Ikeda, Ai; Kitagawa, Kazuo; Kitamura, Akihiko; de Kleijn, Dominique P. V.; Lonn, Eva M.; Lorenz, Matthias W.; Mathiesen, Ellisiv B.; Nijpels, Giel; Okazaki, Shuhei; O’Leary, Daniel H.; Pasterkamp, Gerard; Peters, Sanne A. E.; Polak, Joseph F.; Price, Jacqueline F.; Robertson, Christine; Rembold, Christopher M.; Rosvall, Maria; Rundek, Tatjana; Salonen, Jukka T.; Sitzer, Matthias; Stehouwer, Coen D. A.; Bots, Michiel L.; den Ruijter, Hester M.

2015-01-01

Background Clinical manifestations and outcomes of atherosclerotic disease differ between ethnic groups. In addition, the prevalence of risk factors is substantially different. Primary prevention programs are based on data derived from almost exclusively White people. We investigated how race/ethnic differences modify the associations of established risk factors with atherosclerosis and cardiovascular events. Methods We used data from an ongoing individual participant meta-analysis involving 17 population-based cohorts worldwide. We selected 60,211 participants without cardiovascular disease at baseline with available data on ethnicity (White, Black, Asian or Hispanic). We generated a multivariable linear regression model containing risk factors and ethnicity predicting mean common carotid intima-media thickness (CIMT) and a multivariable Cox regression model predicting myocardial infarction or stroke. For each risk factor we assessed how the association with the preclinical and clinical measures of cardiovascular atherosclerotic disease was affected by ethnicity. Results Ethnicity appeared to significantly modify the associations between risk factors and CIMT and cardiovascular events. The association between age and CIMT was weaker in Blacks and Hispanics. Systolic blood pressure associated more strongly with CIMT in Asians. HDL cholesterol and smoking associated less with CIMT in Blacks. Furthermore, the association of age and total cholesterol levels with the occurrence of cardiovascular events differed between Blacks and Whites. Conclusion The magnitude of associations between risk factors and the presence of atherosclerotic disease differs between race/ethnic groups. These subtle, yet significant differences provide insight in the etiology of cardiovascular disease among race/ethnic groups. These insights aid the race/ethnic-specific implementation of primary prevention. PMID:26134404

Race/Ethnic Differences in the Associations of the Framingham Risk Factors with Carotid IMT and Cardiovascular Events.

PubMed

Gijsberts, Crystel M; Groenewegen, Karlijn A; Hoefer, Imo E; Eijkemans, Marinus J C; Asselbergs, Folkert W; Anderson, Todd J; Britton, Annie R; Dekker, Jacqueline M; Engström, Gunnar; Evans, Greg W; de Graaf, Jacqueline; Grobbee, Diederick E; Hedblad, Bo; Holewijn, Suzanne; Ikeda, Ai; Kitagawa, Kazuo; Kitamura, Akihiko; de Kleijn, Dominique P V; Lonn, Eva M; Lorenz, Matthias W; Mathiesen, Ellisiv B; Nijpels, Giel; Okazaki, Shuhei; O'Leary, Daniel H; Pasterkamp, Gerard; Peters, Sanne A E; Polak, Joseph F; Price, Jacqueline F; Robertson, Christine; Rembold, Christopher M; Rosvall, Maria; Rundek, Tatjana; Salonen, Jukka T; Sitzer, Matthias; Stehouwer, Coen D A; Bots, Michiel L; den Ruijter, Hester M

2015-01-01

Clinical manifestations and outcomes of atherosclerotic disease differ between ethnic groups. In addition, the prevalence of risk factors is substantially different. Primary prevention programs are based on data derived from almost exclusively White people. We investigated how race/ethnic differences modify the associations of established risk factors with atherosclerosis and cardiovascular events. We used data from an ongoing individual participant meta-analysis involving 17 population-based cohorts worldwide. We selected 60,211 participants without cardiovascular disease at baseline with available data on ethnicity (White, Black, Asian or Hispanic). We generated a multivariable linear regression model containing risk factors and ethnicity predicting mean common carotid intima-media thickness (CIMT) and a multivariable Cox regression model predicting myocardial infarction or stroke. For each risk factor we assessed how the association with the preclinical and clinical measures of cardiovascular atherosclerotic disease was affected by ethnicity. Ethnicity appeared to significantly modify the associations between risk factors and CIMT and cardiovascular events. The association between age and CIMT was weaker in Blacks and Hispanics. Systolic blood pressure associated more strongly with CIMT in Asians. HDL cholesterol and smoking associated less with CIMT in Blacks. Furthermore, the association of age and total cholesterol levels with the occurrence of cardiovascular events differed between Blacks and Whites. The magnitude of associations between risk factors and the presence of atherosclerotic disease differs between race/ethnic groups. These subtle, yet significant differences provide insight in the etiology of cardiovascular disease among race/ethnic groups. These insights aid the race/ethnic-specific implementation of primary prevention.

Validation of a multifactorial risk factor model used for predicting future caries risk with Nevada adolescents.

PubMed

Ditmyer, Marcia M; Dounis, Georgia; Howard, Katherine M; Mobley, Connie; Cappelli, David

2011-05-20

The objective of this study was to measure the validity and reliability of a multifactorial Risk Factor Model developed for use in predicting future caries risk in Nevada adolescents in a public health setting. This study examined retrospective data from an oral health surveillance initiative that screened over 51,000 students 13-18 years of age, attending public/private schools in Nevada across six academic years (2002/2003-2007/2008). The Risk Factor Model included ten demographic variables: exposure to fluoridation in the municipal water supply, environmental smoke exposure, race, age, locale (metropolitan vs. rural), tobacco use, Body Mass Index, insurance status, sex, and sealant application. Multiple regression was used in a previous study to establish which significantly contributed to caries risk. Follow-up logistic regression ascertained the weight of contribution and odds ratios of the ten variables. Researchers in this study computed sensitivity, specificity, positive predictive value (PVP), negative predictive value (PVN), and prevalence across all six years of screening to assess the validity of the Risk Factor Model. Subjects' overall mean caries prevalence across all six years was 66%. Average sensitivity across all six years was 79%; average specificity was 81%; average PVP was 89% and average PVN was 67%. Overall, the Risk Factor Model provided a relatively constant, valid measure of caries that could be used in conjunction with a comprehensive risk assessment in population-based screenings by school nurses/nurse practitioners, health educators, and physicians to guide them in assessing potential future caries risk for use in prevention and referral practices.

'He left me a message on Facebook': comparing the risk profiles of self-harming patients who leave paper suicide notes with those who leave messages on new media.

PubMed

Barrett, Jessica R; Shetty, Hitesh; Broadbent, Matthew; Cross, Sean; Hotopf, Matthew; Stewart, Robert; Lee, William

2016-05-01

In cases of non-fatal self-harm, suicide notes are a major risk factor for repeated self-harm and suicide. Suicide notes can now be left on new media services, emails or text messages, as well as on paper. In a group of people who had harmed themselves, we aimed to compare new media note-leavers with paper note-leavers and characterise these groups demographically and by risk factors. Clinical notes of patients who presented with non-fatal self-harm to two London emergency departments were anonymously searched for mentions of new media use. These were categorised and risk factors were compared for those who had left a new media note, a paper note, or no note to establish differences in risk of note-leaving. New media note-leaving was associated with younger age and substance use; both risk factors for repeated self-harm. However, suicidal intent remained highest in paper note-leavers. Paper note-leavers remain at greatest risk, however new media note leaving is still correlated with risk factors related to repeated self-harm and suicide. Clinicians should enquire about new media use during emergency department assessments of self-harm. None. © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.

Detailed assessments of childhood adversity enhance prediction of central obesity independent of gender, race, adult psychosocial risk and health behaviors.

PubMed

Davis, Cynthia R; Dearing, Eric; Usher, Nicole; Trifiletti, Sarah; Zaichenko, Lesya; Ollen, Elizabeth; Brinkoetter, Mary T; Crowell-Doom, Cindy; Joung, Kyoung; Park, Kyung Hee; Mantzoros, Christos S; Crowell, Judith A

2014-02-01

This study examined whether a novel indicator of overall childhood adversity, incorporating number of adversities, severity, and chronicity, predicted central obesity beyond contributions of "modifiable" risk factors including psychosocial characteristics and health behaviors in a diverse sample of midlife adults. The study also examined whether the overall adversity score (number of adversities × severity × chronicity) better predicted obesity compared to cumulative adversity (number of adversities), a more traditional assessment of childhood adversity. 210 Black/African Americans and White/European Americans, mean age=45.8; ±3.3 years, were studied cross-sectionally. Regression analysis examined overall childhood adversity as a direct, non-modifiable risk factor for central obesity (waist-hip ratio) and body mass index (BMI), with and without adjustment for established adult psychosocial risk factors (education, employment, social functioning) and heath behavior risk factors (smoking, drinking, diet, exercise). Overall childhood adversity was an independent significant predictor of central obesity, and the relations between psychosocial and health risk factors and central obesity were not significant when overall adversity was in the model. Overall adversity was not a statistically significant predictor of BMI. Overall childhood adversity, incorporating severity and chronicity and cumulative scores, predicts central obesity beyond more contemporaneous risk factors often considered modifiable. This is consistent with early dysregulation of metabolic functioning. Findings can inform practitioners interested in the impact of childhood adversity and personalizing treatment approaches of obesity within high-risk populations. Prevention/intervention research is necessary to discover and address the underlying causes and impact of childhood adversity on metabolic functioning. © 2013.

Induction of pluripotency by defined factors

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

Okita, Keisuke, E-mail: okita@cira.kyoto-u.ac.jp; Yamanaka, Shinya; Department of Stem Cell Biology, Institute for Frontier Medical Sciences, Kyoto University, Kyoto 606-8507

2010-10-01

Somatic cells can be reprogrammed into pluripotent stem cells by introducing a combination of several transcription factors. The induced pluripotent stem (iPS) cells from a patient's somatic cells could be useful source of cells for drug discovery and cell transplantation therapies. However, most human iPS cells are made by viral vectors, such as retrovirus and lentivirus, which integrate the reprogramming factors into host genomes and may increase the risk of tumor formation. Studies of the mechanisms underlying the reprogramming and establishment of non-integration methods contribute evidence to resolve the safety concerns associated with iPS cells. On the other hand, patient-specificmore » iPS cells have already been established and used for recapitulating disease pathology.« less

Examining the Influence of Ethnic/Racial Socialization on Aggressive Behaviors Among Juvenile Offenders

PubMed Central

Zapolski, Tamika C. B.; Garcia, Crystal A.; Jarjoura, G. Roger; Lau, Katherine S. L.; Aalsma, Matthew C.

2016-01-01

Risk assessment instruments are commonly used within the juvenile justice system to estimate a juvenile's likelihood of reoffending or engaging in aggressive or violent behavior. Although such instruments assess a broad range of factors, the influence of culture is often excluded. The current study examines the unique effect of ethnic/racial socialization on recent aggressive behaviors above and beyond three well-established risk and protective factors: delinquency history, moral disengagement, and social support. Participants were 95 juveniles who were either on probation or in detention centers in three Midwestern counties and who completed structured surveys related to personal experiences within and outside of the juvenile justice system. The findings provided partial support for our hypotheses: Consistent with previous findings, delinquency history and moral disengagement were significant predictors of recent aggressive behavior. Furthermore, when ethnic/racial socialization was added to the model, promotion of mistrust provided additional predictive validity for aggressive behavior above and beyond the other factors assessed. Based on these findings, the inclusion of education on culture may prove to be an important supplement to established intervention tools for juvenile offenders. PMID:27453798

Cardiovascular risk profile and frailty in a population-based study of older British men.

PubMed

Ramsay, S E; Arianayagam, D S; Whincup, P H; Lennon, L T; Cryer, J; Papacosta, A O; Iliffe, S; Wannamethee, S G

2015-04-01

Frailty in older age is known to be associated with cardiovascular disease (CVD) risk. However, the extent to which frailty is associated with the CVD risk profile has been little studied. Our aim was to examine the associations of a range of cardiovascular risk factors with frailty and to assess whether these are independent of established CVD. Cross-sectional study of a socially representative sample of 1622 surviving men aged 71-92 examined in 2010-2012 across 24 British towns, from a prospective study initiated in 1978-1980. Frailty was defined using the Fried phenotype, including weight loss, grip strength, exhaustion, slowness and low physical activity. Among 1622 men, 303 (19%) were frail and 876 (54%) were pre-frail. Compared with non-frail, those with frailty had a higher odds of obesity (OR 2.03, 95% CI 1.38 to 2.99), high waist circumference (OR 2.30, 95% CI 1.67 to 3.17), low high-density lipoprotein-cholesterol (HDL-C) (OR 2.28, 95% CI 1.47 to 3.54) and hypertension (OR 1.79, 95% CI 1.27 to 2.54). Prevalence of these factors was also higher in those with frailty (prevalence in frail vs non-frail groups was 46% vs 31% for high waist circumference, 20% vs 11% for low HDL and 78% vs 65% for hypertension). Frail individuals had a worse cardiovascular risk profile with an increased risk of high heart rate, poor lung function (forced expiratory volume in 1 s (FEV1)), raised white cell count (WCC), poor renal function (low estimated glomerular filtration rate), low alanine transaminase and low serum sodium. Some risk factors (HDL-C, hypertension, WCC, FEV1, renal function and albumin) were also associated with being pre-frail. These associations remained when men with prevalent CVD were excluded. Frailty was associated with increased risk of a range of cardiovascular factors (including obesity, HDL-C, hypertension, heart rate, lung function, renal function) in older people; these associations were independent of established CVD. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Evidence of Gene–Environment Interactions between Common Breast Cancer Susceptibility Loci and Established Environmental Risk Factors

PubMed Central

Nickels, Stefan; Truong, Thérèse; Hein, Rebecca; Stevens, Kristen; Buck, Katharina; Behrens, Sabine; Eilber, Ursula; Schmidt, Martina; Häberle, Lothar; Vrieling, Alina; Gaudet, Mia; Figueroa, Jonine; Schoof, Nils; Spurdle, Amanda B.; Rudolph, Anja; Fasching, Peter A.; Hopper, John L.; Makalic, Enes; Schmidt, Daniel F.; Southey, Melissa C.; Beckmann, Matthias W.; Ekici, Arif B.; Fletcher, Olivia; Gibson, Lorna; dos Santos Silva, Isabel; Peto, Julian; Humphreys, Manjeet K.; Wang, Jean; Cordina-Duverger, Emilie; Menegaux, Florence; Nordestgaard, Børge G.; Bojesen, Stig E.; Lanng, Charlotte; Anton-Culver, Hoda; Ziogas, Argyrios; Bernstein, Leslie; Clarke, Christina A.; Brenner, Hermann; Müller, Heiko; Arndt, Volker; Stegmaier, Christa; Brauch, Hiltrud; Brüning, Thomas; Harth, Volker; The GENICA Network; Mannermaa, Arto; Kataja, Vesa; Kosma, Veli-Matti; Hartikainen, Jaana M.; kConFab; Group, AOCS Management; Lambrechts, Diether; Smeets, Dominiek; Neven, Patrick; Paridaens, Robert; Flesch-Janys, Dieter; Obi, Nadia; Wang-Gohrke, Shan; Couch, Fergus J.; Olson, Janet E.; Vachon, Celine M.; Giles, Graham G.; Severi, Gianluca; Baglietto, Laura; Offit, Kenneth; John, Esther M.; Miron, Alexander; Andrulis, Irene L.; Knight, Julia A.; Glendon, Gord; Mulligan, Anna Marie; Chanock, Stephen J.; Lissowska, Jolanta; Liu, Jianjun; Cox, Angela; Cramp, Helen; Connley, Dan; Balasubramanian, Sabapathy; Dunning, Alison M.; Shah, Mitul; Trentham-Dietz, Amy; Newcomb, Polly; Titus, Linda; Egan, Kathleen; Cahoon, Elizabeth K.; Rajaraman, Preetha; Sigurdson, Alice J.; Doody, Michele M.; Guénel, Pascal; Pharoah, Paul D. P.; Schmidt, Marjanka K.; Hall, Per; Easton, Doug F.; Garcia-Closas, Montserrat; Milne, Roger L.; Chang-Claude, Jenny

2013-01-01

Various common genetic susceptibility loci have been identified for breast cancer; however, it is unclear how they combine with lifestyle/environmental risk factors to influence risk. We undertook an international collaborative study to assess gene-environment interaction for risk of breast cancer. Data from 24 studies of the Breast Cancer Association Consortium were pooled. Using up to 34,793 invasive breast cancers and 41,099 controls, we examined whether the relative risks associated with 23 single nucleotide polymorphisms were modified by 10 established environmental risk factors (age at menarche, parity, breastfeeding, body mass index, height, oral contraceptive use, menopausal hormone therapy use, alcohol consumption, cigarette smoking, physical activity) in women of European ancestry. We used logistic regression models stratified by study and adjusted for age and performed likelihood ratio tests to assess gene–environment interactions. All statistical tests were two-sided. We replicated previously reported potential interactions between LSP1-rs3817198 and parity (Pinteraction = 2.4×10−6) and between CASP8-rs17468277 and alcohol consumption (Pinteraction = 3.1×10−4). Overall, the per-allele odds ratio (95% confidence interval) for LSP1-rs3817198 was 1.08 (1.01–1.16) in nulliparous women and ranged from 1.03 (0.96–1.10) in parous women with one birth to 1.26 (1.16–1.37) in women with at least four births. For CASP8-rs17468277, the per-allele OR was 0.91 (0.85–0.98) in those with an alcohol intake of <20 g/day and 1.45 (1.14–1.85) in those who drank ≥20 g/day. Additionally, interaction was found between 1p11.2-rs11249433 and ever being parous (Pinteraction = 5.3×10−5), with a per-allele OR of 1.14 (1.11–1.17) in parous women and 0.98 (0.92–1.05) in nulliparous women. These data provide first strong evidence that the risk of breast cancer associated with some common genetic variants may vary with environmental risk factors. PMID:23544014

Methodological challenges in a study on falls in an older population of Cape Town, South Africa.

PubMed

Kalula, Sebastiana Z; Ferreira, Monica; Swingler, George H; Badri, Motasim; Sayer, Avan A

2017-09-01

Falls are a major cause of disability, morbidity and mortality in older persons, but have been under researched in developing countries. To describe challenges encountered in a community-based study on falls in a multi-ethnic population aged ≥65 years in a low-income setting. The study was conducted in four stages: A pilot study (n=105) to establish a sample size for the survey. An equipment validation study (n=118) to use for fall risk determination. A cross-sectional baseline (n=837) and a 12-month follow-up survey (n=632) to establish prevalence and risk factors for falls. Prevalence rate of 26.4% (95% CI 23.5-29.5%) and risk factors for recurrent falls: previous falls, self-reported poor mobility and dizziness were established. Adaptations to the gold standard prospective fall research study design were employed: 1) to gain access to the study population in three selected suburbs, 2) to perform assessments in a non-standardised setting, 3) to address subjects' poverty and low literacy levels, and high attrition of subjects and field workers. Studies on falls in the older population of low- to middle-income countries have methodological challenges. Adaptive strategies used in the Cape Town study and the research experience reported may be instructive for investigators planning similar studies in such settings.

Quantifying the Establishment Likelihood of Invasive Alien Species Introductions Through Ports with Application to Honeybees in Australia.

PubMed

Heersink, Daniel K; Caley, Peter; Paini, Dean R; Barry, Simon C

2016-05-01

The cost of an uncontrolled incursion of invasive alien species (IAS) arising from undetected entry through ports can be substantial, and knowledge of port-specific risks is needed to help allocate limited surveillance resources. Quantifying the establishment likelihood of such an incursion requires quantifying the ability of a species to enter, establish, and spread. Estimation of the approach rate of IAS into ports provides a measure of likelihood of entry. Data on the approach rate of IAS are typically sparse, and the combinations of risk factors relating to country of origin and port of arrival diverse. This presents challenges to making formal statistical inference on establishment likelihood. Here we demonstrate how these challenges can be overcome with judicious use of mixed-effects models when estimating the incursion likelihood into Australia of the European (Apis mellifera) and Asian (A. cerana) honeybees, along with the invasive parasites of biosecurity concern they host (e.g., Varroa destructor). Our results demonstrate how skewed the establishment likelihood is, with one-tenth of the ports accounting for 80% or more of the likelihood for both species. These results have been utilized by biosecurity agencies in the allocation of resources to the surveillance of maritime ports. © 2015 Society for Risk Analysis.

Genetic factors influencing prostate cancer risk in Norwegian men.

PubMed

Chen, Haitao; Ewing, Charles M; Zheng, Sigun; Grindedaal, Eli M; Cooney, Kathleen A; Wiley, Kathleen; Djurovic, Srdjan; Andreassen, Ole A; Axcrona, Karol; Mills, Ian G; Xu, Jianfeng; Maehle, Lovise; Fosså, Sophie D; Isaacs, William B

2018-02-01

Norway has one of the highest rates of death due to prostate cancer (PCa) in the world. To assess the contribution of both common and rare single nucleotide variants (SNPs) to the prostate cancer burden in Norway, we assessed the frequency of the established prostate cancer susceptibility allele, HOXB13 G84E, as well as a series of validated, common PCa risk SNPs in a Norwegian PCa population of 779 patients. The G84E allele was observed in 2.3% of patients compared to 0.7% of control individuals, OR = 3.8, P = 1 × 10-4. While there was a trend toward an earlier age at diagnosis, overall the clinicopathologic features of PCa were not significantly different in G84E carriers and non-carriers. Evaluation of 32 established common risk alleles revealed significant associations of risk alleles at 13 loci, including SNPs at 8q24, and near TET2, SLC22A3, NKX3-1, CASC8, MYC, DAP2IP, MSMB, HNF1B, PPP1R14A, and KLK2/3. When the data for each SNP are combined into a genetic risk score (GRS), Norwegian men within the top decile of GRS have over 5-fold greater risk to be diagnosed with PCa than men with GRS in the lowest decile. These results indicate that risk alleles of HOXB13 and common variant SNPs are important components of inherited PCa risk in the Norwegian population, although these factors appear to contribute little to the malignancy's aggressiveness. © 2017 Wiley Periodicals, Inc.

Progression to established smoking among US youths.

PubMed

Mowery, Paul D; Farrelly, Matthew C; Haviland, M Lyndon; Gable, Julia M; Wells, Henry E

2004-02-01

Our study presents national estimates of the proportion of youths in each of 7 stages of smoking and investigates the associations between risk/protective factors and progression to established smoking. We analyzed data from the 1999 and 2000 National Youth Tobacco Surveys. In 1999 and 2000, 48.6% of US adolescents had at least experimented with tobacco, and 7.8% were established smokers. Important correlates of progression to established smoking included parental advice not to smoke, antismoking lessons in school, susceptibility to tobacco industry advertising and promotion, peer smoking, and exposure to smoking at home. Interventions to stop adolescent progression to established smoking should target susceptible never smokers and early experimenters as well as those in later stages of smoking.

Associations between health literacy and established predictors of smoking cessation.

PubMed

Stewart, Diana W; Adams, Claire E; Cano, Miguel A; Correa-Fernández, Virmarie; Li, Yisheng; Waters, Andrew J; Wetter, David W; Vidrine, Jennifer Irvin

2013-07-01

We examined associations between health literacy and predictors of smoking cessation among 402 low-socioeconomic status (SES), racially/ethnically diverse smokers. Data were collected as part of a larger study evaluating smoking health risk messages. We conducted multiple linear regression analyses to examine relations between health literacy and predictors of smoking cessation (i.e., nicotine dependence, smoking outcome expectancies, smoking risk perceptions and knowledge, self-efficacy, intentions to quit or reduce smoking). Lower health literacy was associated with higher nicotine dependence, more positive and less negative smoking outcome expectancies, less knowledge about smoking health risks, and lower risk perceptions. Associations remained significant (P < .05) after controlling for demographics and SES-related factors. These results provide the first evidence that low health literacy may serve as a critical and independent risk factor for poor cessation outcomes among low-socioeconomic status, racially/ethnically diverse smokers. Research is needed to investigate potential mechanisms underlying this relationship.

Utility of Respondent Driven Sampling to Reach Disadvantaged Emerging Adults for Assessment of Substance Use, Weight, and Sexual Behaviors.

PubMed

Tucker, Jalie A; Simpson, Cathy A; Chandler, Susan D; Borch, Casey A; Davies, Susan L; Kerbawy, Shatomi J; Lewis, Terri H; Crawford, M Scott; Cheong, JeeWon; Michael, Max

2016-01-01

Emerging adulthood often entails heightened risk-taking with potential life-long consequences, and research on risk behaviors is needed to guide prevention programming, particularly in under-served and difficult to reach populations. This study evaluated the utility of Respondent Driven Sampling (RDS), a peer-driven methodology that corrects limitations of snowball sampling, to reach at-risk African American emerging adults from disadvantaged urban communities. Initial "seed" participants from the target group recruited peers, who then recruited their peers in an iterative process (110 males, 234 females; M age = 18.86 years). Structured field interviews assessed common health risk factors, including substance use, overweight/obesity, and sexual behaviors. Established gender-and age-related associations with risk factors were replicated, and sample risk profiles and prevalence estimates compared favorably with matched samples from representative U.S. national surveys. Findings supported the use of RDS as a sampling method and grassroots platform for research and prevention with community-dwelling risk groups.

The maternal-age-associated risk of congenital heart disease is modifiable.

PubMed

Schulkey, Claire E; Regmi, Suk D; Magnan, Rachel A; Danzo, Megan T; Luther, Herman; Hutchinson, Alayna K; Panzer, Adam A; Grady, Mary M; Wilson, David B; Jay, Patrick Y

2015-04-09

Maternal age is a risk factor for congenital heart disease even in the absence of any chromosomal abnormality in the newborn. Whether the basis of this risk resides with the mother or oocyte is unknown. The impact of maternal age on congenital heart disease can be modelled in mouse pups that harbour a mutation of the cardiac transcription factor gene Nkx2-5 (ref. 8). Here, reciprocal ovarian transplants between young and old mothers establish a maternal basis for the age-associated risk in mice. A high-fat diet does not accelerate the effect of maternal ageing, so hyperglycaemia and obesity do not simply explain the mechanism. The age-associated risk varies with the mother's strain background, making it a quantitative genetic trait. Most remarkably, voluntary exercise, whether begun by mothers at a young age or later in life, can mitigate the risk when they are older. Thus, even when the offspring carry a causal mutation, an intervention aimed at the mother can meaningfully reduce their risk of congenital heart disease.

The associations between a polygenic score, reproductive and menstrual risk factors and breast cancer risk.

PubMed

Warren Andersen, Shaneda; Trentham-Dietz, Amy; Gangnon, Ronald E; Hampton, John M; Figueroa, Jonine D; Skinner, Halcyon G; Engelman, Corinne D; Klein, Barbara E; Titus, Linda J; Newcomb, Polly A

2013-07-01

We evaluated whether 13 single nucleotide polymorphisms (SNPs) identified in genome-wide association studies interact with one another and with reproductive and menstrual risk factors in association with breast cancer risk. DNA samples and information on parity, breastfeeding, age at menarche, age at first birth, and age at menopause were collected through structured interviews from 1,484 breast cancer cases and 1,307 controls who participated in a population-based case-control study conducted in three US states. A polygenic score was created as the sum of risk allele copies multiplied by the corresponding log odds estimate. Logistic regression was used to test the associations between SNPs, the score, reproductive and menstrual factors, and breast cancer risk. Nonlinearity of the score was assessed by the inclusion of a quadratic term for polygenic score. Interactions between the aforementioned variables were tested by including a cross-product term in models. We confirmed associations between rs13387042 (2q35), rs4973768 (SLC4A7), rs10941679 (5p12), rs2981582 (FGFR2), rs3817198 (LSP1), rs3803662 (TOX3), and rs6504950 (STXBP4) with breast cancer. Women in the score's highest quintile had 2.2-fold increased risk when compared to women in the lowest quintile (95 % confidence interval: 1.67-2.88). The quadratic polygenic score term was not significant in the model (p = 0.85), suggesting that the established breast cancer loci are not associated with increased risk more than the sum of risk alleles. Modifications of menstrual and reproductive risk factors associations with breast cancer risk by polygenic score were not observed. Our results suggest that the interactions between breast cancer susceptibility loci and reproductive factors are not strong contributors to breast cancer risk.

Modifiable risk factors for RA: prevention, better than cure?

PubMed Central

Lahiri, Manjari; Morgan, Catharine; Symmons, Deborah P. M.

2012-01-01

Objective. To perform a meta-synthesis of the evidence for modifiable lifestyle risk factors for inflammatory polyarthritis (IP) and RA. Methods. We performed a MEDLINE literature search. Case–control and cohort studies and systematic reviews published from 1948 through February 2011 and studying modifiable risk factors for RA were retrieved. The main outcome measure was diagnosis of RA according to the standard criteria. Results. Smoking contributes up to 25% of the population burden of RA. The risk is dose related, stronger in males and especially strong for anti-citrullinated peptide antibody positive (ACPA+) RA through an interaction with the shared epitope. After smoking cessation, there is, however, a latency of up to 20 years to return to baseline risk. Other associations are less definitive; however, prospective studies suggest that dietary antioxidants and breastfeeding may be protective and that high coffee consumption may increase RA risk. An inverse association with alcohol intake (especially in smokers) and with education/social class (especially seropositive RA) and an increased risk with obesity (seronegative RA) is also noted. Conclusion. There is a need for further large-scale prospective studies with a consistent definition of RA phenotype (undifferentiated IP through to ACPA+/RF+ disease). This will ultimately afford the opportunity to evaluate preventative population strategies for RA akin to the well-established programmes for cardiovascular disease and cancer, targeting common risk factors. PMID:22120459

Development and external validation of nomograms to predict the risk of skeletal metastasis at the time of diagnosis and skeletal metastasis-free survival in nasopharyngeal carcinoma.

