Reaching out to Multiple Risk Adolescents.

ERIC Educational Resources Information Center

Porter, Laura; Lindberg, Laura Duberstein

This brief describes multiple risk students and maps their links to settings such as the workplace, church, or the health care system. A secondary goal of the brief is to show that although high-risk students have contact with many social institutions, opportunities for interventions are being missed. Data from the 1995 National Longitudinal…

Occupation, exposure to chemicals, sensitizing agents, and risk of multiple myeloma in Sweden.

PubMed

Lope, Virginia; Pérez-Gómez, Beatriz; Aragonés, Nuria; López-Abente, Gonzalo; Gustavsson, Per; Plato, Nils; Zock, Jan-Paul; Pollán, Marina

2008-11-01

This study sought to identify occupations with high incidence of multiple myeloma and to investigate possible excess risk associated with occupational exposure to chemicals and sensitizing agents in Sweden. A historical cohort of 2,992,166 workers was followed up (1971--1989) through record linkage with the National Cancer and Death Registries. For each job category, age and period standardized incidence ratios and age and period adjusted relative risks of multiple myeloma were calculated using Poisson models. Exposure to chemicals and to sensitizing agents was also assessed using two job-exposure matrices. Men and women were analyzed separately. During follow-up, 3,127 and 1,282 myelomas were diagnosed in men and women, respectively. In men, excess risk was detected among working proprietors, agricultural, horticultural and forestry enterprisers, bakers and pastry cooks, dental technicians, stone cutters/carvers, and prison/reformatory officials. In women, this excess was observed among attendants in psychiatric care, metal workers, bakers and pastry cooks, and paper/paperboard product workers. Workers, particularly bakers and pastry cooks, exposed to high molecular weight sensitizing agents registered an excess risk of over 40% across the sexes. Occasional, although intense, exposure to pesticides was also associated with risk of myeloma in our cohort. Our study supports a possible etiologic role for farming and use of pesticides in myeloma risk. The high incidence found in both female and male bakers and pastry cooks has not been described previously. Further research is required to assess the influence of high molecular weight sensitizing agents on risk of multiple myeloma.

Longitudinal patterns and predictors of multiple health risk behaviors among adolescents: The TRAILS study.

PubMed

de Winter, Andrea F; Visser, Leenke; Verhulst, Frank C; Vollebergh, Wilma A M; Reijneveld, Sijmen A

2016-03-01

Most studies on multiple health risk behaviors among adolescents have cross-sectionally studied a limited number of health behaviors or determinants. To examine the prevalence, longitudinal patterns and predictors of individual and multiple health risk behaviors among adolescents. Eight health risk behaviors (no regular consumption of fruit, vegetables or breakfast, overweight or obesity, physical inactivity, smoking, alcohol use and cannabis use) were assessed in a prospective population study (second and third wave). Participants were assessed in three waves between ages 10 and 17 (2001-2008; n=2230). Multiple linear regression was used to assess the influence of gender, self-control, parental health risk behaviors, parental monitoring and socioeconomic factors on the number of health risk behaviors adjusted for preceding multiple health risk behaviors (analysis: 2013-2014). Rates of >5 health risk behaviors were high: 3.6% at age 13.5 and 10.2% at age 16. Smoking at age 13.5 was frequently associated with health risk behaviors at age 16. No regular consumption of fruit, vegetables and breakfast, overweight or obesity, physical inactivity and smoking predicted the co-occurrence of health risk behaviors at follow-up. Significant predictors of the development of multiple health risk behaviors were adolescents' levels of self-control, socioeconomic status and maternal smoking. Multiple health risk behaviors are common among adolescents. Individual and social factors predict changes in multiple health risk behaviors, showing that prevention targeting multiple risk behaviors is needed. Special attention should be paid to adolescents with low self-control and families with low socioeconomic status or a mother who smokes. Copyright © 2015 Elsevier Inc. All rights reserved.

Early alveolar and systemic mediator release in patients at different risks for ARDS after multiple trauma.

PubMed

Raymondos, Konstantinos; Martin, Michael U; Schmudlach, Tanja; Baus, Stefan; Weilbach, Christian; Welte, Tobias; Krettek, Christian; Frink, Michael; Hildebrand, Frank

2012-02-01

Alveolar IL-8 has been reported to early identify patients at-risk to develop ARDS. However, it remains unknown how alveolar IL-8 is related to pulmonary and systemic inflammation in patients predisposed for ARDS. We studied 24 patients 2-6h after multiple trauma. Patients with IL-8 >200 pg/ml in bronchoalveolar lavage (BAL) were assigned to the group at high risk for ARDS (H, n = 8) and patients with BAL IL-8 <200 pg/ml to the group at low risk for ARDS (L, n = 16). ARDS developed within 24h after trauma in 5 patients at high and at least after 1 week in 2 patients at low risk for ARDS (p = 0.003). High-risk patients had also increased BAL IL-6, TNF-α, IL-1β, IL-10 and IL-1ra levels (p<0.05). BAL neutrophil counts did not differ between patient groups (H vs. L, 12% (3-73%) vs. 6% (2-32%), p = 0.1) but correlated significantly with BAL IL-8, IL-6 and IL-1ra. High-risk patients had increased plasma levels of pro- but not anti-inflammatory mediators. The enhanced alveolar and systemic inflammation associated with alveolar IL-8 release should be considered to identify high-risk patients for pulmonary complications after multiple trauma to adjust surgical and other treatment strategies to the individual risk profile. Copyright © 2011 Elsevier Ltd. All rights reserved.

Assessment of Risk Factors of Intrauterine Adhesions in Patients With Induced Abortion and the Curative Effect of Hysteroscopic Surgery.

PubMed

Mo, Xiaoliang; Qin, Guirong; Zhou, Zhoulin; Jiang, Xiaoli

2017-10-03

To explore the risk factors for intrauterine adhesions in patients with artificial abortion and clinical efficacy of hysteroscopic dissection. 1500 patients undergoing artificial abortion between January 2014 and June 2015 were enrolled into this study. The patients were divided into two groups with or without intrauterine adhesions. Univariate and Multiple logistic regression were conducted to assess the effects of multiple factors on the development of intrauterine adhesions following induced abortion. The incidence rate for intrauterine adhesions following induced abortion is 17.0%. Univariate showed that preoperative inflammation, multiple pregnancies and suction evacuation time are the influence risk factors of intrauterine adhesions. Multiple logistic regression demonstrates that multiple pregnancies, high intrauterine negative pressure, and long suction evacuation time are independent risk factors for the development of intrauterine adhesions following induced abortion. Additionally, intrauterine adhesions were observed in 105 mild, 80 moderate, and 70 severe cases. The cure rates for these three categories of intrauterine adhesions by hysteroscopic surgery were 100.0%, 93.8%, and 85.7%, respectively. Multiple pregnancies, high negative pressure suction evacuation and long suction evacuation time are independent risk factors for the development of intrauterine adhesions following induced abortions. Hysteroscopic surgery substantially improves the clinical outcomes of intrauterine adhesions.

Multiple Human Papilloma Virus Infections and Their Impact on the Development of High-Risk Cervical Lesions.

PubMed

Salazar, Katrina L; Zhou, Haijun Steve; Xu, Jiaqiong; Peterson, Leif E; Schwartz, Mary R; Mody, Dina R; Ge, Yimin

2015-01-01

Individuals are often infected with multiple genotypes of human papillomavirus (HPV) simultaneously, but the role these infections play in the development of cervical disease is not well established. This study aimed to determine the association of multiple HPV infections with high-risk cervical lesions (hrCLs). HPV genotyping was performed on 798 SurePath specimens collected between December 1, 2009, and April 30, 2011. The cases were classified as hrCL (n = 90) or non-hrCL (n = 708) based on cytology diagnoses. The association between hrCL and HPV infection patterns was analyzed. Multiple HPV infections were frequently encountered (38.2%) in the cohort. Increased frequency of hrCLs was associated with a single high-risk HPV (hrHPV) infection. An additive or synergistic effect was not observed for hrCL in multiple HPV infections. The hrCL rates appeared to decrease in various patterns of multiple HPV infections, but the reduction was not statistically significant. Multiple HPV infections are common with no additive or synergistic effect on the development of hrCL. Conversely, reduced hrCL rates were observed in various patterns of multiple HPV infections compared to their single-genotype infection counterparts, suggestive of possible intergenotypic competition or more effective immune response triggered by multiple infections. Further studies in larger cohorts are needed. © 2015 S. Karger AG, Basel.

Sex knowledge, attitudes, and high-risk sexual behaviors among unmarried youth in Hong Kong

PubMed Central

2013-01-01

Background Little is known about sex knowledge, attitudes, and high-risk sexual behaviors among unmarried youth in Hong Kong. It is of public health importance to investigate this topic to inform sex education, policymaking, and prevention and intervention programs. Methods Based on the Youth Sexuality Survey conducted by Hong Kong Family Planning Association (FPAHK) in 2011, this study explored the characteristics of sexual knowledge, attitudes, and high-risk sexual behaviors among 1,126 unmarried youth aged 18 to 27 years. Multiple logistic regressions were performed to examine factors associated with unmarried youth’s premarital sex, casual relationships, multiple sex partners, and premarital pregnancy. Results Unmarried youth in Hong Kong had adequate sex knowledge, but contraceptive knowledge was deficient. The majority of unmarried youth (63.8%) held liberal attitudes toward premarital sex and about half held liberal attitudes toward any form of sexual activity and premarital pregnancy. Around 60% held conservative attitudes toward causal sex relationships and multiple sex partners. Males tended to hold more liberal attitudes toward high-risk sex behaviors than female youth. Approximately 41.5% of unmarried youth reported having engaged in premarital sex, whereas less than 10% engaged in high-risk sexual behaviors. Males also reported higher amounts of premarital sex, casual sex relationships, and multiple sex partners. Females reported higher levels of sexual coercion. Logistic regressions indicated that being older, coming from a divorced family, out of school status and liberal attitudes toward risky sex behavior were more likely to engage in premarital sex or high-risk sex behaviors, and being female, being better educated and being immigrants were less likely to engage in premarital sex. However, being immigrants was more likely to engage in casual relationship and to have multiple partners. Conclusions Premarital sex is becoming more prevalent among unmarried youth in Hong Kong, and a small proportion of young adults are engaging in high-risk sexual behaviors. Sex education and HIV prevention programs should equip them with adequate knowledge on contraception and condom use. Intervention programs can start with their attitudes toward sex. PMID:23895326

Sex knowledge, attitudes, and high-risk sexual behaviors among unmarried youth in Hong Kong.

PubMed

Yip, Paul S F; Zhang, Huiping; Lam, Tai-Hing; Lam, Kwok Fai; Lee, Antoinette Marie; Chan, John; Fan, Susan

2013-07-29

Little is known about sex knowledge, attitudes, and high-risk sexual behaviors among unmarried youth in Hong Kong. It is of public health importance to investigate this topic to inform sex education, policymaking, and prevention and intervention programs. Based on the Youth Sexuality Survey conducted by Hong Kong Family Planning Association (FPAHK) in 2011, this study explored the characteristics of sexual knowledge, attitudes, and high-risk sexual behaviors among 1,126 unmarried youth aged 18 to 27 years. Multiple logistic regressions were performed to examine factors associated with unmarried youth's premarital sex, casual relationships, multiple sex partners, and premarital pregnancy. Unmarried youth in Hong Kong had adequate sex knowledge, but contraceptive knowledge was deficient. The majority of unmarried youth (63.8%) held liberal attitudes toward premarital sex and about half held liberal attitudes toward any form of sexual activity and premarital pregnancy. Around 60% held conservative attitudes toward causal sex relationships and multiple sex partners. Males tended to hold more liberal attitudes toward high-risk sex behaviors than female youth. Approximately 41.5% of unmarried youth reported having engaged in premarital sex, whereas less than 10% engaged in high-risk sexual behaviors. Males also reported higher amounts of premarital sex, casual sex relationships, and multiple sex partners. Females reported higher levels of sexual coercion. Logistic regressions indicated that being older, coming from a divorced family, out of school status and liberal attitudes toward risky sex behavior were more likely to engage in premarital sex or high-risk sex behaviors, and being female, being better educated and being immigrants were less likely to engage in premarital sex. However, being immigrants was more likely to engage in casual relationship and to have multiple partners. Premarital sex is becoming more prevalent among unmarried youth in Hong Kong, and a small proportion of young adults are engaging in high-risk sexual behaviors. Sex education and HIV prevention programs should equip them with adequate knowledge on contraception and condom use. Intervention programs can start with their attitudes toward sex.

Prediction of Autism at 3 Years from Behavioural and Developmental Measures in High-Risk Infants: A Longitudinal Cross-Domain Classifier Analysis

ERIC Educational Resources Information Center

Bussu, G.; Jones, E. J. H.; Charman, T.; Johnson, M. H.; Buitelaar, J. K.; Baron-Cohen, S.; Bedford, R.; Bolton, P.; Blasi, A.; Chandler, S.; Cheung, C.; Davies, K.; Elsabbagh, M.; Fernandes, J.; Gammer, I.; Garwood, H.; Gliga, T.; Guiraud, J.; Hudry, K.; Liew, M.; Lloyd-Fox, S.; Maris, H.; O'Hara, L.; Pasco, G.; Pickles, A.; Ribeiro, H.; Salomone, E.; Tucker, L.; Volein, A.

2018-01-01

We integrated multiple behavioural and developmental measures from multiple time-points using machine learning to improve early prediction of individual Autism Spectrum Disorder (ASD) outcome. We examined Mullen Scales of Early Learning, Vineland Adaptive Behavior Scales, and early ASD symptoms between 8 and 36 months in high-risk siblings (HR; n…

HIV Risk Perception, Sexual Behavior, and HIV Prevalence among Men-Who-Have-Sex-with-Men at a Community-Based Voluntary Counseling and Testing Center in Kuala Lumpur, Malaysia.

PubMed

Koh, Kwee Choy; Yong, Lit Sin

2014-01-01

We describe the HIV risk perception, sexual behavior, and HIV prevalence among 423 men-who-have-sex-with-men (MSM) clients who received voluntary counseling and testing (VCT) services at a community-based center in Kuala Lumpur, Malaysia. The mean age was 29 years old. One hundred one (23.9%) clients rated themselves as low risk, 118 (27.9%) as medium risk, 36 (8.5%) as high risk, and 168 (39.7%) were unsure of their risk. Twenty-four (9.4%) clients tested HIV positive (4 (4%) low risk, 9 (7.6%) medium risk, 11 (30.6%) high risk, and 13 (7.7%) unsure risk). We found a positive correlation between risk perception and HIV infection in this study. Clients with high HIV risk perception have 17x the odds of testing HIV positive compared to low risk clients. High HIV risk perception was significantly associated with multiple sex partners, multiple types of sex partners, alcohol use before intercourse, unprotected sex beyond 6 months, and inconsistent condom use during anal sex compared to low risk clients. There were no statistically significant differences between medium risk and unsure risk clients compared to low risk clients. Strategies should be targeted towards change in sexual practices among those who are perceived to be at high risk.

The Changing Landscape of Smoldering Multiple Myeloma: A European Perspective

PubMed Central

Fernández de Larrea, Carlos; Leleu, Xavier; Heusschen, Roy; Zojer, Niklas; Decaux, Olivier; Kastritis, Efstathios; Minnema, Monique; Jurczyszyn, Artur; Beguin, Yves; Wäsch, Ralph; Palumbo, Antonio; Dimopoulos, Meletios; Mateos, Maria Victoria; Ludwig, Heinz; Engelhardt, Monika

2016-01-01

Smoldering multiple myeloma (SMM) is an asymptomatic clonal plasma cell disorder and bridges monoclonal gammopathy of undetermined significance to multiple myeloma (MM), based on higher levels of circulating monoclonal immunoglobulin and bone marrow plasmocytosis without end-organ damage. Until a Spanish study reported fewer MM-related events and better overall survival among patients with high-risk SMM treated with lenalidomide and dexamethasone, prior studies had failed to show improved survival with earlier intervention, although a reduction in skeletal-related events (without any impact on disease progression) has been described with bisphosphonate use. Risk factors have now been defined, and a subset of ultra-high-risk patients have been reclassified by the International Myeloma Working Group as MM, and thus will require optimal MM treatment, based on biomarkers that identify patients with a >80% risk of progression. The number of these redefined patients is small (∼10%), but important to unravel, because their risk of progression to overt MM is substantial (≥80% within 2 years). Patients with a high-risk cytogenetic profile are not yet considered for early treatment, because groups are heterogeneous and risk factors other than cytogenetics are deemed to weight higher. Because patients with ultra-high-risk SMM are now considered as MM and may be treated as such, concerns exist that earlier therapy may increase the risk of selecting resistant clones and induce side effects and costs. Therefore, an even more accurate identification of patients who would benefit from interventions needs to be performed, and clinical judgment and careful discussion of pros and cons of treatment initiation need to be undertaken. For the majority of SMM patients, the standard of care remains observation until development of symptomatic MM occurs, encouraging participation in ongoing and upcoming SMM/early MM clinical trials, as well as consideration of bisphosphonate use in patients with early bone loss. Implications for Practice: Smoldering multiple myeloma is an early stage of myeloma disease and is diagnosed before any symptoms occur. Recent research has redefined the diagnostic criteria for multiple myeloma, offering new insights into testing and classification of this malignancy. Risk factors have now been defined and three biomarkers have been validated that are able to identify patients presenting a high risk of progression toward a symptomatic disease. These biomarkers will help physicians to identify high-risk patients who may benefit from optimal treatment. This article summarizes the views of a European panel of hematologists on the implicated changes in patient care. PMID:26921288

Gender-specific differences in high-risk sexual behaviors among methamphetamine users in Myanmar-China border city, Muse, Myanmar: who is at risk?

PubMed

Saw, Yu Mon; Saw, Thu Nandar; Chan, Nyein; Cho, Su Myat; Jimba, Masamine

2018-02-01

Methamphetamine (MA) use is a significant public health concern due to its negative effects on health. However, to date, no epidemiological research has examined high-risk sexual behaviors (inconsistent condom use, having multiple sexual partners and having a history of sexually transmitted infections) among MA users. This topic is particularly important in Myanmar, which is recognized as one of the key MA production countries in the Southeast Asia region. Therefore, this study examined factors associated with high-risk sexual behaviors among MA users in Muse city, Myanmar. A community-based cross-sectional study was conducted from January to March 2013 in Muse city, Northern Shan State, Myanmar. In total, 1183 MA users (772 male; 411 female) were recruited using respondent-driven sampling and a computer assisted self-interviewing method. Generalized estimating equation models were used to examine factors associated with high-risk sexual behaviors. A large proportion of MA users engaged in high-risk sexual behaviors (inconsistent condom use: males, 90.7%, females, 85.2%; multiple sexual partners: males, 94.2%, females, 47.2%; and history of STIs: males, 55.7%, females, 56.0%). Among males, being a multiple stimulants drug user (adjusted odds ratio [AOR] =1.77; 95% confidence interval [CI] =1.30-2.41) and being a client of sex workers (AOR = 1.41; 95% CI = 1.08-1.83) were risk factors for engaging in high-risk sexual behaviors. Among females, being a migrant worker (AOR = 2.70; 95% CI = 1.86-3.93) and being employed (AOR = 1.57; 95% CI = 1.13-2.18) were risk factors for engaging in high-risk sexual behaviors as well. High-risk sexual behaviors were particularly pronounced among both male and female MA users. MA prevention programs that reflect gender considerations should be developed to pay more attention to vulnerable populations such as migrants, clients of sex workers, and less educated female MA users.

Is Adolescent Poly-tobacco Use Associated with Alcohol and Other Drug Use?

PubMed Central

Creamer, MeLisa R.; Portillo, Gabriela V.; Clendennen, Stephanie L.; Perry, Cheryl L.

2016-01-01

Objectives To examine associations between current multiple tobacco product use, and current use of alcohol and marijuana, binge drinking, and lifetime use of marijuana, alcohol, and other drugs among US high school students. Methods Using 2013 Youth Risk Behavior Survey data (N = 13,583 high school students), logistic regression analyses were conducted to determine if single tobacco product or multiple tobacco product users are more likely to engage in other risk behaviors than zero tobacco product users, controlling for demographic variables. Results Overall, 23% of the sample used tobacco products and 10% of students reported current use of at least 2 tobacco products. Among single tobacco product users, the odds for engaging in risk behaviors ranged from 3.3 to 9.9 compared to non-tobacco users (p < .0001). Among multiple tobacco product users, the odds ranged from 1.5 to 4.7 (p < .01) compared to single tobacco product users. Conclusions Results suggest dual users are significantly more likely to engage in risk behavior than non-users and single product users. Future interventions should consider identifying dual-users as at higher risk, and targeting multiple risk behaviors. PMID:26685820

Prognostic Validation of SKY92 and Its Combination With ISS in an Independent Cohort of Patients With Multiple Myeloma.

PubMed

van Beers, Erik H; van Vliet, Martin H; Kuiper, Rowan; de Best, Leonie; Anderson, Kenneth C; Chari, Ajai; Jagannath, Sundar; Jakubowiak, Andrzej; Kumar, Shaji K; Levy, Joan B; Auclair, Daniel; Lonial, Sagar; Reece, Donna; Richardson, Paul; Siegel, David S; Stewart, A Keith; Trudel, Suzanne; Vij, Ravi; Zimmerman, Todd M; Fonseca, Rafael

2017-09-01

High risk and low risk multiple myeloma patients follow a very different clinical course as reflected in their PFS and OS. To be clinically useful, methodologies used to identify high and low risk disease must be validated in representative independent clinical data and available so that patients can be managed appropriately. A recent analysis has indicated that SKY92 combined with the International Staging System (ISS) identifies patients with different risk disease with high sensitivity. Here we computed the performance of eight gene expression based classifiers SKY92, UAMS70, UAMS80, IFM15, Proliferation Index, Centrosome Index, Cancer Testis Antigen and HM19 as well as the combination of SKY92/ISS in an independent cohort of 91 newly diagnosed MM patients. The classifiers identified between 9%-21% of patients as high risk, with hazard ratios (HRs) between 1.9 and 8.2. Among the eight signatures, SKY92 identified the largest proportion of patients (21%) also with the highest HR (8.2). Our analysis also validated the combination SKY92/ISS for identification of three classes; low risk (42%), intermediate risk (37%) and high risk (21%). Between low risk and high risk classes the HR is >10. Copyright © 2017 Elsevier Inc. All rights reserved.

Ready, set, go: a cross-sectional survey to understand priorities and preferences for multiple health behaviour change in a highly disadvantaged group.

PubMed

Noble, Natasha; Paul, Christine; Sanson-Fisher, Robert; Turon, Heidi; Turner, Nicole; Conigrave, Katherine

2016-09-13

Socially disadvantaged groups, such as Aboriginal Australians, tend to have a high prevalence of multiple lifestyle risk factors, increasing the risk of disease and underscoring the need for services to address multiple health behaviours. The aims of this study were to explore, among a socially disadvantaged group of people attending an Aboriginal Community Controlled Health Service (ACCHS): a) readiness to change health behaviours; b) acceptability of addressing multiple risk factors sequentially or simultaneously; and c) preferred types of support services. People attending an ACCHS in regional New South Wales (NSW) completed a touchscreen survey while waiting for their appointment. The survey assessed participant health risk status, which health risks they would like to change, whether they preferred multiple health changes to be made together or separately, and the types of support they would use. Of the 211 participants who completed the survey, 94 % reported multiple (two or more) health risks. There was a high willingness to change, with 69 % of current smokers wanting to cut down or quit, 51 % of overweight or obese participants wanting to lose weight and 44 % of those using drugs in the last 12 months wanting to stop or cut down. Of participants who wanted to make more than one health change, over half would be willing to make simultaneous or over-lapping health changes. The most popular types of support were help from a doctor or Health Worker and seeing a specialist, with less than a quarter of participants preferring telephone or electronic (internet or smart phone) forms of assistance. The importance of involving family members was also identified. Strategies addressing multiple health behaviour changes are likely to be acceptable for people attending an ACCHS, but may need to allow flexibility in the choice of initial target behaviour, timing of changes, and the format of support provided.

Elevated hardness of peripheral gland on real-time elastography is an independent marker for high-risk prostate cancers.

PubMed

Zhang, Qi; Yao, Jing; Cai, Yehua; Zhang, Limin; Wu, Yishuo; Xiong, Jingyu; Shi, Jun; Wang, Yuanyuan; Wang, Yi

2017-12-01

To examine the role of quantitative real-time elastography (RTE) features on differentiation between high-risk prostate cancer (PCA) and non-high-risk prostatic diseases in the initial transperineal biopsy setting. We retrospectively included 103 patients with suspicious PCA who underwent both RTE and initial transperineal prostate biopsy. Patients were grouped into high-risk and non-high-risk categories according to the D'Amico's risk stratification. With computer assistance based on MATLAB programming, three features were extracted from RTE, i.e., the median hardness within peripheral gland (PG) (H med ), the ratio of the median hardness within PG to that outside PG (H ratio ), and the ratio of the hard area within PG to the total PG area (H ar ). A multiple regression model incorporating an RTE feature, age, transrectal ultrasound finding, and prostate volume was used to identify markers for high-risk PCA. Forty-seven patients (45.6%) were diagnosed with PCA and 34 (33.0%) were diagnosed with high-risk PCA. Three RTE features were all statistically higher in high-risk PCA than in non-high-risk diseases (p < 0.001), indicating that the PGs in high-risk PCA patients were harder than those in non-high-risk patients. A high H ratio , high age, and low prostate volume were found to be independent markers for PCAs (p < 0.05), among which the high H ratio was the only independent marker for high-risk PCAs (p = 0.012). When predicting high-risk PCAs, the multiple regression achieved an area under receiver operating characteristic curve of 0.755, sensitivity of 73.5%, and specificity of 71.0%. The elevated hardness of PG identified high-risk PCA and served as an independent marker of high-risk PCA. As a non-invasive imaging modality, the RTE could be potentially used in routine clinical practice for the detection of high-risk PCA to decrease unnecessary biopsies and reduce overtreatment.