PubMed

Yang, Lin; Xia, Liangping; Wang, Yan; He, Shasha; Chen, Haiyang; Liang, Shaobo; Peng, Peijian; Hong, Shaodong; Chen, Yong

2017-09-06

The skeletal system is the most common site of distant metastasis in nasopharyngeal carcinoma (NPC); various prognostic factors have been reported for skeletal metastasis, though most studies have focused on a single factor. We aimed to establish nomograms to effectively predict skeletal metastasis at initial diagnosis (SMAD) and skeletal metastasis-free survival (SMFS) in NPC. A total of 2685 patients with NPC who received bone scintigraphy (BS) and/or 18F-deoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and 2496 patients without skeletal metastasis were retrospectively assessed to develop individual nomograms for SMAD and SMFS. The models were validated externally using separate cohorts of 1329 and 1231 patients treated at two other institutions. Five independent prognostic factors were included in each nomogram. The SMAD nomogram had a significantly higher c-index than the TNM staging system (training cohort, P = 0.005; validation cohort, P < 0.001). The SMFS nomogram had significantly higher c-index values in the training and validation sets than the TNM staging system (P < 0.001 and P = 0.005, respectively). Three proposed risk stratification groups were created using the nomograms, and enabled significant discrimination of SMFS for each risk group. The prognostic nomograms established in this study enable accurate stratification of distinct risk groups for skeletal metastasis, which may improve counseling and facilitate individualized management of patients with NPC.

Family history, place and season of birth as risk factors for schizophrenia in Denmark: a replication and reanalysis.

PubMed

Pedersen, C B; Mortensen, P B

2001-07-01

Although a family history of schizophrenia is the strongest individual risk factor for schizophrenia, environmental factors related to urbanicity may contribute to a substantial proportion of the population occurrence of the disease. This study replicates previous findings in four mutually exclusive Danish study populations, including out-patient information, ICD-10 diagnoses of schizophrenia, and a broader adjustment for mental illness in family members. We established a population-based cohort of 2.66 million Danish people using data from the Civil Registration System linked with the Psychiatric Case Register. Overall, 10 264 persons developed schizophrenia during the 50.7 million person-years of follow-up. The risk of schizophrenia was increased by urbanicity of place of birth and by family history of schizophrenia or other mental disorders. Urban-rural differences of schizophrenia risk were replicated and could not be associated with the potential sources of bias we assessed. Environmental factors underlying the effect of place of birth are major determinants of schizophrenia occurrence at the population level, although the effect of family history is the strongest at the individual level.

HIV information and behavioral skills moderate the effects of relationship type and substance use on HIV risk behaviors among African American youth.

PubMed

Mustanski, Brian; Byck, Gayle R; Newcomb, Michael E; Henry, David; Bolland, John; Dick, Danielle

2013-06-01

The HIV/AIDS epidemic is disproportionately impacting young African Americans. Efforts to understand and address risk factors for unprotected sex in this population are critical in improving prevention efforts. Situational risk factors, such as relationship type and substance use before sex, are in need of further study. This study explored how established cognitive predictors of risky sexual behavior moderated the association between situational factors and unprotected sex among low-income, African American adolescents. The largest main effect on the number of unprotected sex acts was classifying the relationship as serious (event rate ratio=10.18); other significant main effects were alcohol use before sex, participant age, behavioral skills, and level of motivation. HIV information moderated the effect of partner age difference, motivation moderated the effects of partner age difference and drug use before sex, and behavioral skills moderated the effects of alcohol and drug use before sex. This novel, partnership-level approach provides insight into the complex interactions of situational and cognitive factors in sexual risk taking.

HIV Information and Behavioral Skills Moderate the Effects of Relationship Type and Substance Use on HIV Risk Behaviors Among African American Youth

PubMed Central

Byck, Gayle R.; Newcomb, Michael E.; Henry, David; Bolland, John; Dick, Danielle

2013-01-01

Abstract The HIV/AIDS epidemic is disproportionately impacting young African Americans. Efforts to understand and address risk factors for unprotected sex in this population are critical in improving prevention efforts. Situational risk factors, such as relationship type and substance use before sex, are in need of further study. This study explored how established cognitive predictors of risky sexual behavior moderated the association between situational factors and unprotected sex among low-income, African American adolescents. The largest main effect on the number of unprotected sex acts was classifying the relationship as serious (event rate ratio=10.18); other significant main effects were alcohol use before sex, participant age, behavioral skills, and level of motivation. HIV information moderated the effect of partner age difference, motivation moderated the effects of partner age difference and drug use before sex, and behavioral skills moderated the effects of alcohol and drug use before sex. This novel, partnership-level approach provides insight into the complex interactions of situational and cognitive factors in sexual risk taking. PMID:23701198

Trends in risk factors for coronary heart disease in the Netherlands.

PubMed

Koopman, C; Vaartjes, I; Blokstra, A; Verschuren, W M M; Visser, M; Deeg, D J H; Bots, M L; van Dis, I

2016-08-19

Favourable trends in risk factor levels in the general population may partly explain the decline in coronary heart disease (CHD) morbidity and mortality. Our aim was to present long-term national trends in established risk factors for CHD. Data were obtained from five data sources including several large scale population based surveys, cohort studies and general practitioner registers between 1988 and 2012. We applied linear regression models to age-standardized time trends to test for statistical significant trends. Analyses were stratified by sex and age (younger <65 and older ≥65 years adults). The results demonstrated favourable trends in smoking (except in older women) and physical activity (except in older men). Unfavourable trends were found for body mass index (BMI) and diabetes mellitus prevalence. Although systolic blood pressure (SBP) and total cholesterol trends were favourable for older persons, SBP and total cholesterol remained stable in younger persons. Four out of six risk factors for CHD showed a favourable or stable trend. The rise in diabetes mellitus and BMI is worrying with respect to CHD morbidity and mortality.

Childhood Cognition and Risk Factors for Cardiovascular Disease in Midadulthood: The 1958 British Birth Cohort Study

PubMed Central

Jefferis, Barbara J. M. H.; Manor, Orly

2010-01-01

Objectives. We sought to establish whether associations between childhood cognition and risk factors for cardiovascular disease in adulthood are explained by common causes, or adult social position or health behavior. Methods. We analyzed associations between cognition at age 11 and cardiovascular disease risk factors at age 45 in the 1958 British birth cohort (n = 9377), with and without adjustment for covariates. Results. General ability was inversely associated with systolic and diastolic blood pressure, glycosylated hemoglobin, triglycerides (in women), body mass index, and waist circumference. Systolic blood pressure decreased by 0.47 mm Hg (95% confidence interval [CI] = −0.90, –0.05) for a 1-standard-deviation increase in ability. Separate adjustment for social class at birth, education level by adulthood, adult social class, and health behaviors reduced the associations respectively by 14% to 34%, 36% to 50%, 14% to 36%, and 24% to 73%. Full adjustment reduced associations between ability and risk factors at age 45 years by 43% to 92%, abolishing all associations. Conclusions. Increments across the distribution of childhood cognition are associated with improvements in cardiovascular risk profile in midlife, with associations primarily mediated through adult health behavior and social destinations. PMID:19910352

[Characteristics of falls producing hip fracture in an elderly population. Differences according to age and gender].

PubMed

Formiga, F; Ruiz, D; López-Soto, A; Duaso, E; Chivite, D; Pérez-Castejón, J M

2006-01-01

The majority of hip fractures are produced because of a fall. We examined the characteristics associated with falls causing hip fracture in elderly patients. Characteristics of falls owing to hip fracture were analyzed in 410 consecutive patients admitted in 6 hospitals during the 2004. We evaluated the location, time and the possible cause of fall: intrinsic risk factor, extrinsic or combined. We evaluated 316 women (77%) and 94 men, mean age 81.9 years. Previous to the hip fracture, the mean BI was 77.5. The mean value of falls during the last year was 1.9. Previously to the fall that caused hip fracture, we found that 24% of the patients had fallen repeatedly (more than two falls). Usually falls were at home (68%) and during daytime (80%). In 45% of patients an intrinsic risk factor was considered the most likely cause, in 33% an extrinsic risk factor and in 22% a combination. The majority of falls owing to hip fracture in elderly people happen in daytime, at home and due to intrinsic risk factors. Efforts to identify elderly people at risk of fall should be stressed in order to establish preventive measures.

Gender differences in risk factors for cigarette smoking initiation in childhood.

PubMed

Sylvestre, Marie-Pierre; Wellman, Robert J; O'Loughlin, Erin K; Dugas, Erika N; O'Loughlin, Jennifer

2017-09-01

We investigated whether established risk factors for initiating cigarette smoking during adolescence (parents, siblings, friends smoke; home smoking rules, smokers at home, exposure to smoking in cars, academic performance, susceptibility to smoking, depressive symptoms, self-esteem, school connectedness, use of other tobacco products) are associated with initiation in preadolescents, and whether the effects of these factors differ by gender. In spring 2005, baseline data were collected in self-report questionnaires from 1801 5th grade students including 1553 never-smokers (mean age=10.7years), in the longitudinal AdoQuest I Study in Montréal, Canada. Follow-up data were collected in the fall and spring of 6th grade (2005-2006). Poisson regression analyses with robust variance estimated the effects of each risk factor on initiation and additive interactions with gender were computed to assess the excess risk of each risk factor in girls compared to boys. 101 of 1399 participants in the analytic sample (6.7% of boys; 7.7% of girls) initiated smoking during follow-up. After adjustment for age, gender and maternal education, all risk factors except academic performance and school connectedness were statistically significantly associated with initiation. Paternal and sibling smoking were associated with initiation in girls only, and girls with lower self-esteem had a significant excess risk of initiating smoking in 6th grade. Risk factors for smoking initiation in preadolescents mirror those in adolescents; their effects do not differ markedly by gender. Preventive programs targeting children should focus on reducing smoking in the social environment and the dangers of poly-tobacco use. Copyright © 2017 Elsevier Ltd. All rights reserved.

Risk exposure to vibration and noise in the use of agricultural track-laying tractors.

PubMed

Vallone, Mariangela; Bono, Filippa; Quendler, Elisabeth; Febo, Pierluigi; Catania, Pietro

2016-12-23

Human exposure to mechanical vibration may represent a significant risk factor for exposed workers in the agricultural sector. Also, noise in agriculture is one of the risk factors to be taken into account in the evaluation of workers' health and safety. One of the major sources of discomfort for the workers operating a tractors is the noise to which they are exposed during work. The aim of this study was to evaluate the risk of exposure to whole-body vibration for the operator driving track-laying tractors in vineyard orchard and the noise level. The experimental tests were performed with six different track-laying tractors coupled with the same rototilling machine. The results showed that the vibration values of track-laying tractors coupled to rototilling machine, referred to the 8-hour working day, were always higher than 0.5 m s -2 , the daily exposure action value established by Directive 2002/44/EC of the European Parliament. The daily noise exposure levels always exceeded the exposure limit value of 87 dB(A) established by Directive 2003/10/EC of the European Parliament. The ANOVA repeated measures model showed that the factor 'site', namely, the soil characteristics, did not influence the vibration level on the X and Y-axes of the tractors measured, regardless of their age. In the Z-axis, the vibration level was enhanced as the soil structure increased. As tractor age increased, the influence of soil characteristics was less important. In term of the age of the tractor and the number of hours worked, it was possible to identify three risk classes, which were up to 3,000 hours worked and offered a low risk; from 3,000 - 6,000 hours worked with a medium risk, and over 6,000 hours with a high risk level.

Description of Various Factors Contributing to Traffic Accidents in Youth and Measures Proposed to Alleviate Recurrence

PubMed Central

Gicquel, Ludovic; Ordonneau, Pauline; Blot, Emilie; Toillon, Charlotte; Ingrand, Pierre; Romo, Lucia

2017-01-01

Traffic accidents are the leading cause of hospitalization in adolescence, with the 18–24-year-old age group accounting for 23% of deaths by traffic accidents. Recurrence rate is also high. One in four teenagers will have a relapse within the year following the first accident. Cognitive impairments known in adolescence could cause risky behaviors, defined as repetitive engagement in dangerous situations such as road accidents. Two categories of factors seem to be associated with traffic accidents: (1) factors specific to the traffic environment and (2) “human” factors, which seem to be the most influential. Moreover, the establishment of a stronger relation to high speed driving increases traffic accident risks and can also be intensified by sensation seeking. Other factors such as substance use (alcohol, drugs, and “binge drinking”) are also identified as risk factors. Furthermore, cell phone use while driving and attention deficit disorder with or without hyperactivity also seem to be important risk factors for car accidents. The family environment strongly influences a young person’s driving behavior. Some interventional driving strategies and preventive measures have reduced the risk of traffic accidents among young people, such as the graduated driver licensing program and advertising campaigns. So far, few therapeutic approaches have been implemented. Reason why, we decided to set up an innovative strategy consisting of a therapeutic postaccident group intervention, entitled the ECARR2 protocol, to prevent recurrence among adolescents and young adults identified at risk, taking into account the multiple risk factors. PMID:28620324

A review of caffeine use as a risk or protective factor for women's health and pregnancy.

PubMed

Peacock, Amy; Mattick, Richard P; Bruno, Raimondo

2017-07-01

To provide a narrative synthesis of recently published studies on caffeine use as a risk or protective factor for health outcomes, with a focus on women's health and pregnancy. Based on predominantly observational studies, moderate caffeine intake has been shown to be a protective factor for liver cancer, certain bowel conditions, colorectal cancer, skin cancer, and regular menstrual cycle function. However, heavy consumption is a risk factor for osteoporosis, urinary incontinence, and poorer birth and child developmental outcomes. Residual confounding and issues surrounding retrospective self-reported intake are cited as key limitations in the majority of these studies. Moderate caffeine intake has been associated with lower risk of cardiovascular disease and metabolic syndrome; however, recent genetic epidemiology studies provide no evidence for a causal relationship. Greater inclusion of female participants in studies, and analysis of sex differences in the relationship between caffeine intake and certain health conditions, is necessary. The current literature suggests caffeine's role as a risk or protective factor differs across health conditions. Often, there are plausible biological mechanisms for this relationship. However, a continued precautionary stance is recommended until direct causal pathways are established. Review of recently published studies does not suggest that current intake guidelines for adults and for pregnant woman need to be modified.

An Investigation into the Lifestyle, Health Habits and Risk Factors of Young Adults

PubMed Central

Al-Nakeeb, Yahya; Lyons, Mark; Dodd, Lorna J.; Al-Nuaim, Anwar

2015-01-01

This project examined the lifestyle, health habits and risk factors of young adults at Qatar University. It explored the clustering and differences in dietary habits, body mass index (BMI) and physical activity (PA) amongst male and female students, both Qatari and non-Qatari. Seven hundred thirty two students aged 18–25 years completed a self-reported questionnaire and an objective measure of BMI. Males and females had a high prevalence of being overweight and obesity and low levels of PA, according to well-established international standards. Three clusters were identified based on the students’ lifestyle and dietary habits. Cluster 1 (high risk factors) included those who engaged the least in healthy dietary practices and consumed the most unhealthy foods, participated in less PA and had the highest BMI. Cluster 2 (moderate risk factors) included those with considerably more habits falling into the moderate category, engagement in the most PA, the least TV and computer viewing time and had the lowest BMI. Cluster 3 (low risk factors) included those who engaged the most with the four healthy dietary practices, the least with the four unhealthy dietary practices and participated in moderate PA per week. This project provides valuable data that could be used by policy makers to address issues concerning student’s health. PMID:25913183

Risk factors of bicycle traffic injury among middle school students in chaoshan rural areas of china.

PubMed

Lin, Zhen-Bin; Ji, Yan-Hu; Xiao, Qing-Yu; Luo, Li-Bo; Li, Li-Ping; Choi, Bernard

2017-01-26

Bicycle injuries are a leading cause of accidental death among children in the world, and bicycle-related injuries are also very common in China, thus to find out bicycle injury risk factors is imperative. This study aims to identify the cyclist-, bicycle- and road-related risk factors of bicycle injury, to develop health education programs as an intervention and to provide a scientific basis for establishing policies against bicycle injury. We selected two middle schools randomly among seven schools in Chaoshan rural areas,where the main means of transportation for students from home to school was bicycle. The subjects were middle school students from 7th to 9th grades from Gucuo Middle School and Hefeng Middle School. Cyclists were surveyed through questionnaires about bicycle injury in the past 12 months. Multivariable logistic analysis showed that compared with a combination-type road、 motor lane and a non-intact road were both risk factors of bicycle injuries. This was followed by riding with fatigue, non-motor lane and inattentive riding. Bicycle injuries are frequent in China. Three risk factors on bicycle traffic injury among middle school students in Chaoshan rural areas of China were identified. This study provides important data to develop intervention strategies for China and other developing countries.

Association of gain and loss of weight before and after menopause with risk of postmenopausal breast cancer in the Iowa women's health study.

PubMed

Harvie, Michelle; Howell, Anthony; Vierkant, Robert A; Kumar, Nagi; Cerhan, James R; Kelemen, Linda E; Folsom, Aaron R; Sellers, Thomas A

2005-03-01

Obesity and adult weight gain are well-established risk factors for postmenopausal breast cancer. Although there are a few studies demonstrating the contribution of adult weight gain to breast cancer risk, whether weight gain during a critical time period is specifically associated with risk, or whether subsequent weight loss among women who have gained weight will reduce the excess risk, is not firmly established. We investigated the association of changes in weight (loss or gain in excess of 5% of body weight) using two risk factor models: (a) age 18 to 30 years and age 30 years to menopause and (b) age 30 years to menopause and after the menopause to the baseline study in 1986 on risk of postmenopausal breast cancer in a prospective cohort of 33,660 postmenopausal women in Iowa. Over 15 years of follow-up, 1,987 cases of breast cancer occurred. Data were analyzed using proportional hazards regression models adjusted for established breast cancer risk factors. The most frequently observed pattern of body weight over time was a consistent increase; these women were observed to have the highest rates of breast cancer and served as the reference category for all comparisons. The lowest-risk groups were (a) women who maintained or lost weight from age 18 to 30 years and then lost weight from age 30 years to menopause [risk ratio (RR), 0.36; 95% confidence interval (95% CI), 0.22-0.60] and (b) women who maintained or lost weight from age 30 years to menopause and then lost weight after the menopause (RR, 0.48; 95% CI, 0.22-0.65). Women who gained weight from age 30 years to menopause but then lost weight after the menopause experienced risk reductions (RR, 0.77; 95% CI, 0.64-0.92) although perhaps slightly smaller in magnitude than women who maintained their weight in both time intervals (RR, 0.63; 95% CI, 0.55-0.73). Women who gained weight from age 18 to 30 years and then lost weight from age 30 years to menopause had comparable risk reductions (RR, 0.61; 95% CI, 0.46-0.8) with women who maintained their weight in both time intervals (RR, 0.73; 95% CI, 0.64-0.84). Women who gained weight during the period from age 30 years to menopause but who had stable weight after menopause had rates similar to the reference group. These data suggest prevention of weight gain between age 18 years and menopause or weight loss and maintenance during these years reduces risk of postmenopausal breast cancer.

A Review on Automatic Mammographic Density and Parenchymal Segmentation

PubMed Central

He, Wenda; Juette, Arne; Denton, Erika R. E.; Oliver, Arnau

2015-01-01

Breast cancer is the most frequently diagnosed cancer in women. However, the exact cause(s) of breast cancer still remains unknown. Early detection, precise identification of women at risk, and application of appropriate disease prevention measures are by far the most effective way to tackle breast cancer. There are more than 70 common genetic susceptibility factors included in the current non-image-based risk prediction models (e.g., the Gail and the Tyrer-Cuzick models). Image-based risk factors, such as mammographic densities and parenchymal patterns, have been established as biomarkers but have not been fully incorporated in the risk prediction models used for risk stratification in screening and/or measuring responsiveness to preventive approaches. Within computer aided mammography, automatic mammographic tissue segmentation methods have been developed for estimation of breast tissue composition to facilitate mammographic risk assessment. This paper presents a comprehensive review of automatic mammographic tissue segmentation methodologies developed over the past two decades and the evidence for risk assessment/density classification using segmentation. The aim of this review is to analyse how engineering advances have progressed and the impact automatic mammographic tissue segmentation has in a clinical environment, as well as to understand the current research gaps with respect to the incorporation of image-based risk factors in non-image-based risk prediction models. PMID:26171249

Toward a cumulative ecological risk model for the etiology of child maltreatment

PubMed Central

MacKenzie, Michael J.; Kotch, Jonathan B.; Lee, Li-Ching

2011-01-01

The purpose of the current study was to further the integration of cumulative risk models with empirical research on the etiology of child maltreatment. Despite the well-established literature supporting the importance of the accumulation of ecological risk, this perspective has had difficulty infiltrating empirical maltreatment research and its tendency to focus on more limited risk factors. Utilizing a sample of 842 mother-infant dyads, we compared the capacity of individual risk factors and a cumulative index to predict maltreatment reports in a prospective longitudinal investigation over the first sixteen years of life. The total load of risk in early infancy was found to be related to maternal cognitions surrounding her new role, measures of social support and well-being, and indicators of child cognitive functioning. After controlling for total level of cumulative risk, most single factors failed to predict later maltreatment reports and no single variable provided odd-ratios as powerful as the predictive power of a cumulative index. Continuing the shift away from simplistic causal models toward an appreciation for the cumulative nature of risk would be an important step forward in the way we conceptualize intervention and support programs, concentrating them squarely on alleviating the substantial risk facing so many of society’s families. PMID:24817777

Prevention of shoulder injuries in overhead athletes: a science-based approach

PubMed Central

Cools, Ann M.; Johansson, Fredrik R.; Borms, Dorien; Maenhout, Annelies

2015-01-01

The shoulder is at high risk for injury during overhead sports, in particular in throwing or hitting activities, such as baseball, tennis, handball, and volleyball. In order to create a scientific basis for the prevention of recurrent injuries in overhead athletes, four steps need to be undertaken: (1) risk factors for injury and re-injury need to be defined; (2) established risk factors may be used as return-to-play criteria, with cut-off values based on normative databases; (3) these variables need to be measured using reliable, valid assessment tools and procedures; and (4) preventative training programs need to be designed and implemented into the training program of the athlete in order to prevent re-injury. In general, three risk factors have been defined that may form the basis for recommendations for the prevention of recurrent injury and return to play after injury: glenohumeral internal-rotation deficit (GIRD); rotator cuff strength, in particular the strength of the external rotators; and scapular dyskinesis, in particular scapular position and strength. PMID:26537804

PubMed Central

DE MATOS, L.L.; BELLI, M.; KULCSAR, M.A.V.; CERNEA, C.R.; GARCIA BRANDÃO, L.; PINTO, F.R.

2014-01-01

SUMMARY The pectoralis major myocutaneous flap (PMMF) is a safe and versatile flap used widely for head and neck cancer reconstructions, but one of the major and most feared complications is oro- or pharyngocutaneous fistula. Herein, we attempt to establish risk factors for fistula formation in reconstructions of mucosal defects in the head and neck using PMMF through retrospective analysis of PMMF performed during 3 years at a single institution, with a total of 84 procedures. There were 69 men and 15 women, with a mean age of 59.5 years. There were 15 cases of partial flap loss, two total flap losses and 31 fistulas. The independent risk factors for fistula formation were preoperative serum hemoglobin < 13 g/dl, preoperative serum albumin < 3.4 g/dl and hypopharynx reconstruction. The PMMF is still a very useful flap and this is the first multivariate analysis analysing risk factors for fistula formation. These findings are helpful in selecting patients with elevated risk of fistula formation, and therefore preventive measures can be undertaken to avoid potentially serious complications. PMID:25762830

The prefabricated building risk decision research of DM technology on the basis of Rough Set

NASA Astrophysics Data System (ADS)

Guo, Z. L.; Zhang, W. B.; Ma, L. H.

2017-08-01

With the resources crises and more serious pollution, the green building has been strongly advocated by most countries and become a new building style in the construction field. Compared with traditional building, the prefabricated building has its own irreplaceable advantages but is influenced by many uncertainties. So far, a majority of scholars have been studying based on qualitative researches from all of the word. This paper profoundly expounds its significance about the prefabricated building. On the premise of the existing research methods, combined with rough set theory, this paper redefines the factors which affect the prefabricated building risk. Moreover, it quantifies risk factors and establish an expert knowledge base through assessing. And then reduced risk factors about the redundant attributes and attribute values, finally form the simplest decision rule. This simplest decision rule, which is based on the DM technology of rough set theory, provides prefabricated building with a controllable new decision-making method.

Risk factors for treatment-related adverse events in cancer-bearing dogs receiving piroxicam.

PubMed

Eichstadt, L R; Moore, G E; Childress, M O

2017-12-01

Piroxicam has antitumour effects in dogs with cancer, although side effects may limit its use. The purpose of this study was to retrospectively identify factors predisposing cancer-bearing dogs to adverse events (AEs) following piroxicam therapy. Medical records of dogs presented to the Purdue Veterinary Teaching Hospital between 2005 and 2015 were reviewed, and 137 dogs met the criteria for study inclusion. Toxic effects of piroxicam in these dogs were graded according to an established system. Multivariate logistic regression was used to estimate the extent to which certain factors affected the risk for AEs. Age [odds ratio (OR) 1.250, P = 0.009; 95% confidence interval (CI) 1.057-1.479] and concurrent use of gastroprotectant medications (OR 2.612, P = 0.025; 95% CI 1.127-6.056) significantly increased the risk for gastrointestinal AEs. The results of this study may help inform the risk versus benefit calculation for clinicians considering the use of piroxicam to treat dogs with cancer. © 2016 John Wiley & Sons Ltd.

EULAR recommendations for terminology and research in individuals at risk of rheumatoid arthritis: report from the Study Group for Risk Factors for Rheumatoid Arthritis

PubMed Central

Gerlag, Danielle M; Raza, Karim; van Baarsen, Lisa G M; Brouwer, Elisabeth; Buckley, Christopher D; Burmester, Gerd R; Gabay, Cem; Catrina, Anca I; Cope, Andrew P; Cornelis, François; Dahlqvist, Solbritt Rantapää; Emery, Paul; Eyre, Stephen; Finckh, Axel; Gay, Steffen; Hazes, Johanna M; van der Helm-van Mil, Annette; Huizinga, Tom W J; Klareskog, Lars; Kvien, Tore K; Lewis, Cathryn; Machold, Klaus P; Rönnelid, Johan; van Schaardenburg, Dirkjan; Schett, Georg; Smolen, Josef S; Thomas, Sue; Worthington, Jane; Tak, Paul P

2012-01-01

The Study Group for Risk Factors for Rheumatoid Arthritis was established by the EULAR Standing Committee on Investigative Rheumatology to facilitate research into the preclinical and earliest clinically apparent phases of rheumatoid arthritis (RA). This report describes the recommendation for terminology to be used to define specific subgroups during different phases of disease, and defines the priorities for research in this area. Terminology was discussed by way of a three-stage structured process: A provisional list of descriptors for each of the possible phases preceding the diagnosis of RA were circulated to members of the study group for review and feedback. Anonymised comments from the members on this list were fed back to participants before a 2-day meeting. 18 participants met to discuss these data, agree terminologies and prioritise important research questions. The study group recommended that, in prospective studies, individuals without RA are described as having: genetic risk factors for RA; environmental risk factors for RA; systemic autoimmunity associated with RA; symptoms without clinical arthritis; unclassified arthritis; which may be used in a combinatorial manner. It was recommended that the prefix ‘pre-RA with:’ could be used before any/any combination of the five points above but only to describe retrospectively a phase that an individual had progressed through once it was known that they have developed RA. An approach to dating disease onset was recommended. In addition, important areas for research were proposed, including research of other tissues in which an adaptive immune response may be initiated, and the identification of additional risk factors and biomarkers for the development of RA, its progression and the development of extra-articular features. These recommendations provide guidance on approaches to describe phases before the development of RA that will facilitate communication between researchers and comparisons between studies. A number of research questions have been defined, requiring new cohorts to be established and new techniques to be developed to image and collect material from different sites. PMID:22387728

EULAR recommendations for terminology and research in individuals at risk of rheumatoid arthritis: report from the Study Group for Risk Factors for Rheumatoid Arthritis.

PubMed

Gerlag, Danielle M; Raza, Karim; van Baarsen, Lisa G M; Brouwer, Elisabeth; Buckley, Christopher D; Burmester, Gerd R; Gabay, Cem; Catrina, Anca I; Cope, Andrew P; Cornelis, François; Dahlqvist, Solbritt Rantapää; Emery, Paul; Eyre, Stephen; Finckh, Axel; Gay, Steffen; Hazes, Johanna M; van der Helm-van Mil, Annette; Huizinga, Tom W J; Klareskog, Lars; Kvien, Tore K; Lewis, Cathryn; Machold, Klaus P; Rönnelid, Johan; van Schaardenburg, Dirkjan; Schett, Georg; Smolen, Josef S; Thomas, Sue; Worthington, Jane; Tak, Paul P

2012-05-01

The Study Group for Risk Factors for Rheumatoid Arthritis was established by the EULAR Standing Committee on Investigative Rheumatology to facilitate research into the preclinical and earliest clinically apparent phases of rheumatoid arthritis (RA). This report describes the recommendation for terminology to be used to define specific subgroups during different phases of disease, and defines the priorities for research in this area. Terminology was discussed by way of a three-stage structured process: A provisional list of descriptors for each of the possible phases preceding the diagnosis of RA were circulated to members of the study group for review and feedback. Anonymised comments from the members on this list were fed back to participants before a 2-day meeting. 18 participants met to discuss these data, agree terminologies and prioritise important research questions. The study group recommended that, in prospective studies, individuals without RA are described as having: genetic risk factors for RA; environmental risk factors for RA; systemic autoimmunity associated with RA; symptoms without clinical arthritis; unclassified arthritis; which may be used in a combinatorial manner. It was recommended that the prefix 'pre-RA with:' could be used before any/any combination of the five points above but only to describe retrospectively a phase that an individual had progressed through once it was known that they have developed RA. An approach to dating disease onset was recommended. In addition, important areas for research were proposed, including research of other tissues in which an adaptive immune response may be initiated, and the identification of additional risk factors and biomarkers for the development of RA, its progression and the development of extra-articular features. These recommendations provide guidance on approaches to describe phases before the development of RA that will facilitate communication between researchers and comparisons between studies. A number of research questions have been defined, requiring new cohorts to be established and new techniques to be developed to image and collect material from different sites.