Adolescent Non-Involvement in Multiple Risk Behaviors: An Indicator of Successful Development?

ERIC Educational Resources Information Center

Willoughby, Teena; Chalmers, Heather; Busseri, Michael A.; Bosacki, Sandra; Dupont, Diane; Marini, Zopito; Rose-Krasnor, Linda; Sadava, Stan; Ward, Anthony; Woloshyn, Vera

2007-01-01

Based on the conceptualization of successful development as the joint maximization of desirable outcomes and minimization of undesirable outcomes (Baltes, 1997), the present study examined connections between adolescent non-involvement in multiple risk behaviors and positive developmental status. Results from a survey of 7290 high school students…

Modelling self-assessed vulnerability to HIV and its associated factors in a HIV-burdened country.

PubMed

Fagbamigbe, A F; Lawal, A M; Idemudia, E S

2017-12-01

Globally, individuals' self-assessment of vulnerability to HIV infection is important to maintain safer sexual behaviour and reduce risky behaviours. However, determinants of self-perceived risk of HIV infection are not well documented and differ. We assessed the level of self-perceived vulnerability to HIV infection in Nigeria and also identified its risk factors. We explored a recent nationally representative data with self-reported vulnerability ('high', 'low' and 'no risk at all') to HIV infection as the outcome of interest. Data were weighted and association between the outcomes and the risk factors determined. We used simple ordered logit regression to model relationship between the outcome variable and risk factors, and controlled for the significant variables in multiple ordered logistic regression at 5% significance level. About 74% had good knowledge of HIV transmission and 6% had experienced STI recently. The likelihood of assessing oneself as having 'no risk at all' was 50% and for 'high chances' was 1.6%. Self-perceived high risk of HIV was higher among those who recently experienced STI (5.6%) than those who did not (1.7%), and also higher among those who recently engaged in transactional sex and had multiple sexual partners. The odds of good knowledge of HIV transmission on high self-perceived vulnerability to HIV was 19% higher than poor knowledge (OR = 1.19, 95% CI: 1.12-1.27). Also, respondents who recently had multiple sexual partners were 72% (OR = 1.72, 95% CI: 1.60-1.86) more likely to report self as having high risk. Younger respondents aged 14-19 years had higher odds of 41% (OR = 1.41, 95% CI: 1.29-1.55) to perceive self as having high vulnerability to HIV than older respondents. High vulnerability to HIV infection was reported among younger respondents, those with history of STIS and those who engage in multiple sexual relations. Despite high level of risky sexual behaviour and good knowledge of HIV transmission and prevention found in this study, self-perceived vulnerability to HIV generally is low. For the low perception found in this study to translate to low chance of HIV infection, there is need for all stakeholders to embark on risk reduction initiatives through sexual education that would minimise risky sexual practices and ensuring availability and affordability of HIV prevention methods.

Development and validation of risk profiles of West African rural communities facing multiple natural hazards

PubMed Central

Renaud, Fabrice G.; Kloos, Julia; Walz, Yvonne; Rhyner, Jakob

2017-01-01

West Africa has been described as a hotspot of climate change. The reliance on rain-fed agriculture by over 65% of the population means that vulnerability to climatic hazards such as droughts, rainstorms and floods will continue. Yet, the vulnerability and risk levels faced by different rural social-ecological systems (SES) affected by multiple hazards are poorly understood. To fill this gap, this study quantifies risk and vulnerability of rural communities to drought and floods. Risk is assessed using an indicator-based approach. A stepwise methodology is followed that combines participatory approaches with statistical, remote sensing and Geographic Information System techniques to develop community level vulnerability indices in three watersheds (Dano, Burkina Faso; Dassari, Benin; Vea, Ghana). The results show varying levels of risk profiles across the three watersheds. Statistically significant high levels of mean risk in the Dano area of Burkina Faso are found whilst communities in the Dassari area of Benin show low mean risk. The high risk in the Dano area results from, among other factors, underlying high exposure to droughts and rainstorms, longer dry season duration, low caloric intake per capita, and poor local institutions. The study introduces the concept of community impact score (CIS) to validate the indicator-based risk and vulnerability modelling. The CIS measures the cumulative impact of the occurrence of multiple hazards over five years. 65.3% of the variance in observed impact of hazards/CIS was explained by the risk models and communities with high simulated disaster risk generally follow areas with high observed disaster impacts. Results from this study will help disaster managers to better understand disaster risk and develop appropriate, inclusive and well integrated mitigation and adaptation plans at the local level. It fulfills the increasing need to balance global/regional assessments with community level assessments where major decisions against risk are actually taken and implemented. PMID:28248969

Prediction of HIV Sexual Risk Behaviors among Disadvantaged African American Adults using a Syndemic Conceptual Framework

PubMed Central

Nehl, Eric J.; Klein, Hugh; Sterk, Claire E.; Elifson, Kirk W.

2015-01-01

The focus of this paper is on HIV sexual risk taking among a community-based sample of disadvantaged African American adults. The objective is to examine multiple factors associated with sexual HIV risk behaviors within a syndemic conceptual framework. Face-to-face, computer-assisted, structured interviews were conducted with 1,535 individuals in Atlanta, Georgia. Bivariate analyses indicated a high level of relationships among the HIV sexual risks and other factors. Results from multivariate models indicated that gender, sexual orientation, relationship status, self-esteem, condom use self-efficacy, sex while the respondent was high, and sex while the partner was high were significant predictors of condomless sex. Additionally, a multivariate additive model of risk behaviors indicated that the number of health risks significantly increased the risk of condomless sex. This intersection of HIV sexual risk behaviors and their associations with various other behavioral, socio-demographics, and psychological functioning factors helps explain HIV risk-taking among this sample of African American adults and highlights the need for research and practice that accounts for multiple health behaviors and problems. PMID:26188618

Association between high-risk fertility behaviours and the likelihood of chronic undernutrition and anaemia among married Bangladeshi women of reproductive age.

PubMed

Rahman, Mosiur; Islam, Md Jahirul; Haque, Syed Emdadul; Saw, Yu Mon; Haque, Md Nurruzzaman; Duc, Nguyen Huu Chau; Al-Sobaihi, Saber; Saw, Thu Nandar; Mostofa, Md Golam; Islam, Md Rafiqul

2017-02-01

To explore the association between high-risk fertility behaviours and the likelihood of chronic undernutrition, anaemia and the coexistence of anaemia and undernutrition among women of reproductive age. The 2011 Bangladesh Demographic and Health Survey, conducted from 8 July to 27 December 2011. Selected urban and rural areas of Bangladesh. A total of 2197 ever-married women living with at least one child younger than 5 years. Exposure was determined from maternal reports of high-risk fertility behaviours. We considered three parameters, maternal age at the time of delivery, birth order and birth interval, to define the high-risk fertility behaviours. Chronic undernutrition, anaemia and the coexistence of anaemia and undernutrition among women were the outcome variables. A substantial percentage of women were exposed to have a high-risk fertility pattern (41·8 %); 33·0 % were at single high-risk and 8·8 % were at multiple high-risk. After adjusting for relevant covariates, high-risk fertility behaviours were associated with increased likelihood of chronic undernutrition (adjusted relative risk; 95 % CI: 1·22; 1·03, 1·44), anaemia (1·12; 1·00, 1·25) and the coexistence of anaemia and undernutrition (1·52; 1·17, 1·98). Furthermore, multiple high-risk fertility behaviours appeared to have more profound consequences on the outcome measured. Maternal high-risk fertility behaviours are shockingly frequent practices among women in Bangladesh. High-risk fertility behaviours are important predictors of the increased likelihood of women's chronic undernutrition, anaemia and the coexistence of anaemia and undernutrition.

[Prevalence of human papilloma virus isolated from cervix lesions in a female population from Transilvania].

PubMed

Feticu, Lucia; Bocşan, I S; Bondor, Cosmina loana; Boboş, Cecilia

2012-01-01

Between the years 2008-2011 reverse hibridisation (INNO-LiPA HPV Genotyping Extra test) and genotyping 1a Roche (the kit: Linear array HPV genotyping test) were used for detection of Human Papilloma Virus (HPV) in the cervix secretions of 182 female patients aged 16-63 years, predominantly of urban origin. 99 patients (54.4%) were identified as being infected with various types of HPV, prevalent in urban (53 single infections and 46 multiple infections). HPV infection was not detected in 83 (45.6%) patients. Only 7 females from rural areas were tested (5 females had single or multiple HPV infections). 32 types of HPV were identificated: 15 HPV types with high risk (51, 82, 56, 18, 39, 45, 59, 68, 16, 31, 33, 35, 52, 58, 73), 14 types with low risk (42, 61, 62, 72, 81, 83, 84, CP6108, 70, 6, 11, 55, 74, 54), and 3 types with possible high risk (26, 53, 66). The type of HPV could not be identified in other two cases. The most frecvent types of HPV with high risk isolated were: the type 16. The types 51 and 58 of HPV with high risk and the type 84 with low risk are detected in single infections in urban and in rural. HPV clades involved in single infections are: 1 (1 case), 3 (5 cases), 5 (4 cases), 6 (5 cases), 7 (5 cases), 9 (21 cases), 10 (7 cases). The clades 11 (7 cases) and 13 (6 cases) were involved only in multiple infections detected in urban. The types 35, 39, 59, 68 of HPV with high risk were isolated from multple infections. In rural, multiple infections with two HPV were detected. The citological screening by Babe-Papanicolaou examination was made only in 9 cases: HPV was not detected in 4 cases (one female had ASC-US: atypical squamous cells of "undetermined significance"); in 5 positive cases were detected HPV 16, 31, 58, 6.

Efficiency of MY09/11 consensus PCR in the detection of multiple HPV infections.

PubMed

Şahiner, Fatih; Kubar, Ayhan; Gümral, Ramazan; Ardıç, Medine; Yiğit, Nuri; Şener, Kenan; Dede, Murat; Yapar, Mehmet

2014-09-01

Human papillomavirus (HPV) DNA testing has become an important component of cervical cancer screening programs. In this study, we aimed to evaluate the efficiency of MY09/11 consensus polymerase chain reaction (PCR) for the detection of multiple HPV infections. For this purpose, MY09/11 PCR was compared to an original TaqMan-based type-specific real-time PCR assay, which can detect 20 different HPV types. Of the 654 samples, 34.1% (223/654) were HPV DNA positive according to at least one method. The relative sensitivities of MY09/11 PCR and type-specific PCR were 80.7% (180/223) and 97.8% (218/223), respectively. In all, 352 different HPV isolates (66 low-risk and 286 high-risk or probable high-risk types) were identified in 218 samples, but 5 samples, which were positive by consensus PCR only, could not be genotyped. The distribution of the 286 high-risk or probable high-risk HPVs were as follows: 24.5% HPV-16, 8.4% HPV-52, 7.7% HPV-51, 6.3% HPV-39, 6.3% HPV-82, 5.6% HPV-35, 5.6% HPV-58, 5.6% HPV-66, 5.2% HPV-18, 5.2% HPV-68, and 19.6% the other 8 types. A single HPV type was detected in 57.3% (125/218) of the genotyped samples, and multiple HPV types were found in the remaining 42.7% (93/218). The false-negative rates of MY09/11 PCR were found to be 17.4% in single infections, 23.3% in multiple infections, and 34.6% in multiple infections that contained 3 or more HPV types, with the condition that the low-risk types HPV-6 and HPV-11 be considered as a monotype. These data suggest that broad-range PCR assays may lead to significant data loss and that type-specific PCR assays can provide accurate and reliable results during cervical cancer screening. Copyright © 2014 Elsevier Inc. All rights reserved.

Continued Benefit to Androgen Deprivation Therapy for Prostate Cancer Patients Treated With Dose-Escalated Radiation Therapy Across Multiple Definitions of High-Risk Disease

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

Stenmark, Matthew H.; Blas, Kevin; Halverson, Schuyler

2011-11-15

Purpose: To analyze prognostic factors in patients with high-risk prostate cancer treated with dose-escalated external-beam radiation therapy (EBRT) and androgen deprivation (ADT). Methods and Materials: Between 1998 and 2008 at University of Michigan Medical Center, 718 men were consecutively treated with EBRT to at least 75 Gy. Seven definitions of high-risk prostate cancer, applying to 11-33% of patients, were evaluated. Biochemical failure (BF), salvage ADT use, metastatic progression, and prostate cancer-specific mortality (PCSM) were estimated by the Kaplan-Meier method and Cox proportional hazards regression. Results: Each high-risk definition was associated with increased BF (hazard ratio [HR] 2.8-3.9, p < 0.0001),more » salvage ADT use (HR 3.9-6.3, p < 0.0001), metastasis (HR 3.7-6.6, p < 0.0001), and PCSM (HR 3.7-16.2, p < 0.0001). Furthermore, an increasing number of high-risk features predicted worse outcome. Adjuvant ADT yielded significant reductions in both metastases (HR 0.19-0.38, p < 0.001) and PCSM (HR 0.38-0.50, p < 0.05) for all high-risk definitions (with the exception of clinical Stage T3-4 disease) but improved BF only for those with elevated Gleason scores (p < 0.03, HR 0.25-0.48). When treated with ADT and dose-escalated EBRT, patients with Gleason scores 8 to 10, without other high-risk features, had 8-year freedom from BF of 74%, freedom from distant metastases of 93%, and cause-specific survival of 92%, with salvage ADT used in 16% of patients. Conclusion: Adjuvant ADT results in a significant improvement in clinical progression and PCSM across multiple definitions of high-risk disease even with dose-escalated EBRT. There is a subset of patients, characterized by multiple high-risk features or the presence of Gleason Pattern 5, who remain at significant risk for metastasis and PCSM despite current treatment.« less

Cellular Proliferation by Multiplex Immunohistochemistry Identifies High-Risk Multiple Myeloma in Newly Diagnosed, Treatment-Naive Patients.

PubMed

Ely, Scott; Forsberg, Peter; Ouansafi, Ihsane; Rossi, Adriana; Modin, Alvin; Pearse, Roger; Pekle, Karen; Perry, Arthur; Coleman, Morton; Jayabalan, David; Di Liberto, Maurizio; Chen-Kiang, Selina; Niesvizky, Ruben; Mark, Tomer M

2017-12-01

Therapeutic options for multiple myeloma (MM) are growing, yet clinical outcomes remain heterogeneous. Cytogenetic analysis and disease staging are mainstays of risk stratification, but data suggest a complex interplay between numerous abnormalities. Myeloma cell proliferation is a metric shown to predict outcomes, but available methods are not feasible in clinical practice. Multiplex immunohistochemistry (mIHC), using multiple immunostains simultaneously, is universally available for clinical use. We tested mIHC as a method to calculate a plasma cell proliferation index (PCPI). By mIHC, marrow trephine core biopsy samples were costained for CD138, a plasma cell-specific marker, and Ki-67. Myeloma cells (CD138 + ) were counted as proliferating if coexpressing Ki-67. Retrospective analysis was performed on 151 newly diagnosed, treatment-naive patients divided into 2 groups on the basis of myeloma cell proliferation: low (PCPI ≤ 5%, n = 87), and high (PCPI > 5%, n = 64). Median overall survival (OS) was not reached versus 78.9 months (P = .0434) for the low versus high PCPI groups. Multivariate analysis showed that only high-risk cytogenetics (hazard ratio [HR] = 2.02; P = .023), International Staging System (ISS) stage > I (HR = 2.30; P = .014), and PCPI > 5% (HR = 1.70; P = .041) had independent effects on OS. Twenty-three (36%) of the 64 patients with low-risk disease (ISS stage 1, without high-risk cytogenetics) were uniquely reidentified as high risk by PCPI. PCPI is a practical method that predicts OS in newly diagnosed myeloma and facilitates broader use of MM cell proliferation for risk stratification. Copyright © 2017 Elsevier Inc. All rights reserved.

Variable- and Person-Centered Approaches to Examining Temperament Vulnerability and Resilience to the Effects of Contextual Risk

PubMed Central

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

2016-01-01

Using both variable- and person-centered approaches, this study examined the role of temperament in relation to children's vulnerable or resilient responses to cumulative risk. Observed reactivity and regulation dimensions of temperament were tested as mediating and moderating the relation between family cumulative risk and teacher-reported adjustment problems in a sample of 259 preschool-age children. Further, latent profile analyses were used to examine whether profiles of temperament, accounting for multiple characteristics simultaneously, provided additional information about the role of temperament in children's responses to risk. Results support a diathesis-stress model in which high frustration, low fear, and low delay ability confer particular vulnerability for children in high-risk contexts. Benefits of multiple approaches are highlighted. PMID:28408769

Risk stratification of smoldering multiple myeloma incorporating revised IMWG diagnostic criteria.

PubMed

Lakshman, Arjun; Rajkumar, S Vincent; Buadi, Francis K; Binder, Moritz; Gertz, Morie A; Lacy, Martha Q; Dispenzieri, Angela; Dingli, David; Fonder, Amie L; Hayman, Suzanne R; Hobbs, Miriam A; Gonsalves, Wilson I; Hwa, Yi Lisa; Kapoor, Prashant; Leung, Nelson; Go, Ronald S; Lin, Yi; Kourelis, Taxiarchis V; Warsame, Rahma; Lust, John A; Russell, Stephen J; Zeldenrust, Steven R; Kyle, Robert A; Kumar, Shaji K

2018-06-12

In 2014, the International Myeloma Working Group reclassified patients with smoldering multiple myeloma (SMM) and bone marrow-plasma cell percentage (BMPC%) ≥ 60%, or serum free light chain ratio (FLCr) ≥ 100 or >1 focal lesion on magnetic resonance imaging as multiple myeloma (MM). Predictors of progression in patients currently classified as SMM are not known. We identified 421 patients with SMM, diagnosed between 2003 and 2015. The median time to progression (TTP) was 57 months (CI, 45-72). BMPC% > 20% [hazard ratio (HR): 2.28 (CI, 1.63-3.20); p < 0.0001]; M-protein > 2g/dL [HR: 1.56 (CI, 1.11-2.20); p = 0.01], and FLCr > 20 [HR: 2.13 (CI, 1.55-2.93); p < 0.0001] independently predicted shorter TTP in multivariate analysis. Age and immunoparesis were not significant. We stratified patients into three groups: low risk (none of the three risk factors; n = 143); intermediate risk (one of the three risk factors; n = 121); and high risk (≥2 of the three risk factors; n = 153). The median TTP for low-, intermediate-, and high-risk groups were 110, 68, and 29 months, respectively (p < 0.0001). BMPC% > 20%, M-protein > 2 g/dL, and FLCr > 20 at diagnosis can be used to risk stratify patients with SMM. Patients with high-risk SMM need close follow-up and are candidates for clinical trials aiming to prevent progression.

HIV risk among low-income African American mothers of elementary school children.

PubMed

Cummings, G L; Battle, R; Barker, J; Krasnovsky, F

1997-01-01

Data from 119 African American low-income mothers of school aged children in Oakland, California show that 38% engaged in behavior that might place them at risk of exposure to the human immunodeficiency virus (HIV). Risk behaviors that were investigated included having multiple partners and having a partner with an incarceration history. Of women studied, 23% were at risk because of multiple partners, while 15% were at risk as a result of having had an incarcerated partner. Women who were < or = 35 years of age were three times more likely to report having had an incarcerated partner compared to women > or = 36 years of age (22% vs. 6%) mean 2 = 5.59, P < or = .01). Single women were also more likely to report having had a partner who had been incarcerated, 21% compared to 9% of married women (mean 2 = 3.73, P < or = .05). Although no significant relationships were found with respect to condom use, a larger proportion of women with an incarcerated partner reported never using condoms (71%) compared to women without an incarcerated partner (63%); whereas, fewer women with multiple partners reported never using condoms (56%) compared to women without multiple partners (67%). Findings suggest that low-income African American women outside of traditional high-risk groups (i.e., generally studied in high-risk settings such as drug treatment centers, sexually transmitted disease [STD] clinics, hospitals or from the sex industry) may be at risk and should be targeted in HIV risk prevention programs. These women may not consider themselves to be at risk and are not generally targeted in HIV risk prevention programs because they are mothers, housewives, and working women.

High-risk and multiple human papillomavirus infections among married women in Can Tho, Viet Nam.

PubMed

Vu, Lan Thi Hoang

2012-07-01

The two currently licensed human papillomavirus (HPV) vaccines are highly efficacious in preventing cervical pre-cancers related to HPV 6, 11, 16 and 18. Before implementing a large-scale HPV vaccine campaign in Viet Nam, information about the prevalence of infection with the HPV vaccine types is required. This study was done in Can Tho, the province with the highest prevalence of cervical cancer in the south of Viet Nam, to explore the distribution of other high-risk types of HPV among married women in this province. The study employed a cross-sectional design with multistage sampling. A total of 1000 participants were randomly selected, interviewed and given gynaecological examinations. HPV infection status and HPV genotyping test were completed for all participants. A broad spectrum of HPV types was reported in this study. The prevalence of cases infected with HPV 16 and/or 18 was 7%; the prevalence of cases infected with other high-risk HPV types was 6%. The highest prevalence for single and multiple infections, as well as for high-risk infections, was reported for the youngest age group (less than 30 years). While it is relevant to implement an HPV vaccine campaign in Viet Nam due to the high prevalence of infection with HPV 16 and/or 18, it is important to note that one can be infected with multiple types of HPV. Vaccination does not protect against all types of high-risk HPV. Future vaccine campaigns should openly disclose this information to women receiving vaccines.

The risks of polypharmacy following spinal cord injury

PubMed Central

Kitzman, Patrick; Cecil, Darrin; Kolpek, Jimmi Hatton

2017-01-01

Objective The purpose of this study was to examine the overall prevalence of polypharmacy within the spinal cord injury (SCI) population, the level of polypharmacy with respect to seven classes of high-risk drugs commonly used to treat secondary conditions in the SCI population, and the overall risks for drug-related problems (DRP) related to polypharmacy. Design A retrospective case–control design. Setting A commercially available claims dataset that included patient cases from 4800 hospitals in the USA between 2007 and 2009. Participants Individuals with tetraplegia, paraplegia, and those with SCI but not specified as either tetraplegia or paraplegia as well as a control population of randomly selected, age- and sex-matched individuals without a diagnosis of SCI. Outcome measures The overall prevalence of polypharmacy, the prevalence of commonly prescribed high-risk medications, and the prevalence of reported DRPs. Results Overall, the patients in the SCI population were prescribed significantly more medications than their control counterparts. There was a higher rate of individuals being prescribed medications from multiple high-risk classes (e.g. analgesic-narcotics, anticonvulsant, antidepressant, and skeletal muscle relaxer), as well as multiple medications within each class (e.g. multiple analgesic-narcotics). The SCI group had a higher incidence of DRPs. Conclusion Our results are some of the first to demonstrate the extent of polypharmacy in individuals with SCI, including commonly prescribed high-risk medications, leading to a higher rate of DPRs. The higher rate of polypharmacy and DRPs can impact rehabilitation goals and community integration following neurologic injury. PMID:24970339

The risks of polypharmacy following spinal cord injury.

PubMed

Kitzman, Patrick; Cecil, Darrin; Kolpek, Jimmi Hatton

2017-03-01

The purpose of this study was to examine the overall prevalence of polypharmacy within the spinal cord injury (SCI) population, the level of polypharmacy with respect to seven classes of high-risk drugs commonly used to treat secondary conditions in the SCI population, and the overall risks for drug-related problems (DRP) related to polypharmacy. A retrospective case-control design. A commercially available claims dataset that included patient cases from 4800 hospitals in the USA between 2007 and 2009. Individuals with tetraplegia, paraplegia, and those with SCI but not specified as either tetraplegia or paraplegia as well as a control population of randomly selected, age- and sex-matched individuals without a diagnosis of SCI. The overall prevalence of polypharmacy, the prevalence of commonly prescribed high-risk medications, and the prevalence of reported DRPs. Overall, the patients in the SCI population were prescribed significantly more medications than their control counterparts. There was a higher rate of individuals being prescribed medications from multiple high-risk classes (e.g. analgesic-narcotics, anticonvulsant, antidepressant, and skeletal muscle relaxer), as well as multiple medications within each class (e.g. multiple analgesic-narcotics). The SCI group had a higher incidence of DRPs. Our results are some of the first to demonstrate the extent of polypharmacy in individuals with SCI, including commonly prescribed high-risk medications, leading to a higher rate of DPRs. The higher rate of polypharmacy and DRPs can impact rehabilitation goals and community integration following neurologic injury.

Riboflavin

MedlinePlus

... and nails, to slow aging, for canker sores, multiple sclerosis, memory loss including Alzheimer's disease, high blood pressure, ... the risk of liver cancer in older people. Multiple sclerosis. Early research shows that taking riboflavin by mouth ...

Carfilzomib significantly improves the progression-free survival of high-risk patients in multiple myeloma.

PubMed

Avet-Loiseau, Hervé; Fonseca, Rafael; Siegel, David; Dimopoulos, Meletios A; Špička, Ivan; Masszi, Tamás; Hájek, Roman; Rosiñol, Laura; Goranova-Marinova, Vesselina; Mihaylov, Georgi; Maisnar, Vladimír; Mateos, Maria-Victoria; Wang, Michael; Niesvizky, Ruben; Oriol, Albert; Jakubowiak, Andrzej; Minarik, Jiri; Palumbo, Antonio; Bensinger, William; Kukreti, Vishal; Ben-Yehuda, Dina; Stewart, A Keith; Obreja, Mihaela; Moreau, Philippe

2016-09-01

The presence of certain high-risk cytogenetic abnormalities, such as translocations (4;14) and (14;16) and deletion (17p), are known to have a negative impact on survival in multiple myeloma (MM). The phase 3 study ASPIRE (N = 792) demonstrated that progression-free survival (PFS) was significantly improved with carfilzomib, lenalidomide, and dexamethasone (KRd), compared with lenalidomide and dexamethasone (Rd) in relapsed MM. This preplanned subgroup analysis of ASPIRE was conducted to evaluate KRd vs Rd by baseline cytogenetics according to fluorescence in situ hybridization. Of 417 patients with known cytogenetic risk status, 100 patients (24%) were categorized with high-risk cytogenetics (KRd, n = 48; Rd, n = 52) and 317 (76%) were categorized with standard-risk cytogenetics (KRd, n = 147; Rd, n = 170). For patients with high-risk cytogenetics, treatment with KRd resulted in a median PFS of 23.1 months, a 9-month improvement relative to treatment with Rd. For patients with standard-risk cytogenetics, treatment with KRd led to a 10-month improvement in median PFS vs Rd. The overall response rates for KRd vs Rd were 79.2% vs 59.6% (high-risk cytogenetics) and 91.2% vs 73.5% (standard-risk cytogenetics); approximately fivefold as many patients with high- or standard-risk cytogenetics achieved a complete response or better with KRd vs Rd (29.2% vs 5.8% and 38.1% vs 6.5%, respectively). KRd improved but did not abrogate the poor prognosis associated with high-risk cytogenetics. This regimen had a favorable benefit-risk profile in patients with relapsed MM, irrespective of cytogenetic risk status, and should be considered a standard of care in these patients. This trial was registered at www.clinicaltrials.gov as #NCT01080391. © 2016 by The American Society of Hematology.

Carfilzomib significantly improves the progression-free survival of high-risk patients in multiple myeloma

PubMed Central

Fonseca, Rafael; Siegel, David; Dimopoulos, Meletios A.; Špička, Ivan; Masszi, Tamás; Hájek, Roman; Rosiñol, Laura; Goranova-Marinova, Vesselina; Mihaylov, Georgi; Maisnar, Vladimír; Mateos, Maria-Victoria; Wang, Michael; Niesvizky, Ruben; Oriol, Albert; Jakubowiak, Andrzej; Minarik, Jiri; Palumbo, Antonio; Bensinger, William; Kukreti, Vishal; Ben-Yehuda, Dina; Stewart, A. Keith; Obreja, Mihaela; Moreau, Philippe

2016-01-01

The presence of certain high-risk cytogenetic abnormalities, such as translocations (4;14) and (14;16) and deletion (17p), are known to have a negative impact on survival in multiple myeloma (MM). The phase 3 study ASPIRE (N = 792) demonstrated that progression-free survival (PFS) was significantly improved with carfilzomib, lenalidomide, and dexamethasone (KRd), compared with lenalidomide and dexamethasone (Rd) in relapsed MM. This preplanned subgroup analysis of ASPIRE was conducted to evaluate KRd vs Rd by baseline cytogenetics according to fluorescence in situ hybridization. Of 417 patients with known cytogenetic risk status, 100 patients (24%) were categorized with high-risk cytogenetics (KRd, n = 48; Rd, n = 52) and 317 (76%) were categorized with standard-risk cytogenetics (KRd, n = 147; Rd, n = 170). For patients with high-risk cytogenetics, treatment with KRd resulted in a median PFS of 23.1 months, a 9-month improvement relative to treatment with Rd. For patients with standard-risk cytogenetics, treatment with KRd led to a 10-month improvement in median PFS vs Rd. The overall response rates for KRd vs Rd were 79.2% vs 59.6% (high-risk cytogenetics) and 91.2% vs 73.5% (standard-risk cytogenetics); approximately fivefold as many patients with high- or standard-risk cytogenetics achieved a complete response or better with KRd vs Rd (29.2% vs 5.8% and 38.1% vs 6.5%, respectively). KRd improved but did not abrogate the poor prognosis associated with high-risk cytogenetics. This regimen had a favorable benefit-risk profile in patients with relapsed MM, irrespective of cytogenetic risk status, and should be considered a standard of care in these patients. This trial was registered at www.clinicaltrials.gov as #NCT01080391. PMID:27439911

GENDER DIFFERENCES IN RISK/PROTECTION PROFILES FOR LOW ACADEMIC PERFORMANCE.

PubMed

Whitney, Stephen D; Renner, Lynette M; Herrenkohl, Todd I

2010-05-01

Using holistic-interactionistic theory, the simultaneous nature of risk and protection factors for both males and females (age 6-11 in Wave 1) is examined using Latent Profile Analysis (LPA). Risk/protection classes are estimated using multiple risk factor variables (e.g., physical child abuse) and multiple protective factors (e.g., extracurricular activities). These risk/protection classes were used to predict low academic performance. For both males and females, high risk, low protection individuals were significantly more likely to experience low academic performance than low risk, high protection cases. Gender differences emerged in a class for females that included the importance of parental/peer disapproval of anti-social behavior as a protective factor that was not present for males. Findings support elements of the holistic-interactionistic theory for human development and suggest the need to examine risk and protective factors in combination to account for their shared influences on developmental outcomes. Implications for youths underperforming academically are discussed.

The MAX Statistic is Less Powerful for Genome Wide Association Studies Under Most Alternative Hypotheses.

PubMed

Shifflett, Benjamin; Huang, Rong; Edland, Steven D

2017-01-01

Genotypic association studies are prone to inflated type I error rates if multiple hypothesis testing is performed, e.g., sequentially testing for recessive, multiplicative, and dominant risk. Alternatives to multiple hypothesis testing include the model independent genotypic χ 2 test, the efficiency robust MAX statistic, which corrects for multiple comparisons but with some loss of power, or a single Armitage test for multiplicative trend, which has optimal power when the multiplicative model holds but with some loss of power when dominant or recessive models underlie the genetic association. We used Monte Carlo simulations to describe the relative performance of these three approaches under a range of scenarios. All three approaches maintained their nominal type I error rates. The genotypic χ 2 and MAX statistics were more powerful when testing a strictly recessive genetic effect or when testing a dominant effect when the allele frequency was high. The Armitage test for multiplicative trend was most powerful for the broad range of scenarios where heterozygote risk is intermediate between recessive and dominant risk. Moreover, all tests had limited power to detect recessive genetic risk unless the sample size was large, and conversely all tests were relatively well powered to detect dominant risk. Taken together, these results suggest the general utility of the multiplicative trend test when the underlying genetic model is unknown.

Prevalence and factors associated with parental concerns about development detected by the Parents’ Evaluation of Developmental Status (PEDS) at 6-month, 12-month and 18-month well-child checks in a birth cohort

PubMed Central

Woolfenden, Susan; Eapen, Valsamma; Jalaludin, Bin; Hayen, Andrew; Kemp, Lynn; Dissanyake, Cheryl; Hendry, Alexandra; Axelsson, Emma; Overs, Bronwyn; Eastwood, John; Črnčec, Rudi; McKenzie, Anne; Beasley, Deborah; Murphy, Elisabeth; Williams, Katrina

2016-01-01

Objectives Early identification of developmental vulnerability is vital. This study aimed to estimate the prevalence of moderate or high developmental risk on the Parents' Evaluation of Developmental Status (PEDS) at 6-month, 12-month and 18-month well-child checks; identify associated risk factors; and examine documentation of the PEDS at well-child checks. Design, participants A prospective birth cohort of 2025 children with 50% of those approached agreeing to participate. Demographic data were obtained via questionnaires and linked electronic medical records. Telephone interviews were conducted with parents to collect PEDS data. Primary and secondary outcomes Multiple logistic regression analyses identified risk factors for moderate or high developmental risk on the PEDS. A Cumulative Risk Index examined the impact of multiple risk factors on developmental risk and documentation of the PEDS at the well-child checks. Results Of the original cohort, 792 (39%) had 6-month, 649 (32%) had 12-month and 565 (28%) had 18-month PEDS data. Parental concerns indicating moderate or high developmental risk on the PEDS were 27% (95% CI 24 to 30) at 6 months, 27% (95% CI 24 to 30) at 12 months and 33% (95% CI 29 to 37) at 18 months. Factors associated with moderate or high developmental risk were perinatal risk (OR 12 months: 1.7 (95% CI 1.1 to 2.7)); maternal Middle Eastern or Asian nationality (OR 6 months: 1.6 (95% CI 1.1 to 2.4)), (OR 12 months: 1.7 (95% CI 1.1 to 2.7)); and household disadvantage (OR 6 months: 1.5 (95% CI 1.0 to 2.2). As the number of risk factors increased the odds increased for high or moderate developmental risk and no documentation of the PEDS at well-child checks. Conclusions Children with multiple risk factors are more likely to have parental concerns indicating developmental vulnerability using the PEDS and for these concerns to not be documented. PMID:27609853

The National Cross-Site Evaluation of High-Risk Youth Programs. Preventing Substance Abuse: Major Findings from the National Cross-Site Evaluation of High-Risk Youth Programs. Monograph Series.

ERIC Educational Resources Information Center

Springer, J. Fred; Sambrano, Soledad; Sale, Elizabeth; Kasim, Rafa; Herman, Jack

This multiple-site study assessed 48 prevention programs for high-risk youth funded by the Center for Substance Abuse Prevention, identifying program characteristics associated with strong substance abuse prevention outcomes. Data analysis indicated that substance abuse programs reduced rates of substance use, and the positive effects of program…

Put the Family Back in Family Health History: A Multiple-Informant Approach.

PubMed

Lin, Jielu; Marcum, Christopher S; Myers, Melanie F; Koehly, Laura M

2017-05-01

An accurate family health history is essential for individual risk assessment. This study uses a multiple-informant approach to examine whether family members have consistent perceptions of shared familial risk for four common chronic conditions (heart disease, Type 2 diabetes, high cholesterol, and hypertension) and whether accounting for inconsistency in family health history reports leads to more accurate risk assessment. In 2012-2013, individual and family health histories were collected from 127 adult informants of 45 families in the Greater Cincinnati Area. Pedigrees were linked within each family to assess inter-informant (in)consistency regarding common biological family member's health history. An adjusted risk assessment based on pooled pedigrees of multiple informants was evaluated to determine whether it could more accurately identify individuals affected by common chronic conditions, using self-reported disease diagnoses as a validation criterion. Analysis was completed in 2015-2016. Inter-informant consistency in family health history reports was 54% for heart disease, 61% for Type 2 diabetes, 43% for high cholesterol, and 41% for hypertension. Compared with the unadjusted risk assessment, the adjusted risk assessment correctly identified an additional 7%-13% of the individuals who had been diagnosed, with a ≤2% increase in cases that were predicted to be at risk but had not been diagnosed. Considerable inconsistency exists in individual knowledge of their family health history. Accounting for such inconsistency can, nevertheless, lead to a more accurate genetic risk assessment tool. A multiple-informant approach is potentially powerful when coupled with technology to support clinical decisions. Published by Elsevier Inc.

Multiple Dimensions of Private Information: Evidence from the Long-Term Care Insurance Market.

PubMed

Finkelstein, Amy; McGarry, Kathleen

2006-09-01

We demonstrate the existence of multiple dimensions of private information in the long-term care insurance market. Two types of people purchase insurance: individuals with private information that they are high risk and individuals with private information that they have strong taste for insurance. Ex post, the former are higher risk than insurance companies expect, while the latter are lower risk. In aggregate, those with more insurance are not higher risk. Our results demonstrate that insurance markets may suffer from asymmetric information even absent a positive correlation between insurance coverage and risk occurrence. The results also suggest a general test for asymmetric information.

Multiple Dimensions of Private Information: Evidence from the Long-Term Care Insurance Market

PubMed Central

Finkelstein, Amy; McGarry, Kathleen

2010-01-01

We demonstrate the existence of multiple dimensions of private information in the long-term care insurance market. Two types of people purchase insurance: individuals with private information that they are high risk and individuals with private information that they have strong taste for insurance. Ex post, the former are higher risk than insurance companies expect, while the latter are lower risk. In aggregate, those with more insurance are not higher risk. Our results demonstrate that insurance markets may suffer from asymmetric information even absent a positive correlation between insurance coverage and risk occurrence. The results also suggest a general test for asymmetric information. PMID:21253439

Sun Exposure, Vitamin D Receptor Polymorphisms FokI and BsmI and Risk of Multiple Primary Melanoma

PubMed Central

Mandelcorn-Monson, Rochelle; Marrett, Loraine; Kricker, Anne; Armstrong, Bruce K.; Orlow, Irene; Goumas, Chris; Paine, Susan; Rosso, Stefano; Thomas, Nancy; Millikan, Robert C.; Pole, Jason D.; Cotignola, Javier; Rosen, Cheryl; Kanetsky, Peter A.; Lee-Taylor, Julia; Begg, Colin B.; Berwick, Marianne

2011-01-01

Sunlight exposure increases risk of melanoma. Sunlight also potentiates cutaneous synthesis of vitamin D, which can inhibit melanoma cell growth and promote apoptosis. Vitamin D effects are mediated through the vitamin D receptor (VDR). We hypothesized that genetic variation in VDR affects the relationship of sun exposure to risk of a further melanoma in people who have already had one. We investigated the interaction between VDR polymorphisms and sun exposure in a population-based multinational study comparing 1138 patients with a multiple (second or subsequent) primary melanoma (cases) to 2151 patients with a first primary melanoma (controls); essentially a case-control study of melanoma in a population of melanoma survivors. Sun exposure was assessed using a questionnaire and interview, and was shown to be associated with multiple primary melanoma. VDR was genotyped at the FokI and BsmI loci and the main effects of variants at these loci and their interactions with sun exposure were analyzed. Only the BsmI variant was associated with multiple primary melanoma (OR = 1.27, 95% CI 0.99-1.62 for the homozygous variant genotype). Joint effects analyses showed highest ORs in the high exposure, homozygous variant BsmI genotype category for each sun exposure variable. Stratified analyses showed somewhat higher ORs for the homozygous BsmI variant genotype in people with high sun exposure than with low sun exposure. P values for interaction, however, were high. These results suggest that risk of multiple primary melanoma is increased in people who have the BsmI variant of VDR. PMID:21612999

Clinical dysphagia risk predictors after prolonged orotracheal intubation

PubMed Central

de Medeiros, Gisele Chagas; Sassi, Fernanda Chiarion; Mangilli, Laura Davison; Zilberstein, Bruno; de Andrade, Claudia Regina Furquim

2014-01-01

OBJECTIVES: To elucidate independent risk factors for dysphagia after prolonged orotracheal intubation. METHODS: The participants were 148 consecutive patients who underwent clinical bedside swallowing assessments from September 2009 to September 2011. All patients had received prolonged orotracheal intubations and were admitted to one of several intensive care units of a large Brazilian school hospital. The correlations between the conducted water swallow test results and dysphagia risk levels were analyzed for statistical significance. RESULTS: Of the 148 patients included in the study, 91 were male and 57 were female (mean age, 53.64 years). The univariate analysis results indicated that specific variables, including extraoral loss, multiple swallows, cervical auscultation, vocal quality, cough, choking, and other signs, were possible significant high-risk indicators of dysphagia onset. The multivariate analysis results indicated that cervical auscultation and coughing were independent predictive variables for high dysphagia risk. CONCLUSIONS: Patients displaying extraoral loss, multiple swallows, cervical auscultation, vocal quality, cough, choking and other signs should benefit from early swallowing evaluations. Additionally, early post-extubation dysfunction recognition is paramount in reducing the morbidity rate in this high-risk population. PMID:24473554

Clinical dysphagia risk predictors after prolonged orotracheal intubation.

PubMed

Medeiros, Gisele Chagas de; Sassi, Fernanda Chiarion; Mangilli, Laura Davison; Zilberstein, Bruno; Andrade, Claudia Regina Furquim de

2014-01-01

To elucidate independent risk factors for dysphagia after prolonged orotracheal intubation. The participants were 148 consecutive patients who underwent clinical bedside swallowing assessments from September 2009 to September 2011. All patients had received prolonged orotracheal intubations and were admitted to one of several intensive care units of a large Brazilian school hospital. The correlations between the conducted water swallow test results and dysphagia risk levels were analyzed for statistical significance. Of the 148 patients included in the study, 91 were male and 57 were female (mean age, 53.64 years). The univariate analysis results indicated that specific variables, including extraoral loss, multiple swallows, cervical auscultation, vocal quality, cough, choking, and other signs, were possible significant high-risk indicators of dysphagia onset. The multivariate analysis results indicated that cervical auscultation and coughing were independent predictive variables for high dysphagia risk. Patients displaying extraoral loss, multiple swallows, cervical auscultation, vocal quality, cough, choking and other signs should benefit from early swallowing evaluations. Additionally, early post-extubation dysfunction recognition is paramount in reducing the morbidity rate in this high-risk population.

Management of Skin Cancer in the High-Risk Patient.

PubMed

Behan, James W; Sutton, Adam; Wysong, Ashley

2016-12-01

Skin cancer is the most common of human cancers and outnumbers all other types of cancer combined in the USA by over threefold. The majority of non-melanoma skin cancers are easily treated with surgery or locally destructive techniques performed under local anesthesia in the cost-effective outpatient setting. However, there is a subset of "high-risk" cases that prove challenging in terms of morbidity, mortality, adjuvant treatment required, as well as overall cost to the health care system. In our opinion, the term "high risk" when applied to skin cancer can mean one of three things: a high-risk tumor with aggressive histologic and/or clinical features with an elevated risk for local recurrence or regional/distant metastasis, a high-risk patient with the ongoing development of multiple skin cancers, and a high-risk patient based on immunosuppression. We have recently proposed classifying NMSC as a chronic disease in a certain subset of patients. Although no consensus definition exists for a chronic disease in medicine, there are three components that are present in most definitions: duration of at least 1 year, need for ongoing medical care, and functional impairment and/or alteration of activities of daily living (ADLs) and quality of life (QOL). Immunosuppression can refer to exogenous (organ or stem cell transplant patients,) or endogenous (HIV, leukemia, lymphoma, genodermatoses with DNA mismatch repair problems or other immunosuppression) causes. These patients are at risk for high-risk tumors and/or the development of multiple tumors.

Treatment of multiple-risk patients: using combination therapy to treat beyond LDL lowering.

PubMed

Weintraub, Howard S

2005-08-01

During the past 25 years, the role of traditional "risk factors" in the genesis of atherosclerotic vascular disease has been convincingly validated. The impact of elevated low-density lipoprotein cholesterol, hypertension, type II diabetes, and metabolic syndrome are now well accepted. However, until recently, there was guilt by association without a clear understanding of the manner in which the crime was committed. It is now acknowledged that the presence of multiple risk factors can increase the likelihood of an ischemic event. This has become a great concern, given the very high prevalence of patients who fall into this category. In light of this information, the mandate for appropriate guideline-driven therapy has become even stronger, and we must consider the use of multiple medications to effectively neutralize this risk.

Clustering of lifestyle risk behaviours among residents of forty deprived neighbourhoods in London: lessons for targeting public health interventions.

PubMed

Watts, P; Buck, D; Netuveli, G; Renton, A

2016-06-01

Clustering of lifestyle risk behaviours is very important in predicting premature mortality. Understanding the extent to which risk behaviours are clustered in deprived communities is vital to most effectively target public health interventions. We examined co-occurrence and associations between risk behaviours (smoking, alcohol consumption, poor diet, low physical activity and high sedentary time) reported by adults living in deprived London neighbourhoods. Associations between sociodemographic characteristics and clustered risk behaviours were examined. Latent class analysis was used to identify underlying clustering of behaviours. Over 90% of respondents reported at least one risk behaviour. Reporting specific risk behaviours predicted reporting of further risk behaviours. Latent class analyses revealed four underlying classes. Membership of a maximal risk behaviour class was more likely for young, white males who were unable to work. Compared with recent national level analysis, there was a weaker relationship between education and clustering of behaviours and a very high prevalence of clustering of risk behaviours in those unable to work. Young, white men who report difficulty managing on income were at high risk of reporting multiple risk behaviours. These groups may be an important target for interventions to reduce premature mortality caused by multiple risk behaviours. © The Author 2015. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Molecular profiling of multiple myeloma: from gene expression analysis to next-generation sequencing.

PubMed

Agnelli, Luca; Tassone, Pierfrancesco; Neri, Antonino

2013-06-01

Multiple myeloma is a fatal malignant proliferation of clonal bone marrow Ig-secreting plasma cells, characterized by wide clinical, biological, and molecular heterogeneity. Herein, global gene and microRNA expression, genome-wide DNA profilings, and next-generation sequencing technology used to investigate the genomic alterations underlying the bio-clinical heterogeneity in multiple myeloma are discussed. High-throughput technologies have undoubtedly allowed a better comprehension of the molecular basis of the disease, a fine stratification, and early identification of high-risk patients, and have provided insights toward targeted therapy studies. However, such technologies are at risk of being affected by laboratory- or cohort-specific biases, and are moreover influenced by high number of expected false positives. This aspect has a major weight in myeloma, which is characterized by large molecular heterogeneity. Therefore, meta-analysis as well as multiple approaches are desirable if not mandatory to validate the results obtained, in line with commonly accepted recommendation for tumor diagnostic/prognostic biomarker studies.

Community-Engaged Modeling of Geographic and Demographic Patterns of Multiple Public Health Risk Factors

PubMed Central

Basra, Komal; Fabian, M. Patricia; Holberger, Raymond R.; French, Robert

2017-01-01

Many health risk factors are intervention targets within communities, but information regarding high-risk subpopulations is rarely available at a geographic resolution that is relevant for community-scale interventions. Researchers and community partners in New Bedford, Massachusetts (USA) collaboratively identified high-priority behaviors and health outcomes of interest available in the Behavioral Risk Factor Surveillance System (BRFSS). We developed multivariable regression models from the BRFSS explaining variability in exercise, fruit and vegetable consumption, body mass index, and diabetes prevalence as a function of demographic and behavioral characteristics, and linked these models with population microdata developed using spatial microsimulation to characterize high-risk populations and locations. Individuals with lower income and educational attainment had lower rates of multiple health-promoting behaviors (e.g., fruit and vegetable consumption and exercise) and higher rates of self-reported diabetes. Our models in combination with the simulated population microdata identified census tracts with an elevated percentage of high-risk subpopulations, information community partners can use to prioritize funding and intervention programs. Multi-stressor modeling using data from public databases and microsimulation methods for characterizing high-resolution spatial patterns of population attributes, coupled with strong community partner engagement, can provide significant insight for intervention. Our methodology is transferrable to other communities. PMID:28684710

Development of In Vivo Biomarkers for Progressive Tau Pathology after Traumatic Brain Injury

DTIC Science & Technology

2014-02-01

multiple concussive traumatic brain injuries are at high risk for delayed, progressive neurological and psychiatric deterioration 1-9. This syndrome is...personnel 13, 14 and others who have sustained multiple concussive traumatic brain injuries 15-17 may also be at risk for this condition. Currently...11 Appendices……………………………………………………………………………... 12 4 INTRODUCTION: Athletes in contact sports who have sustained multiple concussive traumatic

Managing Multiple Risk Factors.

DTIC Science & Technology

1998-09-01

to the racial differences in cardiovascular risk and events among women. High levels of socioeconomic stress, higher dietary fat intake and sedentary ... lifestyle are more prevalent among black than white women. The proposed study will address the issue of whether the cluster of risk factors for

Associations between dietary fiber and colorectal polyp risk differ by polyp type and smoking status.

PubMed

Fu, Zhenming; Shrubsole, Martha J; Smalley, Walter E; Ness, Reid M; Zheng, Wei

2014-05-01

The association of dietary fiber intake with colorectal cancer risk is established. However, the association may differ between cigarette smokers and nonsmokers. We evaluated this hypothesis in a large colonoscopy-based case-control study. Dietary fiber intakes were estimated by self-administered food frequency questionnaire. Unconditional logistic regression analysis was used to estimate ORs and 95% CIs with adjustment for potential confounders. Analysis also was stratified by cigarette smoking and sex. High dietary fiber intake was associated with reduced risk of colorectal polyps (P-trend = 0.003). This association was found to be stronger among cigarette smokers (P-trend = 0.006) than nonsmokers (P-trend = 0.21), although the test for multiplicative interaction was not statistically significant (P = 0.11). This pattern of association was more evident for high-risk adenomatous polyps (ADs), defined as advanced or multiple ADs (P-interaction smoking and dietary fiber intake = 0.09). Among cigarette smokers who smoked ≥23 y, a 38% reduced risk of high-risk ADs was found to be associated with high intake of dietary fiber compared with those in the lowest quartile fiber intake group (P-trend = 0.004). No inverse association with dietary fiber intake was observed for low-risk ADs, defined as single nonadvanced ADs. Cigarette smoking may modify the association of dietary fiber intake with the risk of colorectal polyps, especially high-risk ADs, a well-established precursor of colorectal cancer.

The oncogenic transforming potential of the passage of single α particles through mammalian cell nuclei

PubMed Central

Miller, Richard C.; Randers-Pehrson, Gerhard; Geard, Charles R.; Hall, Eric J.; Brenner, David J.