Risk factors for suicide within a year of discharge from psychiatric hospital: a systematic meta-analysis.

PubMed

Large, Matthew; Sharma, Swapnil; Cannon, Elisabeth; Ryan, Christopher; Nielssen, Olav

2011-08-01

The increased risk of suicide in the period after discharge from a psychiatric hospital is a well-recognized and serious problem. The aim of this study was to establish the risk factors for suicide in the year after discharge from psychiatric hospitals and their usefulness in categorizing patients as high or low risk for suicide in the year following discharge. A systematic meta-analysis of controlled studies of suicide within a year of discharge from psychiatric hospitals. There was a moderately strong association between both a history of self-harm (OR = 3.15) and depressive symptoms (OR = 2.70) and post-discharge suicide. Factors weakly associated with post-discharge suicide were reports of suicidal ideas (OR = 2.47), an unplanned discharge (OR = 2.44), recent social difficulty (OR = 2.23), a diagnosis of major depression (OR = 1.91) and male sex (OR = 1.58). Patients who had less contact with services after discharge were significantly less likely to commit suicide (OR = 0.69). High risk patients were more likely to commit suicide than other discharged patients, but the strength of this association was not much greater than the association with some individual risk factors (OR = 3.94, sensitivity = 0.40, specificity = 0.87). No factor, or combination of factors, was strongly associated with suicide in the year after discharge. About 3% of patients categorized as being at high risk can be expected to commit suicide in the year after discharge. However, about 60% of the patients who commit suicide are likely to be categorized as low risk. Risk categorization is of no value in attempts to decrease the numbers of patients who will commit suicide after discharge.

Urine albumin/creatinine ratio, high sensitivity C-reactive protein and N-terminal pro brain natriuretic peptide--three new cardiovascular risk markers--do they improve risk prediction and influence treatment?

PubMed

Olsen, Michael H; Sehestedt, Thomas; Lyngbaek, Stig; Hansen, Tine W; Rasmussen, Susanne; Wachtell, Kristian; Torp-Pedersen, Christian; Hildebrandt, Per R; Ibsen, Hans

2010-01-01

In order to prioritize limited health resources in a time of increasing demands optimal cardiovascular risk stratification is essential. We tested the additive prognostic value of 3 relatively new, but established cardiovascular risk markers: N-terminal pro brain natriuretic peptide (Nt-proBNP), related to hemodynamic cardiovascular risk factors, high sensitivity C-reactive protein (hsCRP), related to metabolic cardiovascular risk factors and urine albumin/creatinine ratio (UACR), related to hemodynamic as well as metabolic risk factors. In healthy subjects with a 10-year risk of cardiovascular death lower than 5% based on HeartScore and therefore not eligible for primary prevention, the actual 10-year risk of cardiovascular death exceeded 5% in a small subgroup of subjects with UACR higher than the 95-percentile of approximately 1.6 mg/mmol. Combined use of high UACR or high hsCRP identified a larger subgroup of 16% with high cardiovascular risk in which primary prevention may be advised despite low-moderate cardiovascular risk based on HeartScore. Furthermore, combined use of high UACR or high Nt-proBNP in subjects with known cardiovascular disease or diabetes identified a large subgroup of 48% with extremely high cardiovascular risk who should be referred for specialist care to optimize treatment.

Vascular endothelium summary statement II: Cardiovascular disease prevention and control.

PubMed

Mensah, George A; Ryan, Una S; Hooper, W Craig; Engelgau, Michael M; Callow, Allan D; Kapuku, Gaston K; Mantovani, Alberto

2007-05-01

The prevention and control of cardiovascular disease (CVD), principally ischemic heart disease and stroke, are a major clinical and public health challenge. Worldwide, CVD accounts for substantial morbidity and mortality. The major modifiable CVD risk factors are known and all of them cause endothelial activation and dysfunction. Preventing and controlling the established risk factors are associated with preserved endothelial function and reduced risk of CVD. Research advances that improve our understanding of strategies to preserve endothelial function or make the endothelial cells resilient to environmental insults may help improve our preventive interventions. This summary statement addresses the current state of the science with respect to endothelial dysfunction and CVD pathogenesis, diagnostic evaluation, and suggested strategies for public health practice and research.

Immunologic Mechanisms of HTLV-III Infection: Role of Autoimmunity in Aids

DTIC Science & Technology

1992-09-15

In keeping with one of the major goals of this project, the prospective evaluation of risk factors for development and progression , we developed a...pertain in acute conditions such as infectious mononucleosis due to infection with Epstein - Barr virus (24) or cytomegalovirus (25), or other viral...W., Volsky, D.J., and Sonnabend, J., Establishment of retrovirus- Epstein - Barr Virus -positive B-lymphoblastoid cell lines from individuals at risk

Loneliness and social isolation as risk factors for mortality: a meta-analytic review.

PubMed

Holt-Lunstad, Julianne; Smith, Timothy B; Baker, Mark; Harris, Tyler; Stephenson, David

2015-03-01

Actual and perceived social isolation are both associated with increased risk for early mortality. In this meta-analytic review, our objective is to establish the overall and relative magnitude of social isolation and loneliness and to examine possible moderators. We conducted a literature search of studies (January 1980 to February 2014) using MEDLINE, CINAHL, PsycINFO, Social Work Abstracts, and Google Scholar. The included studies provided quantitative data on mortality as affected by loneliness, social isolation, or living alone. Across studies in which several possible confounds were statistically controlled for, the weighted average effect sizes were as follows: social isolation odds ratio (OR) = 1.29, loneliness OR = 1.26, and living alone OR = 1.32, corresponding to an average of 29%, 26%, and 32% increased likelihood of mortality, respectively. We found no differences between measures of objective and subjective social isolation. Results remain consistent across gender, length of follow-up, and world region, but initial health status has an influence on the findings. Results also differ across participant age, with social deficits being more predictive of death in samples with an average age younger than 65 years. Overall, the influence of both objective and subjective social isolation on risk for mortality is comparable with well-established risk factors for mortality. © The Author(s) 2015.

Twenty years of scientific progress in injury and violence research and the next public health frontier☆

PubMed Central

Greenspan, Arlene I.; Noonan, Rita K.

2017-01-01

The establishment of the National Center for Injury Prevention and Control (NCIPC or Injury Center) in 1992 as part of the Centers for Disease Control and Prevention (CDC) firmly established the Injury Center as the lead federal agency for non-occupational injury prevention and control (Sleet et al., 2012). Since then, it has provided leadership and a strong scientific base for intramural and extramural-investigator funded injury research. The Injury Center’s scientific mission encompasses efforts from primary prevention to treatment and rehabilitation. Early CDC efforts were primarily focused on describing the extent of the problem, identifying risk and protective factors that affect the extent of violence and injury in our society, and gaining visibility for violence and injury as a major public health problem. Efforts such as the development of injury-based surveillance systems provided population-based surveillance data regarding the extent and distribution of fatal and non-fatal injuries, helped to identify demographic characteristics for those who were most at risk, and identified risk and protective factors that influence that risk. Celebrating the Injury Center’s 20th anniversary presents an opportunity not only to reflect on past accomplishments but also to look ahead at what still needs to be done. PMID:23127673

Epidemiology of mild traumatic brain injury and neurodegenerative disease

PubMed Central

Gardner, Raquel C.; Yaffe, Kristine

2015-01-01

Every year an estimated 42 million people worldwide suffer a mild traumatic brain injury (MTBI) or concussion. More severe traumatic brain injury (TBI) is a well-established risk factor for a variety of neurodegenerative diseases including Alzheimer's disease, Parkinson's disease, and amyotrophic lateral sclerosis (ALS). Recently, large epidemiological studies have additionally identified MTBI as a risk factor for dementia. The role of MTBI in risk of PD or ALS is less well established. Repetitive MTBI and repetitive sub-concussive head trauma has been linked to increased risk for a variety of neurodegenerative diseases including chronic traumatic encephalopathy (CTE). CTE is a unique neurodegenerative tauopathy first described in boxers but more recently described in a variety of contact sport athletes, military veterans, and civilians exposed to repetitive MTBI. Studies of repetitive MTBI and CTE have been limited by referral bias, lack of consensus clinical criteria for CTE, challenges of quantifying MTBI exposure, and potential for confounding. The prevalence of CTE is unknown and the amount of MTBI or sub-concussive trauma exposure necessary to produce CTE is unclear. This review will summarize the current literature regarding the epidemiology of MTBI, post-TBI dementia and Parkinson's disease, and CTE while highlighting methodological challenges and critical future directions of research in this field. PMID:25748121

Examination of premenstrual symptoms as a risk factor for depression in postpartum women.

PubMed

Buttner, Melissa M; Mott, Sarah L; Pearlstein, Teri; Stuart, Scott; Zlotnick, Caron; O'Hara, Michael W

2013-06-01

Postpartum depression (PPD) is a significant public health concern with prevalence of major and minor depressions reaching 20 % in the first three postpartum months. Sociodemographic and psychopathology correlates of PPD are well established; however, information on the relationship between premenstrual disorders and the development of PPD is less well established. Thus, the aim of this study was to examine the role of premenstrual syndrome (PMS)/premenstrual dysphoric disorder (PMDD) as a risk factor for PPD. Premenstrual symptoms were assessed retrospectively using the premenstrual symptoms screening tool (PSST) and depression was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria and assessed using the Hamilton Depression Rating Scale (HDRS). A two-stage screening procedure was applied. In the first stage, the Patient Health Questionnaire (PHQ-9) was employed. In the second stage, women endorsing ≥5 symptoms on the PHQ-9 were administered the Structured Clinical Interview for DSM-IV, HDRS, and PSST. Hierarchical linear regression showed that history of depression and PMS/PMDD contributed an additional 2 % of the variance (p < 0.001), beyond that of sociodemographic factor effects. The full model accounted for 13 % of the variance in postpartum depressive symptoms. Using logistic regression, a significant association also emerged between PMS/PMDD and PPD (OR = 1.97). The findings of this study suggest that PMS/PMDD is an important risk factor for PPD. Women endorsing a history of PMS/PMDD should be monitored during the perinatal period.

Family obligation values as a protective and vulnerability factor among low-income adolescent girls.

PubMed

Milan, Stephanie; Wortel, Sanne

2015-06-01

Adolescents' beliefs about family obligation often reflect cultural variations in their family context, and thus are important for understanding development among diverse youth. In this study, we test hypotheses about the role of family obligation values in risk behavior and mental health in a sample of 194 low-income adolescent girls (mean age = 15.2; 58% Latina, 28% African-American/Black). We hypothesized that family obligation values can be both a protective and vulnerability factor, depending on the type of outcome and the presence of other risk factors. Across the sample, higher family obligation values tended to occur with indicators of positive family functioning (e.g., more frequent communication, less maternal hostility) based on mother and adolescent reports. As hypothesized, family obligation values moderated the relationship between established risk factors and adjustment in distinct ways, such that high family obligation values decreased risk in some domains (i.e., a protective factor) but increased risk in other domains (i.e., a vulnerability factor). Specifically, high family obligation values diminished the relationship between peer norms for risky behavior (sex and substance use) and individual engagement in those behaviors. At the same time, high family obligation values magnified the relationship between exposure to negative life events and poor mental health (PTSD and depressive symptoms). The results suggest that family obligation is an important but complex aspect of development among diverse adolescent girls.

Prenatal Risk Factors and the Etiology of ADHD-Review of Existing Evidence.

PubMed

Sciberras, Emma; Mulraney, Melissa; Silva, Desiree; Coghill, David

2017-01-01

While it is well accepted that attention-deficit/hyperactivity disorder (ADHD) is a highly heritable disorder, not all of the risk is genetic. It is estimated that between 10 and 40% of the variance associated with ADHD is likely to be accounted for by environmental factors. There is considerable interest in the role that the prenatal environment might play in the development of ADHD with previous reviews concluding that despite demonstration of associations between prenatal risk factors (e.g. prematurity, maternal smoking during pregnancy) and ADHD, there remains insufficient evidence to support a definite causal relationship. This article provides an update of research investigating the relationship between prenatal risk factors and ADHD published over the past 3 years. Recently, several epidemiological and data linkage studies have made substantial contributions to our understanding of this relationship. In particular, these studies have started to account for some of the genetic and familial confounds that, when taken into account, throw several established findings into doubt. None of the proposed prenatal risk factors can be confirmed as causal for ADHD, and the stronger the study design, the less likely it is to support an association. We need a new benchmark for studies investigating the etiology of ADHD whereby there is an expectation not only that data will be collected prospectively but also that the design allows the broad range of genetic and familial factors to be accounted for.

[Modifiable risk factors for primary headache. A systematic review].

PubMed

Albers, L; Ziebarth, S; von Kries, R

2014-08-01

Strategies to prevent primary headaches could be very beneficial, especially given that primary headaches can lead to the development of chronic headache. In order to establish headache prevention strategies, the modifiable risk factors for primary headaches need to be identified. A systematic literature search on the risk factors for primary headaches was conducted independently by two persons using the databases MEDLINE and Embase. Further inclusion criteria were observational studies in adult general populations or case-control studies, where the effect sizes were reported as odds ratios or where the odds ratios could be calculated from the given data. In all, 24 studies were included in the analysis. There was a large amount of heterogeneity among the studies concerning headache acquisition, headache classification, and risk factors for headache development. Independent of headache trigger and definition of headache, the association between headache and the risk factor "stress" was very high: The meta-analysis shows an overall effect of 2.26 (odds ratio; 95 %-CI = [1.79; 2.85]). Studies evaluating neck and shoulder pain also report a strong association with headache; however, these results could not be summarized in a meta-analysis. Equally, the overall effects of smoking and coffee consumption on headaches could not be verified because the effect sizes were rather small and predominantly noticeable only at higher doses. A strong association between headache and the risk factors stress and neck and shoulder pain was confirmed. The effect sizes of smoking and coffee consumption on headaches were rather small.

Knowledge of Coronary Heart Disease Risk Factors among a Community Sample in Oman: Pilot study.

PubMed

Ammouri, Ali A; Tailakh, Ayman; Isac, Chandrani; Kamanyire, Joy K; Muliira, Joshua; Balachandran, Shreedevi

2016-05-01

The aim of this study was to assess the knowledge of Omani adults regarding conventional coronary heart disease (CHD) risk factors and to identify demographic variables associated with these knowledge levels. This descriptive cross-sectional pilot study was carried out among a convenience sample of 130 adults attending a health awareness fair held in a local shopping mall in Muscat, Oman, in November 2012. A modified version of the Heart Disease Facts Questionnaire in both English and Arabic was used to assess knowledge of CHD risk factors. Scores were calculated by summing the correct answers for each item (range: 0-21). Inadequate knowledge was indicated by a mean score of <70%. Descriptive and multivariate logistic regression analyses were performed to establish the participants' knowledge levels and identify associated demographic variables. A total of 114 subjects participated in the study (response rate: 87.7%). Of these, 69 participants (60.5%) had inadequate mean CHD knowledge scores. Knowledge of CHD risk factors was significantly associated with body mass index (odds ratio [OR] = 0.739; P = 0.023), marital status (OR = 0.057; P = 0.036) and education level (OR = 9.243; P = 0.006). Low knowledge levels of CHD risk factors were observed among the studied community sample in Oman; this is likely to limit the participants' ability to engage in preventative practices. These findings support the need for education programmes to enhance awareness of risk factors and prevention of CHD in Oman.

Eating disorder-specific risk factors moderate the relationship between negative urgency and binge eating: A behavioral genetic investigation.

PubMed

Racine, Sarah E; VanHuysse, Jessica L; Keel, Pamela K; Burt, S Alexandra; Neale, Michael C; Boker, Steven; Klump, Kelly L

2017-07-01

Theoretical models of binge eating and eating disorders include both transdiagnostic and eating disorder-specific risk factors. Negative urgency (i.e., the tendency to act impulsively when distressed) is a critical transdiagnostic risk factor for binge eating, but limited research has examined interactions between negative urgency and disorder-specific variables. Investigating these interactions can help identify the circumstances under which negative urgency is most strongly associated with binge eating. We examined whether prominent risk factors (i.e., appearance pressures, thin-ideal internalization, body dissatisfaction, dietary restraint) specified in well-established etiologic models of eating disorders moderate negative urgency-binge eating associations. Further, we investigated whether phenotypic moderation effects were due to genetic and/or environmental associations between negative urgency and binge eating. Participants were 988 female twins aged 11-25 years from the Michigan State University Twin Registry. Appearance pressures, thin-ideal internalization, and body dissatisfaction, but not dietary restraint, significantly moderated negative urgency-binge eating associations, with high levels of these risk factors and high negative urgency associated with the greatest binge eating. Twin moderation models revealed that genetic, but not environmental, sharing between negative urgency and binge eating was enhanced at higher levels of these eating disorder-specific variables. Future longitudinal research should investigate whether eating disorder risk factors shape genetic influences on negative urgency into manifesting as binge eating. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Role of imaging in evaluation of sudden cardiac death risk in hypertrophic cardiomyopathy.

PubMed

Geske, Jeffrey B; Ommen, Steve R

2015-09-01

Hypertrophic cardiomyopathy (HCM) is the most common heritable cardiomyopathy and is associated with sudden cardiac death (SCD) - an uncommon but devastating clinical outcome. This review is designed to assess the role of imaging in established risk factor assessment and its role in emerging SCD risk stratification. Recent publications have highlighted the crucial role of imaging in HCM SCD risk stratification. Left ventricular hypertrophy assessment remains the key imaging determinant of risk. Data continue to emerge on the role of systolic dysfunction, apical aneurysms, left atrial enlargement and left ventricular outflow tract obstruction as markers of risk. Quantitative assessment of delayed myocardial enhancement and T1 mapping on cardiac MRI continue to evolve. Recent multicenter trials have allowed multivariate SCD risk assessment in large HCM cohorts. Given aggregate risk with presence of multiple risk factors, a single parameter should not be used in isolation to determine implantable cardiac defibrillator candidacy. Use of all available imaging data, including cardiac magnetic resonance tissue characterization, allows a comprehensive approach to SCD stratification and implantable cardiac defibrillator decision-making.

Major depressive disorder with anger attacks and cardiovascular risk factors.

PubMed

Fraguas, Renerio; Iosifescu, Dan V; Bankier, Bettina; Perlis, Roy; Clementi-Craven, Nicoletta; Alpert, Jonathan; Fava, Maurizio

2007-01-01

Depression and anger have been separately associated with cardiovascular risk factors. We investigated if major depressive disorder (MDD) with concomitant anger attacks was associated with cardiovascular risk factors. We measured total serum cholesterol, glycemia, resting blood pressure, and smoking parameters in 333 (52.9% women) MDD nonpsychotic outpatients, mean age of 39.4 years. MDD was diagnosed with the Structured Clinical Interview (SCID) in accordance with the Diagnostic and Statistic Manual of Mental Disorders, Third Edition, Revised (DSM-III-R). The presence of anger attacks was established with the Massachusetts General Hospital Anger Attacks Questionnaire. In a logistic regression analysis, anger attacks were independently associated with cholesterol levels > or = 200 mg/dL (odds ratio [OR], 2.16; 95% confidence interval [CI], 1.18-3.94) and years of smoking > 11 (OR, 2.59; 95% CI, 1.32-5.04). MDD with anger attacks was significantly associated with increased cholesterol levels and years of smoking.

[Depressive symptoms as a risk factor for dependence in elderly people].

PubMed

Avila-Funes, José Alberto; Melano-Carranza, Efrén; Payette, Hélène; Amieva, Hélène

2007-01-01

To determine the relationship between depressive symptoms and dependence in activities of daily living. Participants, aged 70 to 104 (n= 1 880), were evaluated twice (2001 and 2003). Depressive symptoms were established by a modified version of Center for Epidemiologic Studies Depression scale, whereas functional dependence was assessed with Lawton & Brody and Katz scales. Dependence implies the attendance and assistance of another person to accomplish the activity. Multivariate regression analyses were used to determine the effect of depressive symptoms on incident dependence. At baseline, 37.9% had depressive symptoms. After two years, 6.1 and 12.7% developed functional dependence for one or more ADL and IADL, respectively. Multivariate analyses showed that depressive symptoms were a risk factor to the development of functional dependence only for the instrumental activities for daily living. Depressive symptoms are a risk factor for functional dependence. Systematic screening it seems necessary in the evaluation of geriatric patients.

Intracardiac Shunting and Stroke in Children: A Systematic Review

PubMed Central

Dowling, Michael M.; Ikemba, Catherine M.

2017-01-01

In adults, patent foramen ovale or other potential intracardiac shunts are established risk factors for stroke via paradoxical embolization. Stroke is less common in children and risk factors differ. The authors examined the literature on intracardiac shunting and stroke in children, identifying the methods employed, the prevalence of detectible intracardiac shunts, associated conditions, and treatments. PubMed searches with keywords related to intracardiac shunting and stroke in children identified articles of interest. Additional articles were identified via citations in these articles or in reviews. The authors found that studies of intracardiac shunting in children with stroke are limited. No controlled studies were identified. Detection methods vary and the prevalence of echocardiographically detectible intracardiac shunting appears lower than reported in adults and autopsy studies. Defining the role of intracardiac shunting in pediatric stroke will require controlled studies with unified detection methods in populations stratified by additional risk factors for paradoxical embolization. Optimal treatment is unclear. PMID:21212453

[Present condition and prospect in clinical medicine of osteoporosis].

PubMed

Sugimoto, Toshitsugu

2011-07-01

The criteria for initiating pharmacotherapy to prevent fragility fractures should be provided separately from the criteria for diagnosis of osteoporosis. In Japan, low BMD (bone mineral density), prevalent fracture, and age are established as fracture risk factors. A meta-analysis conducted by the WHO assured that excessive drinking, current smoking, and family history of hip fracture are fracture risk factors. Pharmacotherapy should be initiated with the consideration of the above risk factors. Recent large scale of RCT demonstrated that bisphosphonates as well as raloxifene are top grade of drugs which prevent fragility fracture. As for secondary osteoporosis, accumulating evidence is available about increased fracture threshold in glucocorticoid- and diabetes mellitus-induced osteoporosis. In osteoporotic patients, atherosclerosis often coexists. Multiple vertebral fractures follwed by kyphosis often causes functional disorders of the digestive and respiratory systems. It is, therefore, required to perform tailor-made medicine, based on the possibility that concomitant diseases exist in osteoporotic patients.

[Environmental risk factors in Crohn's disease and ulcerative colitis (excluding tobacco and appendicectomy)].

PubMed

Jantchou, Prévost; Monnet, Elisabeth; Carbonnel, Franck

2006-01-01

A rapid increase in the incidence of Crohn's disease and ulcerative colitis in developed countries, the occurrence of Crohn's disease in spouses, and a lack of complete concordance in monozygotic twins are strong arguments for the role of environmental factors in inflammatory bowel disease (IBD). Research in the field of environmental factors in IBD is based upon epidemiological (geographical and case-control), clinical and experimental studies. The role of two environmental factors has clearly been established in IBD. Smoking is a risk factor for Crohn's disease and a protective factor for ulcerative colitis; appendectomy is a protective factor for ulcerative colitis. Many other environmental factors for IBD have been investigated, including infectious agents, diet, drugs, stress and social status. They are detailed in the present review. Among them, atypical Mycobacteria, oral contraceptives and antibiotics could play a role in Crohn's disease. To date, three hypotheses associate environmental factors with the pathophysiology of IBD (loss of tolerance of intestinal immune system towards commensal bacterial flora): the hygiene, infection and cold chain hypotheses. Much work remains to be done to identify risk factors for IBD. Research identifying environmental factors that might cause a predisposition to IBD is useful. It may lead to disease prevention in subjects who are genetically predisposed and disease improvement in patients.

Workplace and HIV-related sexual behaviours and perceptions among female migrant workers.

PubMed

Yang, H; Li, X; Stanton, B; Fang, X; Lin, D; Mao, R; Liu, H; Chen, X; Severson, R

2005-10-01

Data from 1,543 female migrants working in eight occupational clusters in Beijing and Nanjing, China were analysed to examine the association of workplace with HIV-related behaviours and perceptions. For sexually experienced women (n = 666, 43.2%), those working in entertainment establishments or personal service (e.g., nightclubs, dancing halls, barbershops, beauty salons, massage parlours, etc.) engaged in risky sexual practices twice as frequently as those working in non-entertainment establishments (e.g. restaurants, stalls, domestic service, factories, etc.). About 10% of women in the entertainment establishments reported having sold sex, 30% having multiple sexual partners and 40% having sex with men with multiple sexual partners. The rate of consistent condom use was less than 15%. They also tended to have a higher level of perceptions of both peer risk involvement and positive expectancy of risk behaviours, and lower perceptions of severity of STDs and HIV. For women who were not sexually experienced, those working in 'stalls' or 'domestic service' tended to perceive higher peer risk involvement, less severity of HIV infection, and less effectiveness of protective behaviour. The occupational pattern of sexual risk behaviours and perceptions observed in the current study indicates employment conditions are associated with HIV risk. Intervention strategies should be tailored to address occupational-related factors.

Workplace and HIV-related sexual behaviours and perceptions among female migrant workers

PubMed Central

YANG, H.; LI, X.; STANTON, B.; FANG, X.; LIN, D.; MAO, R.; LIU, H.; CHEN, X.; SEVERSON, R.

2007-01-01

Data from 1,543 female migrants working in eight occupational clusters in Beijing and Nanjing, China were analysed to examine the association of workplace with HIV-related behaviours and perceptions. For sexually experienced women (n = 666, 43.2%), those working in entertainment establishments or personal service (e.g., nightclubs, dancing halls, barbershops, beauty salons, massage parlours, etc.) engaged in risky sexual practices twice as frequently as those working in non-entertainment establishments (e.g. restaurants, stalls, domestic service, factories, etc.). About 10% of women in the entertainment establishments reported having sold sex, 30% having multiple sexual partners and 40% having sex with men with multiple sexual partners. The rate of consistent condom use was less than 15%. They also tended to have a higher level of perceptions of both peer risk involvement and positive expectancy of risk behaviours, and lower perceptions of severity of STDs and HIV. For women who were not sexually experienced, those working in ‘stalls’ or ‘domestic service’ tended to perceive higher peer risk involvement, less severity of HIV infection, and less effectiveness of protective behaviour. The occupational pattern of sexual risk behaviours and perceptions observed in the current study indicates employment conditions are associated with HIV risk. Intervention strategies should be tailored to address occupational-related factors. PMID:16120499

Baseline study and risk analysis of landfill leachate - Current state-of-the-science of computer aided approaches.

PubMed

Butt, T E; Alam, A; Gouda, H M; Paul, P; Mair, N

2017-02-15

For the successful completion of a risk analysis process, its foundation (i.e. a baseline study) has to be well established. For this purpose, a baseline study needs to be more integrated than ever, particularly when environmental legislation is increasingly becoming stringent and integrated. This research investigates and concludes that no clear evidence of computer models for baseline study has been found in a whole-system and integrated format, which risk assessors could readily and effectively use to underpin risk analyses holistically and yet specifically for landfill leachate. This is established on the basis of investigation of software packages that are particularly closely related to landfills. Holistic baseline study is also defined along with its implications and in the context of risk assessment of landfill leachate. The study also indicates a number of factors and features that need to be added to baseline study in order to render it more integrated thereby enhancing risk analyses for landfill leachate. Copyright © 2016 Elsevier B.V. All rights reserved.

[Lessons learned from a distribution incident at the Alps-Mediterranean Division of the French Blood Establishment].

PubMed

Legrand, D

2008-11-01

The Alps-Mediterranean division of the French blood establishment (EFS Alpes-Mediterranée) has implemented a risk management program. Within this framework, the labile blood product distribution process was assessed to identify critical steps. Subsequently, safety measures were instituted including computer-assisted decision support, detailed written instructions and control checks at each step. Failure of these measures to prevent an incident underlines the vulnerability of the process to the human factor. Indeed root cause analysis showed that the incident was due to underestimation of the danger by one individual. Elimination of this type of risk will require continuous training, testing and updating of personnel. Identification and reporting of nonconformities will allow personnel at all levels (local, regional, and national) to share lessons and implement appropriate risk mitigation strategies.

Seroprevalence and risk factors for infection with equine coronavirus in healthy horses in the USA.

PubMed

Kooijman, L J; James, K; Mapes, S M; Theelen, M J P; Pusterla, N

2017-02-01

Equine coronavirus (ECoV) is considered an enteric pathogen of foals and has only recently been associated with infections in adult horses. Seroprevalence data is needed to better understand the epidemiology of ECoV in adult horses, evaluate diagnostic modalities and develop preventive measures. The objective of this study was to investigate the seroprevalence and selective risk factors for ECoV in 5247 healthy adult horses in the USA, using a recently established and validated IgG enzyme-linked immunosorbent assay. Prevalence factors analysed in this study included geographic region, age, breed, sex and use. A total of 504/5247 horses (9.6%) horses tested seropositive. Geographic region (Mid-West; P = 0.008), breed (Draft horses; P = 0.003) and specific uses of horses (ranch/farm, P = 0.034; breeding use, P = 0.016) were all statistically significant risk factors for seropositivity. Copyright © 2017. Published by Elsevier Ltd.