1999-01-01

Domestic, low-level exposure to radon gas is considered a major environmental lung-cancer hazard involving DNA damage to bronchial cells by α particles from radon progeny. At domestic exposure levels, the relevant bronchial cells are very rarely traversed by more than one α particle, whereas at higher radon levels—at which epidemiological studies in uranium miners allow lung-cancer risks to be quantified with reasonable precision—these bronchial cells are frequently exposed to multiple α-particle traversals. Measuring the oncogenic transforming effects of exactly one α particle without the confounding effects of multiple traversals has hitherto been unfeasible, resulting in uncertainty in extrapolations of risk from high to domestic radon levels. A technique to assess the effects of single α particles uses a charged-particle microbeam, which irradiates individual cells or cell nuclei with predefined exact numbers of particles. Although previously too slow to assess the relevant small oncogenic risks, recent improvements in throughput now permit microbeam irradiation of large cell numbers, allowing the first oncogenic risk measurements for the traversal of exactly one α particle through a cell nucleus. Given positive controls to ensure that the dosimetry and biological controls were comparable, the measured oncogenicity from exactly one α particle was significantly lower than for a Poisson-distributed mean of one α particle, implying that cells traversed by multiple α particles contribute most of the risk. If this result applies generally, extrapolation from high-level radon risks (involving cellular traversal by multiple α particles) may overestimate low-level (involving only single α particles) radon risks. PMID:9874764

High Levels of Peripheral Blood Circulating Plasma Cells as a Specific Risk Factor for Progression of Smoldering Multiple Myeloma

PubMed Central

Bianchi, Giada; Kyle, Robert A.; Larson, Dirk R.; Witzig, Thomas E.; Kumar, Shaji; Dispenzieri, Angela; Morice, William G.; Rajkumar, S. Vincent

2012-01-01

Smoldering multiple myeloma (SMM) carries a 50% risk of progression to multiple myeloma (MM) or related malignancy within the first 5 years following diagnosis. The goal of this study was to determine if high levels of circulating plasma cells (PCs) are predictive of SMM transformation within the first 2–3 years from diagnosis. Ninety-one patients diagnosed with SMM at Mayo Clinic from January 1994 through January 2007 who had testing for circulating PCs using an immunofluorescent assay and adequate follow up to ascertain disease progression, were studied. High level of circulating PCs was defined as absolute peripheral blood PCs >5000 ×106/L and/or > 5% cytoplasmic immunoglobulin (Ig) positive PCs per 100 peripheral blood mononuclear cells. Patients with high circulating PCs (14 of 91 patients, 15%) were significantly more likely to progress to active disease within 2 years compared with patients without high circulating PCs, 71% versus 25%, respectively, P=0.001. Corresponding rates for progression within 3 years were 86% versus 35%, respectively, P<0.001. Overall survival (OS) after both SMM diagnosis and MM diagnosis was also significantly different. High levels of circulating PCs identify SMM patients with an elevated risk of progression within the first 2 to 3 years following diagnosis. PMID:22902364

HPV genotype profile in a Norwegian cohort with ASC-US and LSIL cytology with three year cumulative risk of high grade cervical neoplasia.

PubMed

Lie, A K; Tropé, A; Skare, G B; Bjørge, T; Jonassen, C M; Brusegard, K; Lönnberg, S

2018-01-01

To explore the HPVgenotype profile in Norwegian women with ASC-US/LSIL cytology and the subsequent risk of high-grade cervical neoplasia (CIN 3+). In this observational study delayed triage of ASC-US/LSIL of 6058 women were included from 2005 to 2010. High-risk HPV detection with Hybrid Capture 2 (HC2) was used and the HC2+ cases were genotyped with in-house nmPCR. Women were followed-up for histologically confirmed CIN3+ within three years of index HPV test by linkage to the screening databases at the Cancer Registry of Norway. HC2 was positive in 45% (2756/6058) of the women. Within 3years CIN3+ was diagnosed in 26% of women<34year and in 15%≥34year. HC2 was positive at index in 94% of CIN3+ cases and negative in 64 cases including three women with cervical carcinomas. Women<34years with single infections of HPV 16, 35, 58 or 33 or multiple infections including HPV 16, 52, 33 or 31 were associated with highest proportions of CIN 3+. Older women with single infection with HPV 16, 33, 31 or 35 or multiple infections including HPV 16, 33, 31 or 18/39 were more likely to develop CIN 3+. HPV 16 and HPV 33 at baseline both as single or multiple infections, were associated with the highest risk for CIN3+. Among older women, all 13 high-risk genotypes as single infection were associated with >20% risk of CIN3+. Further studies are necessary to risk stratify the individual genotypes to reduce the number of colposcopies in Norway. Copyright © 2017 Elsevier Inc. All rights reserved.

Interaction of a genetic risk score with physical activity, physical inactivity, and body mass index in relation to venous thromboembolism risk.

PubMed

Kim, Jihye; Kraft, Peter; Hagan, Kaitlin A; Harrington, Laura B; Lindstroem, Sara; Kabrhel, Christopher

2018-06-01

Venous thromboembolism (VTE) is highly heritable. Physical activity, physical inactivity and body mass index (BMI) are also risk factors, but evidence of interaction between genetic and environmental risk factors is limited. Data on 2,134 VTE cases and 3,890 matched controls were obtained from the Nurses' Health Study (NHS), Nurses' Health Study II (NHS II), and Health Professionals Follow-up Study (HPFS). We calculated a weighted genetic risk score (wGRS) using 16 single nucleotide polymorphisms associated with VTE risk in published genome-wide association studies (GWAS). Data on three risk factors, physical activity (metabolic equivalent [MET] hours per week), physical inactivity (sitting hours per week) and BMI, were obtained from biennial questionnaires. VTE cases were incident since cohort inception; controls were matched to cases on age, cohort, and genotype array. Using conditional logistic regression, we assessed joint effects and interaction effects on both additive and multiplicative scales. We also ran models using continuous wGRS stratified by risk-factor categories. We observed a supra-additive interaction between wGRS and BMI. Having both high wGRS and high BMI was associated with a 3.4-fold greater risk of VTE (relative excess risk due to interaction = 0.69, p = 0.046). However, we did not find evidence for a multiplicative interaction with BMI. No interactions were observed for physical activity or inactivity. We found a synergetic effect between a genetic risk score and high BMI on the risk of VTE. Intervention efforts lowering BMI to decrease VTE risk may have particularly large beneficial effects among individuals with high genetic risk. © 2018 WILEY PERIODICALS, INC.

Optimization and development of stable w/o/w cosmetic multiple emulsions by means of the Quality by Design approach.

PubMed

Kovács, A; Erős, I; Csóka, I

2016-04-01

The aim of our present work was to develop stable water-in-oil-in-water (w/o/w) cosmetic multiple emulsions that are proper for cosmetic use and can also be applied on the skin as pharmaceutical vehicles by means of Quality by Design (QbD) concept. This product design concept consists of a risk assessment step and also the 'predetermination' of the critical material attributes and process parameters of a stable multiple emulsion system. We have set up the hypothesis that the stability of multiple emulsions can be improved by the development based on such systematic planning - making a map of critical product parameters - so their industrial usage can be increased. The risk assessment and the determination of critical physical-chemical stability parameters of w/o/w multiple emulsions to define critical control points were performed by means of quality tools and the leanqbd(™) (QbD Works LLC, Fremont, CA, U.S.A.) software. Critical materials and process parameters: Based on the results of preformulation experiments, three factors, namely entrapped active agent, preparation methodology and shear rate, were found to be highly critical factors for critical quality attributes (CQAs) and for stability, whereas the nature of oil was found a medium level risk factor. The results of the risk assessment are the following: (i) droplet structure and size distribution should be evaluated together to be able to predict the stability issues, (ii) the presence of entrapped active agents had a great impact on droplet structure, (iii) the viscosity curves represent the structural changes during storage, if the decrease in relative viscosity is >15% the emulsion disintegrates, and (iv) it is enough to use the shear rate between 34g and 116g relative centrifugal force (RCF). CQAs: By risk assessment, we discovered that four factors should be considered to be high-risk variables as compared to others: droplet size, droplet structure, viscosity and multiple character were found to be highly critical attributes. The preformulation experiment is the part of a development plan. On the basis of these results, the control strategy can be defined and a stable multiple emulsion can be ensured that meets the relevant stakeholders' quality expectations. © 2015 Society of Cosmetic Scientists and the Société Française de Cosmétologie.

Multiple health behaviours: overview and implications

PubMed Central

Spring, Bonnie; Moller, Arlen C.; Coons, Michael J.

2012-01-01

Background More remains unknown than known about how to optimize multiple health behaviour change. Methods After reviewing the prevalence and comorbidities among major chronic disease risk behaviours for adults and youth, we consider the origins and applicability of high-risk and population strategies to foster multiple health behaviour change. Results Findings indicate that health risk behaviours are prevalent, increase with age and co-occur as risk behaviour clusters or bundles. Conclusions We conclude that both population and high-risk strategies for health behaviour intervention are warranted, potentially synergistic and need intervention design that accounts for substitute and complementary relationships among bundled health behaviours. To maximize positive public health impact, a pressing need exists for bodies of basic and translational science that explain health behaviour bundling. Also needed is applied science that elucidates the following: (1) the optimal number of behaviours to intervene upon; (2) how target behaviours are best selected (e.g. greatest health impact; patient preference or positive effect on bundled behaviours); (3) whether to increase healthy or decrease unhealthy behaviours; (4) whether to intervene on health behaviours simultaneously or sequentially and (5) how to achieve positive synergies across individual-, group- and population-level intervention approaches. PMID:22363028

Single-visit or multiple-visit root canal treatment: systematic review, meta-analysis and trial sequential analysis

PubMed Central

Schwendicke, Falk; Göstemeyer, Gerd

2017-01-01

Objectives Single-visit root canal treatment has some advantages over conventional multivisit treatment, but might increase the risk of complications. We systematically evaluated the risk of complications after single-visit or multiple-visit root canal treatment using meta-analysis and trial-sequential analysis. Data Controlled trials comparing single-visit versus multiple-visit root canal treatment of permanent teeth were included. Trials needed to assess the risk of long-term complications (pain, infection, new/persisting/increasing periapical lesions ≥1 year after treatment), short-term pain or flare-up (acute exacerbation of initiation or continuation of root canal treatment). Sources Electronic databases (PubMed, EMBASE, Cochrane Central) were screened, random-effects meta-analyses performed and trial-sequential analysis used to control for risk of random errors. Evidence was graded according to GRADE. Study selection 29 trials (4341 patients) were included, all but 6 showing high risk of bias. Based on 10 trials (1257 teeth), risk of complications was not significantly different in single-visit versus multiple-visit treatment (risk ratio (RR) 1.00 (95% CI 0.75 to 1.35); weak evidence). Based on 20 studies (3008 teeth), risk of pain did not significantly differ between treatments (RR 0.99 (95% CI 0.76 to 1.30); moderate evidence). Risk of flare-up was recorded by 8 studies (1110 teeth) and was significantly higher after single-visit versus multiple-visit treatment (RR 2.13 (95% CI 1.16 to 3.89); very weak evidence). Trial-sequential analysis revealed that firm evidence for benefit, harm or futility was not reached for any of the outcomes. Conclusions There is insufficient evidence to rule out whether important differences between both strategies exist. Clinical significance Dentists can provide root canal treatment in 1 or multiple visits. Given the possibly increased risk of flare-ups, multiple-visit treatment might be preferred for certain teeth (eg, those with periapical lesions). PMID:28148534

Individual and social determinants of multiple chronic disease behavioral risk factors among youth.

PubMed

Alamian, Arsham; Paradis, Gilles

2012-03-22

Behavioral risk factors are known to co-occur among youth, and to increase risks of chronic diseases morbidity and mortality later in life. However, little is known about determinants of multiple chronic disease behavioral risk factors, particularly among youth. Previous studies have been cross-sectional and carried out without a sound theoretical framework. Using longitudinal data (n = 1135) from Cycle 4 (2000-2001), Cycle 5 (2002-2003) and Cycle 6 (2004-2005) of the National Longitudinal Survey of Children and Youth, a nationally representative sample of Canadian children who are followed biennially, the present study examines the influence of a set of conceptually-related individual/social distal variables (variables situated at an intermediate distance from behaviors), and individual/social ultimate variables (variables situated at an utmost distance from behaviors) on the rate of occurrence of multiple behavioral risk factors (physical inactivity, sedentary behavior, tobacco smoking, alcohol drinking, and high body mass index) in a sample of children aged 10-11 years at baseline. Multiple behavioral risk factors were assessed using a multiple risk factor score. All statistical analyses were performed using SAS, version 9.1, and SUDAAN, version 9.01. Multivariate longitudinal Poisson models showed that social distal variables including parental/peer smoking and peer drinking (Log-likelihood ratio (LLR) = 187.86, degrees of freedom (DF) = 8, p < .001), as well as individual distal variables including low self-esteem (LLR = 76.94, DF = 4, p < .001) increased the rate of occurrence of multiple behavioral risk factors. Individual ultimate variables including age, sex, and anxiety (LLR = 9.34, DF = 3, p < .05), as well as social ultimate variables including family socioeconomic status, and family structure (LLR = 10.93, DF = 5, p = .05) contributed minimally to the rate of co-occurrence of behavioral risk factors. The results suggest targeting individual/social distal variables in prevention programs of multiple chronic disease behavioral risk factors among youth.

Safety of cerebral angiography and neuroendovascular therapy in patients with chronic kidney disease.

PubMed

Kim, Jae; Male, Shailesh; Jagadeesan, Bharathi D; Streib, Christopher; Tummala, Ramachandra P

2018-05-01

Contrast-induced nephropathy is a common clinical concern in patients undergoing neuroendovascular procedures, especially in those with pre-existent kidney disease. We aimed to define the incidence of contrast-induced nephropathy in these high-risk patients in our practice. We analyzed data retrospectively from patients undergoing neuroendovascular procedures at two academic medical centers over a 4-year period. Contrast-induced nephropathy was determined by an absolute increase in serum creatinine of 0.5 mg/dL or a rise from its baseline value by ≥ 25%, at 48-72 h after exposure to contrast agent after excluding other causes of renal impairment. High-risk patients were identified as those with pre-procedural estimated glomerular filtration rate < 60 mL/min irrespective of creatinine level, corresponding to stages 3-5 of chronic kidney disease. One hundred eighty-five high-risk patients undergoing conventional cerebral angiography and neuroendovascular interventions were identified. Only 1 out of 184 (0.54%) high-risk patients developed contrast-induced nephropathy. That one patient had stage 5 chronic kidney disease and multiple other risk factors. We have observed a very low rate of renal injury in patients with chronic kidney disease, traditionally considered high risk for neuroendovascular procedures. Multiple factors may be responsible in the risk reduction of contrast-induced nephropathy in this patient population.

Short-term, high-dose glucocorticoid treatment does not contribute to reduced bone mineral density in patients with multiple sclerosis.

PubMed

Olsson, A; Oturai, D B; Sørensen, P S; Oturai, P S; Oturai, A B

2015-10-01

Patients with multiple sclerosis (MS) are at increased risk of reduced bone mineral density (BMD). A contributing factor might be treatment with high-dose glucocorticoids (GCs). The objective of this paper is to assess bone mass in patients with MS and evaluate the importance of short-term, high-dose GC treatment and other risk factors that affect BMD in patients with MS. A total of 260 patients with MS received short-term high-dose GC treatment and had their BMD measured by dual x-ray absorptiometry. BMD was compared to a healthy age-matched reference population (Z-scores). Data regarding GCs, age, body mass index (BMI), serum 25(OH)D, disease duration and severity were collected retrospectively and analysed in a multiple linear regression analysis to evaluate the association between each risk factor and BMD. Osteopenia was present in 38% and osteoporosis in 7% of the study population. Mean Z-score was significantly below zero, indicating a decreased BMD in our MS patients. Multiple linear regression analysis showed no significant association between GCs and BMD. In contrast, age, BMI and disease severity were independently associated with both lumbar and femoral BMD. Reduced BMD was prevalent in patients with MS. GC treatment appears not to be the primary underlying cause of secondary osteoporosis in MS patients. © The Author(s), 2015.

The motivation, skills, and decision-making model of "drug abuse" prevention.

PubMed

Sussman, Steve; Earleywine, Mitchell; Wills, Thomas; Cody, Christine; Biglan, Tony; Dent, Clyde W; Newcomb, Michael D

2004-01-01

This article summarizes the theoretical basis for targeted prevention programs as they apply to different high-risk groups. We explain the advantages and disadvantages of different definitions of risk and discuss strategies for preventing drug use related problems in high-risk youth. Productive prevention programs for many at-risk groups share similar components, including those that address motivation, skills, and decision making. We present key aspects of these three components and link them to theories in clinical psychology, social psychology, sociology, and chemical dependence treatment. Among a total of 29 promising targeted prevention programs, we describe examples of empirically evaluated, intensive interventions that have made a positive impact on the attitudes and behavior of multiple problem youth. Incorporating the perspectives of multiple disciplines appears essential for progress in drug abuse and other problem behavior prevention.

Adult Mortality Attributable to Preventable Risk Factors for Non-Communicable Diseases and Injuries in Japan: A Comparative Risk Assessment

PubMed Central

Ikeda, Nayu; Inoue, Manami; Iso, Hiroyasu; Ikeda, Shunya; Satoh, Toshihiko; Noda, Mitsuhiko; Mizoue, Tetsuya; Imano, Hironori; Saito, Eiko; Katanoda, Kota; Sobue, Tomotaka; Tsugane, Shoichiro; Naghavi, Mohsen; Ezzati, Majid; Shibuya, Kenji

2012-01-01

Background The population of Japan has achieved the longest life expectancy in the world. To further improve population health, consistent and comparative evidence on mortality attributable to preventable risk factors is necessary for setting priorities for health policies and programs. Although several past studies have quantified the impact of individual risk factors in Japan, to our knowledge no study has assessed and compared the effects of multiple modifiable risk factors for non-communicable diseases and injuries using a standard framework. We estimated the effects of 16 risk factors on cause-specific deaths and life expectancy in Japan. Methods and Findings We obtained data on risk factor exposures from the National Health and Nutrition Survey and epidemiological studies, data on the number of cause-specific deaths from vital records adjusted for ill-defined codes, and data on relative risks from epidemiological studies and meta-analyses. We applied a comparative risk assessment framework to estimate effects of excess risks on deaths and life expectancy at age 40 y. In 2007, tobacco smoking and high blood pressure accounted for 129,000 deaths (95% CI: 115,000–154,000) and 104,000 deaths (95% CI: 86,000–119,000), respectively, followed by physical inactivity (52,000 deaths, 95% CI: 47,000–58,000), high blood glucose (34,000 deaths, 95% CI: 26,000–43,000), high dietary salt intake (34,000 deaths, 95% CI: 27,000–39,000), and alcohol use (31,000 deaths, 95% CI: 28,000–35,000). In recent decades, cancer mortality attributable to tobacco smoking has increased in the elderly, while stroke mortality attributable to high blood pressure has declined. Life expectancy at age 40 y in 2007 would have been extended by 1.4 y for both sexes (men, 95% CI: 1.3–1.6; women, 95% CI: 1.2–1.7) if exposures to multiple cardiovascular risk factors had been reduced to their optimal levels as determined by a theoretical-minimum-risk exposure distribution. Conclusions Tobacco smoking and high blood pressure are the two major risk factors for adult mortality from non-communicable diseases and injuries in Japan. There is a large potential population health gain if multiple risk factors are jointly controlled. Please see later in the article for the Editors' Summary PMID:22291576

Multiple health behavior change in adults with or at risk for cancer: a systematic review.

PubMed

Green, Amanda C; Hayman, Laura L; Cooley, Mary E

2015-05-01

To identify components of efficacious interventions for multiple health behavior change (MHBC) in adult cancer survivors or adults at high risk for cancer. A systematic review of MHBC interventions was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework. Ten studies met inclusion criteria. Most studies changed at least 2 health behaviors. Diet, exercise, and smoking cessation were consistently changed with in-person interventions. Longer duration interventions using phone or mail contact had a positive association with changing diet and exercise. MHBC interventions positively influenced behavior change in adults with cancer and those at high risk for cancer. Future studies should focus on increasing dissemination and implementation of efficacious interventions.

Sun exposure, vitamin D receptor polymorphisms FokI and BsmI and risk of multiple primary melanoma.

PubMed

Mandelcorn-Monson, Rochelle; Marrett, Loraine; Kricker, Anne; Armstrong, Bruce K; Orlow, Irene; Goumas, Chris; Paine, Susan; Rosso, Stefano; Thomas, Nancy; Millikan, Robert C; Pole, Jason D; Cotignola, Javier; Rosen, Cheryl; Kanetsky, Peter A; Lee-Taylor, Julia; Begg, Colin B; Berwick, Marianne

2011-12-01

Sunlight exposure increases risk of melanoma. Sunlight also potentiates cutaneous synthesis of vitamin D, which can inhibit melanoma cell growth and promote apoptosis. Vitamin D effects are mediated through the vitamin D receptor (VDR). We hypothesized that genetic variation in VDR affects the relationship of sun exposure to risk of a further melanoma in people who have already had one. We investigated the interaction between VDR polymorphisms and sun exposure in a population-based multinational study comparing 1138 patients with a multiple (second or subsequent) primary melanoma (cases) to 2151 patients with a first primary melanoma (controls); essentially a case-control study of melanoma in a population of melanoma survivors. Sun exposure was assessed using a questionnaire and interview, and was shown to be associated with multiple primary melanoma. VDR was genotyped at the FokI and BsmI loci and the main effects of variants at these loci and their interactions with sun exposure were analyzed. Only the BsmI variant was associated with multiple primary melanoma (OR=1.27, 95% CI 0.99-1.62 for the homozygous variant genotype). Joint effects analyses showed highest ORs in the high exposure, homozygous variant BsmI genotype category for each sun exposure variable. Stratified analyses showed somewhat higher ORs for the homozygous BsmI variant genotype in people with high sun exposure than with low sun exposure. P values for interaction, however, were high. These results suggest that risk of multiple primary melanoma is increased in people who have the BsmI variant of VDR. Copyright © 2011 Elsevier Ltd. All rights reserved.

Project START: Using a Multiple Intelligences Model in Identifying and Promoting Talent in High-Risk Students. Research Monograph 95136.

ERIC Educational Resources Information Center

Callahan, Carolyn M.; Tomlinson, Carol A.; Moon, Tonya R.; Tomchin, Ellen M.; Plucker, Jonathan A.

This monograph describes Project START (Support To Affirm Rising Talent), a three-year collaborative research effort to develop and apply gifted identification procedures based on Howard Gardner's (1983) theory of multiple intelligences. Specifically, the study attempted to: (1) develop identification procedures; (2) identify high-potential…

Evaluation of Risk Perception and Risk-Comparison Information Regarding Dietary Radionuclides after the 2011 Fukushima Nuclear Power Plant Accident.

PubMed

Murakami, Michio; Nakatani, Jun; Oki, Taikan

2016-01-01

In the wake of the 2011 Fukushima Daiichi Nuclear Power Station accident, to facilitate evidence-based risk communication we need to understand radiation risk perception and the effectiveness of risk-comparison information. We measured and characterized perceptions of dread risks and unknown risks regarding dietary radionuclides in residents of Fukushima, Tokyo, and Osaka to identify the primary factors among location, evacuation experience, gender, age, employment status, absence/presence of spouse, children and grandchildren, educational background, humanities/science courses, smoking habits, and various types of trustworthy information sources. We then evaluated the effects of these factors and risk-comparison information on multiple outcomes, including subjective and objective understanding, perceived magnitude of risk, perceived accuracy of information, backlash against information, and risk acceptance. We also assessed how risk-comparison information affected these multiple outcomes for people with high risk perception. Online questionnaires were completed by people (n = 9249) aged from 20 to 69 years in the three prefectures approximately 5 years after the accident. We gave each participant one of 15 combinations of numerical risk data and risk-comparison information, including information on standards, smoking-associated risk, and cancer risk, in accordance with Covello's guidelines. Dread-risk perception among Fukushima residents with no experience of evacuation was much lower than that in Osaka residents, whereas evacuees had strikingly higher dread-risk perception, irrespective of whether their evacuation had been compulsory or voluntary. We identified location (distance from the nuclear power station), evacuation experience, and trust of central government as primary factors. Location (including evacuation experience) and trust of central government were significantly associated with the multiple outcomes above. Only information on "cancer risk from radiation and smoking risk" enhanced both subjective and objective understanding without diminishing trust in all participants and in the high dread-risk perception group; use of other risk-comparison information could lead the public to overestimate risk.

Associations between parenting, media use, cumulative risk, and children's executive functioning.

PubMed

Linebarger, Deborah L; Barr, Rachel; Lapierre, Matthew A; Piotrowski, Jessica T

2014-01-01

This study was designed to examine how parenting style, media exposure, and cumulative risk were associated with executive functioning (EF) during early childhood. A nationally representative group of US parents/caregivers (N = 1156) with 1 child between 2 and 8 years participated in a telephone survey. Parents were asked to report on their child's exposure to television, music, and book reading through a 24-hour time diary. Parents also reported a host of demographic and parenting variables as well as questions on their child's EF. Separate multiple regressions for preschool (2-5 years) and school-aged (6-8 years) children grouped by cumulative risk were conducted. Parenting style moderated the risks of exposure to background television on EF for high-risk preschool-age children. Educational TV exposure served as a buffer for high-risk school-aged children. Cumulative risk, age, and parenting quality interacted with a number of the exposure effects. The study showed a complex pattern of associations between cumulative risk, parenting, and media exposure with EF during early childhood. Consistent with the American Academy of Pediatrics, these findings support the recommendation that background television should be turned off when a child is in the room and suggest that exposure to high-quality content across multiple media platforms may be beneficial.

Knowledge, attitude and practices of women in maldives related to the risk factors, prevention and early detection of cervical cancer.

PubMed

Basu, Partha; Hassan, Salma; Fileeshia, Fathmath; Mohamed, Sizna; Nahoodha, Aminath; Shiuna, Aminath; Sulaiman, Asma Ibrahim; Najeeb, Nazeera; Saleem, Fathmath Jeehan

2014-01-01

A population-based cervical cancer screening program using visual inspection with acetic acid was launched in Maldives in 2014. Our study aimed to assess the knowledge, attitude and practices of women in relation to risk factors of cervical cancer, early detection of the disease and its prevention. The questionnaire based survey was conducted among 20 to 50 year old women, systematically sampled to represent three regions of Maldives. Trained investigators interviewed a total of 2,845 women at home. The prevalence of the risk factors of cervical cancer like early age at marriage and childbirth, multiple marriages, multiple marriages of the husbands, and multiple pregnancies was high. More women knew about breast cancer than cervical cancer. Even among the small number of women who knew of cervical cancer, only 34.6% had the knowledge of at least one early symptom. Very few women knew that the cancer could be prevented by any test. Only 6.2% of the women reported having ever undergone a Pap smear. Many women had the misconception that cervical cancer was infectious. In Maldives the younger women have high literacy rate due to the policy of universal free education and those with higher levels of education had improved knowledge of cervical cancer and its risk factors. The prevalence of risk factors also reduced with improved literacy. Awareness about risk factors and prevention of cervical cancer is limited among Maldivian women in spite of having high exposure to some of the risk factors. A universal literacy program in the country has helped to improve the knowledge of cervical cancer prevention and to reduce the exposure to various risk factors in the younger population.

Prevalence and factors associated with parental concerns about development detected by the Parents' Evaluation of Developmental Status (PEDS) at 6-month, 12-month and 18-month well-child checks in a birth cohort.

PubMed

Woolfenden, Susan; Eapen, Valsamma; Jalaludin, Bin; Hayen, Andrew; Kemp, Lynn; Dissanyake, Cheryl; Hendry, Alexandra; Axelsson, Emma; Overs, Bronwyn; Eastwood, John; Črnčec, Rudi; McKenzie, Anne; Beasley, Deborah; Murphy, Elisabeth; Williams, Katrina

2016-09-08

Early identification of developmental vulnerability is vital. This study aimed to estimate the prevalence of moderate or high developmental risk on the Parents' Evaluation of Developmental Status (PEDS) at 6-month, 12-month and 18-month well-child checks; identify associated risk factors; and examine documentation of the PEDS at well-child checks. A prospective birth cohort of 2025 children with 50% of those approached agreeing to participate. Demographic data were obtained via questionnaires and linked electronic medical records. Telephone interviews were conducted with parents to collect PEDS data. Multiple logistic regression analyses identified risk factors for moderate or high developmental risk on the PEDS. A Cumulative Risk Index examined the impact of multiple risk factors on developmental risk and documentation of the PEDS at the well-child checks. Of the original cohort, 792 (39%) had 6-month, 649 (32%) had 12-month and 565 (28%) had 18-month PEDS data. Parental concerns indicating moderate or high developmental risk on the PEDS were 27% (95% CI 24 to 30) at 6 months, 27% (95% CI 24 to 30) at 12 months and 33% (95% CI 29 to 37) at 18 months. Factors associated with moderate or high developmental risk were perinatal risk (OR 12 months: 1.7 (95% CI 1.1 to 2.7)); maternal Middle Eastern or Asian nationality (OR 6 months: 1.6 (95% CI 1.1 to 2.4)), (OR 12 months: 1.7 (95% CI 1.1 to 2.7)); and household disadvantage (OR 6 months: 1.5 (95% CI 1.0 to 2.2). As the number of risk factors increased the odds increased for high or moderate developmental risk and no documentation of the PEDS at well-child checks. Children with multiple risk factors are more likely to have parental concerns indicating developmental vulnerability using the PEDS and for these concerns to not be documented. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Prevalence of multiple organ dysfunction in the pediatric intensive care unit: Pediatric Risk of Mortality III versus Pediatric Logistic Organ Dysfunction scores for mortality prediction

PubMed Central

Hamshary, Azza Abd Elkader El; Sherbini, Seham Awad El; Elgebaly, HebatAllah Fadel; Amin, Samah Abdelkrim

2017-01-01

Objectives To assess the frequency of primary multiple organ failure and the role of sepsis as a causative agent in critically ill pediatric patients; and calculate and evaluate the accuracy of the Pediatric Risk of Mortality III (PRISM III) and Pediatric Logistic Organ Dysfunction (PELOD) scores to predict the outcomes of critically ill children. Methods Retrospective study, which evaluated data from patients admitted from January to December 2011 in the pediatric intensive care unit of the Children's Hospital of the University of Cairo. Results Out of 237 patients in the study, 72% had multiple organ dysfunctions, and 45% had sepsis with multiple organ dysfunctions. The mortality rate in patients with multiple organ dysfunction was 73%. Independent risk factors for death were mechanical ventilation and neurological failure [OR: 36 and 3.3, respectively]. The PRISM III score was more accurate than the PELOD score in predicting death, with a Hosmer-Lemeshow X2 (Chi-square value) of 7.3 (df = 8, p = 0.5). The area under the curve was 0.723 for PRISM III and 0.78 for PELOD. Conclusion A multiple organ dysfunctions was associated with high mortality. Sepsis was the major cause. Pneumonia, diarrhea and central nervous system infections were the major causes of sepsis. PRISM III had a better calibration than the PELOD for prognosis of the patients, despite the high frequency of the multiple organ dysfunction syndrome. PMID:28977260

Evaluation of Risk Perception and Risk-Comparison Information Regarding Dietary Radionuclides after the 2011 Fukushima Nuclear Power Plant Accident

PubMed Central

Murakami, Michio; Nakatani, Jun; Oki, Taikan

2016-01-01

In the wake of the 2011 Fukushima Daiichi Nuclear Power Station accident, to facilitate evidence-based risk communication we need to understand radiation risk perception and the effectiveness of risk-comparison information. We measured and characterized perceptions of dread risks and unknown risks regarding dietary radionuclides in residents of Fukushima, Tokyo, and Osaka to identify the primary factors among location, evacuation experience, gender, age, employment status, absence/presence of spouse, children and grandchildren, educational background, humanities/science courses, smoking habits, and various types of trustworthy information sources. We then evaluated the effects of these factors and risk-comparison information on multiple outcomes, including subjective and objective understanding, perceived magnitude of risk, perceived accuracy of information, backlash against information, and risk acceptance. We also assessed how risk-comparison information affected these multiple outcomes for people with high risk perception. Online questionnaires were completed by people (n = 9249) aged from 20 to 69 years in the three prefectures approximately 5 years after the accident. We gave each participant one of 15 combinations of numerical risk data and risk-comparison information, including information on standards, smoking-associated risk, and cancer risk, in accordance with Covello’s guidelines. Dread-risk perception among Fukushima residents with no experience of evacuation was much lower than that in Osaka residents, whereas evacuees had strikingly higher dread-risk perception, irrespective of whether their evacuation had been compulsory or voluntary. We identified location (distance from the nuclear power station), evacuation experience, and trust of central government as primary factors. Location (including evacuation experience) and trust of central government were significantly associated with the multiple outcomes above. Only information on “cancer risk from radiation and smoking risk” enhanced both subjective and objective understanding without diminishing trust in all participants and in the high dread-risk perception group; use of other risk-comparison information could lead the public to overestimate risk. PMID:27802304

The Dual Participants: A High Risk Drinking Driver Target Group.

ERIC Educational Resources Information Center

Kline, Michael V.; And Others

1988-01-01

Studied dual participants (N=2,525), multiple offender drinking driver program participants who also attend non-drinking driver alcohol treatment programs. Findings support need for drinking driver programs to be aware of high risk dual participants and for alcohol-related treatment programs to provide drinking and driving education to all dual…

Associations between multiple health risk behaviors and mental health among Chinese college students.

PubMed

Ye, Yong-ling; Wang, Pei-gang; Qu, Geng-cong; Yuan, Shuai; Phongsavan, Philayrath; He, Qi-qiang

2016-01-01

Although there is substantial evidence that health risk behaviors increase risks of premature morbidity and mortality, little is known about the multiple health risk behaviors in Chinese college students. Here, we investigated the prevalence of multiple health risk behaviors and its relation to mental health among Chinese college students. A cross-sectional study was conducted in Wuhan, China from May to June 2012. The students reported their health risk behaviors using self-administered questionnaires. Depression and anxiety were assessed using the self-rating depression scale and self-rating anxiety scale, respectively. A total of 2422 college students (1433 males) aged 19.7 ± 1.2 years were participated in the study. The prevalence of physical inactivity, sleep disturbance, poor dietary behavior, Internet addiction disorder (IAD), frequent alcohol use and current smoking was 62.0, 42.6, 29.8, 22.3, 11.6 and 9.3%, respectively. Significantly increased risks for depression and anxiety were found among students with frequent alcohol use, sleep disturbance, poor dietary behavior and IAD. Two-step cluster analysis identified two different clusters. Participants in the cluster with more unhealthy behaviors showed significantly increased risk for depression (odds ratio (OR): 2.21; 95% confidence interval (CI): 1.83, 2.67) and anxiety (OR: 2.32; 95% CI: 1.85, 2.92). This study indicates that a relatively high prevalence of multiple health risk behaviors was found among Chinese college students. Furthermore, the clustering of health risk behaviors was significantly associated with increased risks for depression and anxiety.

[Psychoactive substances use and health-related quality of life among school age adolescents].

PubMed

Vilugrón Aravena, Fabiola; Hidalgo-Rasmussen, Carlos Alejandro; Molina G, Temístocles; Gras Pérez, María Eugenia; Font-Mayolas, Silvia

2017-12-01

Background The use of psychoactive substances among adolescents is a major social and public health concern. Aim To analyze association of substance abuse and multiple drug use with health-related quality of life (HRQOL) in adolescents attending a high school in Valparaiso, Chile. Material and Methods Analytical cross-sectional study conducted in a sample of adolescents attending high school. HRQOL was assessed using KIDSCREEN-52 questionnaire and substance use was measured using the Global school-based student health survey. Participants had to complete online, self-administered, anonymous questionnaires. Multiple logistic regression analyses were conducted to calculate Odd ratios. Results A total of 550 adolescents aged 16 ± 1 years old completed the questionnaires. Thirty nine percent consumed alcohol during the last month, 31% smoked, 33% used marijuana and 33% admitted the use of multiple drugs. High-risk alcohol consumption was associated with a lower perception of psychological well-being, self-perception and school environment. This last dimension was affected in those who admitted marijuana use during the last month. Multiple drug use (three substances) was associated with a lower perception of physical and psychological well-being, self-perception, relationship with parents, family life and school environment. Conclusions High-risk alcohol consumption and multiple drug use (three substances) have a negative impact on the HRQOL of school age adolescents.

Recurrent transient ischaemic attack and early risk of stroke: data from the PROMAPA study.

PubMed

Purroy, Francisco; Jiménez Caballero, Pedro Enrique; Gorospe, Arantza; Torres, María José; Alvarez-Sabin, José; Santamarina, Estevo; Martínez-Sánchez, Patricia; Cánovas, David; Freijo, María José; Egido, Jose Antonio; Ramírez-Moreno, Jose M; Alonso-Arias, Arantza; Rodríguez-Campello, Ana; Casado, Ignacio; Delgado-Mederos, Raquel; Martí-Fàbregas, Joan; Fuentes, Blanca; Silva, Yolanda; Quesada, Helena; Cardona, Pere; Morales, Ana; de la Ossa, Natalia Pérez; García-Pastor, Antonio; Arenillas, Juan F; Segura, Tomas; Jiménez, Carmen; Masjuán, Jaime

2013-06-01

Many guidelines recommend urgent intervention for patients with two or more transient ischaemic attacks (TIAs) within 7 days (multiple TIAs) to reduce the early risk of stroke. To determine whether all patients with multiple TIAs have the same high early risk of stroke. Between April 2008 and December 2009, we included 1255 consecutive patients with a TIA from 30 Spanish stroke centres (PROMAPA study). We prospectively recorded clinical characteristics. We also determined the short-term risk of stroke (at 7 and 90 days). Aetiology was categorised using the TOAST (Trial of Org 10172 in Acute Stroke Treatment) classification. Clinical variables and extracranial vascular imaging were available and assessed in 1137/1255 (90.6%) patients. 7-Day and 90-day stroke risk were 2.6% and 3.8%, respectively. Large-artery atherosclerosis (LAA) was confirmed in 190 (16.7%) patients. Multiple TIAs were seen in 274 (24.1%) patients. Duration <1 h (OR=2.97, 95% CI 2.20 to 4.01, p<0.001), LAA (OR=1.92, 95% CI 1.35 to 2.72, p<0.001) and motor weakness (OR=1.37, 95% CI 1.03 to 1.81, p=0.031) were independent predictors of multiple TIAs. The subsequent risk of stroke in these patients at 7 and 90 days was significantly higher than the risk after a single TIA (5.9% vs 1.5%, p<0.001 and 6.8% vs 3.0%, respectively). In the logistic regression model, among patients with multiple TIAs, no variables remained as independent predictors of stroke recurrence. According to our results, multiple TIAs within 7 days are associated with a greater subsequent risk of stroke than after a single TIA. Nevertheless, we found no independent predictor of stroke recurrence among these patients.

Development of in Vivo Biomarkers for Progressive Tau Pathology after Traumatic Brain Injury

DTIC Science & Technology

2015-02-01

13. SUPPLEMENTARY NOTES 14. ABSTRACT Athletes in contact sports who have sustained multiple concussive traumatic brain injuries are at high risk for...multiple concussive traumatic brain injuries 15-17 may also be at risk for this condition. Currently, there are no methods to identify progressive tau...after traumatic brain injury. Progress to date: To date, none of the attempts to model progressive tau pathology after repetitive concussive TBI in

[High Risk Sex Behaviors and Associated Factors in Young Men in Chengdu].

PubMed

2015-11-01

To determine the prevalence of high risk sex behaviors and associated factors in 18-34 years old men in Chengdu. Methods An anonymous questionnaire survey was conducted in 18-34 years old men selected by multi-stage random sampling in Chengdu. Data of 1536 respondents who reported having sex contacts were analyzed. 23.6% of respondents had multiple sex partners in the past 12 months; 11.8% were involved commercial sex; 9.0% had group sex; 4. 7% had anal sex; 15.6% had never used a condom; 37.7% had sex under the influence of alcohol or drugs. Logistic regression analysis revealed that marital status [married, standardized partial regression coefficient (B) = -0.086, P<0.05] , level of education (bachelor or above, B= -0.063, P<0.05), frequency of exposure to pornography (B=0.058, P<0.05), childhood sexual abuse (B= 0.042, P<0.05), first sexual intercourse at an earlier age (B=0.162, P<0.05), frequency of sex under the influence of alcohol or drugs (B=0.054, P<0.05) were significant predictors of having multiple sexual partners. Sexual orientation, age, smoking, alcohol abuse, drug use, anxiety, depression, childhood physical abuse did not appear to be significant factors associated with having multiple sexual partners. Having multiple sexual partners is the main high risk sex behavior of young men in Chengdu. Childhood sexual abuse and early start of sexual intercourse are the major predictors of having multiple sexual partners.

The Prevalence of High-Risk HPV Types and Factors Determining Infection in Female Colombian Adolescents

PubMed Central

Del Río-Ospina, Luisa; Soto-De León, Sara Cecilia; Camargo, Milena; Sánchez, Ricardo; Mancilla, Cindy Lizeth; Patarroyo, Manuel Elkin

2016-01-01

This study reports six HR-HPV types’ infection prevalence discriminated by species and multiple infection in unvaccinated Colombian female adolescents, as well as some factors modulating the risk of infection. HPV DNA for six high-risk viral types was identified in cervical samples taken from 2,134 12–19 year-old females using conventional generic and type-specific PCR. Binomial logistical regression analysis was used for modelling HR-HPV infection and multiple infection risk. The interaction between variables in a stepwise model was also included in such analysis. Viral DNA was detected in 48.97% of the females; 28.52% of them had multiple infections, HPV-16 being the most frequently occurring type (37.44%). Cytological abnormality prevalence was 15.61%. Being over 16 years-old (1.66: 1.01–2.71 95%CI), white ethnicity (4.40: 1.16–16.73 95%CI), having had 3 or more sexual partners (1.77: 1.11–2.81 95%CI) and prior sexually-transmitted infections (STI) (1.65: 1.17–2.32 95%CI) were associated with a greater risk of HPV infection. Having given birth was related to a higher risk of infection by A7 species and antecedent of abortion to less risk of coinfection. Where the females in this study came from also influenced the risk of infection by A7 species as female adolescents from the Andean region had a lower risk of infection (0.42: 0.18–0.99 95%CI). The presence of factors related to risky sexual behaviour in the study population indicated that public health services should pay special attention to female adolescents to modify the risk of infection by high-risk HPV types and decrease their impact on this age group. PMID:27846258

Incident Detection of High-Risk Human Papillomavirus Infections in a Cohort of High-Risk Women Aged 25–65 Years

PubMed Central

Winer, Rachel L.; Hughes, James P.; Feng, Qinghua; Stern, Joshua E.; Xi, Long Fu; Koutsky, Laura A.

2016-01-01

Background. The risk of incident high-risk human papillomavirus (HR-HPV) infection associated with recent sexual behaviors is undefined in mid-adult women (defined as women aged 25–65 years). Methods. Triannually, 420 female online daters aged 25–65 years submitted vaginal specimens for HPV testing and completed health and sexual behavior questionnaires. The cumulative incidence of and risk factors for incident HR-HPV detection were estimated by Kaplan–Meier and Cox proportional hazards methods. Results. The 12-month cumulative incidence of HR-HPV detection was 25.4% (95% confidence interval [CI], 21.3%–30.1%). Current hormonal contraceptive use was positively associated with incident HR-HPV detection. Lifetime number of male sex partners was also positively associated but only among women not recently sexually active with male partners. In analysis that adjusted for hormonal contraceptive use and marital status, women reporting multiple male partners or male partners who were new, casual, or had ≥1 concurrent partnership had a hazard of incident HR-HPV detection that was 2.81 times (95% CI, 1.38–5.69 times) that for women who reported no male sex partners in the past 6 months. Thus, among women with multiple male partners or male partners who were new, casual, or had ≥1 concurrent partnership, approximately 64% of incident HR-HPV infections were attributable to one of those partners. Conclusions. Among high-risk mid-adult women with recent new male partners, multiple male partners, or male partners who were casual or had ≥1 concurrent partnership, about two thirds of incident HR-HPV detections are likely new acquisitions, whereas about one third of cases are likely redetections of prior infections. PMID:27009602

Victimization and Human Immunodeficiency Virus-Related Risk Among Transgender Women in India: A Latent Profile Analysis.

PubMed

Willie, Tiara C; Chakrapani, Venkatesan; White Hughto, Jaclyn M; Kershaw, Trace S

2017-12-01

Globally, transgender women (TGW) experience multiple forms of victimization such as violence and discrimination that can place them at risk for poor sexual health. To date, research overlooks the heterogeneity in experiences of victimization among TGW. Furthermore, few studies have examined the association between victimization and sexual risk among TGW in India, despite the high burden of HIV and victimization in this community. Latent profile analysis was performed to identify patterns of victimization in a convenience sample of 299 TGW recruited from nongovernmental organizations across four states in India. Analysis of covariance was performed to examine differences in sexual risk (i.e., alcohol use before sex; inconsistent condom use with a male regular partner, a male causal partner, and a male paying partner; and having multiple sexual partners) between latent profiles. Five distinct profiles of Indian TGW were identified based on the type and severity of victimization: (1) Low victimization, (2) High verbal police victimization, (3) High verbal and physical police victimization, (4) Moderate victimization, and (5) High victimization. While controlling for age, education, income, HIV status, and marital status, results revealed that TGW in the moderate victimization and high victimization profiles had higher sexual risk than TGW in the low victimization and high verbal police victimization profiles. In addition, TGW in high verbal and physical police victimization profile had higher sexual risk than TGW in low victimization profile. These findings underscore the importance of tailoring sexual risk reduction interventions to the specific needs of TGW based on patterns of victimization.

Pancreatic ductal adenocarcinoma: Risk factors, screening, and early detection

PubMed Central

Becker, Andrew E; Hernandez, Yasmin G; Frucht, Harold; Lucas, Aimee L

2014-01-01

Pancreatic cancer is the fourth most common cause of cancer-related deaths in the United States, with over 38000 deaths in 2013. The opportunity to detect pancreatic cancer while it is still curable is dependent on our ability to identify and screen high-risk populations before their symptoms arise. Risk factors for developing pancreatic cancer include multiple genetic syndromes as well as modifiable risk factors. Genetic conditions include hereditary breast and ovarian cancer syndrome, Lynch Syndrome, familial adenomatous polyposis, Peutz-Jeghers Syndrome, familial atypical multiple mole melanoma syndrome, hereditary pancreatitis, cystic fibrosis, and ataxia-telangiectasia; having a genetic predisposition can raise the risk of developing pancreatic cancer up to 132-fold over the general population. Modifiable risk factors, which include tobacco exposure, alcohol use, chronic pancreatitis, diet, obesity, diabetes mellitus, as well as certain abdominal surgeries and infections, have also been shown to increase the risk of pancreatic cancer development. Several large-volume centers have initiated such screening protocols, and consensus-based guidelines for screening high-risk groups have recently been published. The focus of this review will be both the genetic and modifiable risk factors implicated in pancreatic cancer, as well as a review of screening strategies and their diagnostic yields. PMID:25170203

Multiple Peer Group Self-Identification and Adolescent Tobacco Use

PubMed Central

Fuqua, Juliana L.; Gallaher, Peggy E.; Unger, Jennifer B.; Trinidad, Dennis R.; Sussman, Steve; Ortega, Enrique; Johnson, C. Anderson

2014-01-01

Associations between peer group self-identification and smoking were examined among 2,698 ethnically diverse middle school students in Los Angeles who self-identified with groups such as Rockers, Skaters, and Gamers. The sample was 47.1% male, 54.7% Latino, 25.4% Asian, 10.8% White, 9.1% Other ethnicity, and 59.3% children of immigrant parents. Multiple group self-identification was common: 84% identified with two or more groups and 65% identified with three or more groups. Logistic regression analyses indicated that as students endorsed more high-risk groups, the greater their risk of tobacco use. A classification tree analysis identified risk groups based on interactions among ethnicity, gender, and group self-identification. Psychographic targeting based on group self-identification could be useful to design more relevant smoking prevention messages for adolescents who identify with high-risk peer groups. PMID:22458850

Multiple health behaviors in an ethnically diverse sample of adults with risk factors for cardiovascular disease.

PubMed

Heinrich, Katie M; Maddock, Jay

2011-01-01

Health behaviors of adults living with cardiovascular disease (CVD) risk factors affect additional risk, where lifestyle behavioral choices become even more important in controlling disease and preventing additional negative health outcomes. In addition, both lifestyle behaviors and CVD risk factor prevalence can vary by ethnicity. We compared multiple health behaviors of adults with diabetes, hypertension, high cholesterol, and obesity to the behaviors of adults without those conditions in a diverse ethnic sample to determine if significant differences existed between groups. Data were obtained from 30-minute random-digit-dial telephone surveys in 2007 (n = 3607). All data were self-reports. Healthy behaviors included meeting recommendations for intake of fruits and vegetables; consuming low or very low amounts of dietary fat; eating breakfast six or seven days per week; having a healthy diet; and meeting recommendations for walking, moderate, and vigorous physical activity. Unhealthy behaviors included frequent consumption of soda and fast food, smoking, binge drinking, and high stress. More than 6% of respondents had diabetes, 15.9% had hypertension, 16.4% had high cholesterol, and 18.5% were obese. Significantly fewer healthy and more unhealthy behaviors were reported for those who had CVD risk factors than were reported by those who did not have such conditions. Ethnic differences in CVD risk factor prevalence and health behaviors existed as well (p < 0.001). Logistic regression models indicated that not eating a healthy diet (odds ratio [OR] = 1.82) was a significant predictor for diabetes; not eating a healthy diet (OR = 1.52) and not doing vigorous physical activity (OR = 1.79) were significant predictors for hypertension; consumption of high amounts of dietary fat (OR = 1.70) and of fast food (OR = 1.51) were significant predictors for high cholesterol levels; and not eating a healthy diet (OR = 1.52), high consumption of dietary fat (OR = 2.20), not eating breakfast (OR = 1.33) and not performing vigorous physical activity (OR = 1.63), but less consumption of fast food (OR = 0.64) were significant predictors for obesity. Specifically tailored and culturally sensitive interventions that address multiple health behaviors may be necessary for these high-risk populations.

A comparison of genetic variants between proficient low- and high-risk sport participants.

PubMed

Thomson, Cynthia J; Power, Rebecca J; Carlson, Scott R; Rupert, Jim L; Michel, Grégory

2015-01-01

Athletes participating in high-risk sports consistently report higher scores on sensation-seeking measures than do low-risk athletes or non-athletic controls. To determine whether genetic variants commonly associated with sensation seeking were over-represented in such athletes, proficient practitioners of high-risk (n = 141) and low-risk sports (n = 132) were compared for scores on sensation seeking and then genotyped at 33 polymorphic loci in 14 candidate genes. As expected, athletes participating in high-risk sports score higher on sensation seeking than did low-risk sport athletes (P < .01). Genotypes were associated with high-risk sport participation for two genes (stathmin, (P = .004) and brain-derived neurotrophic factor (P = .03)) as well as when demographically matched subsets of the sport cohorts were compared (P < .05); however, in all cases, associations did not survive correction for multiple testing.

International note: association between perceived resilience and health risk behaviours in homeless youth.