Genetic Factors Involved in Fumonisin Accumulation in Maize Kernels and Their Implications in Maize Agronomic Management and Breeding

PubMed Central

Santiago, Rogelio; Cao, Ana; Butrón, Ana

2015-01-01

Contamination of maize with fumonisins depends on the environmental conditions; the maize resistance to contamination and the interaction between both factors. Although the effect of environmental factors is a determinant for establishing the risk of kernel contamination in a region, there is sufficient genetic variability among maize to develop resistance to fumonisin contamination and to breed varieties with contamination at safe levels. In addition, ascertaining which environmental factors are the most important in a region will allow the implementation of risk monitoring programs and suitable cultural practices to reduce the impact of such environmental variables. The current paper reviews all works done to address the influence of environmental variables on fumonisin accumulation, the genetics of maize resistance to fumonisin accumulation, and the search for the biochemical and/or structural mechanisms of the maize plant that could be involved in resistance to fumonisin contamination. We also explore the outcomes of breeding programs and risk monitoring of undertaken projects. PMID:26308050

Genetic Factors Involved in Fumonisin Accumulation in Maize Kernels and Their Implications in Maize Agronomic Management and Breeding.

PubMed

Santiago, Rogelio; Cao, Ana; Butrón, Ana

2015-08-20

Contamination of maize with fumonisins depends on the environmental conditions; the maize resistance to contamination and the interaction between both factors. Although the effect of environmental factors is a determinant for establishing the risk of kernel contamination in a region, there is sufficient genetic variability among maize to develop resistance to fumonisin contamination and to breed varieties with contamination at safe levels. In addition, ascertaining which environmental factors are the most important in a region will allow the implementation of risk monitoring programs and suitable cultural practices to reduce the impact of such environmental variables. The current paper reviews all works done to address the influence of environmental variables on fumonisin accumulation, the genetics of maize resistance to fumonisin accumulation, and the search for the biochemical and/or structural mechanisms of the maize plant that could be involved in resistance to fumonisin contamination. We also explore the outcomes of breeding programs and risk monitoring of undertaken projects.

The epidemiology of bovine respiratory disease: What is the evidence for predisposing factors?

PubMed Central

Taylor, Jared D.; Fulton, Robert W.; Lehenbauer, Terry W.; Step, Douglas L.; Confer, Anthony W.

2010-01-01

Bovine respiratory disease (BRD) is the most costly disease of beef cattle in North America. It is multi-factorial, with a variety of physical and physiological stressors combining to predispose cattle to pneumonia. However, efforts to discern which factors are most important have frequently failed to establish definitive answers. Calves are at highest risk shortly after transport. Risk factors include purchasing from sale barns and commingling. It is unclear whether or not these practices increase susceptibility, increase exposure, or are proxies for poor management. Lighter-weight calves appear to be at greater risk, although this has not been consistent. Persistent infection (PI) with bovine virus diarrhea virus increases BRD occurrence, but it is unclear if PI calves affect other cattle in the feedlot. The complexity of BRD has made it difficult to define involvement of individual factors. Stressors may play a role as “necessary but not sufficient” components, requiring additive effects to cause disease. PMID:21197200

Fibroblast growth factor 20 (FGF20) polymorphism is a risk factor for Parkinson's disease in Chinese population.

PubMed

Pan, Jing; Li, Hui; Wang, Ying; Ma, Jian-Fang; Zhang, Jin; Wang, Gang; Liu, Jun; Wang, Xi-Jin; Xiao, Qin; Chen, Sheng-Di

2012-06-01

The etiology of Parkinson's disease (PD) is not well established. Genetic variation in fibroblast growth factor 20 (FGF20) might influence the risk of PD occurrence and development. In this study, Two DNA polymorphisms at genetic variation in FGF20, rs2720208 (C/T) and rs1721100 (C/G), were genotyped by direct sequencing in Han Chinese population, including 394 PD patients and 383 healthy controls. Statistical analyses revealed that for rs1721100 (C/G) polymorphism, there were significant differences in genotype distribution between PD and healthy-matched controls. For rs12720208 (C/T) polymorphism, there was no significant difference in genotype distribution and gender and age-related differences between PD and control group. Results in this study revealed that the rs1721100(C/G) polymorphism is a risk factor for PD in Han Chinese population, while rs12720208(C/T) polymorphism is not significantly associated with PD. Copyright © 2012 Elsevier Ltd. All rights reserved.

Maternal history of adoption or foster care placement in childhood: a risk factor for preterm birth.

PubMed

Bublitz, Margaret H; Rodriguez, Daniel; Polly Gobin, Asi; Waldemore, Marissa; Magee, Susanna; Stroud, Laura R

2014-10-01

The objective of the study was to assess the impact of maternal history of adoption or foster care placement in childhood on the risk for preterm birth (PTB), controlling for other known risk factors for PTB. Participants were 302 pregnant women from a low-income, diverse sample drawn from 2 intensive prospective studies of maternal mood and behavior and fetal and infant development. Gestational age was determined by best obstetric estimate. Maternal history of adoption or foster care placement prior to age 18 years was determined by maternal report. Other maternal characteristics, including maternal medical conditions, psychosocial characteristics, and health behaviors, were measured during the second and third trimesters of pregnancy. The odds of delivering preterm (gestational age <37 weeks) were approximately 4 times greater among women with a history of childhood adoption or foster care placement compared with women who were never placed out of the home during childhood. This association remained significant after adjusting for other known risk factors for PTB including maternal medical conditions, psychosocial characteristics, and negative health behaviors in pregnancy. Findings suggest that a history of adoption/foster care placement is an important risk factor for PTB and may be comparable with other established risk factors for PTB including prior history of PTB, body mass index, African-American race, and advanced maternal age. More studies are needed to understand why women with placement histories may be at increased risk to deliver preterm. Copyright © 2014 Elsevier Inc. All rights reserved.

Sex Differences in Placental Mitochondrial Function Associated with Ozone-Induced Fetal Growth Restriction

EPA Science Inventory

Fetal growth restriction is a major underlying cause of infant mortality worldwide. Despite knowledge of risk factors for adverse pregnancy outcomes, the mechanisms that drive compromised growth during pregnancy have not been well established. Placental maladaptation, particularl...

Job strain (demands and control model) as a predictor of cardiovascular risk factors among petrochemical personnel

PubMed Central

Habibi, Ehsanollah; Poorabdian, Siamak; Shakerian, Mahnaz

2015-01-01

Background: One of the practical models for the assessment of stressful working conditions due to job strain is job demand and control model, which explains how physical and psychological adverse consequences, including cardiovascular risk factors can be established due to high work demands (the amount of workload, in addition to time limitations to complete that work) and low control of the worker on his/her work (lack of decision making) in the workplace. The aim of this study was to investigate how certain cardiovascular risk factors (including body mass index [BMI], heart rate, blood pressure, cholesterol and smoking) and the job demand and job control are related to each other. Materials and Methods: This prospective cohort study was conducted on 500 workers of the petrochemical industry in south of Iran, 2009. The study population was selected using simple random statistical method. They completed job demand and control questionnaire. The cardiovascular risk factors data was extracted from the workers hygiene profiles. Chi-square (χ2) test and hypothesis test (η) were used to assess the possible relationship between different quantified variables, individual demographic and cardiovascular risk factors. Results: The results of this study revealed that a significant relationship can be found between job demand control model and cardiovascular risk factors. Chi-square test result for the heart rate showed the highest (χ2 = 145.078) relationship, the corresponding results for smoking and BMI were χ2 = 85.652 and χ2 = 30.941, respectively. Subsequently, hypothesis testing results for cholesterol and hypertension was 0.469 and 0.684, respectively. Discussion: Job strain is likely to be associated with an increased risk of cardiovascular risk factors among male staff in a petrochemical company in Iran. The parameters illustrated in the Job demands and control model can act as acceptable predictors for the probability of job stress occurrence followed by showing a high trend of CVD risk factors. PMID:25861661

High prevalence of cardiovascular risk factors in Peruvian adolescents living in a peri-urban shantytown: a cross-sectional study.

PubMed

Abbs, Elizabeth S; Viñoles, José; Alarcón, Jorge O; Johnson, Heather M; Zunt, Joseph R

2017-05-22

Adults of the peri-urban Peruvian shantytown of Lomas de Zapallal have a high prevalence of risk factors for developing cardiovascular disease (CVD)-likely due to behavioral choices established during childhood and adolescence. To guide the development of community-based risk reduction programs, we assessed the prevalence of risk factors for developing CVD among adolescents. We collected cross sectional data from adolescents of Peruvian peri-urban shantytown to evaluate four domains of CVD risk factors: (1) clinical (blood pressure, fasting blood glucose, and blood lipids), (2) anthropometric (height, weight, and waist circumference), (3) behavioral (physical activity, diet, and substance abuse), and (4) psychosocial (mental health and violence). We enrolled 275 adolescents (56.4% female, mean age 14 years). Prevalence of overweight or obese status was 27.8%. High blood pressure was more common in males (37.4%) than females (20.5%) (p = 0.002). Total cholesterol was elevated (>170 mg/dL) in nearly half (45.5%) of the adolescents, and 71% had impaired fasting blood glucose (>100 mg/dL). Females were less likely to exercise daily (95.4%) than males (84.2%) (p = 0.002) but reported higher rates of depression (66.4%), anhedonia (67.6%), and self-harm behavior (37.9%) (all p < 0.01). Adolescents living in the peri-urban population of Puente Piedra had high prevalence of risk factors for future development of CVD; preventative efforts focused on improving nutrition, increasing physical inactivity, and addressing mental health conditions could reduce such risk factors.

A Risk Score Model for Evaluation and Management of Patients with Thyroid Nodules.

PubMed

Zhang, Yongwen; Meng, Fanrong; Hong, Lianqing; Chu, Lanfang

2018-06-12

The study is aimed to establish a simplified and practical tool for analyzing thyroid nodules. A novel risk score model was designed, risk factors including patient history, patient characteristics, physical examination, symptoms of compression, thyroid function, ultrasonography (US) of thyroid and cervical lymph nodes were evaluated and classified into high risk factors, intermediate risk factors, and low risk factors. A total of 243 thyroid nodules in 162 patients were assessed with risk score system and Thyroid Imaging-Reporting and Data System (TI-RADS). The diagnostic performance of risk score system and TI-RADS was compared. The accuracy in the diagnosis of thyroid nodules was 89.3% for risk score system, 74.9% for TI-RADS respectively. The specificity, accuracy and positive predictive value (PPV) of risk score system were significantly higher than the TI-RADS system (χ 2 =26.287, 17.151, 11.983; p <0.05), statistically significant differences were not observed in the sensitivity and negative predictive value (NPV) between the risk score system and TI-RADS (χ 2 =1.276, 0.290; p>0.05). The area under the curve (AUC) for risk score diagnosis system was 0.963, standard error 0.014, 95% confidence interval (CI)=0.934-0.991, the AUC for TI-RADS diagnosis system was 0.912 with standard error 0.021, 95% CI=0.871-0.953, the AUC for risk score system was significantly different from that of TI-RADS (Z=2.02; p <0.05). Risk score model is a reliable, simplified and cost-effective diagnostic tool used in diagnosis of thyroid cancer. The higher the score is, the higher the risk of malignancy will be. © Georg Thieme Verlag KG Stuttgart · New York.

A novel scoring system for gastric cancer risk assessment based on the expression of three CLIP4 DNA methylation-associated genes

PubMed Central

Hu, Chenggong; Zhou, Yongfang; Liu, Chang; Kang, Yan

2018-01-01

Gastric cancer (GC) is the fifth most common cancer and the third leading cause of cancer-associated mortality worldwide. In the current study, comprehensive bioinformatic analyses were performed to develop a novel scoring system for GC risk assessment based on CAP-Gly domain containing linker protein family member 4 (CLIP4) DNA methylation status. Two GC datasets with methylation sequencing information and mRNA expression profiling were downloaded from the The Cancer Genome Atlas and Gene Expression Omnibus databases. Differentially expressed genes (DEGs) between the CLIP4 hypermethylation and CLIP4 hypomethylation groups were screened using the limma package in R 3.3.1, and survival analysis of these DEGs was performed using the survival package. A risk scoring system was established via regression factor-weighted gene expression based on linear combination to screen the most important genes associated with CLIP4 methylation and prognosis. Genes associated with high/low-risk value were selected using the limma package. Functional enrichment analysis of the top 500 DEGs that positively and negatively associated with risk values was performed using DAVID 6.8 online and the gene set enrichment analysis (GSEA) software. In total, 35 genes were identified to be that significantly associated with prognosis and CLIP4 DNA methylation, and three prognostic signature genes, claudin-11 (CLDN11), apolipoprotein D (APOD), and chordin like 1 (CHRDL1), were used to establish a risk assessment system. The prognostic scoring system exhibited efficiency in classifying patients with different prognoses, where the low-risk groups had significantly longer overall survival times than those in the high-risk groups. CLDN11, APOD and CHRDL1 exhibited reduced expression in the hypermethylation and low-risk groups compare with the hypomethylation and high-risk groups, respectively. Multivariate Cox analysis indicated that risk value could be used as an independent prognostic factor. In functional analysis, six functional gene ontology terms and five GSEA pathways were associated with CLDN11, APOD and CHRDL1. The results established the credibility of the scoring system in this study. Additionally, these three genes, which were significantly associated with CLIP4 DNA methylation and GC risk assessment, were identified as potential prognostic biomarkers. PMID:29901187

Assessment of cardiovascular risk based on a data-driven knowledge discovery approach.

PubMed

Mendes, D; Paredes, S; Rocha, T; Carvalho, P; Henriques, J; Cabiddu, R; Morais, J

2015-01-01

The cardioRisk project addresses the development of personalized risk assessment tools for patients who have been admitted to the hospital with acute myocardial infarction. Although there are models available that assess the short-term risk of death/new events for such patients, these models were established in circumstances that do not take into account the present clinical interventions and, in some cases, the risk factors used by such models are not easily available in clinical practice. The integration of the existing risk tools (applied in the clinician's daily practice) with data-driven knowledge discovery mechanisms based on data routinely collected during hospitalizations, will be a breakthrough in overcoming some of these difficulties. In this context, the development of simple and interpretable models (based on recent datasets), unquestionably will facilitate and will introduce confidence in this integration process. In this work, a simple and interpretable model based on a real dataset is proposed. It consists of a decision tree model structure that uses a reduced set of six binary risk factors. The validation is performed using a recent dataset provided by the Portuguese Society of Cardiology (11113 patients), which originally comprised 77 risk factors. A sensitivity, specificity and accuracy of, respectively, 80.42%, 77.25% and 78.80% were achieved showing the effectiveness of the approach.

Inter-hospital variations in caesarean sections. A risk adjusted comparison in the Valencia public hospitals

PubMed Central

Librero, J.; Peiro, S.; Calderon, S. M.

2000-01-01

BACKGROUND—The aim of this study was to describe the variability in caesarean rates in the public hospitals in the Valencia Region, Spain, and to analyse the association between caesarean sections and clinical and extra-clinical factors.
METHODS—Analysis of data contained in the Minimum Basic Data Set (MBDS) compiled for all births in 11 public hospitals in Valencia during 1994-1995 (n=36 819). Bivariate and multivariate analyses were used to evaluate the association between caesarean section rates and specific risk factors. The multivariate model was used to construct predictions about caesarean rates for each hospital, for comparison with rates observed.
RESULTS—Caesarean rates were 17.6% (inter-hospital range: 14.7% to 25.0%), with ample variability between hospitals in the diagnosis of maternal-fetal risk factors (particularly dystocia and fetal distress), and the indication for caesarean in the presence of these factors. Multivariate analysis showed that maternal-fetal risk factors correlated strongly with caesarean section, although extra-clinical factors, such as the day of the week, also correlated positively. After adjusting for the risk factors, the inter-hospital variation in caesarean rates persisted.
CONCLUSIONS—Although certain limitations (imprecision of some diagnoses and information biases in the MBDS) make it impossible to establish unequivocal conclusions, results show a high degree of variability among hospitals when opting for caesarean section. This variability cannot be justified by differences in obstetric risks.


Keywords: hospital utilisation; medical practice variation; caesarean section; administrative databases PMID:10890876

From design to implementation--the Joint Asia Diabetes Evaluation (JADE) program: a descriptive report of an electronic web-based diabetes management program.

PubMed

Ko, Gary T; So, Wing-Yee; Tong, Peter C; Le Coguiec, Francois; Kerr, Debborah; Lyubomirsky, Greg; Tamesis, Beaver; Wolthers, Troels; Nan, Jennifer; Chan, Juliana

2010-05-13

The Joint Asia Diabetes Evaluation (JADE) Program is a web-based program incorporating a comprehensive risk engine, care protocols, and clinical decision support to improve ambulatory diabetes care. The JADE Program uses information technology to facilitate healthcare professionals to create a diabetes registry and to deliver an evidence-based care and education protocol tailored to patients' risk profiles. With written informed consent from participating patients and care providers, all data are anonymized and stored in a databank to establish an Asian Diabetes Database for research and publication purpose. The JADE electronic portal (e-portal: http://www.jade-adf.org) is implemented as a Java application using the Apache web server, the mySQL database and the Cocoon framework. The JADE e-portal comprises a risk engine which predicts 5-year probability of major clinical events based on parameters collected during an annual comprehensive assessment. Based on this risk stratification, the JADE e-portal recommends a care protocol tailored to these risk levels with decision support triggered by various risk factors. Apart from establishing a registry for quality assurance and data tracking, the JADE e-portal also displays trends of risk factor control at each visit to promote doctor-patient dialogues and to empower both parties to make informed decisions. The JADE Program is a prototype using information technology to facilitate implementation of a comprehensive care model, as recommended by the International Diabetes Federation. It also enables health care teams to record, manage, track and analyze the clinical course and outcomes of people with diabetes.

Prevention and Control Program for Cardiovascular Diseases in Turkish Population: PRE-CONTROL Study Group.

PubMed

Kozan, Ömer; Zoghi, Mehdi; Ergene, Oktay; Arıcı, Mustafa; Derici, Ülver; Bakaç, Göksel; Güllü, Sevim; Sain Güven, Gülay

2013-06-01

Cardiovascular disease (CVD) is the leading cause of death throughout the world. Despite its high prevalence, the atherosclerotic process can be slowed and its consequences markedly reduced by preventive measures. The lack of risk factor awareness is a major barrier. We aimed to assess total CV risk, determine the knowledge and awareness regarding CVD, and evaluate the effectiveness of education program in urban population of Turkey. A 24-item questionnaire was used to detect CV risk factors and the awareness of participants about CVD. The feedback data for the education program were collected by either questionnaires or individual interviews with participants. For comparison of total CVD risk in men and women in different age groups, a sample t test was used. The level of statistical significance was set at p < 0.05. The prevalence of hyperlipidemia was established to be 41.3%. Nearly one-quarter of the women and one-third of the men were smokers (p < 0.001). One-quarter of the responders had a history of hypertension (men: 21.5%, women: 18.6%), and one-tenth were diabetic. The high CV risk rate was more pronounced among men (p < 0.01) and those with low socioeconomic level (p < 0.01). Awareness regarding CV risk factors following the educational program increased from 6.6% to 12.7% for high blood pressure, from 3.9% to 9.2% for diabetes mellitus, and from 10.2% to 15.1% for elevated cholesterol levels. All the increases were statistically significant. The educational program significantly increased the awareness of CVD and risk factors. The prevalence of CV risk factors was higher in low socioeconomic level groups. The knowledge and awareness of the risk factors for CVD before the education program was very low in our study group. The awareness of CVD and risk factors significantly increased following our education programs. Copyright © 2013 World Heart Federation (Geneva). Published by Elsevier B.V. All rights reserved.

Part 1: Pressure ulcer assessment - the development of Critical Care Pressure Ulcer Assessment Tool made Easy (CALCULATE).

PubMed

Richardson, Annette; Barrow, Isabel

2015-11-01

Critically ill patients are at high risk of developing pressure ulcers resulting in serious untoward patient and health care system outcomes. Pressure ulcer prevention is therefore an important patient safety priority and establishing a structured approach to pressure ulcer risk assessment to identify patients at risk is a critical first step. The literature was searched using three electronic databases from 2000 to 2011 to identify papers reporting on pressure ulcer risk factors and assessment in adult critical care. The review and appraisal of papers were conducted by two critical care nurses. Papers underwent detailed review if they met inclusion criteria where they identified pressure ulcer assessment scores, scales or risk factors and related to adult critical care patients Seven papers were reviewed. No single assessment tool was sufficiently validated for critically ill patients and seven key critical care risk factors were identified. These risk factors were: mechanical ventilation, impaired circulation, dialysis, long surgery, low protein and too unstable to turn. The tool Critical Care Pressure Ulcer Assessment Tool made Easy (CALCULATE) was developed utilizing the risk factors from the literature and expert critical care nursing consensus decision-making. In the absence of current consensus, valid assessment scales and limited evidence for the most appropriate pressure ulcer assessment for critically ill patients, this assessment tool offers an easy, appropriate alternative for critically ill patients than existing tools primarily validated for acute care wards. 'CALCULATE' offers an important contribution towards the advancement and development of critical care pressure ulcer risk assessment. Future research is needed to further enhance and inform pressure ulcer risk assessment of the critically ill patients. The identification of critical care risk factors may be an indicative method of assessing pressure ulcer risk in the critically ill patients. © 2015 British Association of Critical Care Nurses.

Estimating the impact of adding C-reactive protein as a criterion for lipid lowering treatment in the United States.

PubMed

Woloshin, Steven; Schwartz, Lisa M; Kerin, Kevin; Welch, H Gilbert

2007-02-01

There is growing interest in using C-reactive protein (CRP) levels to help select patients for lipid lowering therapy--although this practice is not yet supported by evidence of benefit in a randomized trial. To estimate the number of Americans potentially affected if a CRP criteria were adopted as an additional indication for lipid lowering therapy. To provide context, we also determined how well current lipid lowering guidelines are being implemented. We analyzed nationally representative data to determine how many Americans age 35 and older meet current National Cholesterol Education Program (NCEP) treatment criteria (a combination of risk factors and their Framingham risk score). We then determined how many of the remaining individuals would meet criteria for treatment using 2 different CRP-based strategies: (1) narrow: treat individuals at intermediate risk (i.e., 2 or more risk factors and an estimated 10-20% risk of coronary artery disease over the next 10 years) with CRP > 3 mg/L and (2) broad: treat all individuals with CRP > 3 mg/L. Analyses are based on the 2,778 individuals participating in the 1999-2002 National Health and Nutrition Examination Survey with complete data on cardiac risk factors, fasting lipid levels, CRP, and use of lipid lowering agents. The estimated number and proportion of American adults meeting NCEP criteria who take lipid-lowering drugs, and the additional number who would be eligible based on CRP testing. About 53 of the 153 million Americans aged 35 and older meet current NCEP criteria (that do not involve CRP) for lipid-lowering treatment. Sixty-five percent, however, are not currently being treated, even among those at highest risk (i.e., patients with established heart disease or its risk equivalent)-62% are untreated. Adopting the narrow and broad CRP strategies would make an additional 2.1 and 25.3 million Americans eligible for treatment, respectively. The latter strategy would make over half the adults age 35 and older eligible for lipid-lowering therapy, with most of the additionally eligible (57%) coming from the lowest NCEP heart risk category (i.e., 0-1 risk factors). There is substantial underuse of lipid lowering therapy for American adults at high risk for coronary disease. Rather than adopting CRP-based strategies, which would make millions more lower risk patients eligible for treatment (and for whom treatment benefit has not yet been demonstrated in a randomized trial), we should ensure the treatment of currently defined high-risk patients for whom the benefit of therapy is established.

Prevalence, risk factors and underdiagnosis of asthma and wheezing in adults 40 years and older: A population-based study.

PubMed

Gonzalez-Garcia, Mauricio; Caballero, Andres; Jaramillo, Claudia; Maldonado, Dario; Torres-Duque, Carlos A

2015-10-01

There are differences in the prevalence and risk factors of asthma around the world. The epidemiological situation of adults 40 years and older is not well established. Our aim was to determine the prevalence, underdiagnosis and risk factors of asthma and wheezing in adults in Colombia. A cross-sectional, population-based study including 5539 subjects from 40 to 93 years selected by a probabilistic sampling technique in five cities was conducted. respiratory symptoms and risk factors questionnaire and spirometry. (a) Wheezing: Affirmative answer to the question "have you ever had two or more attacks of "wheezes" causing you to feel short of breath?" (b) Asthma: Wheezing definition and FEV1/FVC post-bronchodilator ≥ 70%. (c) Underdiagnosis: Asthma definition without a physician-diagnosis. Logistic regression was used for exploring risk factors. Prevalence of asthma was 9.0% (95% CI: 8.3-9.8) and wheezing 11.9% (95% CI: 11.0-12.8). Asthma underdiagnosis was 69.9% and increased to 79.0% in subjects 64 years or older. The risk factors related to asthma and/or wheezing were: living in Bogota or Medellin, female gender, first degree relative with asthma, respiratory disease before 16 years of age, obesity, no education, indoor wood smoke exposure and occupational exposure to dust particles, gases or fumes. We described the epidemiologic situation of asthma in adults 40 years and older in Colombia. In addition to some recognized risk factors, our data supports the association of indoor wood smoke and occupational exposures with asthma and wheezing. Underdiagnosis of asthma in adults was high, particularly in older subjects.

Early life course risk factors for childhood obesity: the IDEFICS case-control study.

PubMed

Bammann, Karin; Peplies, Jenny; De Henauw, Stefaan; Hunsberger, Monica; Molnar, Denes; Moreno, Luis A; Tornaritis, Michael; Veidebaum, Toomas; Ahrens, Wolfgang; Siani, Alfonso

2014-01-01

The early life course is assumed to be a critical phase for childhood obesity; however the significance of single factors and their interplay is not well studied in childhood populations. The investigation of pre-, peri- and postpartum risk factors on the risk of obesity at age 2 to 9. A case-control study with 1,024 1:1-matched case-control pairs was nested in the baseline survey (09/2007-05/2008) of the IDEFICS study, a population-based intervention study on childhood obesity carried out in 8 European countries in pre- and primary school settings. Conditional logistic regression was used for identification of risk factors. For many of the investigated risk factors, we found a raw effect in our study. In multivariate models, we could establish an effect for gestational weight gain (adjusted OR = 1.02; 95%CI 1.00-1.04), smoking during pregnancy (adjusted OR = 1.48; 95%CI 1.08-2.01), Caesarian section (adjusted OR = 1.38; 95%CI 1.10-1.74), and breastfeeding 4 to 11 months (adjusted OR = 0.77; 95%CI 0.62-0.96). Birth weight was related to lean mass rather than to fat mass, the effect of smoking was found only in boys, but not in girls. After additional adjustment for parental BMI and parental educational status, only gestational weight gain remained statistically significant. Both, maternal as well as paternal BMI were the strongest risk factors in our study, and they confounded several of the investigated associations. Key risk factors of childhood obesity in our study are parental BMI and gestational weight gain; consequently prevention approaches should target not only children but also adults. The monitoring of gestational weight seems to be of particular importance for early prevention of childhood obesity.

Risk factors for benign serous and mucinous epithelial ovarian tumors.

PubMed

Jordan, Susan J; Green, Adèle C; Whiteman, David C; Webb, Penelope M

2007-03-01

To investigate the risk factors for benign serous and mucinous epithelial ovarian tumors. Cases were women newly diagnosed with benign serous ovarian tumors (n=230) or benign mucinous tumors (n=133) between 2002 and 2005. Control women were selected at random from the general population (n=752). All participants completed a comprehensive reproductive and lifestyle questionnaire. Multivariable logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) and to simultaneously adjust for potential confounding factors. Current smoking was associated with a three-fold increase in risk of benign mucinous tumors (OR 3.25, 95% CI 1.97-5.34), and there was a trend of increasing risk with increasing amount smoked (P<.001). Both recent obesity (OR 1.93, 95% CI 1.30-2.88) and obesity at age 20 (OR 4.38, 95% CI 1.88-10.20) were associated with increased risk of benign serous ovarian tumors, and having had a hysterectomy was also related to increased risk of serous (OR 2.75, 95% CI 1.90-3.96), but not mucinous tumors. Ever having had a term pregnancy was inversely associated with both tumor types (combined OR 0.65, 95% CI 0.43-0.97), although greater numbers of pregnancies did not decrease risk further. Use of hormonal contraceptives was unrelated to risk. Our results suggest some differences in risk factors between benign serous and mucinous epithelial ovarian tumors and that risk factors for benign serous tumors differ from those well established for ovarian cancer. The results also suggest that there is potential for prevention of these common conditions through avoidance of smoking and obesity. II.

[Development of a portable fall risk index for elderly people living in the community].