PubMed

Oppong Asante, Kwaku; Meyer-Weitz, Anna

2015-02-01

Homeless youth are regarded as an extremely high risk group, susceptible to suicidal ideation substance abuse, and high rates of mental illness. While there exists a substantial body of knowledge regarding resilience of homeless youth, few studies has examined the relationship between perceived resilience and health risk behaviours. The present study describes the findings from a quantitative examination of street-related demographics, resilience, suicidal ideation, substance abuse, sexual risk behaviours and violent related behaviours among 227 homeless youth. The findings revealed that perceived resilience was negatively related to suicidal ideation, substance abuse and violence. Suicidal ideation was positively related to both substance abuse and violence, whilst violence and substance abuse were positively correlated. Multiple regressions showed that perceived resilience served as a protective factor for suicidal ideation and having multiple sexual lifetime partners, suggesting that youth with lower level of perceived resilience were more likely to engage in various health risks behaviours. Copyright © 2014 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

Genetic modifiers of CHEK2*1100delC associated breast cancer risk

PubMed Central

Muranen, Taru A.; Greco, Dario; Blomqvist, Carl; Aittomäki, Kristiina; Khan, Sofia; Hogervorst, Frans; Verhoef, Senno; Pharoah, Paul D.P.; Dunning, Alison M.; Shah, Mitul; Luben, Robert; Bojesen, Stig E.; Nordestgaard, Børge G.; Schoemaker, Minouk; Swerdlow, Anthony; García-Closas, Montserrat; Figueroa, Jonine; Dörk, Thilo; Bogdanova, Natalia V.; Hall, Per; Li, Jingmei; Khusnutdinova, Elza; Bermisheva, Marina; Kristensen, Vessela; Borresen-Dale, Anne-Lise; Peto, Julian; dos Santos Silva, Isabel; Couch, Fergus J.; Olson, Janet E.; Hillemans, Peter; Park-Simon, Tjoung-Won; Brauch, Hiltrud; Hamann, Ute; Burwinkel, Barbara; Marme, Frederik; Meindl, Alfons; Schmutzler, Rita K.; Cox, Angela; Cross, Simon S.; Sawyer, Elinor J.; Tomlinson, Ian; Lambrechts, Diether; Moisse, Matthieu; Lindblom, Annika; Margolin, Sara; Hollestelle, Antoinette; Martens, John W.M.; Fasching, Peter A.; Beckmann, Matthias W.; Andrulis, Irene L.; Knight, Julia A.; Anton-Culver, Hoda; Ziogas, Argyrios; Giles, Graham G.; Milne, Roger L.; Brenner, Hermann; Arndt, Volker; Mannermaa, Arto; Kosma, Veli-Matti; Chang-Claude, Jenny; Rudolph, Anja; Devilee, Peter; Seynaeve, Caroline; Hopper, John L.; Southey, Melissa C.; John, Esther M.; Whittemore, Alice S.; Bolla, Manjeet K.; Wang, Qin; Michailidou, Kyriaki; Dennis, Joe; Easton, Douglas F.; Schmidt, Marjanka K.; Nevanlinna, Heli

2016-01-01

Purpose CHEK2*1100delC is a founder variant in European populations conferring a 2–3 fold increased risk of breast cancer (BC). Epidemiologic and family studies have suggested that the risk associated with CHEK2*1100delC is modified by other genetic factors in a multiplicative fashion. We have investigated this empirically using data from the Breast Cancer Association Consortium (BCAC). Methods With genotype data of 39,139 (624 1100delC carriers) BC patients and 40,063 (224) healthy controls from 32 BCAC studies, we analyzed the combined risk effects of CHEK2*1100delC and 77 common variants in terms of a polygenic risk score (PRS) and pairwise interaction. Results The PRS conferred an odds ratio (OR) of 1.59 [95% CI 1.21–2.09] per standard deviation for BC for CHEK2*1100delC carriers and 1.58 [1.55–1.62] for non-carriers. No evidence for deviation from the multiplicative model was found. The OR for the highest quintile of the PRS was 2.03 [0.86–4.78] for CHEK2*1100delC carriers placing them to the high risk category according to UK NICE guidelines. OR for the lowest quintile was 0.52 [0.16–1.74], indicating life-time risk close to population average. Conclusion Our results confirm the multiplicative nature of risk effects conferred by CHEK2*1100delC and the common susceptibility variants. Furthermore, the PRS could identify the carriers at a high life-time risk for clinical actions. PMID:27711073

Genetic modifiers of CHEK2*1100delC-associated breast cancer risk.

PubMed

Muranen, Taru A; Greco, Dario; Blomqvist, Carl; Aittomäki, Kristiina; Khan, Sofia; Hogervorst, Frans; Verhoef, Senno; Pharoah, Paul D P; Dunning, Alison M; Shah, Mitul; Luben, Robert; Bojesen, Stig E; Nordestgaard, Børge G; Schoemaker, Minouk; Swerdlow, Anthony; García-Closas, Montserrat; Figueroa, Jonine; Dörk, Thilo; Bogdanova, Natalia V; Hall, Per; Li, Jingmei; Khusnutdinova, Elza; Bermisheva, Marina; Kristensen, Vessela; Borresen-Dale, Anne-Lise; Investigators, Nbcs; Peto, Julian; Dos Santos Silva, Isabel; Couch, Fergus J; Olson, Janet E; Hillemans, Peter; Park-Simon, Tjoung-Won; Brauch, Hiltrud; Hamann, Ute; Burwinkel, Barbara; Marme, Frederik; Meindl, Alfons; Schmutzler, Rita K; Cox, Angela; Cross, Simon S; Sawyer, Elinor J; Tomlinson, Ian; Lambrechts, Diether; Moisse, Matthieu; Lindblom, Annika; Margolin, Sara; Hollestelle, Antoinette; Martens, John W M; Fasching, Peter A; Beckmann, Matthias W; Andrulis, Irene L; Knight, Julia A; Investigators, kConFab/Aocs; Anton-Culver, Hoda; Ziogas, Argyrios; Giles, Graham G; Milne, Roger L; Brenner, Hermann; Arndt, Volker; Mannermaa, Arto; Kosma, Veli-Matti; Chang-Claude, Jenny; Rudolph, Anja; Devilee, Peter; Seynaeve, Caroline; Hopper, John L; Southey, Melissa C; John, Esther M; Whittemore, Alice S; Bolla, Manjeet K; Wang, Qin; Michailidou, Kyriaki; Dennis, Joe; Easton, Douglas F; Schmidt, Marjanka K; Nevanlinna, Heli

2017-05-01

CHEK2*1100delC is a founder variant in European populations that confers a two- to threefold increased risk of breast cancer (BC). Epidemiologic and family studies have suggested that the risk associated with CHEK2*1100delC is modified by other genetic factors in a multiplicative fashion. We have investigated this empirically using data from the Breast Cancer Association Consortium (BCAC). Using genotype data from 39,139 (624 1100delC carriers) BC patients and 40,063 (224) healthy controls from 32 BCAC studies, we analyzed the combined risk effects of CHEK2*1100delC and 77 common variants in terms of a polygenic risk score (PRS) and pairwise interaction. The PRS conferred odds ratios (OR) of 1.59 (95% CI: 1.21-2.09) per standard deviation for BC for CHEK2*1100delC carriers and 1.58 (1.55-1.62) for noncarriers. No evidence of deviation from the multiplicative model was found. The OR for the highest quintile of the PRS was 2.03 (0.86-4.78) for CHEK2*1100delC carriers, placing them in the high risk category according to UK NICE guidelines. The OR for the lowest quintile was 0.52 (0.16-1.74), indicating a lifetime risk close to the population average. Our results confirm the multiplicative nature of risk effects conferred by CHEK2*1100delC and the common susceptibility variants. Furthermore, the PRS could identify carriers at a high lifetime risk for clinical actions.Genet Med advance online publication 06 October 2016.

Teachers' Perceptions of a Multiple High-Risk Behavior Prevention Program and Delivery of Universal Programming

ERIC Educational Resources Information Center

Collier, Crystal; Henriksen, Richard C., Jr.

2012-01-01

Much of the success of high-risk behavior prevention programs rests with teachers who deliver the curriculum however; few studies have investigated teachers' perceptions of program implementation. The objective of this phenomenological study was to answer the question, "What are the experiences of teachers who are asked to be involved in the…

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

PubMed

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

2014-01-01

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

Sexual risk behaviours of high school female learners in Mbonge subdivision of rural Cameroon.

PubMed

Tarkang, Elvis Enowbeyang

2015-01-01

Since female learners in high schools in Cameroon fall within the age group hardest hit by HIV/AIDS, it is assumed that these learners might be exposed to sexual risk behaviours. However, little has been explored on the sexual risk behaviours of high school female learners in Cameroon. This study aimed at examining the sexual risk behaviours of high school female learners in Mbonge subdivision of rural Cameroon. A cross sectional design was adopted, using a self-administered questionnaire for data collection. Respondents were selected through disproportional stratified simple random sampling resulting in 210 female grade 10 to grade 12 learners from three participating high schools in Mbonge subdivision, Cameroon. Descriptive and inferential statistics were calculated using SPSS version 20 software program. Majority of the respondents, 54.0% reported being sexually active, of whom only 39.8% used condoms during first sex; 49.5% used condoms during last sex and 29.6% used condoms consistently. Up to 32% of the sexually active respondents had multiple sexual partners in the past one year before the study, while 9.3% had multiple sexual partners during the study period. The mean age of first sex was 15.6 years. Lack of parental control, religion, academic profile, poverty, place of residence and perception of risk of HIV infection were the main factors significantly associated with sexual risk behaviours. The findings indicate that sexual risk behaviours exist among high school female learners in Mbonge, Cameroon. There is need for campaigns and interventions to bring about sexual behaviour change.

Sexual risk behaviours of high school female learners in Mbonge subdivision of rural Cameroon

PubMed Central

Tarkang, Elvis Enowbeyang

2015-01-01

Introduction Since female learners in high schools in Cameroon fall within the age group hardest hit by HIV/AIDS, it is assumed that these learners might be exposed to sexual risk behaviours. However, little has been explored on the sexual risk behaviours of high school female learners in Cameroon. This study aimed at examining the sexual risk behaviours of high school female learners in Mbonge subdivision of rural Cameroon. Methods A cross sectional design was adopted, using a self-administered questionnaire for data collection. Respondents were selected through disproportional stratified simple random sampling resulting in 210 female grade 10 to grade 12 learners from three participating high schools in Mbonge subdivision, Cameroon. Descriptive and inferential statistics were calculated using SPSS version 20 software program. Results Majority of the respondents, 54.0% reported being sexually active, of whom only 39.8% used condoms during first sex; 49.5% used condoms during last sex and 29.6% used condoms consistently. Up to 32% of the sexually active respondents had multiple sexual partners in the past one year before the study, while 9.3% had multiple sexual partners during the study period. The mean age of first sex was 15.6 years. Lack of parental control, religion, academic profile, poverty, place of residence and perception of risk of HIV infection were the main factors significantly associated with sexual risk behaviours. Conclusion The findings indicate that sexual risk behaviours exist among high school female learners in Mbonge, Cameroon. There is need for campaigns and interventions to bring about sexual behaviour change. PMID:26090007

Use of the Impella 2.5 for prophylactic circulatory support during elective high-risk percutaneous coronary intervention.

PubMed

Alasnag, Mirvat A; Gardi, Delair O; Elder, Mahir; Kannam, Hari; Ali, Farhan; Petrina, Mircea; Kheterpal, Vipin; Hout, Mariah S; Schreiber, Theodore L

2011-01-01

Patients undergoing percutaneous coronary intervention (PCI) who are at high risk for cardiovascular collapse during the procedure may benefit from prophylactic circulatory support. The objective was to evaluate the safety and feasibility of prophylactic use of the Impella 2.5 during high-risk PCI. We used the Impella 2.5 for partial circulatory support during 60 consecutive elective high-risk PCI cases over 20 months. All patients either were deemed inoperable by the cardiac surgeons or were offered bypass surgery but declined. The patients had multiple risk factors including hypertension (95%), diabetes (52%), chronic pulmonary disease (23%), prior myocardial infarction (62%) and prior bypass surgery (18%). Forty-five percent presented with acute coronary syndrome. The mean left ventricular ejection fraction was 23%±15%. Nearly all patients had multivessel disease (93%), and 60% had left main disease. The average SYNTAX score was 30±9. Despite lesion complexity and high-risk factors, we achieved an angiographic success rate of 96%. Left main lesions were treated in 55% of the patients, and 83% of patients had multiple lesions treated. There was one procedural death. At 30 days postintervention, mortality was 5%, and rates of myocardial infarction, stroke, target vessel revascularization and urgent bypass surgery were 0%. The single-center experience reported here demonstrates that use of the Impella 2.5 during high-risk PCI in the "real world" - outside the controlled environment of a clinical trial - is safe and feasible. Copyright © 2011 Elsevier Inc. All rights reserved.

Mortality characteristics of aortic root surgery in North America†

PubMed Central

Caceres, Manuel; Ma, Yicheng; Rankin, J. Scott; Saha-Chaudhuri, Paramita; Englum, Brian R.; Gammie, James S.; Suri, Rakesh M.; Thourani, Vinod H.; Esmailian, Fardad; Czer, Lawrence S.; Puskas, John D.; Svensson, Lars G.

2014-01-01

OBJECTIVES Aortic root surgery is transitioning to aortic valve sparing (AVS), but little is known about the relative early outcomes of AVS versus composite graft-valve replacement (CVR). This study assessed mortality differences for AVS versus CVR to guide future practice decisions. METHODS From January 2000 to June 2011, 31 747 patients had aortic root replacement with AVS (n = 3585; 11%) or CVR (n = 28 162; 89%). The cohort of Overall patients was divided into two subgroups: high-risk patients (n = 20 356; 6% AVS) having age >75 years, endocarditis, aortic stenosis, dialysis, multiple valves, reoperation or emergency/salvage status, and the remaining low-risk patients (n = 11 388; 21% AVS). Using logistic regression analysis, outcomes were presented as unadjusted operative mortality (UOM), risk-adjusted operative mortality (AOM) and adjusted odds ratio (AOR) for mortality. RESULTS Baseline characteristics for the Overall group (AVS versus CVR) were: mean age (52 vs 57 years), endocarditis (1 vs 11%), aortic stenosis (4 vs 36%), dialysis (1 vs 2%), multiple valves (7 vs 10%), reoperation (6 vs 17%) and emergency status (14 vs 12%) (all P < 0.0001). In high- and low-risk groups, baseline differences narrowed, and lower mortality was generally observed with AVS: (AVS versus CVR) UOM group Overall (4.5 vs 8.9%)*, group High-risk (10.5 vs 11.7%), group Low-risk (1.4 vs 3.1%)*; AOM group Overall (6.2 vs 8.6%), group High-risk (10.1 vs 11.7%), group Low-risk (2.2 vs 2.8%); AOR group Overall (0.59)*, group High-risk (0.62)*, group Low-risk (0.69). *P < 0.05. CONCLUSIONS Relative risk-adjusted mortality seemed comparable with AVS versus CVR in low- and high-risk subgroups. These data support judicious expansion of aortic valve repair in patients having aortic root replacement. PMID:24639452

Mortality characteristics of aortic root surgery in North America.

PubMed

Caceres, Manuel; Ma, Yicheng; Rankin, J Scott; Saha-Chaudhuri, Paramita; Englum, Brian R; Gammie, James S; Suri, Rakesh M; Thourani, Vinod H; Esmailian, Fardad; Czer, Lawrence S; Puskas, John D; Svensson, Lars G

2014-11-01

Aortic root surgery is transitioning to aortic valve sparing (AVS), but little is known about the relative early outcomes of AVS versus composite graft-valve replacement (CVR). This study assessed mortality differences for AVS versus CVR to guide future practice decisions. From January 2000 to June 2011, 31 747 patients had aortic root replacement with AVS (n = 3585; 11%) or CVR (n = 28 162; 89%). The cohort of Overall patients was divided into two subgroups: high-risk patients (n = 20 356; 6% AVS) having age >75 years, endocarditis, aortic stenosis, dialysis, multiple valves, reoperation or emergency/salvage status, and the remaining low-risk patients (n = 11 388; 21% AVS). Using logistic regression analysis, outcomes were presented as unadjusted operative mortality (UOM), risk-adjusted operative mortality (AOM) and adjusted odds ratio (AOR) for mortality. Baseline characteristics for the Overall group (AVS versus CVR) were: mean age (52 vs 57 years), endocarditis (1 vs 11%), aortic stenosis (4 vs 36%), dialysis (1 vs 2%), multiple valves (7 vs 10%), reoperation (6 vs 17%) and emergency status (14 vs 12%) (all P < 0.0001). In high- and low-risk groups, baseline differences narrowed, and lower mortality was generally observed with AVS: (AVS versus CVR) UOM group Overall (4.5 vs 8.9%)*, group High-risk (10.5 vs 11.7%), group Low-risk (1.4 vs 3.1%)*; AOM group Overall (6.2 vs 8.6%), group High-risk (10.1 vs 11.7%), group Low-risk (2.2 vs 2.8%); AOR group Overall (0.59)*, group High-risk (0.62)*, group Low-risk (0.69). *P < 0.05. Relative risk-adjusted mortality seemed comparable with AVS versus CVR in low- and high-risk subgroups. These data support judicious expansion of aortic valve repair in patients having aortic root replacement. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Single-visit or multiple-visit root canal treatment: systematic review, meta-analysis and trial sequential analysis.

PubMed

Schwendicke, Falk; Göstemeyer, Gerd

2017-02-01

Single-visit root canal treatment has some advantages over conventional multivisit treatment, but might increase the risk of complications. We systematically evaluated the risk of complications after single-visit or multiple-visit root canal treatment using meta-analysis and trial-sequential analysis. Controlled trials comparing single-visit versus multiple-visit root canal treatment of permanent teeth were included. Trials needed to assess the risk of long-term complications (pain, infection, new/persisting/increasing periapical lesions ≥1 year after treatment), short-term pain or flare-up (acute exacerbation of initiation or continuation of root canal treatment). Electronic databases (PubMed, EMBASE, Cochrane Central) were screened, random-effects meta-analyses performed and trial-sequential analysis used to control for risk of random errors. Evidence was graded according to GRADE. 29 trials (4341 patients) were included, all but 6 showing high risk of bias. Based on 10 trials (1257 teeth), risk of complications was not significantly different in single-visit versus multiple-visit treatment (risk ratio (RR) 1.00 (95% CI 0.75 to 1.35); weak evidence). Based on 20 studies (3008 teeth), risk of pain did not significantly differ between treatments (RR 0.99 (95% CI 0.76 to 1.30); moderate evidence). Risk of flare-up was recorded by 8 studies (1110 teeth) and was significantly higher after single-visit versus multiple-visit treatment (RR 2.13 (95% CI 1.16 to 3.89); very weak evidence). Trial-sequential analysis revealed that firm evidence for benefit, harm or futility was not reached for any of the outcomes. There is insufficient evidence to rule out whether important differences between both strategies exist. Dentists can provide root canal treatment in 1 or multiple visits. Given the possibly increased risk of flare-ups, multiple-visit treatment might be preferred for certain teeth (eg, those with periapical lesions). Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Risk assessment of pesticides and other stressors in bees: Principles, data gaps and perspectives from the European Food Safety Authority.

PubMed

Rortais, Agnès; Arnold, Gérard; Dorne, Jean-Lou; More, Simon J; Sperandio, Giorgio; Streissl, Franz; Szentes, Csaba; Verdonck, Frank

2017-06-01

Current approaches to risk assessment in bees do not take into account co-exposures from multiple stressors. The European Food Safety Authority (EFSA) is deploying resources and efforts to move towards a holistic risk assessment approach of multiple stressors in bees. This paper describes the general principles of pesticide risk assessment in bees, including recent developments at EFSA dealing with risk assessment of single and multiple pesticide residues and biological hazards. The EFSA Guidance Document on the risk assessment of plant protection products in bees highlights the need for the inclusion of an uncertainty analysis, other routes of exposures and multiple stressors such as chemical mixtures and biological agents. The EFSA risk assessment on the survival, spread and establishment of the small hive beetle, Aethina tumida, an invasive alien species, is provided with potential insights for other bee pests such as the Asian hornet, Vespa velutina. Furthermore, data gaps are identified at each step of the risk assessment, and recommendations are made for future research that could be supported under the framework of Horizon 2020. Finally, the recent work conducted at EFSA is presented, under the overarching MUST-B project ("EU efforts towards the development of a holistic approach for the risk assessment on MUltiple STressors in Bees") comprising a toolbox for harmonised data collection under field conditions and a mechanistic model to assess effects from pesticides and other stressors such as biological agents and beekeeping management practices, at the colony level and in a spatially complex landscape. Future perspectives at EFSA include the development of a data model to collate high quality data to calibrate and validate the model to be used as a regulatory tool. Finally, the evidence collected within the framework of MUST-B will support EFSA's activities on the development of a holistic approach to the risk assessment of multiple stressors in bees. In conclusion, EFSA calls for collaborative action at the EU level to establish a common and open access database to serve multiple purposes and different stakeholders. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

The Human Immunodeficiency Virus Endemic: Maintaining Disease Transmission in At-Risk Urban Areas.

PubMed

Rothenberg, Richard B; Dai, Dajun; Adams, Mary Anne; Heath, John Wesley

2017-02-01

A study of network relationships, geographic contiguity, and risk behavior was designed to test the hypothesis that all 3 are required to maintain endemicity of human immunodeficiency virus (HIV) in at-risk urban communities. Specifically, a highly interactive network, close geographic proximity, and compound risk (multiple high-risk activities with multiple partners) would be required. We enrolled 927 participants from two contiguous geographic areas in Atlanta, GA: a higher-risk area and lower-risk area, as measured by history of HIV reporting. We began by enrolling 30 "seeds" (15 in each area) who were comparable in their demographic and behavioral characteristics, and constructed 30 networks using a chain-link design. We assessed each individual's geographic range; measured the network characteristics of those in the higher and lower-risk areas; and measured compound risk as the presence of two or more (of 6) major risks for HIV. Among participants in the higher-risk area, the frequency of compound risk was 15%, compared with 5% in the lower-risk area. Geographic cohesion in the higher-risk group was substantially higher than that in the lower-risk group, based on comparison of geographic distance and social distance, and on the extent of overlap of personal geographic range. The networks in the 2 areas were similar: both areas show highly interactive networks with similar degree distributions, and most measures of network attributes were virtually the same. Our original hypothesis was supported in part. The higher and lower-risk groups differed appreciably with regard to risk and geographic cohesion, but were substantially the same with regard to network properties. These results suggest that a "minimum" network configuration may be required for maintenance of endemic transmission, but a particular prevalence level may be determined by factors related to risk, geography, and possibly other factors.

Developmental Dyslexia: Predicting Individual Risk

ERIC Educational Resources Information Center

Thompson, Paul A.; Hulme, Charles; Nash, Hannah M.; Gooch, Debbie; Hayiou-Thomas, Emma; Snowling, Margaret J.

2015-01-01

Background: Causal theories of dyslexia suggest that it is a heritable disorder, which is the outcome of multiple risk factors. However, whether early screening for dyslexia is viable is not yet known. Methods: The study followed children at high risk of dyslexia from preschool through the early primary years assessing them from age 3 years and 6…

A robust prognostic signature for hormone-positive node-negative breast cancer.

PubMed

Griffith, Obi L; Pepin, François; Enache, Oana M; Heiser, Laura M; Collisson, Eric A; Spellman, Paul T; Gray, Joe W

2013-01-01

Systemic chemotherapy in the adjuvant setting can cure breast cancer in some patients that would otherwise recur with incurable, metastatic disease. However, since only a fraction of patients would have recurrence after surgery alone, the challenge is to stratify high-risk patients (who stand to benefit from systemic chemotherapy) from low-risk patients (who can safely be spared treatment related toxicities and costs). We focus here on risk stratification in node-negative, ER-positive, HER2-negative breast cancer. We use a large database of publicly available microarray datasets to build a random forests classifier and develop a robust multi-gene mRNA transcription-based predictor of relapse free survival at 10 years, which we call the Random Forests Relapse Score (RFRS). Performance was assessed by internal cross-validation, multiple independent data sets, and comparison to existing algorithms using receiver-operating characteristic and Kaplan-Meier survival analysis. Internal redundancy of features was determined using k-means clustering to define optimal signatures with smaller numbers of primary genes, each with multiple alternates. Internal OOB cross-validation for the initial (full-gene-set) model on training data reported an ROC AUC of 0.704, which was comparable to or better than those reported previously or obtained by applying existing methods to our dataset. Three risk groups with probability cutoffs for low, intermediate, and high-risk were defined. Survival analysis determined a highly significant difference in relapse rate between these risk groups. Validation of the models against independent test datasets showed highly similar results. Smaller 17-gene and 8-gene optimized models were also developed with minimal reduction in performance. Furthermore, the signature was shown to be almost equally effective on both hormone-treated and untreated patients. RFRS allows flexibility in both the number and identity of genes utilized from thousands to as few as 17 or eight genes, each with multiple alternatives. The RFRS reports a probability score strongly correlated with risk of relapse. This score could therefore be used to assign systemic chemotherapy specifically to those high-risk patients most likely to benefit from further treatment.