PubMed

Toba, Kenji; Okochi, Jiro; Takahashi, Tai; Matsubayashi, Kozo; Nishinaga, Masanori; Yamada, Shizuru; Takahashi, Ryutaro; Nishijima, Reiko; Kobayashi, Yoshio; Machida, Ayako; Akishita, Masahiro; Sasaki, Hidetada

2005-05-01

To develop a portable risk index for falls. Risk factors were chosen from previously established factors then we added several environmental factors to the risk index; previous falls in the last 12 month, trippig or stumbling, inability to ascend or descend stairs without help, decreased walking speed, inability to cross a road within the green signal interval, inability to walk 1km without a break, inability to stand on one leg for 5 seconds (eyes open), using a cane, inability to wring out a towel, dizziness or faintness, stooped or rounded back, knee joint pain, visual disturbance, hearing disturbance, cognitive decline, fear of falling, receiving 5 or more prescribed drugs, sensation of darkness at home, obstacles inside, barrier on the carpet or floor, using steps daily at home, steep slopes around home. The questionnaire sheet was completed by 2,439 community-dwelling elderly subjects (76.3 +/- 7.4 years old). The frequency of each items of fall risk index was compared between fallers (history of fall within one year) and non-fallers. Multiple regression analysis was performed to identify independent risk factors for previous falls. Except barrier, step use and steep slope around home, all items in the fall risk index were more frequent in fallers. Multivariate analysis revealed that tripping or stumbling, inability to cross a road within the green signal interval, dizziness or faintness, obstacles inside, inability to wring out a towel, cane use and knee joint pain were independent risk factors for previous falls. These 7 selected items were further analyzed as predictors. The maximum sum of sensitivity and specificity was reached at the cut-off point of 2/3 (sensitivity 0.65, specificity 0.72) by receiver operating curve. Portable fall risk index is useful for clinical settings to identify high-risk subjects.

Renal-Stone Risk Assessment During Space Shuttle Flights

NASA Technical Reports Server (NTRS)

Whitson, Peggy A.; Pietrzyk, Robert A.; Pak, Charles Y. C.

1996-01-01

The metabolic and environmental factors influencing renal stone formation before, during, and after Space Shuttle flights were assessed. We established the contributing roles of dietary factors in relationship to the urinary risk factors associated with renal stone formation. 24-hr urine samples were collected prior to, during space flight, and following landing. Urinary factors associated with renal stone formation were analyzed and the relative urinary supersaturation ratios of calcium oxalate, calcium phosphate (brushite), sodium urate, struvite and uric acid were calculated. Food and fluid consumption was recorded for a 48-hr period ending with the urine collection. Urinary composition changed during flight to favor the crystallization of stone-forming salts. Factors that contributed to increased potential for stone formation during space flight were significant reductions in urinary pH and increases in urinary calcium. Urinary output and citrate, a potent inhibitor of calcium-containing stones, were slightly reduced during space flight. Dietary intakes were significantly reduced for a number of variables, including fluid, energy, protein, potassium, phosphorus and magnesium. This is the first in-flight characterization of the renal stone forming potential in astronauts. With the examination of urinary components and nutritional factors, it was possible to determine the factors that contributed to increased risk or protected from risk. In spite of the protective components, the negative contributions to renal stone risk predominated and resulted in a urinary environment that favored the supersaturation of stone-forming salts. The importance of the hypercalciuria was noted since renal excretion was high relative to the intake.

Renal stone risk assessment during Space Shuttle flights

NASA Technical Reports Server (NTRS)

Whitson, P. A.; Pietrzyk, R. A.; Pak, C. Y.

1997-01-01

PURPOSE: The metabolic and environmental factors influencing renal stone formation before, during, and after Space Shuttle flights were assessed. We established the contributing roles of dietary factors in relationship to the urinary risk factors associated with renal stone formation. MATERIALS AND METHODS: 24-hr. urine samples were collected prior to, during space flight, and following landing. Urinary and dietary factors associated with renal stone formation were analyzed and the relative urinary supersaturation of calcium oxalate, calcium phosphate (brushite), sodium urate, struvite and uric acid were calculated. RESULTS: Urinary composition changed during flight to favor the crystallization of calcium-forming salts. Factors that contributed to increased potential for stone formation during space flight were significant reductions in urinary pH and increases in urinary calcium. Urinary output and citrate, a potent inhibitor of calcium-containing stones, were slightly reduced during space flight. Dietary intakes were significantly reduced for a number of variables, including fluid, energy, protein, potassium, phosphorus and magnesium. CONCLUSIONS: This is the first in-flight characterization of the renal stone forming potential in astronauts. With the examination of urinary components and nutritional factors, it was possible to determine the factors that contributed to increased risk or protected from risk. In spite of the protective components, the negative contributions to renal stone risk predominated and resulted in a urinary environment that favored the supersaturation of stone-forming salts. Dietary and pharmacologic therapies need to be assessed to minimize the potential for renal stone formation in astronauts during/after space flight.

Application of discriminant analysis-based model for prediction of risk of low back disorders due to workplace design in industrial jobs.

PubMed

Ganga, G M D; Esposto, K F; Braatz, D

2012-01-01

The occupational exposure limits of different risk factors for development of low back disorders (LBDs) have not yet been established. One of the main problems in setting such guidelines is the limited understanding of how different risk factors for LBDs interact in causing injury, since the nature and mechanism of these disorders are relatively unknown phenomena. Industrial ergonomists' role becomes further complicated because the potential risk factors that may contribute towards the onset of LBDs interact in a complex manner, which makes it difficult to discriminate in detail among the jobs that place workers at high or low risk of LBDs. The purpose of this paper was to develop a comparative study between predictions based on the neural network-based model proposed by Zurada, Karwowski & Marras (1997) and a linear discriminant analysis model, for making predictions about industrial jobs according to their potential risk of low back disorders due to workplace design. The results obtained through applying the discriminant analysis-based model proved that it is as effective as the neural network-based model. Moreover, the discriminant analysis-based model proved to be more advantageous regarding cost and time savings for future data gathering.

Development of a Risk Assessment Tool to Predict Fall-Related Severe Injuries Occurring in a Hospital

PubMed Central

Toyabe, Shin-ichi

2014-01-01

Inpatient falls are the most common adverse events that occur in a hospital, and about 3 to 10% of falls result in serious injuries such as bone fractures and intracranial haemorrhages. We previously reported that bone fractures and intracranial haemorrhages were two major fall-related injuries and that risk assessment score for osteoporotic bone fracture was significantly associated not only with bone fractures after falls but also with intracranial haemorrhage after falls. Based on the results, we tried to establish a risk assessment tool for predicting fall-related severe injuries in a hospital. Possible risk factors related to fall-related serious injuries were extracted from data on inpatients that were admitted to a tertiary-care university hospital by using multivariate Cox’ s regression analysis and multiple logistic regression analysis. We found that fall risk score and fracture risk score were the two significant factors, and we constructed models to predict fall-related severe injuries incorporating these factors. When the prediction model was applied to another independent dataset, the constructed model could detect patients with fall-related severe injuries efficiently. The new assessment system could identify patients prone to severe injuries after falls in a reproducible fashion. PMID:25168984

Detailed Assessments of Childhood AdversityEnhance Prediction of Central Obesity Independent of Gender, Race, Adult Psychosocial Risk and Health Behaviors

PubMed Central

Davis, Cynthia R.; Dearing, Eric; Usher, Nicole; Trifiletti, Sarah; Zaichenko, Lesya; Ollen, Elizabeth; Brinkoetter, Mary T.; Crowell-Doom, Cindy; Joung, Kyoung; Park, Kyung Hee; Mantzoros, Christos S.; Crowell, Judith A.

2017-01-01

Objective This study examined whether a novel indicator of overall childhood adversity, incorporating number of adversities, severity, and chronicity, predicted central obesity beyond contributions of “modifiable” risk factors including psychosocial characteristics and health behaviors in a diverse sample of midlife adults. The study also examined whether the overall adversity score (number of adversities X severity X chronicity) better predicted obesity compared to cumulative adversity (number of adversities), a more traditional assessment of childhood adversity. Materials/Methods 210 Black/African Americans and White/European Americans, mean age = 45.8; ±3.3 years, were studied cross-sectionally. Regression analysis examined overall childhood adversity as a direct, non-modifiable risk factor for central obesity (waist-hip ratio) and body mass index (BMI), with and without adjustment for established adult psychosocial risk factors (education, employment, social functioning) and heath behavior risk factors (smoking, drinking, diet, exercise). Results Overall childhood adversity was an independent significant predictor of central obesity, and the relations between psychosocial and health risk factors and central obesity were not significant when overall adversity was in the model. Overall adversity was not a statistically significant predictor of BMI. Conclusions Overall childhood adversity, incorporating severity and chronicity and cumulative scores, predicts central obesity beyond more contemporaneous risk factors often considered modifiable. This is consistent with early dysregulation of metabolic functioning. Findings can inform practitioners interested in the impact of childhood adversity and personalizing treatment approaches of obesity within high-risk populations. Prevention/intervention research is necessary to discover and address the underlying causes and impact of childhood adversity on metabolic functioning. PMID:24211017

Normal breast tissue DNA methylation differences at regulatory elements are associated with the cancer risk factor age.

PubMed

Johnson, Kevin C; Houseman, E Andres; King, Jessica E; Christensen, Brock C

2017-07-10

The underlying biological mechanisms through which epidemiologically defined breast cancer risk factors contribute to disease risk remain poorly understood. Identification of the molecular changes associated with cancer risk factors in normal tissues may aid in determining the earliest events of carcinogenesis and informing cancer prevention strategies. Here we investigated the impact cancer risk factors have on the normal breast epigenome by analyzing DNA methylation genome-wide (Infinium 450 K array) in cancer-free women from the Susan G. Komen Tissue Bank (n = 100). We tested the relation of established breast cancer risk factors, age, body mass index, parity, and family history of disease, with DNA methylation adjusting for potential variation in cell-type proportions. We identified 787 cytosine-guanine dinucleotide (CpG) sites that demonstrated significant associations (Q value <0.01) with subject age. Notably, DNA methylation was not strongly associated with the other evaluated breast cancer risk factors. Age-related DNA methylation changes are primarily increases in methylation enriched at breast epithelial cell enhancer regions (P = 7.1E-20), and binding sites of chromatin remodelers (MYC and CTCF). We validated the age-related associations in two independent populations, using normal breast tissue samples (n = 18) and samples of normal tissue adjacent to tumor tissue (n = 97). The genomic regions classified as age-related were more likely to be regions altered in both pre-invasive (n = 40, P = 3.0E-03) and invasive breast tumors (n = 731, P = 1.1E-13). DNA methylation changes with age occur at regulatory regions, and are further exacerbated in cancer, suggesting that age influences breast cancer risk in part through its contribution to epigenetic dysregulation in normal breast tissue.

Behaviour, the key factor for sports injury prevention.

PubMed

Verhagen, Evert A L M; van Stralen, Maartje M; van Mechelen, Willem

2010-11-01

Safety in sports and physical activity is an important prerequisite for continuing participation in sports, as well as for maintenance of a healthy physically active lifestyle. For this reason, prevention, reduction and control of sports injuries are important goals for society as a whole. Recent advances in sports medicine discuss the need for research on real-life injury prevention. Such views call for a more behavioural approach when it comes to actual sports injury prevention. Nevertheless, the role of behaviour in sports injury prevention remains under-researched. In order to push the field of sports injury prevention forward, this article provides an overview of the relationship between behaviour and sports injury risk. Different types of behaviour relate to injury risk factors and injury mechanisms. Behaviour that influences risk factors and injury mechanisms is not confined only to the athlete. Various types of behaviour by, for example, the coach, referee, physical therapist or sports associations, also influence risk factors and injury mechanisms. In addition, multiple behaviours often act together. Some types of behaviour may directly affect injury risk and are by definition a risk factor. Other behaviours may only affect risk factors and injury mechanisms, and influence injury risk indirectly. Recent ideas on injury prevention that call for studies on real-life injury prevention still rely heavily on preventive measures that are established through efficacy research. A serious limitation in such an approach is that one expects that proven preventive measures will be adopted if the determinants and influences of sports safety behaviours are understood. Therefore, if one truly wants to prevent sports injuries in a real-life situation, a broader research focus is needed. In trying to do so, we need to look at lessons learned from other fields of injury prevention research.

Parental intermittent claudication as risk factor for claudication in adults.

PubMed

Prushik, Scott G; Farber, Alik; Gona, Philimon; Shrader, Peter; Pencina, Michael J; D'Agostino, Ralph B; Murabito, Joanne M

2012-03-01

Little is known about the familial aggregation of intermittent claudication (IC). Our objective was to examine whether parental IC increased the risk of IC in adult offspring, independent of the established cardiovascular risk factors. We evaluated the Offspring Cohort Participants of the Framingham Heart Study who were ≥30 years old, cardiovascular disease free, and had both parents enrolled in the Framingham Heart Study (n = 2,970 unique participants, 53% women). Pooled proportional hazards regression analysis was used to examine whether the 12-year risk of incident IC in offspring participants was associated with parental IC, adjusting for age, gender, diabetes, smoking, systolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, and antihypertensive and lipid treatment. Of the 909 person-examinations in the parental IC history group and 5,397 person-examinations in the no-parental IC history group, there were 101 incident IC events (29 with parental IC history and 72 without a parental IC history) during follow-up. The age- and gender-adjusted 12-year cumulative incidence rate per 1,000 person-years was 5.08 (95% confidence interval [CI] 2.74 to 7.33) and 2.34 (95% CI 1.46 to 3.19) in participants with and without a parental IC history. A parental history of IC significantly increased the risk of incident IC in the offspring (multivariable adjusted hazard ratio 1.81, 95% CI 1.14 to 2.88). The hazard ratio was unchanged, with an adjustment for the occurrence of cardiovascular disease (hazard ratio 1.83, 95% CI 1.15 to 2.91). In conclusion, IC in parents increases the risk of IC in adult offspring, independent of the established risk factors. These data suggest a genetic component of peripheral artery disease and support future research into genetic causes. Copyright © 2012 Elsevier Inc. All rights reserved.

Atrial Fibrillation in Hypertrophic Cardiomyopathy: Prevalence, Clinical Correlations, and Mortality in a Large High‐Risk Population

PubMed Central

Siontis, Konstantinos C.; Geske, Jeffrey B.; Ong, Kevin; Nishimura, Rick A.; Ommen, Steve R.; Gersh, Bernard J.

2014-01-01

Background Atrial fibrillation (AF) is a common sequela of hypertrophic cardiomyopathy (HCM), but evidence on its prevalence, risk factors, and effect on mortality is sparse. We sought to evaluate the prevalence of AF, identify clinical and echocardiographic correlates, and assess its effect on mortality in a large high‐risk HCM population. Methods and Results We identified HCM patients who underwent evaluation at our institution from 1975 to 2012. AF was defined by known history (either chronic or paroxysmal), electrocardiogram, or Holter monitoring at index visit. We examined clinical and echocardiographic variables in association with AF. The effect of AF on overall and cause‐specific mortality was evaluated with multivariate Cox proportional hazards models. Of 3673 patients with HCM, 650 (18%) had AF. Patients with AF were older and more symptomatic (P<0.001). AF was less common among patients with obstructive HCM phenotype and was associated with larger left atria, higher E/e’ ratios, and worse cardiopulmonary exercise tolerance (all P values<0.001). During median (interquartile range) follow‐up of 4.1 (0.2 to 10) years, 1069 (29%) patients died. Patients with AF had worse survival compared to those without AF (P<0.001). In multivariate analysis adjusted for established risk factors of mortality in HCM, the hazard ratio (95% confidence interval) for the effect of AF on overall mortality was 1.48 (1.27 to 1.71). AF did not have an effect on sudden or nonsudden cardiac death. Conclusions In this large referral HCM population, approximately 1 in 5 patients had AF. AF was a strong predictor of mortality, even after adjustment for established risk factors. PMID:24965028

Alzheimer's disease prevention: from risk factors to early intervention.

PubMed

Crous-Bou, Marta; Minguillón, Carolina; Gramunt, Nina; Molinuevo, José Luis

2017-09-12

Due to the progressive aging of the population, Alzheimer's disease (AD) is becoming a healthcare burden of epidemic proportions for which there is currently no cure. Disappointing results from clinical trials performed in mild-moderate AD dementia combined with clear epidemiological evidence on AD risk factors are contributing to the development of primary prevention initiatives. In addition, the characterization of the long asymptomatic stage of AD is allowing the development of intervention studies and secondary prevention programmes on asymptomatic at-risk individuals, before substantial irreversible neuronal dysfunction and loss have occurred, an approach that emerges as highly relevant.In this manuscript, we review current strategies for AD prevention, from primary prevention strategies based on identifying risk factors and risk reduction, to secondary prevention initiatives based on the early detection of the pathophysiological hallmarks and intervention at the preclinical stage of the disease. Firstly, we summarize the evidence on several AD risk factors, which are the rationale for the establishment of primary prevention programmes as well as revising current primary prevention strategies. Secondly, we review the development of public-private partnerships for disease prevention that aim to characterize the AD continuum as well as serving as platforms for secondary prevention trials. Finally, we summarize currently ongoing clinical trials recruiting participants with preclinical AD or a higher risk for the onset of AD-related cognitive impairment.The growing body of research on the risk factors for AD and its preclinical stage is favouring the development of AD prevention programmes that, by delaying the onset of Alzheimer's dementia for only a few years, would have a huge impact on public health.

Associations of Breast Density With Demographic, Reproductive, and Lifestyle Factors in a Developing Southeast Asian Population.

PubMed

Dung Yun Trieu, Phuong; Mello-Thoms, Claudia; Peat, Jennifer K; Doan Do, Thuan; Brennan, Patrick C

2017-07-01

The aim of this study was to investigate how breast density interacted with demographic, reproductive, and lifestyle features among Vietnamese women. Mammographic density and established risk factors for breast cancer were collected from 1651 women (345 cancer cases and 1306 normal cases) in Vietnam. The association of breast density categories with potential risk factors was investigated using Spearman's test for continuous variables and χ 2 tests for categorical variables. Independent factors associated with high breast density and breast cancer in specific density groupings were assessed using logistic regression. Results showed that high breast density was significantly associated with young age, low body mass index, low number of children, early age at having the last child, premenopausal status, and increased vegetable consumption. Reproductive factors were key agents associated with breast cancer for women with high breast density, which was not so evident for women with low breast density.

Reasons for participation and non-participation in a diabetes prevention trial among women with prior gestational diabetes mellitus (GDM)

PubMed Central

2014-01-01

Background Gestational diabetes mellitus (GDM) is a risk factor for the development of type 2 diabetes. Lifestyle intervention can prevent progression to type 2 diabetes in high risk populations. We designed a randomised controlled trial (RCT) to evaluate the effectiveness of an established lifestyle intervention compared to standard care for delaying diabetes onset in European women with recent GDM. Recruitment into the RCT was more challenging than anticipated with only 89 of 410 (22%) women agreeing to participate. This paper identifies factors that could enhance participation of the target population in future interventions. Methods We hypothesised that women who agreed to participate would have higher diabetes risk profiles than those who declined, and secondly that it would be possible to predict participation on the bases of those risk factors. To test our hypothesis, we identified the subset of women for whom we had comprehensive data on diabetes risks factors 3-5 years following GDM, reducing the sample to 43 participants and 73 decliners. We considered established diabetes risk factors: smoking, daily fruit and vegetable intake, participation in exercise, family history of diabetes, glucose values and BMI scores on post-partum re-screens, use of insulin during pregnancy, and age at delivery. We also analysed narrative data from 156 decliners to further understand barriers to and facilitators of participation. Results Two factors differentiated participants and decliners: age at delivery (with women older than 34 years being more likely to participate) and insulin use during pregnancy (with women requiring the use of insulin in pregnancy less likely to participate). Binary logistic regression confirmed that insulin use negatively affected the odds of participation. The most significant barriers to participation included the accessibility, affordability and practicality of the intervention. Conclusions Women with recent GDM face multiple barriers to lifestyle change. Intervention designers should consider: (i) the practicalities of participation for this population, (ii) research designs that capitalise on motivational differences between participants, (iii) alleviating concerns about long-term diabetes management. We hope this work will support future researchers in developing interventions that are more relevant, effective and successful in recruiting the desired population. Trial registration Current Controlled Trials ISRCTN41202110 PMID:24461045

Heterogeneity in Periodontitis Prevalence in the Hispanic Community Health Study/Study of Latinos

PubMed Central

Sanders, Anne E.; Campbell, Steven M.; Beck, James D.; Mauriello, Sally M.; Jimenez, Monik C.; Kaste, Linda M.; Singer, Richard H.; Beaver, Shirley M.; Finlayson, Tracy L.; Badner, Victor M.

2014-01-01

Purpose To examine acculturation and established risk factors in explaining variation in periodontitis prevalence among Hispanic/Latino subgroups. Methods Participants were 12,730 dentate adults aged 18–74 years recruited into the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) from four U.S. field centers between 2008 and 2011. A standardized periodontal assessment measured probing pocket depth and gingival recession at six sites per tooth for up to 28 teeth. Periodontitis was defined according to the CDC/AAP case classifications developed for population surveillance. Covariates included acculturation indicators and established periodontitis risk factors. Survey estimation procedures took account of the complex sampling design. Adjusted multivariate binomial regression estimated prevalence ratios (PR) and 95% confidence limits (95% CL). Results Unadjusted prevalence of moderate/severe periodontitis was 38.5% and ranged from 24.7% among Dominicans to 52.1% among Cubans. Adjusted prevalence ratios for subgroups relative to Dominicans were: 1.34 (95% CL: 1.13, 1.58) among South Americans; 1.37 (95% CL: 1.17, 1.61) among Puerto Ricans; 1.43 (95% CL: 1.25, 1.64) among Mexicans; 1.53 (95% CL: 1.32, 1.76) among Cubans; and 1.55 (95% CL: 1.35, 1.78) among Central Americans. Conclusion Heterogeneity in prevalence of moderate/severe periodontitis among Hispanic/Latino subpopulations was not explained by acculturation or periodontitis risk factors. PMID:24731697

Meat retail conditions within the establishments of Kigali city (Rwanda): bacteriological quality and risk factors for Salmonella occurrence.

PubMed

Niyonzima, Eugène; Ongol, Martin Patrick; Brostaux, Yves; Korsak, Nicolas; Daube, Georges; Kimonyo, Anastase; Sindic, Marianne

2018-03-01

Meat constitutes one of the major vehicles for human foodborne infections. This study aimed to assess the retail conditions and to determine the microbiological quality and safety of meat retailed within the establishments of Kigali (Rwanda). A questionnaire survey was carried out in 150 retail outlets to characterise meat retail conditions. Additionally, 270 retail meat samples were analysed for the enumeration of hygiene indicator bacteria (total mesophilic bacteria and Escherichia coli) and for the qualitative detection of Salmonella, using conventional culture methods. The results revealed that beef was the predominant meat sold within the retail premises of Kigali city, while meat from non-bovine animal species was mainly sold in large establishments. Salmonella was detected in 19.6% of all the retailed meat samples evaluated, whereas the mean loads for total mesophilic bacteria and E. coli were 7.3 and 3.5 log cfu/g, respectively. Three factors, namely the temperature conditions of the meat under retail, the cleanability of the used meat cutting boards, and the training of personnel in hygienic meat handling practices, were found to be significantly (p ≤ 0.05) associated with the risk of Salmonella occurrence in the retailed meat. The findings from this study highlight the need for improvements in hygienic meat handling practices, particularly, in small and medium meat retail establishments in Kigali.

Risk Factors of HIV and Other Sexually Transmitted Infections in China: A Systematic Review of Reviews

PubMed Central

Wong, William Chi Wai

2015-01-01

Background Sexually Transmitted Infections (STIs) are a global challenge. China, once said to have eradicated STIs, is now facing a rapid rise in the prevalence of HIV/STIs. This review of reviews aims to map HIV/STI risk factors among the Chinese population, with the objective of identifying risk factors to inform the formulation of effective prevention strategies. Methods A systematic search using key terms related to HIV/STIs, risk factors and the Chinese population in both English and Chinese databases (PubMed, PsycINFO, the Cochrane Library; Wanfang data, CNKI, VIP and SINOMED) was conducted, and peer-reviewed systematic reviews on the topic from 1991 to 2014 were selected. Identified risk factors were grouped into different level determinants based on the HIV Social Epidemiology Model, and then evaluated and reported based on the PRISMA checklist. Findings Of the twenty-eight reviews included, the majority were focused on well-established, individual level risk factors within key populations, with some highlighting the complexity of interacting factors (e.g., alcohol use and higher income in male migrants). While twenty-two reviews covered individual factors, only ten mentioned social factors and five had contents on structural factors. There are gaps in the evidence on social and structural level impacts of HIV/STIs, such as on stigma, discrimination, health policy, access to care, and illicit drug control policies. Migration and social expectation appear to pose a significant threat in aggravating the HIV/STI situation in China; for example, incarceration patterns indicated a significant risk of HIV/STIs for female sex workers. Conclusions Since international guidelines recommend an integrated and multi-level approach to HIV/STI prevention, a comprehensive approach targeting interventions at all levels along the continuum of care is needed to effectively curtail HIV/STI transmission in China. More research is needed to better understand the impact of socio-political interventions within a Chinese context. PMID:26468650

The Modification of Biocellular Chemical Reactions by Environmental Physicochemicals

NASA Astrophysics Data System (ADS)

Ishido, M.

Environmental risk factors affect human biological system to different extent from modification of biochemical reaction to cellular catastrophe. There are considerable public concerns about electromagnetic fields and endocrine disruptors. Their risk assessments have not been fully achieved because of their scientific uncertainty: electromagnetic fields just modify the bioreaction in the restricted cells and endocrine disruptors are quite unique in that their expression is dependent on the exposure periods throughout a life. Thus, we here describe their molecular characterization to establish the new risk assessments for environmental physicochemicals.

Human migration and pig/pork import in the European Union: What are the implications for Taenia solium infections?

PubMed

Gabriël, S; Johansen, M V; Pozio, E; Smit, G S A; Devleesschauwer, B; Allepuz, A; Papadopoulos, E; van der Giessen, J; Dorny, P

2015-09-30

Taenia solium taeniasis/cysticercosis is a neglected zoonotic disease complex occurring primarily in developing countries. Though claimed eradicated from the European Union (EU), an increasing number of human neurocysticercosis cases is being detected. Risk factors such as human migration and movement of pigs/pork, as well as the increasing trend in pig rearing with outside access are discussed in this review. The entry of a tapeworm carrier into the EU seems a lot more plausible than the import of infected pork. The establishment of local transmission in the EU is presently very unlikely. However, considering the potential changes in risk factors, such as the increasing trend in pig farming with outdoor access, the increasing human migration from endemic areas into the EU, this situation might change, warranting the establishment of an early warning system, which should include disease notification of taeniasis/cysticercosis both in human and animal hosts. As currently human-to-human transmission is the highest risk, prevention strategies should focus on the early detection and treatment of tapeworm carriers, and should be designed in a concerted way, across the EU and across the different sectors. Copyright © 2015 Elsevier B.V. All rights reserved.

[The prevention of pressure sores in paediatric intensive care].

PubMed

Thueux, Emilie

2014-01-01

In paediatric intensive care, children develop pressure sores as a result of various mechanical and clinical factors. The prevention and assessment of the risk of pressure sores constitute a key concern for the nursing teams which establish prevention strategies adapted to the young patients.

Alcohol consumption, Wnt/ß-catenin cignaling, and hepatocarcinogenesis

USDA-ARS?s Scientific Manuscript database

Alcohol is a well-established risk factor for hepatocellular carcinoma, and the mechanisms by which alcohol liver cancer is complex. It has been suggested that ethanol (EtOH) metabolism may enhance tumor progression by increasing hepatocyte proliferation. To test this hypothesis, ethanol (EtOH) feed...

Homicide offenders 32 years later - a Swedish population-based study on recidivism.

PubMed

Sturup, Joakim; Lindqvist, Per

2014-02-01

The literature on recidivism by homicide offenders is scarce despite its importance for individuals and for society. To establish the rate of seriously violent re-offending among homicide offenders and identify risk factors for such recidivism. A 1970s incident cohort of all homicide offenders, sane and insane, from two regions of Sweden (N = 153) was followed up until 2007 using data from the national crime register. Ten per cent of the cohort (n = 15) re-offended. The mean time from index offence to recidivism was 9.4 years. Five people (3%) committed a further homicide, and it was established that another five (3%) offenders had killed before the index offence. Prospective risk factors for violent recidivism were young age, psychotic disorder, male victim, acquainted victim and intoxicated victim. The prevalence of repeated homicide is higher than previously reported. Victim variables and mental disorder in conjunction with substance abuse appear to be two domains of particular significance for recidivism. Copyright © 2013 John Wiley & Sons, Ltd.

Evidence-Based Medicine: Cleft Palate.

PubMed

Woo, Albert S

2017-01-01

After studying this article, the participant should be able to: 1. Describe the incidence of cleft palate and risk factors associated with development of an orofacial cleft. 2. Understand differences among several techniques to repair clefts of both the hard and soft palates. 3. Discuss risk factors for development of postoperative fistulas, velopharyngeal insufficiency, and facial growth problems. 4. Establish a treatment plan for individualized care of a cleft palate patient. Orofacial clefts are the most common congenital malformations of the head and neck region, and approximately three-quarters of these patients have some form of cleft palate deformity. Cleft palate repair is generally performed in children between 6 and 12 months of age. The goals of palate repair are to minimize the occurrence of fistulas, establish a normal velopharyngeal mechanism, and optimize facial growth. This Maintenance of Certification review discusses the incidence and epidemiology associated with cleft palate deformity and specifics associated with patient care, including analgesia, surgical repair techniques, and complications associated with repair of the cleft palate.

[Empirical therapeutic approach to infection by resistant gram positive (acute bacterial skin and skin structure infections and health care pneumonia). Value of risk factors].