A robust prognostic signature for hormone-positive node-negative breast cancer

PubMed Central

2013-01-01

Background Systemic chemotherapy in the adjuvant setting can cure breast cancer in some patients that would otherwise recur with incurable, metastatic disease. However, since only a fraction of patients would have recurrence after surgery alone, the challenge is to stratify high-risk patients (who stand to benefit from systemic chemotherapy) from low-risk patients (who can safely be spared treatment related toxicities and costs). Methods We focus here on risk stratification in node-negative, ER-positive, HER2-negative breast cancer. We use a large database of publicly available microarray datasets to build a random forests classifier and develop a robust multi-gene mRNA transcription-based predictor of relapse free survival at 10 years, which we call the Random Forests Relapse Score (RFRS). Performance was assessed by internal cross-validation, multiple independent data sets, and comparison to existing algorithms using receiver-operating characteristic and Kaplan-Meier survival analysis. Internal redundancy of features was determined using k-means clustering to define optimal signatures with smaller numbers of primary genes, each with multiple alternates. Results Internal OOB cross-validation for the initial (full-gene-set) model on training data reported an ROC AUC of 0.704, which was comparable to or better than those reported previously or obtained by applying existing methods to our dataset. Three risk groups with probability cutoffs for low, intermediate, and high-risk were defined. Survival analysis determined a highly significant difference in relapse rate between these risk groups. Validation of the models against independent test datasets showed highly similar results. Smaller 17-gene and 8-gene optimized models were also developed with minimal reduction in performance. Furthermore, the signature was shown to be almost equally effective on both hormone-treated and untreated patients. Conclusions RFRS allows flexibility in both the number and identity of genes utilized from thousands to as few as 17 or eight genes, each with multiple alternatives. The RFRS reports a probability score strongly correlated with risk of relapse. This score could therefore be used to assign systemic chemotherapy specifically to those high-risk patients most likely to benefit from further treatment. PMID:24112773

Joint Associations of Diet, Lifestyle, and Genes with Age-Related Macular Degeneration.

PubMed

Meyers, Kristin J; Liu, Zhe; Millen, Amy E; Iyengar, Sudha K; Blodi, Barbara A; Johnson, Elizabeth; Snodderly, D Max; Klein, Michael L; Gehrs, Karen M; Tinker, Lesley; Sarto, Gloria E; Robinson, Jennifer; Wallace, Robert B; Mares, Julie A

2015-11-01

Unhealthy lifestyles have been associated with increased odds for age-related macular degeneration (AMD). Whether this association is modified by genetic risk for AMD is unknown and was investigated. Interactions between healthy lifestyles AMD risk genotypes were studied in relation to the prevalence of AMD, assessed 6 years later. Women 50 to 79 years of age in the Carotenoids in Age-Related Eye Disease Study with exposure and AMD data (n=1663). Healthy lifestyle scores (0-6 points) were assigned based on Healthy Eating Index scores, physical activity (metabolic equivalent of task hours/week), and smoking pack years assessed in 1994 and 1998. Genetic risk was based on Y402H in complement factor H (CFH) and A69S in age-related maculopathy susceptibility locus 2 (ARMS2). Additive and multiplicative interactions in odds ratios were assessed using the synergy index and a multiplicative interaction term, respectively. AMD presence and severity were assessed from grading of stereoscopic fundus photographs taken in 2001-2004. AMD was present in 337 women, 91% of whom had early AMD. The odds of AMD were 3.3 times greater (95% confidence interval [CI], 1.8-6.1) in women with both low healthy lifestyle score (0-2) and high-risk CFH genotype (CC), relative to those who had low genetic risk (TT) and high healthy lifestyle scores (4-6). There were no significant additive (synergy index [SI], 1.08; 95% CI, 0.70-1.67) or multiplicative (Pinteraction=0.94) interactions in the full sample. However, when limiting the sample to women with stable diets before AMD assessment (n=728) the odds for AMD associated with low healthy lifestyle scores and high-risk CFH genotype were strengthened (odds ratio, 4.6; 95% CI, 1.8-11.6) and the synergy index was significant (SI, 1.34; 95% CI, 1.05-1.70). Adjusting for dietary lutein and zeaxanthin attenuated, and therefore partially explained, the joint association. There were no significant additive or multiplicative interactions for ARMS2 and lifestyle score. Having unhealthy lifestyles and 2 CFH risk alleles increased AMD risk (primarily in the early stages), in an or additive or greater (synergistic) manner. However, unhealthy lifestyles increased AMD risk regardless of AMD risk genotype. Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

A prospective study of risk-based colposcopy demonstrates improved detection of cervical precancers.

PubMed

Wentzensen, Nicolas; Walker, Joan; Smith, Katie; Gold, Michael A; Zuna, Rosemary; Massad, L Stewart; Liu, Angela; Silver, Michelle I; Dunn, S Terence; Schiffman, Mark

2018-06-01

Sensitivity for detection of precancers at colposcopy and reassurance provided by a negative colposcopy are in need of systematic study and improvement. We sought to evaluate whether selecting the appropriate women for multiple targeted cervical biopsies based on screening cytology, human papillomavirus testing, and colposcopic impression could improve accuracy and efficiency of cervical precancer detection. In all, 690 women aged 18-67 years referred to colposcopy subsequent to abnormal cervical cancer screening results were included in the study (ClinicalTrials.gov: NCT00339989). Up to 4 cervical biopsies were taken during colposcopy to evaluate the incremental benefit of multiple biopsies. Cervical cytology, human papillomavirus genotyping, and colposcopy impression were used to establish up to 24 different risk strata. Outcomes for the primary analysis were cervical precancers, which included p16 + cervical intraepithelial neoplasia 2 and all cervical intraepithelial neoplasia 3 that were detected by colposcopy-guided biopsy during the colposcopy visit. Later outcomes in women without cervical intraepithelial neoplasia 2 + at baseline were abstracted from electronic medical records. The risk of detecting precancer ranged from 2-82% across 24 strata based on colposcopy impression, cytology, and human papillomavirus genotyping. The risk of precancer in the lowest stratum increased only marginally with multiple biopsies. Women in the highest-risk strata had risks of precancer consistent with immediate treatment. In other risk strata, multiple biopsies substantially improved detection of cervical precancer. Among 361 women with cervical intraepithelial neoplasia <2 at baseline, 195 (54%) had follow-up cytology or histology data with a median follow-up time of 508 days. Lack of detection of precancer at initial colposcopy that included multiple biopsies predicted low risk of precancer during follow-up. Risk assessment at the colposcopy visit makes identification of cervical precancers more effective and efficient. Not finding precancer after a multiple-biopsy protocol provides high reassurance and allows releasing women back to regular screening. Published by Elsevier Inc.

Magnetic resonance imaging correlates of bee sting induced multiple organ dysfunction syndrome: A case report.

PubMed

Das, Sushant K; Zeng, Li-Chuan; Li, Bing; Niu, Xiang-Ke; Wang, Jing-Liang; Bhetuwal, Anup; Yang, Han-Feng

2014-09-28

Occasionally systemic complications with high risk of death, such as multiple organ dysfunction syndrome (MODS), can occur following multiple bee stings. This case study reports a patient who presented with MODS, i.e., acute kidney injury, hepatic and cardiac dysfunction, after multiple bee stings. The standard clinical findings were then correlated with magnetic resonance imaging (MRI) findings, which demonstrates that MRI may be utilized as a simpler tool to use than other multiple diagnostics.

Momentary assessment of PTSD symptoms and sexual risk behavior in male OEF/OIF/OND Veterans.

PubMed

Black, Anne C; Cooney, Ned L; Justice, Amy C; Fiellin, Lynn E; Pietrzak, Robert H; Lazar, Christina M; Rosen, Marc I

2016-01-15

Post-traumatic stress disorder (PTSD) in Veterans is associated with increased sexual risk behaviors, but the nature of this association is not well understood. Typical PTSD measurement deriving a summary estimate of symptom severity over a period of time precludes inferences about symptom variability, and whether momentary changes in symptom severity predict risk behavior. We assessed the feasibility of measuring daily PTSD symptoms, substance use, and high-risk sexual behavior in Veterans using ecological momentary assessment (EMA). Feasibility indicators were survey completion, PTSD symptom variability, and variability in rates of substance use and sexual risk behavior. Nine male Veterans completed web-based questionnaires by cell phone three times per day for 28 days. Median within-day survey completion rates maintained near 90%, and PTSD symptoms showed high within-person variability, ranging up to 59 points on the 80-point scale. Six Veterans reported alcohol or substance use, and substance users reported use of more than one drug. Eight Veterans reported 1 to 28 high-risk sexual events. Heightened PTSD-related negative affect and externalizing behaviors preceded high-risk sexual events. Greater PTSD symptom instability was associated with having multiple sexual partners in the 28-day period. These results are preliminary, given this small sample size, and multiple comparisons, and should be verified with larger Veteran samples. Results support the feasibility and utility of using of EMA to better understand the relationship between PTSD symptoms and sexual risk behavior in Veterans. Specific antecedent-risk behavior patterns provide promise for focused clinical interventions. Published by Elsevier B.V.

Patterns of multiple health risk-behaviours in university students and their association with mental health: application of latent class analysis.

PubMed

Kwan, M Y; Arbour-Nicitopoulos, K P; Duku, E; Faulkner, G

2016-08-01

University and college campuses may be the last setting where it is possible to comprehensively address the health of a large proportion of the young adult population. It is important that health promoters understand the collective challenges students are facing, and to better understand the broader lifestyle behavioural patterning evident during this life stage. The purpose of this study was to examine the clustering of modifiable health-risk behaviours and to explore the relationship between these identified clusters and mental health outcomes among a large Canadian university sample. Undergraduate students (n = 837; mean age = 21 years) from the University of Toronto completed the National College Health Assessment survey. The survey consists of approximately 300 items, including assessments of student health status, mental health and health-risk behaviours. Latent class analysis was used to identify patterning based on eight salient health-risk behaviours (marijuana use, other illicit drug use, risky sex, smoking, binge drinking, poor diet, physical inactivity, and insufficient sleep). A three-class model based on student behavioural patterns emerged: "typical," "high-risk" and "moderately healthy." Results also found high-risk students reporting significantly higher levels of stress than typical students (χ2(1671) = 7.26, p < .01). Students with the highest likelihood of engaging in multiple health-risk behaviours reported poorer mental health, particularly as it relates to stress. Although these findings should be interpreted with caution due to the 28% response rate, they do suggest that interventions targeting specific student groups with similar patterning of multiple health-risk behaviours may be needed.

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

Protective effects of self-esteem and family support on suicide risk behaviors among at-risk adolescents.

PubMed

Sharaf, Amira Y; Thompson, Elaine A; Walsh, Elaine

2009-08-01

If and how family support and self-esteem might interact to protect against adolescent suicide risk is not well understood. Hierarchical multiple regression was used to examine the moderating effect of family support on the relationship between self-esteem and suicide risk behaviors among potential high school dropouts (N = 849), using questionnaires and in-depth assessment interviews. Family support moderated the impact of self-esteem on suicide risk; the ameliorating effect of self-esteem was stronger among adolescents with low versus high family support. Self-esteem influences adolescent suicide risk behaviors for youth with low as well as high family support. Interventions designed to strengthen both self-esteem and support resources are appropriate.

Social Anxiety and Heavy Situational Drinking: Coping and Conformity Motives as Multiple Mediators

PubMed Central

Terlecki, Meredith A.; Buckner, Julia D.

2014-01-01

Individuals with clinically elevated social anxiety are at greater risk for alcohol use disorder, and the relation between social anxiety and drinking problems is at least partially accounted for by drinking more in negative emotional (e.g., feeling sad or angry) and personal/intimate (e.g., before sexual intercourse) situations. Identification of cognitive/motivational factors related to drinking in these high-risk situations could inform the development of treatment and prevention interventions for these high-risk drinkers. The current study examined the mediating effect of drinking motives on the relationship between social anxiety and drinking these high-risk situations amongst undergraduates (N = 232). Clinically elevated social anxiety was associated with greater coping and conformity motives. Both coping and conformity motives mediated the relation between social anxiety and heavier alcohol consumption in negative emotional and personal/intimate contexts. Multiple mediation analyses indicated that these motives work additively to mediate the social anxiety-drinking situations relationship, such that that heavy situational drinking amongst undergraduates with clinically elevated social anxiety can be jointly attributed to desire to cope with negative affect and to avoid social scrutiny. PMID:25233446

Use of Case History Data for the Development of Equations in Predicting High Risk, Reading Disabled Students.

ERIC Educational Resources Information Center

Stratton, Beverly D.; And Others

Demographic data on 92 subjects identified as having reading problems were used to develop equations useful in identifying high risk, reading disabled students. Multiple linear regression analysis of the data indicated that reading disability (1) had a significant positive relationship with birth order and number of siblings; (2) had a positive…

Multiple paternity in the freshwater snail, Potamopyrgus antipodarum

PubMed Central

Soper, Deanna M; Delph, Lynda F; Lively, Curt M

2012-01-01

Mating multiply may incur costs, such as exposure to predators and to sexually transmitted diseases. Nevertheless, it may be favored, in spite of these costs, as a way to increase the genetic diversity of offspring through fertilization by multiple males. Here, we tested for multiple paternity in a freshwater snail (Potamopyrgus antipodarum), which is host to several species of sterilizing trematode worms. Using microsatellites markers, we found multiple paternity in two different snail populations, with as many as seven males fertilizing a single female. In addition, high evenness of sire fertilization was found within individual broods. Multiple paternity can occur for a variety of reasons; however, given that these populations experience high risk of infection by a sterilizing trematode, one potential explanation may be that multiple paternity and high evenness of sire fertilizations increase the chances of the production of parasite-resistant offspring. PMID:23301182

Sociodemographic factors associated with multiple cardiovascular risk factors among Malaysian adults.

PubMed

Ghazali, Sumarni Mohd; Seman, Zamtira; Cheong, Kee Chee; Hock, Lim Kuang; Manickam, Mala; Kuay, Lim Kuang; Yusoff, Ahmad Faudzi; Mustafa, Feisul Idzwan; Mustafa, Amal Nasir

2015-01-31

To determine the prevalence and sociodemographic correlates of multiple risk factors for cardiovascular disease (CVD) among Malaysian adults. We analysed data on 1044 men and 1528 women, aged 24-64 years, participants in the Non Communicable Disease Surveillance 2005/2006, a nationally representative, population-based, cross-sectional study. Prevalence of obesity, high blood pressure, dyslipidaemia, hyperglycemia, physical inactivity, smoking, risky drinking, low vegetable and fruit intake were determined and multivariable logistic regression was used to identify sociodemographic factors associated with having ≥3 of these cardiovascular disease risk factors. The response rate was 84.6% (2572/3040). Overall, 68.4% (95% CI: 63.2, 73.1) had at least three risk factors. Among men, older age and Indian ethnicity were independently associated with having ≥3 CVD risk factors; while among women, older age, low education, and housewives were more likely to have ≥3 CVD risk factors. The prevalence of cardiovascular risk factors clustering among Malaysian adults is high, raising concerns that cardiovascular disease incidence will rise steeply in the near future if no immediate preventive measures are taken. The current national health education and promotion programmes pertaining to modifiable risk factors can be further improved by taking into account the sociodemographic variation in CVD risk factors clustering.

A demand-side view of risk adjustment.

PubMed

Feldman, R; Dowd, B E; Maciejewski, M

2001-01-01

This paper analyzes the efficient allocation of consumers to health plans. Specifically, we address the question of why employers that offer multiple health plans often make larger contributions to the premiums of the high-cost plans. Our perspective is that the subsidy for high-cost plans represents a form of demand-side risk adjustment that improves efficiency. Without such subsidies (and in the absence of formal risk adjustment), too few employees would choose the high-cost plans preferred by high-risk workers. We test the theory by estimating a model of the employer premium subsidy, using data from a survey of large public employers in 1994. Our empirical analysis shows that employers are more likely to subsidize high-cost plans when the benefits of risk adjustment are greater. The findings suggest that the premium subsidy can accomplish some of the benefits of formal risk adjustment.

Child and Family Factors Associated With Child Maltreatment in Vietnam.

PubMed

Tran, Nhu K; van Berkel, Sheila R; van IJzendoorn, Marinus H; Alink, Lenneke R A

2018-04-01

This study aims to explore possible risk factors for child maltreatment in Vietnam by investigating the association of child and family factors with different types of child maltreatment (i.e., sexual abuse, physical abuse, emotional abuse, witnessing parental conflict, and neglect) and the occurrence of multiple types of child maltreatment. Cross-sectional data of 1,851 secondary and high school students aged 12 to 17 years (47.3% boys) in four provinces of Northern Vietnam were obtained using self-report questionnaires. Results indicated that the likelihood of emotional abuse, witnessing parental conflict, and experiencing multiple types of child maltreatment during lifetime increased with age. Boys had a higher risk than girls on lifetime sexual abuse, and past year and lifetime physical abuse. Living in a single parent family was the risk factor related to most types of child maltreatment including lifetime sexual abuse, neglect, and multiple types of child maltreatment, and both past year and lifetime witnessing parental conflict. Interestingly, low socioeconomic status (SES) and parental unemployment were associated with a decreased risk on experiencing emotional abuse in the past year and during lifetime, respectively. "Tiger parenting," a parenting style observed frequently in East Asian parents, may be more common in families with high SES and might explain this finding. This study highlights the importance of prioritizing single parent families in parenting programs and implementing child maltreatment interventions early because of the risk on child maltreatment increased with age. More research on emotional abuse and "Tiger parenting" in Vietnam could clarify the association of emotional abuse with high SES and parental employment. Finally, the underlying mechanisms of the risk factors in Vietnam should be studied more to inform interventions.

Sex differences in mortality in children undergoing congenital heart disease surgery: a United States population-based study.

PubMed

Marelli, Ariane; Gauvreau, Kimberlee; Landzberg, Mike; Jenkins, Kathy

2010-09-14

The changing demographics of the adult congenital heart disease (CHD) population requires an understanding of the factors that impact patient survival to adulthood. We sought to investigate sex differences in CHD surgical mortality in children. Children <18 years old hospitalized for CHD surgery were identified using the Kids' Inpatient Database in 2000, 2003, and 2006. Demographic, diagnostic, and procedural variables were grouped according to RACHS-1 (Risk Adjustment for Congenital Heart Surgery) method. Logistic regression was used to determine the odds ratio of death in females versus males adjusting for RACHS-1 risk category, age, prematurity, major noncardiac anomalies, and multiple procedures. Analyses were stratified by RACHS-1 risk categories and age. Of 33 848 hospitalizations for CHD surgery, 54.7% were in males. Males were more likely than females to have CHD surgery in infancy, high-risk CHD surgery, and multiple CHD procedures. Females had more major noncardiac structural anomalies and more low-risk procedures. However, the adjusted risk of in-hospital death was higher in females (odds ratio, 1.21; 95% confidence interval, 1.08 to 1.36) on account of the subgroup with high-risk surgeries who were <1 year of age (odds ratio, 1.39; 95% confidence interval, 1.16 to 1.67). In this large US population study, more male children underwent CHD surgery and had high-risk procedures. Female infants who had high-risk procedures were at higher risk for death, but this accounted for a small proportion of females and is therefore unlikely to have a major impact on the changing demographics in adults in CHD.

Sun exposure over the life course and associations with multiple sclerosis.

PubMed

Tremlett, Helen; Zhu, Feng; Ascherio, Alberto; Munger, Kassandra L

2018-04-03

To examine sun exposure and multiple sclerosis (MS) over the life course (ages 5-15 and 16-20 years, every 10 years thereafter). Cases with MS (n = 151) and age-matched controls (n = 235) from the Nurses' Health Study cohorts completed summer, winter, and lifetime sun exposure history questionnaires. Cumulative ambient ultraviolet (UV)-B (based on latitude, altitude, cloud cover) exposure before MS onset was expressed as tertiles. Seasonal sun exposure was defined as low vs high hours per week (summer [≤9 vs >10 h/wk]; winter [≤3 vs >4 h/wk]). Relative risks (RRs) and 95% confidence intervals (CIs) were estimated via conditional logistic regression with adjustment for body mass index, ancestry, smoking, and vitamin D supplementation. Most participants were white (98%); the mean age at MS onset was 39.5 years. Living in high (vs low) UV-B areas before MS onset was associated with a 45% lower MS risk (adjusted RR 0.55, 95% CI 0.42-0.73). Similar reduced risks (51%-52%) for medium or high exposure were observed at ages 5 to 15 years and at 5 to 15 years before MS onset (adjusted p < 0.05). At age 5 to 15 years, living in a high (vs low) UV-B area and having high (vs low) summer sun exposure were associated with a lower MS risk (RR 0.45, 95% CI 0.21-0.96). Living in high ambient UV-B areas during childhood and the years leading up to MS onset was associated with a lower MS risk. High summer sun exposure in high ambient UV-B areas was also associated with a reduced risk. © 2018 American Academy of Neurology.

The Queensland high risk foot form (QHRFF) – is it a reliable and valid clinical research tool for foot disease?

PubMed Central

2014-01-01

Background Foot disease complications, such as foot ulcers and infection, contribute to considerable morbidity and mortality. These complications are typically precipitated by “high-risk factors”, such as peripheral neuropathy and peripheral arterial disease. High-risk factors are more prevalent in specific “at risk” populations such as diabetes, kidney disease and cardiovascular disease. To the best of the authors’ knowledge a tool capturing multiple high-risk factors and foot disease complications in multiple at risk populations has yet to be tested. This study aimed to develop and test the validity and reliability of a Queensland High Risk Foot Form (QHRFF) tool. Methods The study was conducted in two phases. Phase one developed a QHRFF using an existing diabetes foot disease tool, literature searches, stakeholder groups and expert panel. Phase two tested the QHRFF for validity and reliability. Four clinicians, representing different levels of expertise, were recruited to test validity and reliability. Three cohorts of patients were recruited; one tested criterion measure reliability (n = 32), another tested criterion validity and inter-rater reliability (n = 43), and another tested intra-rater reliability (n = 19). Validity was determined using sensitivity, specificity and positive predictive values (PPV). Reliability was determined using Kappa, weighted Kappa and intra-class correlation (ICC) statistics. Results A QHRFF tool containing 46 items across seven domains was developed. Criterion measure reliability of at least moderate categories of agreement (Kappa > 0.4; ICC > 0.75) was seen in 91% (29 of 32) tested items. Criterion validity of at least moderate categories (PPV > 0.7) was seen in 83% (60 of 72) tested items. Inter- and intra-rater reliability of at least moderate categories (Kappa > 0.4; ICC > 0.75) was seen in 88% (84 of 96) and 87% (20 of 23) tested items respectively. Conclusions The QHRFF had acceptable validity and reliability across the majority of items; particularly items identifying relevant co-morbidities, high-risk factors and foot disease complications. Recommendations have been made to improve or remove identified weaker items for future QHRFF versions. Overall, the QHRFF possesses suitable practicality, validity and reliability to assess and capture relevant foot disease items across multiple at risk populations. PMID:24468080

Utility of multiple rule out CT screening of high-risk atraumatic patients in an emergency department-a feasibility study.

PubMed

Pries-Heje, Mia M; Hasselbalch, Rasmus B; Raaschou, Henriette; Rezanavaz-Gheshlagh, Bijan; Heebøll, Hanne; Rehman, Shazia; Kristensen, Mariana; Andersen, Erik Henning; Ravn, Lisbet; Nèmery, Michel C; Lind, Morten N; Boel, Thomas; Ulriksen, Peter Sommer; Iversen, Kasper K

2018-02-17

Several large trials have evaluated the effect of CT screening based on specific symptoms, with varying outcomes. Screening of patients with CT based on their prognosis alone has not been examined before. For moderate-to-high risk patients presenting in the emergency department (ED), the potential gain from a CT scan might outweigh the risk of radiation exposure. We hypothesized that an accelerated "multiple rule out" CT screening of moderate-to-high risk patients will detect many clinically unrecognized diagnoses that affect change in treatment. Patients ≥ 40 years, triaged as high-risk or moderate-to-high risk according to vital signs, were eligible for inclusion. Patients were scanned with a combined ECG-gated and dual energy CT scan of cerebrum, thorax, and abdomen. The impact of the CT scan on patient diagnosis and treatment was examined prospectively by an expert panel. A total of 100 patients were included in the study, (53% female, mean age 73 years [age range, 43-93]). The scan lead to change in treatment or additional examinations in 37 (37%) patients, of which 24 (24%) were diagnostically significant, change in acute treatment in 11 (11%) cases and previously unrecognized malignant tumors in 10 (10%) cases. The mean size specific radiation dose was 15.9 mSv (± 3.1 mSv). Screening with a multi-rule out CT scan of high-risk patients in an ED is feasible and result in discovery of clinically unrecognized diagnoses and malignant tumors, but at the cost of radiation exposure and downstream examinations. The clinical impact of these findings should be evaluated in a larger randomized cohort.

Motor vehicle driving in high incidence psychiatric disability: comparison of drivers with ADHD, depression, and no known psychopathology.

PubMed

Aduen, Paula A; Kofler, Michael J; Cox, Daniel J; Sarver, Dustin E; Lunsford, Erin

2015-05-01

Although not often discussed in clinical settings, motor vehicle driving is a complex multitasking endeavor during which a momentary attention lapse can have devastating consequences. Previous research suggests that drivers with high incidence psychiatric disabilities such as ADHD contribute disproportionately to collision rates, which in turn portend myriad adverse social, financial, health, mortality, and legal outcomes. However, self-referral bias and the lack of psychiatric comparison groups constrain the generalizability of these findings. The current study addressed these limitations and examined the unique associations among ADHD, Depression, and adverse driving outcomes, independent of self-selection, driving exposure, and referral bias. The Strategic Highway Research Program (SHRP-2) Naturalistic Driving Study comprises U.S. drivers from six sites selected via probability-based sampling. Groups were defined by Barkley ADHD and psychiatric diagnosis questionnaires, and included ADHD (n = 275), Depression (n = 251), and Healthy Control (n = 1828). Primary outcomes included self-reported traffic collisions, moving violations, collision-related injuries, and collision fault (last 3 years). Accounting for demographic differences, ADHD but not Depression portended increased risk for multiple violations (OR = 2.3) and multiple collisions (OR = 2.2). ADHD but not Depression portended increased risk for collision fault (OR = 2.1). Depression but not ADHD predicted increased risk for self-reported injury following collisions (OR = 2.4). ADHD appears uniquely associated with multiple collisions, multiple violations, and collision fault, whereas Depression is uniquely associated with self-reported injury following a collision. Identification of the specific mechanisms underlying this risk will be critical to designing effective interventions to improve long-term functioning for drivers with high incidence psychiatric disability. Copyright © 2015 Elsevier Ltd. All rights reserved.