PubMed

González-DelCastillo, J; Núñez-Orantos, M J; Candel, F J; Martín-Sánchez, F J

2016-09-01

Antibiotic treatment inadequacy is common in these sites of infection and may have implications for the patient's prognosis. In acute bacterial skin and skin structure infections, the document states that for the establishment of an adequate treatment it must be assessed the severity, the patient comorbidity and the risk factors for multidrug-resistant microorganism. The concept of health care-associated pneumonia is discussed and leads to errors in the etiologic diagnosis and therefore in the selection of antibiotic treatment. This paper discusses how to perform this approach to the possible etiology to guide empirical treatment.

Motor vehicle accident or driver suicide? Identifying cases of failed driver suicide in the trauma setting.

PubMed

Henderson, Antony F; Joseph, Anthony P

2012-01-01

Many authors have suggested that some road traffic crashes are disguised suicide attempts. A case report and literature review is used to explore this claim and to examine the frequency and risk factors associated with driver suicide. The author concludes the methodological difficulty of establishing the driver's intent of suicide accounts for an under-estimation of the frequency of this event and that many cases of driver suicide go unrecognised. Familiarity with the risk factors associated with driver suicide may assist in the identification of cases of failed driver suicide and referral to psychiatric services. Copyright © 2011 Elsevier Ltd. All rights reserved.

[Is cancer preventable?].

PubMed

López-Carrillo, L

1999-01-01

Cancer prevention is possible when the causes and risk factors for this disease are known and can be avoided. Lung, breast, stomach and cervical cancers are those with the highest incidence internationally. Smoking, diet, physical activity and certain viruses are factors that have potential for modification, and they determine most of the cancers in the world. To reduce cancer risk, the following is recommended at the individual level: increasing fruit and vegetable consumption, decreasing consumption of red meats, animal fats and alcoholic beverages, avoiding smoking, exercising regularly and avoiding weight gain. Health education, restrictions as to where smoking is prohibited and establishing taxes on tobacco consumption are the principal strategies for designing population prevention programs.

The Link between Suicide and Insomnia: Theoretical Mechanisms

PubMed Central

Black, Carmen G.

2013-01-01

Insomnia has been established as a risk factor for depression and mental illness for decades, but a growing body of evidence has recently exposed insomnia to be an independent risk factor for suicide that encompasses all age ranges. This discovery has invigorated investigation to elucidate the relationship between insomnia and suicide, and over 20 studies reinforcing this association in adults have been published since 2010 alone. This article analyzes relevant research and emphasizes studies published within the last three years with the intent of proposing theoretical mechanisms explaining the link between suicide and insomnia. These mechanisms may then be used as targets for future investigation of treatment. PMID:23949486

[Risk factors for adverse course of gastric and duodenal peptic ulcer].

PubMed

Komar, Olena M; Kizlova, Nataliya M; Trylevych, Oleksandra D; Kravchenko, Vasyl V

2018-01-01

Introduction: High morbidity rate, frequent relapses, and significant economic losses give reasons for highlighting the peptic ulcer disease as the most topical medical-statistical problem. The aim of the study is to assess the influence of the main risk factors on the course of gastric and duodenal peptic ulcer. Materials and methods: We formed up the risk groups consisted of patients with 12 modified (4) and regular (8) factors, each characterized with its own signs and gradations. We performed the quantitative evaluation of the factors and scored the signs thereof, the results of which were used for determination of the most informative ones. Results: Among the regular factors, we placed emphasis on gender, age, burdened heredity, and 0(I), Rh+ blood type. The risk of peptic ulcer in hereditary tainted young men of the working age with parental lineage (+2.3) and in males with 0(I) Rh+ blood type (+1.4) was proved. Helicobacter pylori (Hp) infection is a key contributor (a predictor of) to severity of the disease course (+9.7) among the modified risk factors. Negative effect of a concomitant pathology (+5.0), including hepatobiliary lesions (+3.8), hypertension (+4.0), and diabetes mellitus (+1.3) is also significant. Diet violation (+3.7), tobacco smoking (+3.2) and stress (+3.0) were ranked third. Conclusions: The results of quantitative evaluation of the factors scoring suggest of the underlying H.pylori infection (the significance of which is growing along with the growth of the disease incidence) and irrational diet as the most informatively important ones. We have established the direct dependence between the most important peptic ulcer risk factors, severity of the disease, and duration and periodicity of treatment thereof.

Interactions between lower urinary tract symptoms and cardiovascular risk factors determine distinct patterns of erectile dysfunction: a latent class analysis.

PubMed

Barbosa, João A B A; Muracca, Eduardo; Nakano, Élcio; Assalin, Adriana R; Cordeiro, Paulo; Paranhos, Mario; Cury, José; Srougi, Miguel; Antunes, Alberto A

2013-12-01

An epidemiological association between lower urinary tract symptoms and erectile dysfunction is well established. However, interactions among multiple risk factors and the role of each in pathological mechanisms are not fully elucidated We enrolled 898 men undergoing prostate cancer screening for evaluation with the International Prostate Symptom Score (I-PSS) and simplified International Index of Erectile Function-5 (IIEF-5) questionnaires. Age, race, hypertension, diabetes, dyslipidemia, metabolic syndrome, cardiovascular disease, serum hormones and anthropometric parameters were also evaluated. Risk factors for erectile dysfunction were identified by logistic regression. The 333 men with at least mild to moderate erectile dysfunction (IIEF 16 or less) were included in a latent class model to identify relationships across erectile dysfunction risk factors. Age, hypertension, diabetes, lower urinary tract symptoms and cardiovascular event were independent predictors of erectile dysfunction (p<0.05). We identified 3 latent classes of patients with erectile dysfunction (R2 entropy=0.82). Latent class 1 had younger men at low cardiovascular risk and a moderate/high prevalence of lower urinary tract symptoms. Latent class 2 had the oldest patients at moderate cardiovascular risk with an increased prevalence of lower urinary tract symptoms. Latent class 3 had men of intermediate age with the highest prevalence of cardiovascular risk factors and lower urinary tract symptoms. Erectile dysfunction severity and lower urinary tract symptoms increased from latent class 1 to 3. Risk factor interactions determined different severities of lower urinary tract symptoms and erectile dysfunction. The effect of lower urinary tract symptoms and cardiovascular risk outweighed that of age. While in the youngest patients lower urinary tract symptoms acted as a single risk factor for erectile dysfunction, the contribution of vascular disease resulted in significantly more severe dysfunction. Applying a risk factor interaction model to prospective trials could reveal distinct classes of drug responses and help define optimal treatment strategies for specific groups. Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

[Genetic polymorphisms of ARL15 and HLA-DMA are associated with rheumatoid arthritis in Han population from northwest China].

PubMed

Wang, Jiao; Qi, Xiaoming; Zhang, Xiaozhen; Yan, Wen; You, Chongge

2017-12-01

Objective To establish the methods for detecting single nucleotide polymorphisms (SNPs) of ADP-ribosylation factor-like GTPase 15 (ARL15), major histocompatibility complex class II-DM alpha (HLA-DMA ) and nuclear factor kappa B subunit 2 (NFKB2) genes using high resolution melting (HRM) technology, and to explore the association of those SNPs with the susceptibility of rheumatoid arthritis (RA) in northwestern Han Chinese population. Methods The PCR-HRM detection system for four SNPs (rs255758, rs1063478, rs397514331 and rs397514332) was established for genotyping, and gene sequencing was performed to validate the genotyping ability of the system. 588 RA cases and 200 controls were enrolled in a case-control study to analyze the associations of ARL15 and HLA-DMA gene polymorphisms with RA risk. Results The direct sequencing validated that the established PCR-HRM detection system could be used for genotyping clinical samples correctly. The mutated genotype of rs397514331 and rs397514332 from NFKB2 gene are not found in this study. The genotype frequencies of rs255758 and rs1063478 had statistical difference between the cases and controls, but no statistical difference in allelic frequencies. Under the dominant model (AA vs AC/CC), the AA genotype of rs255758 decreases the RA risk (OR=0.666, 95%CI=0.478-0.927, P=0.016). Conclusion The method of PCR-HRM we established can be applied to the routine detection of rs255758, rs1063478, rs397514331 and rs397514332. The ARL15 and HLA-DMA gene polymorphisms are associated with RA risk in Northwestern Han Chinese population.

Violent reinjury risk assessment instrument (VRRAI) for hospital-based violence intervention programs.

PubMed

Kramer, Erik J; Dodington, James; Hunt, Ava; Henderson, Terrell; Nwabuo, Adaobi; Dicker, Rochelle; Juillard, Catherine

2017-09-01

Violent injury is the second most common cause of death among 15- to 24-year olds in the US. Up to 58% of violently injured youth return to the hospital with a second violent injury. Hospital-based violence intervention programs (HVIPs) have been shown to reduce injury recidivism through intensive case management. However, no validated guidelines for risk assessment strategies in the HVIP setting have been reported. We aimed to use qualitative methods to investigate the key components of risk assessments employed by HVIP case managers and to propose a risk assessment model based on this qualitative analysis. An established academic hospital-affiliated HVIP served as the nexus for this research. Thematic saturation was reached with 11 semi-structured interviews and two focus groups conducted with HVIP case managers and key informants identified through snowball sampling. Interactions were analyzed by a four-member team using Nvivo 10, employing the constant comparison method. Risk factors identified were used to create a set of models presented in two follow-up HVIP case managers and leadership focus groups. Eighteen key themes within seven domains (environment, identity, mental health, behavior, conflict, indicators of lower risk, and case management) and 141 potential risk factors for use in the risk assessment framework were identified. The most salient factors were incorporated into eight models that were presented to the HVIP case managers. A 29-item algorithmic structured professional judgment model was chosen. We identified four tiers of risk factors for violent reinjury that were incorporated into a proposed risk assessment instrument, VRRAI. Copyright © 2017 Elsevier Inc. All rights reserved.

Biological risk factors for deep vein trombosis.

PubMed

Vayá, Amparo; Mira, Yolanda; Martínez, Marcial; Villa, Piedad; Ferrando, Fernando; Estellés, Amparo; Corella, Dolores; Aznar, Justo

2002-01-01

Hypercoagulable states due either to inherited or acquired thrombotic risk factors are only present in approximately half of cases of DVT, but the causes in the other half, remain unknown. The importance of biological risk factors such as hyperlipidemia, hypofibrinolysis and hemorheological alterations in the pathogenesis of DVT has not been well established. In order to ascertain whether the above mentioned biological factors are associated with DVT and could constitute independent risk factors, we carried out a case-control study in 109 first DVT patients in whom inherited or acquired thrombophilic risk factors had been ruled out and 121 healthy controls age (42+/-15 years) and sex matched. From all the biological variables analyzed (cholesterol, triglycerides, glucose, fibrinogen, erythrocyte aggregation, hematocrit, plasma viscosity and PAI-1) only fibrinogen concentration reached a statistically significant difference on the comparison of means (290+/-73 mg/dl in cases vs 268+/-58 mg/dl in controls, p<0.05). After this continuous variables were dichotomized according to our reference values, the percentage of cases with cholesterolemia >220 mg/dl, hematocrit >45% and fibrinogen >300 mg/dl was higher in cases than in controls: 38% vs 22%; p<0.01; 43% vs 27%; p<0.05; 36% vs 23%; p<0.05, respectively. The percentage of cases with PAI-1 values >30 ng/ml, 37% vs 25% was borderline significant; p=0.055. Multivariate logistic regression analysis showed that cholesterolemia >220 mg/dl and fibrinogen >300 mg/dl constitute independent predictors of venous thrombotic risk. The adjusted OR's were 2.03 (95% CI; 1.12-3.70) for cholesterolemia and 1.94 (95% CI; 1.07-3.55) for fibrinogen. When these two variables combined DVT risk rose about fourfold (3.96; p<0.05). Our results suggest that hypercholesterolemia and hyperfibrinogenemia should be added to the list of known DVT risk factors and we recommend adopting measures to decrease these variables in the population with a high risk of DVT.

Population-Attributable Risk Proportion of Clinical Risk Factors for Breast Cancer.

PubMed

Engmann, Natalie J; Golmakani, Marzieh K; Miglioretti, Diana L; Sprague, Brian L; Kerlikowske, Karla

2017-09-01

Many established breast cancer risk factors are used in clinical risk prediction models, although the proportion of breast cancers explained by these factors is unknown. To determine the population-attributable risk proportion (PARP) for breast cancer associated with clinical breast cancer risk factors among premenopausal and postmenopausal women. Case-control study with 1:10 matching on age, year of risk factor assessment, and Breast Cancer Surveillance Consortium (BCSC) registry. Risk factor data were collected prospectively from January 1, 1996, through October 31, 2012, from BCSC community-based breast imaging facilities. A total of 18 437 women with invasive breast cancer or ductal carcinoma in situ were enrolled as cases and matched to 184 309 women without breast cancer, with a total of 58 146 premenopausal and 144 600 postmenopausal women enrolled in the study. Breast Imaging Reporting and Data System (BI-RADS) breast density (heterogeneously or extremely dense vs scattered fibroglandular densities), first-degree family history of breast cancer, body mass index (>25 vs 18.5-25), history of benign breast biopsy, and nulliparity or age at first birth (≥30 years vs <30 years). Population-attributable risk proportion of breast cancer. Of the 18 437 women with breast cancer, the mean (SD) age was 46.3 (3.7) years among premenopausal women and 61.7 (7.2) years among the postmenopausal women. Overall, 4747 (89.8%) premenopausal and 12 502 (95.1%) postmenopausal women with breast cancer had at least 1 breast cancer risk factor. The combined PARP of all risk factors was 52.7% (95% CI, 49.1%-56.3%) among premenopausal women and 54.7% (95% CI, 46.5%-54.7%) among postmenopausal women. Breast density was the most prevalent risk factor for both premenopausal and postmenopausal women and had the largest effect on the PARP; 39.3% (95% CI, 36.6%-42.0%) of premenopausal and 26.2% (95% CI, 24.4%-28.0%) of postmenopausal breast cancers could potentially be averted if all women with heterogeneously or extremely dense breasts shifted to scattered fibroglandular breast density. Among postmenopausal women, 22.8% (95% CI, 18.3%-27.3%) of breast cancers could potentially be averted if all overweight and obese women attained a body mass index of less than 25. Most women with breast cancer have at least 1 breast cancer risk factor routinely documented at the time of mammography, and more than half of premenopausal and postmenopausal breast cancers are explained by these factors. These easily assessed risk factors should be incorporated into risk prediction models to stratify breast cancer risk and promote risk-based screening and targeted prevention efforts.

Special features of total knee replacement in hemophilia.

PubMed

Rodriguez-Merchan, Emerito Carlos

2013-12-01

Total knee replacement is an operation frequently needed by hemophilia patients, which greatly improves their quality of life. This operation, however, carries a higher risk of bleeding and infection for hemophiliacs than it does for osteoarthritis sufferers. It is advisable to implant prosthetic components using antibiotic-loaded cement. It is essential to maintain a level of 100% of the replacement clotting factor for 2 weeks. Hematological treatment must be established, depending on the patient's factor levels and other pharmacokinetic parameters such as recovery and half-life, optimal doses and treatment time. It is preferable to use general anesthesia due to the risk of spinal bleeding. The lifespan of total knee replacement in hemophilic patients is shorter than in patients with osteoarthritis because of the increased risk of infection.

Extra-hepatic hepatocellular carcinoma presenting as obstructive jaundice.

PubMed

Batsis, J A; Halfdanarson, T R; Pitot, H

2006-10-01

Hepatocellular carcinoma is a neoplasm with a uniformly poor prognosis. Risk factors for its development include chronic hepatitis B or C infection, haemochromatosis and alpha-1-antitrypsin deficiency, but individuals with any type of chronic liver disease are predisposed. The incidence is significantly higher in Asia and Africa although it has been noted to be increasing in the United States. We present a patient with notable atypical clinical features for hepatocellular carcinoma. The patient had neither predisposing risk factors nor a primary liver lesion causing obstructive jaundice. After multiple tissue specimens were obtained, the final pathological diagnosis was established. Hepatocellular carcinoma generally requires a surgical cure, but patients who are icteric often portend poorer prognoses. For those at high risk, screening may be indicated to identify early curative treatment.

Prognostic value of insulin-like growth factor 1 and insulin-like growth factor binding protein 3 blood levels in breast cancer.

PubMed

Hartog, H; Boezen, H M; de Jong, M M; Schaapveld, M; Wesseling, J; van der Graaf, W T A

2013-12-01

High circulating insulin-like growth factor 1 (IGF-1) levels are firmly established as a risk factor for developing breast cancer, especially estrogen positive tumors. The effect of circulating IGF-1 on prognosis once a tumor is established is unknown. The authors explored the effect of IGF-1 blood levels and of it's main binding protein, IGFBP-3, on overall survival and occurrence of second primary breast tumors in breast cancer patients, as well as reproductive and lifestyle factors that could modify this risk. Patients were accrued from six hospitals in the Netherlands between 1998 and 2003. Total IGF-1 and IGFBP-3 were measured in 582 plasma samples. No significant association between IGF-1 and IGFBP-3 plasma levels and overall survival was found. However, in a multivariate Cox regression model including standard prognostic variables high IGF-1 levels were related to worse overall survival in patients receiving endocrine therapy (HR = 1.37, 95% CI: 1.11, 1.69, P 0.004). These data at least indicate that higher IGF-1 levels, and as a consequence most likely IGF-1-induced signaling, are related to a less favorable overall survival in breast cancer patients treated with endocrine therapy. Interventions aimed at reducing circulating levels of IGF-1 in hormone receptor positive breast cancer may improve survival. Copyright © 2013 Elsevier Ltd. All rights reserved.

Workplace Bullying as a Predictor of Disability Retirement

PubMed Central

Nielsen, Morten Birkeland; Emberland, Jan Shahid; Knardahl, Stein

2017-01-01

Objective: The aim of this study was to determine 1) whether bullying is related to all-cause disability retirement, 2) whether bullying contributes to the variance in disability retirement above high job demands and lack of job control, and 3) to establish gender differences in the relationship. Methods: Survey data from 14,501 Norwegian employees on exposure factors linked to registry data on all-cause disability retirement. Results: Bullying significantly predicted risk of disability retirement (hazard ratio = 1.55; 95% confidence interval = 1.13 to 2.12). This relationship remained statistically significant after adjusting for job demands and lack of job control. Women had the highest risk of disability, but both bullied men and women had a higher risk of disability than nonbullied employees of the same gender. Conclusion: Bullying is a risk factor for disability retirement. Measures taken to prevent bullying may be beneficial for reducing both health problems and disability retirement. PMID:28445177

Workplace Bullying as a Predictor of Disability Retirement: A Prospective Registry Study of Norwegian Employees.

PubMed

Nielsen, Morten Birkeland; Emberland, Jan Shahid; Knardahl, Stein

2017-07-01

The aim of this study was to determine 1) whether bullying is related to all-cause disability retirement, 2) whether bullying contributes to the variance in disability retirement above high job demands and lack of job control, and 3) to establish gender differences in the relationship. Survey data from 14,501 Norwegian employees on exposure factors linked to registry data on all-cause disability retirement. Bullying significantly predicted risk of disability retirement (hazard ratio = 1.55; 95% confidence interval = 1.13 to 2.12). This relationship remained statistically significant after adjusting for job demands and lack of job control. Women had the highest risk of disability, but both bullied men and women had a higher risk of disability than nonbullied employees of the same gender. Bullying is a risk factor for disability retirement. Measures taken to prevent bullying may be beneficial for reducing both health problems and disability retirement.

Explaining homeless youths' criminal justice interactions: childhood trauma or surviving life on the streets?

PubMed

Yoder, Jamie Rae; Bender, Kimberly; Thompson, Sanna J; Ferguson, Kristin M; Haffejee, Badiah

2014-02-01

Homeless youth are at increased risk for involvement in the criminal justice system. This study investigated childhood trauma as a risk factor for arrest or jail among a sample of youth seeking services at drop in, shelter, and transitional housing settings, while controlling for more established risk factors including: substance use, peer deviance, and engagement in survival behaviors. Standardized and researcher developed measures collected quantitative data through face-to-face interviews with youth (N = 202). Two sequential logic regression models identified significant predictors of arrest and jail, with a particular interest in the effects of childhood maltreatment. Youth with a history of physical abuse were nearly twice as likely to be arrested and to be jailed compared to non-abused youth, controlling for the significant influence of drug use and survival behaviors. These findings suggest the need for trauma screening and trauma-informed services for homeless youth at risk of illegal behavior.

Exercise Prescription in Patients with Different Combinations of Cardiovascular Disease Risk Factors: A Consensus Statement from the EXPERT Working Group.

PubMed

Hansen, Dominique; Niebauer, Josef; Cornelissen, Veronique; Barna, Olga; Neunhäuserer, Daniel; Stettler, Christoph; Tonoli, Cajsa; Greco, Eugenio; Fagard, Robert; Coninx, Karin; Vanhees, Luc; Piepoli, Massimo F; Pedretti, Roberto; Ruiz, Gustavo Rovelo; Corrà, Ugo; Schmid, Jean-Paul; Davos, Constantinos H; Edelmann, Frank; Abreu, Ana; Rauch, Bernhard; Ambrosetti, Marco; Braga, Simona Sarzi; Beckers, Paul; Bussotti, Maurizio; Faggiano, Pompilio; Garcia-Porrero, Esteban; Kouidi, Evangelia; Lamotte, Michel; Reibis, Rona; Spruit, Martijn A; Takken, Tim; Vigorito, Carlo; Völler, Heinz; Doherty, Patrick; Dendale, Paul

2018-05-04

Whereas exercise training is key in the management of patients with cardiovascular disease (CVD) risk (obesity, diabetes, dyslipidaemia, hypertension), clinicians experience difficulties in how to optimally prescribe exercise in patients with different CVD risk factors. Therefore, a consensus statement for state-of-the-art exercise prescription in patients with combinations of CVD risk factors as integrated into a digital training and decision support system (the EXercise Prescription in Everyday practice & Rehabilitative Training (EXPERT) tool) needed to be established. EXPERT working group members systematically reviewed the literature for meta-analyses, systematic reviews and/or clinical studies addressing exercise prescriptions in specific CVD risk factors and formulated exercise recommendations (exercise training intensity, frequency, volume and type, session and programme duration) and exercise safety precautions, for obesity, arterial hypertension, type 1 and 2 diabetes, and dyslipidaemia. The impact of physical fitness, CVD risk altering medications and adverse events during exercise testing was further taken into account to fine-tune this exercise prescription. An algorithm, supported by the interactive EXPERT tool, was developed by Hasselt University based on these data. Specific exercise recommendations were formulated with the aim to decrease adipose tissue mass, improve glycaemic control and blood lipid profile, and lower blood pressure. The impact of medications to improve CVD risk, adverse events during exercise testing and physical fitness was also taken into account. Simulations were made of how the EXPERT tool provides exercise prescriptions according to the variables provided. In this paper, state-of-the-art exercise prescription to patients with combinations of CVD risk factors is formulated, and it is shown how the EXPERT tool may assist clinicians. This contributes to an appropriately tailored exercise regimen for every CVD risk patient.

Onset of Impaired Sleep and Cardiovascular Disease Risk Factors: A Longitudinal Study

PubMed Central

Clark, Alice Jessie; Salo, Paula; Lange, Theis; Jennum, Poul; Virtanen, Marianna; Pentti, Jaana; Kivimäki, Mika; Rod, Naja Hulvej; Vahtera, Jussi

2016-01-01

Study Objectives: Impaired sleep has been linked to increased risk of cardiovascular disease (CVD), but the underlying mechanisms are still unsettled. We sought to determine how onset of impaired sleep affects the risk of established physiological CVD risk factors (i.e., hypertension, diabetes, and dyslipidemia). Methods: In a longitudinal cohort study with 3 survey waves (2000, 2004, 2008) from the Finnish Public Sector study we used repeated information on sleep duration and disturbances to determine onset of impaired sleep. Information on development of CVD risk factors, as indicated by initiation of medication for hypertension, diabetes, and dyslipidemia was derived from electronic medical records within 8 years of follow-up. Data on 45,647 participants was structured as two data-cycles to examine the effect of change in sleep (between two waves) on incident CVD events. We applied strict inclusion and exclusion criteria to determine temporality between changes in sleep and the outcomes. Results: While we did not find consistent effects of onset of short or long sleep, we found onset of disturbed sleep to predict subsequent risk of hypertension (hazard ratio = 1.22, 95% CI: 1.04–1.44) and dyslipidemia (HR = 1.17, 95% CI: 1.07–1.29) in fully adjusted analyses. Conclusions: Results suggest that onset of sleep disturbances rather than short or long sleep mark an increase in physiological risk factors, which may partly explain the higher risk of CVD observed among impaired sleepers. Commentary: A commentary on this paper appears in this issue on page 1629. Citation: Clark AJ, Salo P, Lange T, Jennum P, Virtanen M, Pentti J, Kivimäki M, Rod NH, Vahtera J. Onset of impaired sleep and cardiovascular disease risk factors: a longitudinal study. SLEEP 2016;39(9):1709–1718. PMID:27397560

Elevated levels of serum cholesterol are associated with better performance on tasks of episodic memory.

PubMed

Leritz, Elizabeth C; McGlinchey, Regina E; Salat, David H; Milberg, William P

2016-04-01

We examined how serum cholesterol, an established risk factor for cerebrovascular disease (CVD), relates to cognitive function in healthy middle-older aged individuals with no neurologic or CVD history. A complete lipid panel was obtained from a cohort of one hundred twenty individuals, ages 43-85, who also underwent a comprehensive neuropsychological examination. In order to reduce the number of variables and empirically identify broad cognitive domains, scores from neuropsychological tests were submitted into a factor analysis. This analysis revealed three explainable factors: Memory, Executive Function and Memory/Language. Three separate hierarchical multiple regression analyses were conducted using individual cholesterol metrics (total cholesterol, low density lipoprotein; LDL, high density lipoprotein; HDL, and triglycerides), as well as age, education, medication status (lipid lowering agents), ApoE status, and additional risk factors for CVD to predict neuropsychological function. The Memory Factor was predicted by a combination of age, LDL, and triglyceride levels; both age and triglycerides were negatively associated with factor score, while LDL levels revealed a positive relationship. Both the Executive and Memory/Language factor were only explained by education, whereby more years were associated with better performance. These results provide evidence that individual cholesterol lipoproteins and triglycerides may differentially impact cognitive function, over and above other common CVD risk factors and ApoE status. Our findings demonstrate the importance of consideration of vascular risk factors, such as cholesterol, in studies of cognitive aging.

Tocotrienols and cardiovascular health.

PubMed

Prasad, Kailash

2011-01-01

This review emphasizes the effects of tocotrienols on the risk factors for atherosclerosis, plaque instability and thrombogenesis, and compares these effects with tocopherol. Tocotrienols reduce serum lipids and raise serum HDL-C. Alpha-tocopherol, on the other hand, has no effect on serum lipids. Tocotrienols have greater antioxidant activity than tocopherols. Both reduce the serum levels of C-reactive protein (CRP) and advanced glycation end products, and expression of cell adhesion molecules. The CRP-lowering effects of tocotrienols are greater than tocopherol. Tocotrienols reduce inflammatory mediators, δ-tocotrienol being more potent, followed by γ- and α-tocotrienol. Tocotrienols are antithrombotic and suppress the expression of matrix metalloproteinases. They suppress, regress and slow the progression of atherosclerosis, while tocopherol only suppresses, and has no effect on regression and slowing of progression of atherosclerosis. Tocotrienol reduces risk factors for destabilization of atherosclerotic plaques. There are no firm data to suggest that tocotrienols are effective in reducing the risk of cardiac events in established ischemic heart disease. Alpha-tocopherol is effective in primary prevention of coronary artery disease (CAD), but has no conclusive evidence that it has beneficial effects in patients with established ischemic heart disease. Tocotrienols are effective in reducing ischemia-reperfusion cardiac injury in experimental animals and has the potential to be used in patients undergoing angioplasty, stent implantation and aorto-coronary bypass surgery. In conclusion, experimental data suggest that tocotrienols have a potential for cardiovascular health, but long-term randomized clinical trials are needed to establish their efficacy in primary and secondary prevention of CAD.

Spatio-Temporal Trends and Risk Factors for Shigella from 2001 to 2011 in Jiangsu Province, People's Republic of China

PubMed Central

Bao, Changjun; Hu, Jianli; Liu, Wendong; Liang, Qi; Wu, Ying; Norris, Jessie; Peng, Zhihang; Yu, Rongbin; Shen, Hongbing; Chen, Feng

2014-01-01

Objective This study aimed to describe the spatial and temporal trends of Shigella incidence rates in Jiangsu Province, People's Republic of China. It also intended to explore complex risk modes facilitating Shigella transmission. Methods County-level incidence rates were obtained for analysis using geographic information system (GIS) tools. Trend surface and incidence maps were established to describe geographic distributions. Spatio-temporal cluster analysis and autocorrelation analysis were used for detecting clusters. Based on the number of monthly Shigella cases, an autoregressive integrated moving average (ARIMA) model successfully established a time series model. A spatial correlation analysis and a case-control study were conducted to identify risk factors contributing to Shigella transmissions. Results The far southwestern and northwestern areas of Jiangsu were the most infected. A cluster was detected in southwestern Jiangsu (LLR = 11674.74, P<0.001). The time series model was established as ARIMA (1, 12, 0), which predicted well for cases from August to December, 2011. Highways and water sources potentially caused spatial variation in Shigella development in Jiangsu. The case-control study confirmed not washing hands before dinner (OR = 3.64) and not having access to a safe water source (OR = 2.04) as the main causes of Shigella in Jiangsu Province. Conclusion Improvement of sanitation and hygiene should be strengthened in economically developed counties, while access to a safe water supply in impoverished areas should be increased at the same time. PMID:24416167

Wellbeing and resilience: mechanisms of transmission of health and risk in parents with complex mental health problems and their offspring--The WARM Study.

PubMed

Harder, Susanne; Davidsen, Kirstine; MacBeth, Angus; Lange, Theis; Minnis, Helen; Andersen, Marianne Skovsager; Simonsen, Erik; Lundy, Jenna-Marie; Nyström-Hansen, Maja; Trier, Christopher Høier; Røhder, Katrine; Gumley, Andrew

2015-12-09

The WARM study is a longitudinal cohort study following infants of mothers with schizophrenia, bipolar disorder, depression and control from pregnancy to infant 1 year of age. Children of parents diagnosed with complex mental health problems including schizophrenia, bipolar disorder and depression, are at increased risk of developing mental health problems compared to the general population. Little is known regarding the early developmental trajectories of infants who are at ultra-high risk and in particular the balance of risk and protective factors expressed in the quality of early caregiver-interaction. We are establishing a cohort of pregnant women with a lifetime diagnosis of schizophrenia, bipolar disorder, major depressive disorder and a non-psychiatric control group. Factors in the parents, the infant and the social environment will be evaluated at 1, 4, 16 and 52 weeks in terms of evolution of very early indicators of developmental risk and resilience focusing on three possible environmental transmission mechanisms: stress, maternal caregiver representation, and caregiver-infant interaction. The study will provide data on very early risk developmental status and associated psychosocial risk factors, which will be important for developing targeted preventive interventions for infants of parents with severe mental disorder. NCT02306551, date of registration November 12, 2014.

Potential roles of high salt intake and maternal malnutrition in the development of hypertension in disadvantaged populations.

PubMed

Thrift, Amanda G; Srikanth, Velandai; Fitzgerald, Sharyn M; Kalyanram, Kartik; Kartik, Kamakshi; Hoppe, Chantal C; Walker, Karen Z; Evans, Roger G

2010-02-01

1. It has been argued that all major risk factors for cardiovascular disease have been identified. Yet, epidemiological studies undertaken to identify risk factors have largely focused on populations in developed nations or on the urban or relatively affluent rural populations of developing countries. Poor rural populations are seldom studied. 2. Somewhat different risk factors may operate in poor rural populations. Evidence for this is provided by the finding that, in disadvantaged rural India, the prevalence of hypertension is greater than would be expected based on established risk factors in these populations. One risk factor to be considered is a poor intrauterine environment. 3. In animals, maternal macro- and micronutrient malnutrition can lead to reduced nephron endowment. Nephron deficiency, in turn, can render blood pressure salt sensitive. The combination of nephron deficiency and excessive salt intake will predispose to hypertension. 4. Human malnutrition may have similar effects, particularly in regions of the world where malnutrition is endemic and where women are disadvantaged by existing social practices. 5. Moreover, high salt intake is endemic in many parts of Asia, including India. Therefore, we propose that maternal malnutrition (leading to reduced nephron endowment), when combined with excessive salt intake postnatally, will account, at least in part, for the unexpectedly high prevalence of hypertension in disadvantaged rural communities in India and elsewhere.

The Impact of Risk Factors of Chronic Pancreatitis on Secretin Pancreatic Function Testing: Results of a 20-Year Study.

PubMed

Kothari, Darshan; Ketwaroo, Gyanprakash; Freedman, Steven D; Sheth, Sunil G

2017-08-01

The aim of this study was to determine the effect of established risk factors on the outcome of secretin pancreatic function testing (sPFT) in patients undergoing work-up for suspected chronic pancreatitis. We completed a retrospective review of patients who underwent sPFT for suspected chronic pancreatitis over 20 years. We compared peak bicarbonate concentrations between groups and completed univariate and multivariate analyses to determine associations between risk factors and positive sPFT results (peak bicarbonate <80 mEq/L). Forty-three of 162 patients had positive sPFT results. There were significant differences in peak bicarbonate concentrations in patients with and without recurrent acute pancreatitis (RAP) and with local complications from acute pancreatitis (AP) (P ≤ 0.05). The bicarbonate concentration in patients with and without other risk factors such as tobacco use, alcohol use, and family history of pancreatitis was not significantly different. Female sex, a history of AP, and a history of RAP were associated with positive sPFT results on univariate analysis (P ≤ 0.05). On multivariate analysis, sex and RAP remained significant. Our study demonstrates that female sex, history of AP and RAP, and AP with local complications are associated with positive sPFT results or lower peak bicarbonate concentration. However, other risk factors do not impact the results of sPFT.

Review of toxoplasmosis in Morocco: seroprevalence and risk factors for toxoplasma infection among pregnant women and HIV- infected patients.

PubMed

Laboudi, Majda

2017-01-01

Toxoplasmosis is a disease caused by a protozoal parasite: Toxoplasma gondii . This infection can cause severe illness when the organism is contracted congenitally or when it is reactivated in immunosuppressed people. In this paper we review for the first time prevalence and risk factors of T. gondii among pregnant women and HIV-infected adults in Morocco. A systematic review methodology was used to consult three databases: Pub Med, Science Direct and Google Scholar dated until 2015, regarding prevalence data and risk factors of infection among pregnant women and people living with HIV. Data collection and eligibility criteria were established in this paper. No statistical method was employed in this study. Our review resulted in a total of 6 publications meeting the inclusion criteria of prevalence and risk factors of toxoplasmosis in Morocco. Seropositive rates of T. gondii infection reach up to 51% in pregnant women. Risk factors that were reported included contact with soil, lack of knowledge about toxoplasmosis, and a low educational level. For HIV-infected adults, the limited data show a 62.1% prevalence rate of T. gondii .According to our review, there is still very little information on toxoplasmosis disease in pregnant women and HIV infected patients in Morocco. Further research on toxoplasmosis is needed to better ascertain the human disease burden in Morocco.

Review of toxoplasmosis in Morocco: seroprevalence and risk factors for toxoplasma infection among pregnant women and HIV- infected patients

PubMed Central

Laboudi, Majda

2017-01-01

Toxoplasmosis is a disease caused by a protozoal parasite: Toxoplasma gondii. This infection can cause severe illness when the organism is contracted congenitally or when it is reactivated in immunosuppressed people. In this paper we review for the first time prevalence and risk factors of T. gondii among pregnant women and HIV-infected adults in Morocco. A systematic review methodology was used to consult three databases: Pub Med, Science Direct and Google Scholar dated until 2015, regarding prevalence data and risk factors of infection among pregnant women and people living with HIV. Data collection and eligibility criteria were established in this paper. No statistical method was employed in this study. Our review resulted in a total of 6 publications meeting the inclusion criteria of prevalence and risk factors of toxoplasmosis in Morocco. Seropositive rates of T. gondii infection reach up to 51% in pregnant women. Risk factors that were reported included contact with soil, lack of knowledge about toxoplasmosis, and a low educational level. For HIV-infected adults, the limited data show a 62.1% prevalence rate of T. gondii .According to our review, there is still very little information on toxoplasmosis disease in pregnant women and HIV infected patients in Morocco. Further research on toxoplasmosis is needed to better ascertain the human disease burden in Morocco. PMID:29187938

Model Development for Risk Assessment of Driving on Freeway under Rainy Weather Conditions

PubMed Central

Cai, Xiaonan; Wang, Chen; Chen, Shengdi; Lu, Jian

2016-01-01

Rainy weather conditions could result in significantly negative impacts on driving on freeways. However, due to lack of enough historical data and monitoring facilities, many regions are not able to establish reliable risk assessment models to identify such impacts. Given the situation, this paper provides an alternative solution where the procedure of risk assessment is developed based on drivers’ subjective questionnaire and its performance is validated by using actual crash data. First, an ordered logit model was developed, based on questionnaire data collected from Freeway G15 in China, to estimate the relationship between drivers’ perceived risk and factors, including vehicle type, rain intensity, traffic volume, and location. Then, weighted driving risk for different conditions was obtained by the model, and further divided into four levels of early warning (specified by colors) using a rank order cluster analysis. After that, a risk matrix was established to determine which warning color should be disseminated to drivers, given a specific condition. Finally, to validate the proposed procedure, actual crash data from Freeway G15 were compared with the safety prediction based on the risk matrix. The results show that the risk matrix obtained in the study is able to predict driving risk consistent with actual safety implications, under rainy weather conditions. PMID:26894434

Sinusoidal obstruction syndrome after allogeneic hematopoietic stem cell transplantation: Incidence, risk factors and outcomes.

PubMed

Yakushijin, K; Atsuta, Y; Doki, N; Yokota, A; Kanamori, H; Miyamoto, T; Ohwada, C; Miyamura, K; Nawa, Y; Kurokawa, M; Mizuno, I; Mori, T; Onizuka, M; Taguchi, J; Ichinohe, T; Yabe, H; Morishima, Y; Kato, K; Suzuki, R; Fukuda, T

2016-03-01

This retrospective study was conducted in Japan to determine the incidence, risk factors and outcomes of sinusoidal obstruction syndrome (SOS) after allogeneic hematopoietic stem cell transplantation (HSCT). Among 4290 patients undergoing allogeneic HSCT between 1999 and 2010, 462 were diagnosed with SOS according to the Seattle criteria (cumulative incidence, 10.8%). The cumulative incidence of SOS diagnosed by the modified Seattle criteria was 9.3%. Of 462 patients, 107 met the Baltimore criteria and 168 had severe SOS with renal and/or respiratory failure. The median onset for SOS was 12 days after HSCT (range, -2-30). Overall survival at day 100 was 32% for SOS and 15% for severe SOS. Multivariate analyses showed that significant independent risk factors for SOS were the number of HSCTs, age, performance status, hepatitis C virus-seropositivity, advanced disease status and myeloablative regimen. SOS was highly associated with overall mortality (hazard ratio, 2.09; P<0.001). Our retrospective survey showed that the cumulative incidence of SOS in Japan was 10.8%, similar to that previously reported in Western countries, and that the overall survival of patients who developed SOS was low. Furthermore, several risk factors were identified. Preventive and therapeutic strategies for high-risk SOS patients must be established to improve overall survival.

Non-infective occupational risk factors for hepatocellular carcinoma: A review

PubMed Central

Ledda, Caterina; Loreto, Carla; Zammit, Christian; Marconi, Andrea; Fago, Lucrezia; Matera, Serena; Costanzo, Valentina; Sanzà, Giovanni Fuccio; Palmucci, Stefano; Ferrante, Margherita; Costa, Chiara; Fenga, Concettina; Biondi, Antonio; Pomara, Cristoforo; Rapisarda, Venerando

2017-01-01

Liver cancer is the second leading worldwide cause of cancer-associated mortalities. Hepatocellular carcinoma, which accounts for the majority of liver tumors, ranks fifth among types of human cancer. Well-established risk factors for liver cancer include the hepatitis B and C viruses, aflatoxins, alcohol consumption, and oral contraceptives. Tobacco smoking, androgenic steroids, and diabetes mellitus are suspected risk factors. Current knowledge regarding non-infective occupational risk factors for liver cancer is inconclusive. The relevance of liver disorders to occupational medicine lies in the fact that the majority of chemicals are metabolized in the liver, and toxic metabolites generated via metabolism are the predominant cause of liver damage. However, their non-specific clinical manifestations that are similar in a number of liver diseases make diagnosis difficult. Furthermore, concomitant conditions, such as viral hepatitis and alcohol or drug abuse, may mask liver disorders that result from occupational hepatotoxic agents and block the demonstration of an occupational cause. The identification of environmental agents that result in human cancer is a long and often difficult process. The purpose of the present review is to summarize current knowledge regarding the association of non-infective occupational risk exposure and HCC, to encourage further research and draw attention to this global occupational public health problem. PMID:28000892

IQ in late adolescence/early adulthood, risk factors in middle age, and later cancer mortality in men: the Vietnam Experience Study.

PubMed

Batty, G David; Mortensen, Laust H; Gale, Catharine R; Shipley, Martin J; Roberts, Beverly A; Deary, Ian J

2009-10-01

(i) examine the relation, if any, of pre-morbid IQ scores at 20 years of age with the risk of later cancer mortality; and (ii) explore the role, if any, of potential mediating factors (e.g. smoking, obesity), assessed in middle age, in explaining the IQ-cancer relation. Cohort study of 14, 491 male, Vietnam-era, former US army personnel with IQ test scores at around 20 years of age (1965-71), who participated in a risk factor survey at around age 38 years of age (1985-6), who were then followed up for mortality experience for 15 years. There were 176 cancer deaths during mortality surveillance. We found an inverse association of IQ with later mortality from all cancers combined (age-adjusted HR(per one SD decrease in IQ); 95% confidence interval: 1.27; 1.10, 1.46) and smoking-related malignancies (1.37; 1.14, 1.64). There was some attenuation following control for mediating variables, particularly smoking and income, but the gradients generally held at conventional levels of statistical significance. Higher scores on pre-morbid IQ tests are associated with lower risk of later cancer morality. The strength of the relation was partially mediated by established risk factors.

Evaluation of dental implants as a risk factor for the development of bisphosphonate-related osteonecrosis of the jaw in breast cancer patients.

PubMed

Matsuo, Akira; Hamada, Hayato; Takahashi, Hidetoshi; Okamoto, Ayako; Kaise, Hiroshi; Chikazu, Daichi

2016-09-01

It remains unclear whether dental implants are a risk factor for the development of bisphosphonate-related osteonecrosis of the jaw (BRONJ). We retrospectively evaluated the status of dental implants in patients given intravenous bisphosphonates (BPs) in a breast cancer cohort to elucidate the risk for BRONJ at the implant site. We established a BRONJ oral monitoring program for 247 breast cancer patients given intravenous BP in our institution. The 3-year cumulative incidence rate was determined. The systemic and local risk factors of 44 patients who completed comprehensive oral examinations were evaluated by logistic regression analysis. The 3-year cumulative incidence rate of the 247 patients was 0.074 % (8/247, 95 % CI 0.0081-0.014). In the 44 orally examined patients, 6 (13.6 %: 6/44) had dental implants. Of these 6 patients, 1 developed BRONJ at the implant site. There were no significant differences in the age, total BP treatment period, number of residual teeth, time of regular oral monitoring, oral hygiene level, or dental implant insertion. Although a case of ONJ was identified, dental implants which were inserted before intravenous BP administration were not a risk factor for the development of ONJ in breast cancer patients.

Sleep disturbance and cardiometabolic risk factors in early pregnancy: a preliminary study.

PubMed

Haney, Alyssa; Buysse, Daniel J; Rosario, Bedda L; Chen, Yi-Fan; Okun, Michele L

2014-04-01

Cardiometabolic (CM) risk factors are linked to increased morbidity. Disturbed sleep is associated with CM risk factors in late pregnancy, but little is known about sleep in early pregnancy and CM risk factors. Diary and actigraphy-assessed sleep information, as well as CM outcomes (blood pressure (BP) and body mass index (BMI)), were collected thrice from pregnant women (N=161) in early pregnancy: T1 (10-12 weeks), T2 (14-16 weeks) and T3 (18-20 weeks). The sleep variables evaluated included sleep onset latency (SOL), wake after sleep onset (WASO) and total sleep time (TST). Sleep variables were dichotomised using established clinical cut-offs. BMI and BP significantly changed across time. Women with persistent SOL≥20 min had greater BMI than women without persistent SOL≥20 min prior to covariate adjustment at T1 and T2, but at T3 the BMI values converged. Similar results were observed for persistent WASO≥30 min. Persistently long WASO, as measured by actigraphy, was associated with elevated SBP, after controlling for covariates. Consistent with anecdotal evidence, it appears as if a subset of women report substantial difficulty initiating and maintaining sleep during early pregnancy and this may augment the risk of higher BP and BMI. Understanding these relationships is important as CM risk factors are linked to maternal and infant morbidity. Assessing sleep in early pregnancy may bestow time necessary for appropriate intervention. Copyright © 2014 Elsevier B.V. All rights reserved.

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

PubMed

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

2013-07-01

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

[Risk factors for preterm labor].

PubMed

Rodrigues, T; Barros, H

1998-10-01

Most studies investigating preterm risk factors include medically induced preterm labor due to fetal or maternal complications and do not distinguish preterm labor from preterm premature rupture of membranes. Thus, the objective of this study was to determine the proportion of the three types of preterm birth and identify risk factors for spontaneous preterm labor in a sample of pregnant women who delivered at two level III units. From January to October 1996, we interviewed 385 women with live preterm newborns and, as controls, 357 mothers of term newborns. Preterm births were classified as preterm labor, preterm premature rupture of membranes and iathrogenic preterm. Independent associations between maternal sociodemographic, constitutional, nutritional and obstetric characteristics and preterm labor were identified using logistic regression analysis. In this sample of preterm births, 29% corresponded to preterm labor, 49% to preterm premature rupture of the membranes and 22% were iathrogenic preterm. The identified risk factors for preterm labor were multiple gestation, no paid work during pregnancy, less than six prenatal care visits, arm circumference less than 26 cm and previous preterm or low birth-weight. Gestational bleeding during the first or third trimester was significantly associated with preterm labor. As previously recognized, multiple gestation, prior preterm or low birthweight and gestational bleeding are established risk factors for preterm labor. However, prenatal care, maternal work and nutritional status have also been revealed as important issues in preterm risk, deserving special interest since they are susceptible to preventive intervention.

Alcohol consumption and risk of type 2 diabetes mellitus in Japanese: a systematic review.

PubMed

Seike, Nobuko; Noda, Mitsuhiko; Kadowaki, Takashi

2008-01-01

To evaluate the association between alcohol consumption and the risk for type 2 diabetes (DM) in Japanese. We searched the MEDLINE data base with the key words 'alcohol intake' (or 'alcohol consumption') and 'Japanese' cross-linked with 'diabetes mellitus' (or 'impaired glucose tolerance'). The reports we sought were restricted to prospective cohort studies, randomized controlled trials, meta-analyses and systematic reviews. Computerized and hand searches were conducted in June 2007. Seven prospective cohort studies were adopted. We previously reported that in lean Japanese men (BMI < or =22.0 kg/m2), moderate to heavy alcohol intake is a risk factor for diabetes. One study found heavy alcohol intake to be associated with an increased risk in low-BMI men while moderate alcohol intake was associated with a reduced risk in higher-BMI men. Another study suggested daily alcohol consumption to be a risk factor in low-BMI participants, while being protective in middle-BMI participants. Yet another study demonstrated a U-shaped association between alcohol consumption and the risk of diabetes in men. Three other studies, which did not divide the subjects in terms of BMI values, indicated alcohol intake to be an increased risk for diabetes, two being in men and one being in women, respectively. For a large number of Japanese men who have relatively low BMI, alcohol intake is an established risk factor for diabetes.

A Longitudinal Assessment of the Victim-Offender Overlap

ERIC Educational Resources Information Center

Jennings, Wesley G.; Higgins, George E.; Tewksbury, Richard; Gover, Angela R.; Piquero, Alex R.

2010-01-01

Although research has established an offending/victimization overlap and that offenders and victims share similar characteristics, much less work has examined the longitudinal sequencing of victimization and offending in the same developmental period and whether key risk/protective factors significantly distinguish both offenders and victims. This…

IDENTIFICATION AND INTERPRETATION OF DEVELOPMENTAL NEUROTOXICITY EFFECTS: A REPORT FROM THE ILSI RESEARCH FOUNDATION/RISK SCIENCE INSTITUTE EXPERT WORKING GROUP ON NEURODEVELOPMENTAL ENDPOINTS

EPA Science Inventory

The reliable detection, measurement, and interpretation of treatment-related developmental neurotoxicity (DNT) effects depend on appropriate study design and execution, using scientifically established methodologies, with appropriate controls to minimize confounding factors. App...

Analysis on Dangerous Source of Large Safety Accident in Storage Tank Area

NASA Astrophysics Data System (ADS)

Wang, Tong; Li, Ying; Xie, Tiansheng; Liu, Yu; Zhu, Xueyuan

2018-01-01

The difference between a large safety accident and a general accident is that the consequences of a large safety accident are particularly serious. To study the tank area which factors directly or indirectly lead to the occurrence of large-sized safety accidents. According to the three kinds of hazard source theory and the consequence cause analysis of the super safety accident, this paper analyzes the dangerous source of the super safety accident in the tank area from four aspects, such as energy source, large-sized safety accident reason, management missing, environmental impact Based on the analysis of three kinds of hazard sources and environmental analysis to derive the main risk factors and the AHP evaluation model is established, and after rigorous and scientific calculation, the weights of the related factors in four kinds of risk factors and each type of risk factors are obtained. The result of analytic hierarchy process shows that management reasons is the most important one, and then the environmental factors and the direct cause and Energy source. It should be noted that although the direct cause is relatively low overall importance, the direct cause of Failure of emergency measures and Failure of prevention and control facilities in greater weight.

Risk and protective factors for childhood asthma: what is the evidence?

PubMed Central

Castro-Rodriguez, Jose A.; Forno, Erick; Rodriguez-Martinez, Carlos E.; Celedón, Juan C.

2016-01-01

In order to summarize the principal findings on risk and protective factors for childhood asthma, we retrieved systematic reviews on these topics in children (ages 1 to 18 years), up to January 2016, through MEDLINE, EMBASE, CINAHL, SCOPUS and CDSR. Two hundred twenty seven studies were searched from databases. Among those, 41 systematic reviews (SRs) were included: 9 focused on prenatal factors, 5 on perinatal factors, and 27 on postnatal factors. Of these 41 SRs, 83% had good methodological quality, as determined by the AMSTAR tool. After reviewing all evidence, parental asthma, prenatal environmental tobacco smoke and prematurity (particularly very preterm birth) are well-established risk factors for childhood asthma. Current findings do suggest mild to moderate causal effects of certain modifiable behaviors or exposures during pregnancy (maternal weight gain or obesity, maternal use of antibiotics or paracetamol, and maternal stress), the perinatal period (birth by Caesarean delivery), or postnatal life (severe RSV infection, overweight or obesity, indoor exposure to mold or fungi, and outdoor air pollution) on childhood asthma, but this suggestive evidence must be confirmed in interventional studies or (if interventions are not feasible) well-designed prospective studies. PMID:27286779

Prevalence and Risk Factors for the Peripheral Neuropathy in Patients with Peripheral Arterial Occlusive Disease

PubMed Central

Kim, Young Ae; Kim, Eun Su; Hwang, Ho Kyeong; Lee, Kyung Bok; Lee, Sol; Jung, Ji Woong; Kwon, Yu Jin; Cho, Dong Hui; Park, Sang Su; Yoon, Jin; Jang, Yong-Seog

2014-01-01

Purpose: Peripheral neuropathy (PN) is known as a major contributor of the worsening of ischemic symptoms and the foot ulceration in patients with peripheral arterial occlusive disease (PAOD). However, there are few studies reporting the prevalence and risk factors for PN in PAOD. This study aimed to evaluate these issues for PN and to establish the importance of screening as additional treatment target for PN in PAOD. Materials and Methods: A total of 52 limbs with PAOD were enrolled from January 2011 to December 2012. PN was divided into radiculopathy, ischemic PN (IPN), and diabetic PN (DPN), based on electromyographic findings. We investigated the prevalence of overall PN and subtypes of PN and then analyzed the risk factors. Results: The prevalence of overall PN in PAOD was 43 of 52 limbs (82.7%). In terms of subtypes of PN, the prevalence rate of radiculopathy and IPN was 30.8% and 23.1%, respectively. DPN showed in 22 limbs (73.3%) among 30 diabetic limbs. There was no significant correlation between each type of PN and ischemic symptoms. Our analysis showed that coronary artery disease (CAD) was a significant risk factor (P=0.01) for IPN, however, did not identify any significant risk factors for DPN. Conclusion: This present study indicated that most patients with PAOD had PN and CAD was a risk factor for IPN. In particular, PAOD with diabetes represented a higher prevalence for DPN. Our study suggests that PN should be evaluated and considered as another treatment target in patients with PAOD. PMID:26217631

Investigation of risk factors of psychological acceptance and burnout syndrome among nurses in China.

PubMed

Yao, Yongcheng; Yao, Wu; Wang, Wei; Li, Hong; Lan, Yajia

2013-10-01

The objectives of this study were to determine reliability of Chinese version of Acceptance and Action Questionnaire-II (AAQ-II), the relationship between psychological acceptance (PA), and burnout syndrome and their risk factors among nurses in China. The reliability of AAQ-II in Chinese was evaluated first by testing on 111 doctors and 108 nurses in China. On the number of 845 nurses selected from nine city hospitals by using stratified cluster sampling method, the Maslach Burnout Inventory-General Survey was administered to establish the presence of burnout, and the AAQ-II was used to measure their PA. Results showed that the AAQ-II in Chinese had a good test-retest reliability. PA was statistically significantly negatively correlated to the three dimensionalities of burnout among nurses in China. Male and female nurses had a significant difference in PA. Risk factors for burnout were age (25-44 years), marital status (married), gender (male), hospital department (emergency) and position (primary title) as well as PA. The findings provide insights into the risk factors of burnout in Chinese nurses and may have clinical implications in preventing burnout in Chinese nurses. © 2013 Wiley Publishing Asia Pty Ltd.

Lower life satisfaction, active coping and cardiovascular disease risk factors in older African Americans: outcomes of a longitudinal church-based intervention.

PubMed

Mendez, Yesenia P; Ralston, Penny A; Wickrama, Kandauda K A S; Bae, Dayoung; Young-Clark, Iris; Ilich, Jasminka Z

2018-06-01

This study examined lower life satisfaction, active coping and cardiovascular disease risk factors (diastolic and systolic blood pressure, body mass index, and circumferences) in older African Americans over the phases of an 18-month church-based intervention, using a quasi-experimental design. Participants (n = 89) were 45 years of age and older from six churches (three treatment, three comparison) in North Florida. Lower life satisfaction had a persistent unfavorable effect on weight variables. Active coping showed a direct beneficial effect on selected weight variables. However, active coping was adversely associated with blood pressure, and did not moderate the association between lower life satisfaction and cardiovascular risk factors. The intervention had a beneficial moderating influence on the association between lower life satisfaction and weight variables and on the association between active coping and these variables. Yet, this pattern did not hold for the association between active coping and blood pressure. The relationship of lower life satisfaction and selected cardiovascular risk factors and the positive effect of active coping were established, but findings regarding blood pressure suggest further study is needed.

Comparing Diabetes Prevalence Between African Americans and Whites of Similar Socioeconomic Status

PubMed Central

Signorello, Lisa B.; Schlundt, David G.; Cohen, Sarah S.; Steinwandel, Mark D.; Buchowski, Maciej S.; McLaughlin, Joseph K.; Hargreaves, Margaret K.; Blot, William J.

2007-01-01

Objectives. We investigated whether racial disparities in the prevalence of type 2 diabetes exist beyond what may be attributable to differences in socioeconomic status (SES) and other modifiable risk factors. Methods. We analyzed data from 34331 African American and 9491 White adults aged 40 to 79 years recruited into the ongoing Southern Community Cohort Study. Participants were enrolled at community health centers and had similar socioeconomic circumstances and risk factor profiles. We used logistic regression to estimate the association between race and prevalence of self-reported diabetes after taking into account age, SES, health insurance coverage, body mass index, physical activity, and hypertension. Results. Multivariate analyses accounting for several diabetes risk factors did not provide strong support for higher diabetes prevalence rates among African Americans than among Whites (men: odds ratio [OR]=1.07; 95% confidence interval [CI]=0.95, 1.20); women: OR=1.13, 95% CI=1.04, 1.22). Conclusions. Our findings suggest that major differences in diabetes prevalence between African Americans and Whites may simply reflect differences in established risk factors for the disease, such as SES, that typically vary according to race. PMID:17971557

Prediction of Floor Water Inrush: The Application of GIS-Based AHP Vulnerable Index Method to Donghuantuo Coal Mine, China

NASA Astrophysics Data System (ADS)

Wu, Qiang; Liu, Yuanzhang; Liu, Donghai; Zhou, Wanfang

2011-09-01

Floor water inrush represents a geohazard that can pose significant threat to safe operations for instance in coal mines in China and elsewhere. Its occurrence is controlled by many factors, and the processes are often not amenable to mathematical expressions. To evaluate the water inrush risk, the paper proposes the vulnerability index approach by coupling the analytic hierarchy process (AHP) and geographic information system (GIS). The detailed procedures of using this innovative approach are shown in a case study in China (Donghuantuo Coal Mine). The powerful spatial data analysis functions of GIS was used to establish the thematic layer of each of the six factors that control the water inrush, and the contribution weights of each factor was determined with the AHP method. The established AHP evaluation model was used to determine the threshold value for each risk level with a histogram of the water inrush vulnerability index. As a result, the mine area was divided into five regions with different vulnerability levels which served as general guidelines for the mine operations. The prediction results were further corroborated with the actual mining data, and the evaluation result is satisfactory.

Liver transplantation for hepatocellular carcinoma: a proposal of a prognostic scoring system.

PubMed

Iwatsuki, S; Dvorchik, I; Marsh, J W; Madariaga, J R; Carr, B; Fung, J J; Starzl, T E

2000-10-01

The current staging system of hepatocellular carcinoma established by the International Union Against Cancer and the American Joint Committee on Cancer does not necessarily predict the outcomes after hepatic resection or transplantation. Various clinical and pathologic risk factors for tumor recurrence were examined on 344 consecutive patients who received hepatic transplantation in the presence of nonfibrolamellar hepatocellular carcinoma to establish a reliable risk scoring system. Multivariate analysis identified three factors as independently significant poor prognosticators: 1) bilobarly distributed tumors, 2) size of the greatest tumor (2 to 5 cm and > 5 cm), and 3) vascular invasion (microscopic and macroscopic). Prognostic risk score (PRS) of each patient was calculated from the relative risks of multivariate analysis. The patients were grouped into five grades of tumor recurrence risk: grade 1: PRS = 0 to < 7.5; grade 2: PRS = 7.5 to < or = 11.0; grade 3: PRS > 11.0 to 15.0; grade 4: PRS > or = 15.0; and grade 5: positive node, metastasis, or margin. The proposed PRS system correlated extremely well with tumor-free survival after liver transplantation (100%, 61%, 40%, 5%, and 0%, from grades 1 to 5, respectively, at 5 years), but current pTNM staging did not. 1) Patients with grades 1 and 2 are effectively treated with liver transplantation, 2) patients with grades 4 and 5 are poor candidates for liver transplantation, and 3) patients with grade 1 do not benefit from adjuvant chemotherapy.

Consensus and controversy regarding osteoporosis in the pediatric population.

PubMed

Bachrach, Laura Keyes

2007-09-01

To review current consensus and controversy surrounding the diagnosis and treatment of osteoporosis in childhood and adolescence. The medical literature was reviewed with emphasis on the importance of early skeletal health, risk factors for bone fragility, and the diagnosis and management of children at risk for osteoporosis. Childhood and adolescence are critical periods for optimizing bone growth and mineral accrual. Bone strength is determined by bone size, geometry, quality, and mass-variables that are influenced by genetic factors, activity, nutrition, and hormones. For children with genetic skeletal disorders or chronic disease, bone growth and mineral accrual may be compromised, increasing the lifetime risk of osteoporosis. The goal for the clinician is to identify children at greatest risk for future fragility fracture. Bone densitometry and turnover markers are challenging to interpret in children. Prevention and treatment of bone fragility in children are less well established than in adults. Optimizing nutrition and activity may not restore bone health, but the drug armamentarium is limited. Sex steroid replacement has not proven effective in restoring bone mass in patients with anorexia nervosa or exercise-associated amenorrhea. Bisphosphonates can increase bone mass and may reduce bone pain and fractures, most convincingly in patients with osteogenesis imperfecta. Further studies are needed to establish the safety, efficacy, and optimal drug, duration, and dosage in pediatric patients. Bone health during the first 2 decades contributes to the lifetime risk of osteoporosis. Further research is needed to develop evidence-based recommendations for the diagnosis and treatment of osteoporosis in childhood.

A Quantitative Climate-Match Score for Risk-Assessment Screening of Reptile and Amphibian Introductions

NASA Astrophysics Data System (ADS)

van Wilgen, Nicola J.; Roura-Pascual, Núria; Richardson, David M.

2009-09-01

Assessing climatic suitability provides a good preliminary estimate of the invasive potential of a species to inform risk assessment. We examined two approaches for bioclimatic modeling for 67 reptile and amphibian species introduced to California and Florida. First, we modeled the worldwide distribution of the biomes found in the introduced range to highlight similar areas worldwide from which invaders might arise. Second, we modeled potentially suitable environments for species based on climatic factors in their native ranges, using three sources of distribution data. Performance of the three datasets and both approaches were compared for each species. Climate match was positively correlated with species establishment success (maximum predicted suitability in the introduced range was more strongly correlated with establishment success than mean suitability). Data assembled from the Global Amphibian Assessment through NatureServe provided the most accurate models for amphibians, while ecoregion data compiled by the World Wide Fund for Nature yielded models which described reptile climatic suitability better than available point-locality data. We present three methods of assigning a climate-match score for use in risk assessment using both the mean and maximum climatic suitabilities. Managers may choose to use different methods depending on the stringency of the assessment and the available data, facilitating higher resolution and accuracy for herpetofaunal risk assessment. Climate-matching has inherent limitations and other factors pertaining to ecological interactions and life-history traits must also be considered for thorough risk assessment.

Pleiotropic effects of type 2 diabetes management strategies on renal risk factors.

PubMed

Muskiet, Marcel H A; Tonneijck, Lennart; Smits, Mark M; Kramer, Mark H H; Heerspink, Hiddo J Lambers; van Raalte, Daniël H

2015-05-01

In parallel with the type 2 diabetes pandemic, diabetic kidney disease has become the leading cause of end-stage renal disease worldwide, and is associated with high cardiovascular morbidity and mortality. As established in landmark randomised trials and recommended in clinical guidelines, prevention and treatment of diabetic kidney disease focuses on control of the two main renal risk factors, hyperglycaemia and systemic hypertension. Treatment of systemic hypertension with angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers is advocated because these drugs seem to exert specific renoprotective effects beyond blood pressure lowering. Emerging evidence shows that obesity, glomerular hyperfiltration, albuminuria, and dyslipidaemia might also adversely affect the kidney in diabetes. Control of these risk factors could have additional benefits on renal outcome in patients with type 2 diabetes. However, despite multifactorial treatment approaches, residual risk for the development and progression of diabetic kidney disease in patients with type 2 diabetes remains, and novel strategies or therapies to treat the disease are urgently needed. Several drugs used in the treatment of type 2 diabetes are associated with pleiotropic effects that could favourably or unfavourably change patients' renal risk profile. We review the risk factors and treatment of diabetic kidney disease, and describe the pleiotropic effects of widely used drugs in type 2 diabetes management on renal outcomes, with special emphasis on antihyperglycaemic drugs. Copyright © 2015 Elsevier Ltd. All rights reserved.

Risk Factors for Dystocia in Pigtailed Macaques (Macaca nemestrina)

PubMed Central

Stockinger, Diane E; Torrence, Anne E; Hukkanen, Renee R; Vogel, Keith W; Hotchkiss, Charlotte E; Ha, James C

2011-01-01

Dystocia (difficult labor) is an important component of the management of nonhuman primates and results in significant fetal and maternal morbidity and increased use of veterinary resources. Dystocias can arise from abnormalities of the maternal pelvis or fetus or uncoordinated uterine activity. Although risk factors for stillbirths have been established in nonhuman primates, risk factors for dystocias have not. The objective of this study was to determine maternal and fetal risk factors for dystocia in macaques. Retrospective data were collected from 83 pigtailed macaques (Macaca nemestrina) diagnosed with dystocia. The diagnosis of dystocia was made based on clinical or pathologic evidence. Maternal records of age, reproductive history, experimental history, clinical records, and fetal birth weight and any applicable fetal necropsy reports were reviewed. The gestational age of the fetus, the infant's birth weight, total previous births by the dam, and the proportions of both viable delivery (inverse effect) and surgical pregnancy interventions (direct effect) in the dam's history generated a model that maximized the experimental variance for predicting dystocia in the current pregnancy and explained 24% of the dystocia deliveries. The number of total previous births and proportion of previous cesarean sections accounted for the greatest effect. This model can identify individual dams within a colony that are at risk for dystocias and allow for changes in breeding colony management, more intense monitoring of dams at risk, or allocation of additional resources. PMID:21535929

Method for assessing coal-floor water-inrush risk based on the variable-weight model and unascertained measure theory

NASA Astrophysics Data System (ADS)

Wu, Qiang; Zhao, Dekang; Wang, Yang; Shen, Jianjun; Mu, Wenping; Liu, Honglei

2017-11-01

Water inrush from coal-seam floors greatly threatens mining safety in North China and is a complex process controlled by multiple factors. This study presents a mathematical assessment system for coal-floor water-inrush risk based on the variable-weight model (VWM) and unascertained measure theory (UMT). In contrast to the traditional constant-weight model (CWM), which assigns a fixed weight to each factor, the VWM varies with the factor-state value. The UMT employs the confidence principle, which is more effective in ordered partition problems than the maximum membership principle adopted in the former mathematical theory. The method is applied to the Datang Tashan Coal Mine in North China. First, eight main controlling factors are selected to construct the comprehensive evaluation index system. Subsequently, an incentive-penalty variable-weight model is built to calculate the variable weights of each factor. Then, the VWM-UMT model is established using the quantitative risk-grade divide of each factor according to the UMT. On this basis, the risk of coal-floor water inrush in Tashan Mine No. 8 is divided into five grades. For comparison, the CWM is also adopted for the risk assessment, and a differences distribution map is obtained between the two methods. Finally, the verification of water-inrush points indicates that the VWM-UMT model is powerful and more feasible and reasonable. The model has great potential and practical significance in future engineering applications.

Ovarian Cancer Risk Factors by Histologic Subtype: An Analysis From the Ovarian Cancer Cohort Consortium.

PubMed

Wentzensen, Nicolas; Poole, Elizabeth M; Trabert, Britton; White, Emily; Arslan, Alan A; Patel, Alpa V; Setiawan, V Wendy; Visvanathan, Kala; Weiderpass, Elisabete; Adami, Hans-Olov; Black, Amanda; Bernstein, Leslie; Brinton, Louise A; Buring, Julie; Butler, Lesley M; Chamosa, Saioa; Clendenen, Tess V; Dossus, Laure; Fortner, Renee; Gapstur, Susan M; Gaudet, Mia M; Gram, Inger T; Hartge, Patricia; Hoffman-Bolton, Judith; Idahl, Annika; Jones, Michael; Kaaks, Rudolf; Kirsh, Victoria; Koh, Woon-Puay; Lacey, James V; Lee, I-Min; Lundin, Eva; Merritt, Melissa A; Onland-Moret, N Charlotte; Peters, Ulrike; Poynter, Jenny N; Rinaldi, Sabina; Robien, Kim; Rohan, Thomas; Sandler, Dale P; Schairer, Catherine; Schouten, Leo J; Sjöholm, Louise K; Sieri, Sabina; Swerdlow, Anthony; Tjonneland, Anna; Travis, Ruth; Trichopoulou, Antonia; van den Brandt, Piet A; Wilkens, Lynne; Wolk, Alicja; Yang, Hannah P; Zeleniuch-Jacquotte, Anne; Tworoger, Shelley S

2016-08-20

An understanding of the etiologic heterogeneity of ovarian cancer is important for improving prevention, early detection, and therapeutic approaches. We evaluated 14 hormonal, reproductive, and lifestyle factors by histologic subtype in the Ovarian Cancer Cohort Consortium (OC3). Among 1.3 million women from 21 studies, 5,584 invasive epithelial ovarian cancers were identified (3,378 serous, 606 endometrioid, 331 mucinous, 269 clear cell, 1,000 other). By using competing-risks Cox proportional hazards regression stratified by study and birth year and adjusted for age, parity, and oral contraceptive use, we assessed associations for all invasive cancers by histology. Heterogeneity was evaluated by likelihood ratio test. Most risk factors exhibited significant heterogeneity by histology. Higher parity was most strongly associated with endometrioid (relative risk [RR] per birth, 0.78; 95% CI, 0.74 to 0.83) and clear cell (RR, 0.68; 95% CI, 0.61 to 0.76) carcinomas (P value for heterogeneity [P-het] < .001). Similarly, age at menopause, endometriosis, and tubal ligation were only associated with endometrioid and clear cell tumors (P-het ≤ .01). Family history of breast cancer (P-het = .008) had modest heterogeneity. Smoking was associated with an increased risk of mucinous (RR per 20 pack-years, 1.26; 95% CI, 1.08 to 1.46) but a decreased risk of clear cell (RR, 0.72; 95% CI, 0.55 to 0.94) tumors (P-het = .004). Unsupervised clustering by risk factors separated endometrioid, clear cell, and low-grade serous carcinomas from high-grade serous and mucinous carcinomas. The heterogeneous associations of risk factors with ovarian cancer subtypes emphasize the importance of conducting etiologic studies by ovarian cancer subtypes. Most established risk factors were more strongly associated with nonserous carcinomas, which demonstrate challenges for risk prediction of serous cancers, the most fatal subtype. © 2016 by American Society of Clinical Oncology.

Ovarian Cancer Risk Factors by Histologic Subtype: An Analysis From the Ovarian Cancer Cohort Consortium

PubMed Central

Poole, Elizabeth M.; Trabert, Britton; White, Emily; Arslan, Alan A.; Patel, Alpa V.; Setiawan, V. Wendy; Visvanathan, Kala; Weiderpass, Elisabete; Adami, Hans-Olov; Black, Amanda; Bernstein, Leslie; Brinton, Louise A.; Buring, Julie; Butler, Lesley M.; Chamosa, Saioa; Clendenen, Tess V.; Dossus, Laure; Fortner, Renee; Gapstur, Susan M.; Gaudet, Mia M.; Gram, Inger T.; Hartge, Patricia; Hoffman-Bolton, Judith; Idahl, Annika; Jones, Michael; Kaaks, Rudolf; Kirsh, Victoria; Koh, Woon-Puay; Lacey, James V.; Lee, I-Min; Lundin, Eva; Merritt, Melissa A.; Onland-Moret, N. Charlotte; Peters, Ulrike; Poynter, Jenny N.; Rinaldi, Sabina; Robien, Kim; Rohan, Thomas; Sandler, Dale P.; Schairer, Catherine; Schouten, Leo J.; Sjöholm, Louise K.; Sieri, Sabina; Swerdlow, Anthony; Tjonneland, Anna; Travis, Ruth; Trichopoulou, Antonia; van den Brandt, Piet A.; Wilkens, Lynne; Wolk, Alicja; Yang, Hannah P.; Zeleniuch-Jacquotte, Anne; Tworoger, Shelley S.

2016-01-01

Purpose An understanding of the etiologic heterogeneity of ovarian cancer is important for improving prevention, early detection, and therapeutic approaches. We evaluated 14 hormonal, reproductive, and lifestyle factors by histologic subtype in the Ovarian Cancer Cohort Consortium (OC3). Patients and Methods Among 1.3 million women from 21 studies, 5,584 invasive epithelial ovarian cancers were identified (3,378 serous, 606 endometrioid, 331 mucinous, 269 clear cell, 1,000 other). By using competing-risks Cox proportional hazards regression stratified by study and birth year and adjusted for age, parity, and oral contraceptive use, we assessed associations for all invasive cancers by histology. Heterogeneity was evaluated by likelihood ratio test. Results Most risk factors exhibited significant heterogeneity by histology. Higher parity was most strongly associated with endometrioid (relative risk [RR] per birth, 0.78; 95% CI, 0.74 to 0.83) and clear cell (RR, 0.68; 95% CI, 0.61 to 0.76) carcinomas (P value for heterogeneity [P-het] < .001). Similarly, age at menopause, endometriosis, and tubal ligation were only associated with endometrioid and clear cell tumors (P-het ≤ .01). Family history of breast cancer (P-het = .008) had modest heterogeneity. Smoking was associated with an increased risk of mucinous (RR per 20 pack-years, 1.26; 95% CI, 1.08 to 1.46) but a decreased risk of clear cell (RR, 0.72; 95% CI, 0.55 to 0.94) tumors (P-het = .004). Unsupervised clustering by risk factors separated endometrioid, clear cell, and low-grade serous carcinomas from high-grade serous and mucinous carcinomas. Conclusion The heterogeneous associations of risk factors with ovarian cancer subtypes emphasize the importance of conducting etiologic studies by ovarian cancer subtypes. Most established risk factors were more strongly associated with nonserous carcinomas, which demonstrate challenges for risk prediction of serous cancers, the most fatal subtype. PMID:27325851

Risk Factors for Infection After Shoulder Arthroscopy in a Large Medicare Population.

PubMed

Cancienne, Jourdan M; Brockmeier, Stephen F; Carson, Eric W; Werner, Brian C

2018-03-01

Shoulder arthroscopy is well established as a highly effective and safe procedure for the treatment for several shoulder disorders and is associated with an exceedingly low risk of infectious complications. Few data exist regarding risk factors for infection after shoulder arthroscopy, as previous studies were not adequately powered to evaluate for infection. To determine patient-related risk factors for infection after shoulder arthroscopy by using a large insurance database. Case-control study; Level of evidence, 3. The PearlDiver patient records database was used to query the 100% Medicare Standard Analytic Files from 2005 to 2014 for patients undergoing shoulder arthroscopy. Patients undergoing shoulder arthroscopy for a diagnosis of infection or with a history of prior infection were excluded. Postoperative infection within 90 days postoperatively was then assessed with International Classification of Diseases, Ninth Revision codes for a diagnosis of postoperative infection or septic shoulder arthritis or a procedure for these indications. A multivariate binomial logistic regression analysis was then utilized to evaluate the use of an intraoperative steroid injection, as well as numerous patient-related risk factors for postoperative infection. Adjusted odds ratios (ORs) and 95% CIs were calculated for each risk factor, with P < .05 considered statistically significant. A total of 530,754 patients met all inclusion and exclusion criteria. There were 1409 infections within 90 days postoperatively (0.26%). Revision shoulder arthroscopy was the most significant risk factor for infection (OR, 3.25; 95% CI, 2.7-4.0; P < .0001). Intraoperative steroid injection was also an independent risk factor for postoperative infection (OR, 1.46; 95% CI, 1.2-1.9; P = .002). There were also numerous independent patient-related risk factors for infection, the most significant of which were chronic anemia (OR, 1.58; 95% CI, 1.4-1.8; P < .0001), malnutrition (OR, 1.42; 95% CI, 1.2-1.7; P = .001), male sex (OR, 2.71; 95% CI, 2.4-3.1; P < .0001), morbid obesity (OR, 1.41; 95% CI, 1.2-1.6; P < .0001), and depression (OR, 1.36; 95% CI, 1.2-1.5; P < .0001). Intraoperative steroid injection was a significant independent risk factor for postoperative infection after shoulder arthroscopy. There were also numerous significant patient-related risk factors for postoperative infection, including revision surgery, obesity, male sex, chronic anemia, malnutrition, depression, and alcohol use, among others.

Do ethnic patterns in cryptorchidism reflect those found in testicular cancer?

PubMed

Gurney, Jason; Sarfati, Diana; Stanley, James; Studd, Rodney

2013-11-01

There are established variations in testicular cancer incidence between ethnic groups within countries. It is currently unclear whether the occurrence of cryptorchidism-a known risk factor for testicular cancer-follows similar patterns. In New Zealand Māori have unusually high rates of testicular cancer compared to individuals of European ancestry. We hypothesized that ethnic trends in the incidence of cryptorchidism would reflect those for testicular cancer in this setting. We followed 318,441 eligible male neonates born in New Zealand between 2000 and 2010 for the incidence of orchiopexy confirmed cryptorchidism and the incidence of known risk factors for cryptorchidism (low birth weight, short gestation, small size for gestational age) using routine maternity, hospitalization and mortality records. Logistic regression was used to calculate odds ratios for the presence of known risk factors for cryptorchidism by ethnic group. Poisson regression was used to calculate relative risk of cryptorchidism by ethnicity, adjusted for risk factors. Ethnic patterns of cryptorchidism incidence in New Zealand closely mirrored those previously observed for testicular cancer. Māori had higher rates of cryptorchidism than all other ethnic groups (adjusted RR 1.2 [95% CI 1.11-1.3]), with Pacific (0.89 [0.8-0.99]) and Asian groups (0.68 [0.59-0.79]) having the lowest rates (European/other, referent). Since the principal risk factors for cryptorchidism are present in utero, the results of the current study strengthen the likelihood that the ethnic patterning of testicular cancer is at least partly due to prenatal risk factors. Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Potential host-related risk factors for recurrent urinary tract infection in Saudi women of childbearing age.

PubMed

Ahmed, Abul-Fotouh Abdel-Maguid; Solyman, Awatif Abdel-Karim; Kamal, Sanaa Moharram

2016-08-01

Risk factors for recurrent urinary tract infection (rUTI) in women may differ between individuals, age, and the community. This study aimed to evaluate host related risk factors for rUTI in sexually active Saudi women during the childbearing period. A case-control study was conducted in five healthcare centers and included married, nonpregnant women aged 18-40 years. A total of 217 women had rUTI (cases) and 252 did not (controls). A validated questionnaire, with a face-to-face interview, was applied to assess various demographic, behavioral, medical, and sexual data. Additionally, a thorough physical examination, saliva and blood analyses, uroflowmetry, and genitourinary ultrasonography were performed. Multivariate logistic regression analysis was used to identify the significant host related risk factors associated with rUTI. In multivariate analysis, attributable risks for rUTI were a history of childhood UTI [odds ratio (OR) = 6.8)] back-to-front douching/wiping after bowel movement (OR = 2.6), younger age at first intercourse (OR = 6.3), increased frequency of sexual intercourse (OR = 4.8), obstructed urinary flow (OR = 1.9), and genital prolapse (OR = 3.4). A total of 9.68 % of cases and none of the controls had high postvoid residual urine (positive predictive value for rUTI = 100 %). This is the first reported study to evaluate host related risk factors for rUTI in childbearing-age women in Saudi Arabia. Study findings indicate the association between rUTI and various factors that have been already established, with addition of improper rectal hygiene as a potential risk for recurrence.

Cannabis use as an indicator of risk for mental health problems in adolescents: a population-based study at secondary schools.

PubMed

van Gastel, W A; Tempelaar, W; Bun, C; Schubart, C D; Kahn, R S; Plevier, C; Boks, M P M

2013-09-01

Although the association between cannabis use and a wide range of psychiatric symptoms is fairly well established, it is not clear whether cannabis use is also a risk factor for general mental health problems at secondary school. Method A total of 10 324 secondary school children aged 11-16 years, participating in an ongoing Public Health Service School Survey, gave information on demographics, substance use, school factors and stressful life events and completed the Strengths and Difficulties Questionnaire (SDQ). Cannabis use in the past month was associated with a clinically relevant score on the SDQ [unadjusted odds ratio (OR) 4.46, 95% confidence interval (CI) 3.46-5.76]. Other risk factors associated with poor psychosocial functioning were: a low level of education, alcohol use, cigarette smoking, hard drug use, frequent truancy, an unfavourable school evaluation, feeling unsafe at school, being victimized, frequent absence due to illness, a mentally ill parent, molestation by a parent, financial problems and feeling distressed by an adverse event. In a full model adjusting for these risk factors, cannabis was not significantly associated with mental health problems, although an association at trend level was apparent. Of these risk factors, regular alcohol use, cigarette smoking, hard drug use, frequent truancy, an unfavourable school evaluation and frequent absence due to illness were also associated with cannabis use. The association between cannabis use and poor psychosocial functioning in adolescence is due, at least in part, to confounding by other risk factors. Thus, cannabis use can best be viewed as an indicator of risk for mental health problems in adolescence.

Risk Factors Predicting Infectious Lactational Mastitis: Decision Tree Approach versus Logistic Regression Analysis.

PubMed

Fernández, Leónides; Mediano, Pilar; García, Ricardo; Rodríguez, Juan M; Marín, María

2016-09-01

Objectives Lactational mastitis frequently leads to a premature abandonment of breastfeeding; its development has been associated with several risk factors. This study aims to use a decision tree (DT) approach to establish the main risk factors involved in mastitis and to compare its performance for predicting this condition with a stepwise logistic regression (LR) model. Methods Data from 368 cases (breastfeeding women with mastitis) and 148 controls were collected by a questionnaire about risk factors related to medical history of mother and infant, pregnancy, delivery, postpartum, and breastfeeding practices. The performance of the DT and LR analyses was compared using the area under the receiver operating characteristic (ROC) curve. Sensitivity, specificity and accuracy of both models were calculated. Results Cracked nipples, antibiotics and antifungal drugs during breastfeeding, infant age, breast pumps, familial history of mastitis and throat infection were significant risk factors associated with mastitis in both analyses. Bottle-feeding and milk supply were related to mastitis for certain subgroups in the DT model. The areas under the ROC curves were similar for LR and DT models (0.870 and 0.835, respectively). The LR model had better classification accuracy and sensitivity than the DT model, but the last one presented better specificity at the optimal threshold of each curve. Conclusions The DT and LR models constitute useful and complementary analytical tools to assess the risk of lactational infectious mastitis. The DT approach identifies high-risk subpopulations that need specific mastitis prevention programs and, therefore, it could be used to make the most of public health resources.

Weight stigma "gets under the skin"-evidence for an adapted psychological mediation framework: a systematic review.

PubMed

Sikorski, Claudia; Luppa, Melanie; Luck, Tobias; Riedel-Heller, Steffi G

2015-02-01

Research consistently shows a negative view of individuals with obesity in the general public and in various other settings. Stigma and discrimination can be considered chronic stressors, as these factors have a profound impact on the psychological well-being of the affected individuals. This article proposes a framework that entails a mediation of the adverse effects of discrimination and stigmatization on mental well-being through elevated psychological risk factors that are not unique to weight but that could affect overweight and normal-weight individuals alike. A systematic review was conducted to assess the prevalence of psychological risk factors, such as self-esteem and coping, in individuals with obesity. Forty-six articles were assessed and included for detailed analysis. The number of studies on these topics is limited to certain dimensions of psychological processes. The best evaluated association of obesity and psychosocial aspects is seen for self-esteem. Most studies establish a negative association of weight and self-esteem in children and adults. All studies with mediation analysis find a positive mediation through psychological risk factors on mental health outcomes. This review shows that elevated psychological risk factors are existent in individuals with obesity and that they may be a mediator between weight discrimination and pathopsychological outcomes. © 2014 The Obesity Society.

Risk and protective factors in the clinical rehabilitation of chronic back pain

PubMed Central

Wippert, Pia-Maria; Fliesser, Michael; Krause, Matthias

2017-01-01

Objectives Chronic back pain (CBP) can lead to disability and burden. In addition to its medical causes, its development is influenced by psychosocial risk factors, the so-called flag factors, which are categorized and integrated into many treatment guidelines. Currently, most studies investigate single flag factors, which limit the estimation of individual factor significance in the development of chronic pain. Furthermore, factors concerning patients’ lifestyle, biography and treatment history are often neglected. Therefore, the objectives of the present study are to identify commonly neglected factors of CBP and integrate them into an analysis model comparing their significance with established flag factors. Methods A total of 24 patients and therapists were cross-sectionally interviewed to identify commonly neglected factors of CBP. Subsequently, the impact of these factors was surveyed in a longitudinal study. In two rehabilitation clinics, CBP patients (n = 145) were examined before and 6 months after a 3-week inpatient rehabilitation. Outcome variables, chronification factor pain experience (CF-PE) and chronification factor disability (CF-D), were ascertained with confirmatory factor analysis (CFA) of standardized questionnaires. Predictors were evaluated using stepwise calculations of simple and multiple regression models. Results Through interviews, medical history, iatrogenic factors, poor compliance, critical life events (LEs), social support (SS) type and effort–reward were identified as commonly neglected factors. However, only the final three held significance in comparison to established factors such as depression and pain-related cognitions. Longitudinally, lifestyle factors found to influence future pain were initial pain, physically demanding work, nicotine consumption, gender and rehabilitation clinic. LEs were unexpectedly found to be a strong predictor of future pain, as were the protective factors, reward at work and perceived SS. Discussion These findings shed insight regarding often overlooked factors in the development of CBP, suggesting that more detailed operationalization and superordinate frameworks would be beneficial to further research. Conclusion In particular, LEs should be taken into account in future research. Protective factors should be integrated in therapeutic settings. PMID:28740424

Predictive factors that influence treatment outcomes of innovative single incision sling: comparing TVT-Secur to an established transobturator sling for female stress urinary incontinence.

PubMed

Hwang, Eugene; Shin, Ju Hyun; Lim, Jae Sung; Song, Ki Hak; Sul, Chong Koo; Na, Yong Gil

2012-07-01

This study aims to identify independent risk factors for treatment failure of tension-free vaginal tape TVT-Secur (TVT-S) compared to that of the well-established transobturator tape. Of a total of 175 consecutive patients with urodynamically confirmed stress urinary incontinence (SUI) identified between July 2007 and March 2010, 89 patients underwent TVT-S, and 86 underwent TOT. Cure was defined using the Urogenital Distress Inventory as no urinary leakage during physical activity, coughing, or sneezing as reported by patients during a telephone survey. To identify predictors of treatment failure, multivariable logistic regression models were used, and odds ratios (ORs) were calculated using variables identified during univariate analysis. There were more patients with cystocele ≥ grade 2 in the TVT-S group (p = 0.031); otherwise the groups were well matched. After a median follow-up of 32 months (range, 12-44 months), the overall cure rate was 80.6%; it was 70.8% for those treated with TVT-S and 90.7% for those treated with TOT (p = 0.001). In a multivariate model, previous incontinence surgery (OR 27.1, p = 0.005) and a cystocele ≥ grade 2 (OR 3.0, p = 0.020) were independent risk factors influencing the outcome of TVT-S procedures. For the TOT procedures, detrusor overactivity was an independent risk factor in a multivariate model (OR 8.6, p = 0.033). TVT-S could be performed for selected patients, but conventional TOT procedures are still superior to the novel TVT-S device.

Variability of Sex Disparities in Cancer Incidence over 30 Years: The Striking Case of Kidney Cancer.

PubMed

Scelo, Ghislaine; Li, Peng; Chanudet, Estelle; Muller, David C

2017-01-31

It is well established that men are at higher risk of most non-sex-specific cancers than women, but there has been surprisingly little research investigating these differences. This is possibly because differences in exposure to established risk factors and hypothesised protection by female sex hormones are thought to account for the totality of the sex differences. These explanations remain somewhat speculative, as the magnitude of the sex ratio in cancer incidence has not been systematically studied, with no quantitative estimate of the variability of the sex ratio across countries, age groups, and periods of diagnosis. We analysed worldwide cancer incidence data for the years 1978-2007 in terms of sex disparities, and explicitly quantified the variability in sex disparities by age, year, and geographical region. Our analysis highlights several cancer types for which suspected and commonly accepted factors are unlikely to fully explain the observed sex disparity. In particular, kidney cancer showed a 2:1 male/female case incidence ratio that was constant by age, year, and region, suggesting that factors other than sociocultural habits and health behaviours are responsible for this sex disparity. We quantified the difference in the incidence of various cancer types between men and women across the world over 30 years. While the trends for some cancers such as lung cancer are clearly correlated with known variations in lifestyle habits, we found that the sex disparity observed for others such as kidney cancer is unlikely to be explained by known risk factors. Copyright © 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.