Coronary Heart Disease Risk between Active and Inactive Women with Multiple Sclerosis.

ERIC Educational Resources Information Center

Slawta, Jennifer N.; McCubbin, Jeffrey A.; Wilcox, Anthony R.; Fox, Susan D.; Nalle, Darek J.; Anderson, Gail

2002-01-01

Investigated whether abdominal fat accumulation and levels of triglyceride, high-density lipoprotein cholesterol, and glucose differed between 123 active and inactive women with multiple sclerosis (MS). Results indicated that low-to-moderate leisure time physical activity significantly related to less abdominal fat accumulation, lower triglyceride…

High-Risk Obtainment of Prescription Drugs by Older Adults in New Jersey: The Role of Prescription Opioids.

PubMed

Gold, Sarah L; Powell, Kristen Gilmore; Eversman, Michael H; Peterson, N Andrew; Borys, Suzanne; Hallcom, Donald K

2016-10-01

To explore the high-risk ways in which older adults obtain prescription opioids and to identify predictors of obtaining prescription opioids from high-risk sources, such as obtaining the same drug from multiple doctors, sharing drugs, and stealing prescription pads. Logistic regression analyses of cross-sectional survey data from the New Jersey Older Adult Survey on Drug Use and Health, a representative random-sample survey. Adults aged 60 and older (N = 725). Items such as obtaining prescriptions for the same drug from more than one doctor and stealing prescription drugs were measured to determine high-risk obtainment of prescription opioids. Almost 15% of the sample used high-risk methods of obtaining prescription opioids. Adults who previously used a prescription opioid recreationally had three times the risk of high-risk obtainment of prescription opioids. These findings illustrate the importance of strengthening prescription drug monitoring programs to reduce high-risk use of prescription drugs in older adults by alerting doctors and pharmacists to potential prescription drug misuse and interactions. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

A metasynthesis of risk perception in women with high risk pregnancies.

PubMed

Lee, Suzanne; Ayers, Susan; Holden, Des

2014-04-01

risk perception in women with high risk pregnancies affects their decisions about perinatal care and is of interest to anyone involved in the care of pregnant women. This paper provides a metasynthesis of qualitative studies of risk perception in women with high risk pregnancies. a systematic search of eight electronic databases was conducted. Additional papers were obtained through searching references of identified articles. Six studies were identified that reported qualitative research into risk perception in relation to high risk pregnancy. A metasynthesis was developed to describe and interpret the studies. the synthesis resulted in the identification of five themes: determinants of risk perception; not seeing it the way others do; normality versus risk; if the infant is ok, I׳m ok; managing risk. this metasynthesis suggests women at high risk during pregnancy use multiple sources of information to determine their risk status. It shows women are aware of the risks posed by their pregnancies but do not perceive risk in the same way as healthcare professionals. They will take steps to ensure the health of themselves and their infants but these may not include following all medical recommendations. Copyright © 2013 Elsevier Ltd. All rights reserved.

Multiple and concurrent sexual partnerships among men who have sex with men in Viet Nam: results from a National Internet-based Cross-sectional Survey.

PubMed

García, M C; Duong, Q L; Meyer, S B; Ward, P R

2016-03-01

Men who have sex with men (MSM) are one of the largest HIV risk groups in Viet Nam and have been understudied. Sexual concurrency and multiple sex partnerships may contribute to high HIV incidence among MSM in Viet Nam. Limited information is available on concurrency and multiple sexual partnerships among MSM in Viet Nam or on the extent to which this population engages in concurrent and multiple unprotected anal intercourse. Data are from a self-administered Internet-based survey of Vietnamese MSM aged 18 years or older, having sex with male partner(s) in the last 12 months and recruited from social networking MSM-specific websites in Viet Nam. Multiple partnerships and concurrency were measured using the UNAIDS-recommended sexual partner matrix, a key component in the questionnaire. Concurrent and multiple sexual partnerships were analyzed at the individual level. Logistic regression analyses were conducted to assess the demographic characteristics and behaviors associated with multiple sexual partnerships. A total of 1695 MSM reported on multiple sexual partnerships; 69.5% indicated multiple sexual partnerships in the last 6 months. A total of 257 MSM reported on concurrent sexual partnerships, with 51.0% reporting penetrative sex with concurrent partners in the last 6 months. Respondents were more likely to engage in multiple sexual partnerships if they were no longer a student, consumed alcohol before and/or during sex, used the Internet to meet casual sex partners and had never participated in a behavioral HIV intervention. Multiple sexual partnerships in the previous 6 months were common among MSM surveyed, as was sexual concurrency. High levels of multiple and concurrent sexual partnerships may be catalyzing the transmission of HIV among MSM in Viet Nam. Given the high prevalence of this high-risk sexual behavior, our findings underscore the urgent need for targeted prevention efforts, focusing on the reduction of multiple and concurrent sexual partners among this key population. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Escalation to Major Depressive Disorder among Adolescents with Subthreshold Depressive Symptoms: Evidence of Distinct Subgroups at Risk

PubMed Central

Hill, Ryan M.; Pettit, Jeremy W.; Lewinsohn, Peter M.; Seeley, John R.; Klein, Daniel N.

2014-01-01

Background The presence of subthreshold depressive symptoms (SubD) in adolescence is associated with high prospective risk of developing Major Depressive Disorder (MDD). Little is known about variables that predict escalation from SubD to MDD. This study used a longitudinal prospective design in a community sample of adolescents to identify combinations of risk factors that predicted escalation from SubD to MDD. Methods Classification tree analysis was used to identify combinations of risk factors that improved the sensitivity and specificity of prediction of MDD onset among 424 adolescents with a lifetime history of SubD. Results Of the 424, 144 developed MDD during the follow-up period. Evidence for multiple subgroups was found: Among adolescents with poor friend support, the highest risk of escalation was among participants with lifetime histories of an anxiety or substance use disorder. Among adolescents with high friend support, those reporting multiple major life events in the past year or with a history of an anxiety disorder were at highest risk of escalation. Limitations Study findings may not inform prevention efforts for individuals who first develop SubD during adulthood. This study did not examine the temporal ordering of predictors involved in escalation from SubD to MDD. Conclusions Adolescents with a history of SubD were at highest risk of escalation to MDD in the presence of poor friend support and an anxiety or substance use disorder, or in the presence of better friend support, multiple major life events, and an anxiety disorder. Findings may inform case identification approaches for adolescent depression prevention programs. PMID:24655777

Alcohol Use Problems and Sexual Risk among Young Adult African American Mothers

PubMed Central

Swartzendruber, Andrea; Sales, Jessica M.; Rose, Eve S.; DiClemente, Ralph J.

2015-01-01

Studies have documented high levels of alcohol use and sexual risk among young mothers. We examined parenting satisfaction and self-efficacy in relation to alcohol use problems and sexual risk among 346 young African American women enrolled in an HIV prevention trial, 41% (n=141) of whom were mothers. Among mothers, greater parenting satisfaction was associated with a reduced likelihood of problematic alcohol use, having multiple sex partners, and testing positive for Trichomonas vaginalis. Relative to non-parenting women, mothers reported lower condom use. Compared to non-parenting women, mothers with the highest parenting satisfaction reported fewer alcohol use problems; mothers with the lowest parenting satisfaction reported lower condom use and were more likely to have multiple partners and test positive for T. vaginalis. Parenting self-efficacy was not associated with the outcomes examined. Future research investigating relationships between parenting satisfaction, alcohol use and sexual risk may be useful for improving multiple maternal health outcomes. PMID:26499334

The Recidivism Patterns of Previously Deported Aliens Released from a Local Jail: Are They High-Risk Offenders?

ERIC Educational Resources Information Center

Hickman, Laura J.; Suttorp, Marika J.

2010-01-01

Previously deported aliens are a group about which numerous claims are made but very few facts are known. Using data on male deportable aliens released from a local jail, the study sought to test the ubiquitous claim that they pose a high risk of recidivism. Using multiple measures of recidivism and propensity score weighting to account for…

Synthetic Lethality as a Targeted Approach to Advanced Prostate Cancer

DTIC Science & Technology

2014-05-01

syndrome (MDS) [36-41]. Multiple Phase III trials of tipifarnib monotherapy in acute myeloid leukemia (AML) and in refractory advanced colorectal...cytarabine for patients with newly diagnosed acute myeloid leukemia and high-risk myelodysplastic syndrome . Cancer 2011;117(6):1236-44 42. Harousseau JL...multicenter phase 2 study of the farnesyltransferase inhibitor tipifarnib in intermediate- to high-risk myelodysplastic syndrome . Blood 2007;109(10):4158

Affective Functioning among Early Adolescents at High and Low Familial Risk for Depression and Their Mothers: A Focus on Individual and Transactional Processes across Contexts

ERIC Educational Resources Information Center

McMakin, Dana L.; Burkhouse, Katie L.; Olino, Thomas M.; Siegle, Greg J.; Dahl, Ronald E.; Silk, Jennifer S.

2011-01-01

This study aimed to characterize affective functioning in families of youth at high familial risk for depression, with particular attention to features of affective functioning that appear to be critical to adaptive functioning but have been underrepresented in prior research including: positive "and" negative affect across multiple contexts,…

Sick Populations and Sick Subpopulations: Reducing Disparities in Cardiovascular Disease Between Blacks and Whites in the United States.

PubMed

Lu, Yuan; Ezzati, Majid; Rimm, Eric B; Hajifathalian, Kaveh; Ueda, Peter; Danaei, Goodarz

2016-08-09

Cardiovascular disease (CVD) death rates are much higher in blacks than whites in the United States. It is unclear how CVD risk and events are distributed among blacks versus whites and how interventions reduce racial disparities. We developed risk models for fatal and for fatal and nonfatal CVD using 8 cohorts in the United States. We used 6154 adults who were 50 to 69 years of age in the National Health and Nutrition Examination Survey 1999 to 2012 to estimate the distributions of risk and events in blacks and whites. We estimated the total and disparity impacts of a range of population-wide, targeted, and risk-based interventions on 10-year CVD risks and event rates. Twenty-five percent (95% confidence interval [CI], 22-28) of black men and 12% (95% CI, 10-14) of black women were at ≥6.67% risk of fatal CVD (almost equivalent to 20% risk of fatal or nonfatal CVD) compared with 10% (95% CI, 8-12) of white men and 3% (95% CI, 2-4) of white women. These high-risk individuals accounted for 55% (95% CI, 49-59) of CVD deaths among black men and 42% (95% CI, 35-46) in black women compared with 30% (95% CI, 24-35) in white men and 18% (95% CI, 13-22) in white women. We estimated that an intervention that treated multiple risk factors in high-risk individuals could reduce black-white difference in CVD death rate from 1659 to 1244 per 100 000 in men and from 1320 to 897 in women. Rates of fatal and nonfatal CVD were generally similar between black and white men. In women, a larger proportion of women were at ≥7.5% risk of CVD (30% versus 19% in whites), and an intervention that targeted multiple risk factors among this group was estimated to reduce black-white differences in CVD rates from 1688 to 1197 per 100 000. A substantially larger proportion of blacks have a high risk of fatal CVD and bear a large share of CVD deaths. A risk-based intervention that reduces multiple risk factors could substantially reduce overall CVD rates and racial disparities in CVD death rates. © 2016 American Heart Association, Inc.

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

PubMed Central

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

2011-01-01

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

Sexual activity, substance use, and HIV/STD knowledge among detained male adolescents with multiple versus first admissions.

PubMed

Harwell, T S; Trino, R; Rudy, B; Yorkman, S; Gollub, E L

1999-05-01

Incarcerated and detained youth are at high risk for sexually transmitted diseases (STD), including human immunodeficiency virus (HIV). To compare the level of sexual activity and substance use-related risk and knowledge regarding HIV/STD among male adolescents with multiple (YMA) versus first admissions (YFA) to a detention facility as a basis for the development of specific intervention strategies. Sexual and substance use histories, HIV/STD knowledge, and perceived risk were collected through structured interviews of a consecutive sample of detained youth. Human immunodeficiency virus antibody seroprevalence was determined using a blind study of discarded blood. Overall, these youth (N = 486) reported high levels of noninjection drug use, sexual risk activities, and knowledge regarding HIV/STD prevention. Furthermore, most of these youth reported that their risk for HIV infection was low (68%). Eighty-one percent of all youth reported recent (past 6 months) vaginal sex, and 14% reported insertive anal sex. Controlling for age, YMA were more likely to initiate sex at age 13 or younger (OR 1.38; 95% CI, 1.11-1.70), to report eight or more lifetime sex partners (OR 1.36; 95% CI, 1.13-1.63), and to have ever exchanged drugs or money for sex (OR 1.54; 95% CI, 1.08-2.19). However, these youth were less likely to report condom use with their last sex partner (OR 0.74; 95% CI, 0.60-0.93). More than one third (34%) of all youth felt that consistent use of condoms would not provide a high level of protection against HIV. Youth with multiple versus first admissions are at higher risk of HIV/STD infections through their lifetime and recent sexual activities. Interventions targeted to this population will need to address the barriers to and facilitators of condom use, strategies to promote positive attitudes toward condoms, and strategies to reduce the high level of alcohol and substance use.

The renal protective effect of angiotensin receptor blockers depends on intra-individual response variation in multiple risk markers.

PubMed

Schievink, Bauke; de Zeeuw, Dick; Parving, Hans-Henrik; Rossing, Peter; Lambers Heerspink, Hiddo Jan

2015-10-01

Angiotensin receptor blockers (ARBs) are renoprotective and targeted to blood pressure. However, ARBs have multiple other (off-target) effects which may affect renal outcome. It is unknown whether on-target and off-target effects are congruent within individuals. If not, this variation in short term effects may have important implications for the prediction of individual long term renal outcomes. Our aim was to assess intra-individual variability in multiple parameters in response to ARBs in type 2 diabetes. Changes in systolic blood pressure (SBP), albuminuria, potassium, haemoglobin, cholesterol and uric acid after 6 months of losartan treatment were assessed in the RENAAL database. Improvement in predictive performance of renal outcomes (ESRD or doubling serum creatinine) for each individual using ARB-induced changes in all risk markers was assessed by the relative integrative discrimination index (RIDI). SBP response showed high variability (mean -5.7 mmHg, 5(th) to 95(th) percentile -36.5 to +24.0 mmHg) between individuals. Changes in off-target parameters also showed high variability between individuals. No congruency was observed between responses to losartan in multiple parameters within individuals. Using individual responses in all risk markers significantly improved renal risk prediction (RIDI 30.4%, P < 0.01) compared with using only SBP changes. Results were successfully replicated in two independent trials with irbesartan, IDNT and IRMA-2. In this post hoc analysis we showed that ARBs have multiple off-target effects which vary between and within individuals. Combining all ARB-induced responses beyond SBP provides a more accurate prediction of who will benefit from ARB therapy. Prospective trials are required to validate these findings. © 2015 The British Pharmacological Society.

An assessment of high risk sexual behaviour and HIV transmission among migrant oil workers in the Niger Delta area of Nigeria.

PubMed

Nwauche, C A; Akani, C I

2006-06-01

A cross--sectional behavioural survey undertaken amongst migrant oil-workers of an oil exploration outfit operating in the Niger-Delta of Nigeria with the aim of assessing the interplay of migrancy, high-risk sexual behaviour and HIV transmission. A total of 300 randomly selected migrant oil workers were assessed using structured questionnaires to evaluate key high - risk sexual behavioral parameters such as multiplicity of sexual partners, bisexuality (closet homosexuality), high grade sexual behaviour and lesbianism. Sampling period was two months with a control cohort of 200. The prevalence of high risk sexual behaviour (HRSB) amongst the migrant oil workers was found to be 7.7% while low-risk sexual behaviour (LRSB) was 92.3%. There was no record of HRSB in the control group. We did not also encounter any lesbian sexual orientation in this study. The distribution of HRSB amongst the migrant oil workers showed that the commonest variety was bisexuality (closet homosexuality) with 10(43.5%) followed by high-risk sexual behaviour 7(30.4%), while the least common was multiplicity of sexual partners with 6 (26.1%). Furthermore, majority of these individuals 19 (82.6%) were above the age of 35 years. The index of condom-use and acceptance was high. Here 14 (60.9%) found condom-use convenient while 13 (56.5%) regularly used the condom. This study confirms the existence of HRSB among migrant oil workers in the Niger delta. It is therefore advisable to focus interventionist and prevention programmes on this group which appear to be pivotal in the transmission and spread of HIV/AIDS in this environment.

Risk-taking behavior in the presence of nonconvex asset dynamics.

PubMed

Lybbert, Travis J; Barrett, Christopher B

2011-01-01

The growing literature on poverty traps emphasizes the links between multiple equilibria and risk avoidance. However, multiple equilibria may also foster risk-taking behavior by some poor people. We illustrate this idea with a simple analytical model in which people with different wealth and ability endowments make investment and risky activity choices in the presence of known nonconvex asset dynamics. This model underscores a crucial distinction between familiar static concepts of risk aversion and forward-looking dynamic risk responses to nonconvex asset dynamics. Even when unobservable preferences exhibit decreasing absolute risk aversion, observed behavior may suggest that risk aversion actually increases with wealth near perceived dynamic asset thresholds. Although high ability individuals are not immune from poverty traps, they can leverage their capital endowments more effectively than lower ability types and are therefore less likely to take seemingly excessive risks. In general, linkages between behavioral responses and wealth dynamics often seem to run in both directions. Both theoretical and empirical poverty trap research could benefit from making this two-way linkage more explicit.

Cognitive Phenotype of Velocardiofacial Syndrome: A Review

ERIC Educational Resources Information Center

Furniss, Frederick; Biswas, Asit B.; Gumber, Rohit; Singh, Niraj

2011-01-01

The behavioural phenotype of velocardiofacial syndrome (VCFS), one of the most common human multiple anomaly syndromes, includes developmental disabilities, frequently including intellectual disability (ID) and high risk of diagnosis of psychotic disorders including schizophrenia. VCFS may offer a model of the relationship between ID and risk of…

Risk factors for development of multiple-class resistance to Streptococcus pneumoniae Strains in Belgium over a 10-year period: antimicrobial consumption, population density, and geographic location.

PubMed

Van Eldere, Johan; Mera, Robertino M; Miller, Linda A; Poupard, James A; Amrine-Madsen, Heather

2007-10-01

We investigated the impact of the usage of antibiotics in ambulatory patients in Belgium in 147 defined geographical circumscriptions and at the individual isolate level. The study included 14,448 Streptococcus pneumoniae strains collected by the Belgium national reference lab from 1994 to 2004. Additional risk factors for resistance, such as population density/structure and day care attendance, were investigated for the same time-space window. A statistical model that included resistance to two or more antimicrobial classes offered the best fit for measuring the changes in nonsusceptibility to penicillin, macrolides, and tetracycline over time and place in Belgium. Analysis at the geographic level identified antimicrobial consumption with a 1-year lag (0.5% increase per additional defined daily dose) and population density as independent predictors of multiple resistance. Independent risk factors at the isolate level were age (odds ratio [OR], 1.55 for children aged <5 years), population density (7% increase in multiple resistance per 100 inhabitants/km(2)), conjugate 7-valent vaccine serotype (OR, 14.3), location (OR, 1.55 for regions bordering high-resistance France), and isolate source (OR, 1.54 for ear isolates). The expansion of multiple-resistant strains explains most of the overall twofold increase and subsequent decrease in single antimicrobial resistance between 1994 and 2004. We conclude that factors in addition to antibiotic use, such as high population density and proximity to high-resistance regions, favor multiple resistance. Regional resistance rates are not linearly related to actual antibiotic use but are linked to past antibiotic use plus a combination of demographic and geographic factors.

Serum miRNA levels are related to glucose homeostasis and islet autoantibodies in children with high risk for type 1 diabetes.

PubMed

Åkerman, Linda; Casas, Rosaura; Ludvigsson, Johnny; Tavira, Beatriz; Skoglund, Camilla

2018-01-01

Micro RNAs (miRNAs) are promising disease biomarkers due to their high stability. Their expression in serum is altered in type 1 diabetes, but whether deviations exist in individuals with high risk for type 1 diabetes remains unexplored. We therefore assessed serum miRNAs in high-risk individuals (n = 21) positive for multiple islet autoantibodies, age-matched healthy children (n = 17) and recent-onset type 1 diabetes patients (n = 8), using Serum/Plasma Focus microRNA PCR Panels from Exiqon. The miRNA levels in the high-risk group were similar to healthy controls, and no specific miRNA profile was identified for the high-risk group. However, serum miRNAs appeared to reflect glycemic status and ongoing islet autoimmunity in high-risk individuals, since several miRNAs were associated to glucose homeostasis and autoantibody titers. High-risk individuals progressing to clinical disease after the sampling could not be clearly distinguished from non-progressors, while miRNA expression in the type 1 diabetes group deviated significantly from high-risk individuals and healthy controls, perhaps explained by major metabolic disturbances around the time of diagnosis.

IKZF1 expression is a prognostic marker in newly diagnosed standard-risk multiple myeloma treated with lenalidomide and intensive chemotherapy: a study of the German Myeloma Study Group (DSMM).

PubMed

Krönke, J; Kuchenbauer, F; Kull, M; Teleanu, V; Bullinger, L; Bunjes, D; Greiner, A; Kolmus, S; Köpff, S; Schreder, M; Mügge, L-O; Straka, C; Engelhardt, M; Döhner, H; Einsele, H; Bassermann, F; Bargou, R; Knop, S; Langer, C

2017-06-01

Lenalidomide is an immunomodulatory compound with high clinical activity in multiple myeloma. Lenalidomide binding to the Cereblon (CRBN) E3 ubiquitin ligase results in targeted ubiquitination and degradation of the lymphoid transcription factors Ikaros (IKZF1) and Aiolos (IKZF3) leading to growth inhibition of multiple myeloma cells. Recently, Basigin (BSG) was identified as another protein regulated by CRBN that is involved in the activity of lenalidomide. Here, we analyzed the prognostic value of IKZF1, IKZF3, CRBN and BSG mRNA expression levels in pretreatment plasma cells from 60 patients with newly diagnosed multiple myeloma uniformly treated with lenalidomide in combination with intensive chemotherapy within a clinical trial. We found that IKZF1 mRNA expression levels are significantly associated with progression-free survival (PFS). Patients in the lowest quartile (Q1) of IKZF1 expression had a superior PFS compared with patients in the remaining quartiles (Q2-Q4; 3-year PFS of 86 vs 51%, P=0.01). This translated into a significant better overall survival (100 vs 74%, P=0.03). Subgroup analysis revealed a significant impact of IKZF1, IKZF3 and BSG expression levels on PFS in cytogenetically defined standard-risk but not high-risk patients. Our data suggest a prognostic role of IKZF1, IKZF3 and BSG expression levels in lenalidomide-treated multiple myeloma.

Randomized pilot trial of a cognitive-behavioral alcohol, self-harm, and HIV prevention program for teens in mental health treatment.

PubMed

Esposito-Smythers, Christianne; Hadley, Wendy; Curby, Timothy W; Brown, Larry K

2017-02-01

Adolescents with mental health conditions represent a high-risk group for substance use, deliberate self-harm (DSH), and risky sexual behavior. Mental health treatment does not uniformly decrease these risks. Effective prevention efforts are needed to offset the developmental trajectory from mental health problems to these behaviors. This study tested an adjunctive cognitive-behavioral family-based alcohol, DSH, and HIV prevention program (ASH-P) for adolescents in mental healthcare. A two group randomized design was used to compare ASH-P to an assessment only control (AO-C). Participants included 81 adolescents and a parent. Assessments were completed at pre-intervention as well as 1, 6, and 12-months post-enrollment, and included measures of family-based mechanisms and high-risk behaviors. ASH-P relative to AO-C was associated with greater improvements in most family process variables (perceptions of communication and parental disapproval of alcohol use and sexual behavior) as well as less DSH and greater refusal of sex to avoid a sexually transmitted infection. It also had a moderate (but non-significant) effect on odds of binge drinking. No differences were found in suicidal ideation, alcohol use, or sexual intercourse. ASH-P showed initial promise in preventing multiple high-risk behaviors. Further testing of prevention protocols that target multiple high-risk behaviors in clinical samples is warranted. Copyright © 2016 Elsevier Ltd. All rights reserved.

Investment in different sized SMRs: Economic evaluation of stochastic scenarios by INCAS code

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

Barenghi, S.; Boarin, S.; Ricotti, M. E.

2012-07-01

Small Modular LWR concepts are being developed and proposed to investors worldwide. They capitalize on operating track record of GEN II LWR, while introducing innovative design enhancements allowed by smaller size and additional benefits from the higher degree of modularization and from deployment of multiple units on the same site. (i.e. 'Economy of Multiple' paradigm) Nevertheless Small Modular Reactors pay for a dis-economy of scale that represents a relevant penalty on a capital intensive investment. Investors in the nuclear power generation industry face a very high financial risk, due to high capital commitment and exceptionally long pay-back time. Investment riskmore » arise from uncertainty that affects scenario conditions over such a long time horizon. Risk aversion is increased by current adverse conditions of financial markets and general economic downturn, as is the case nowadays. This work investigates both the investment profitability and risk of alternative investments in a single Large Reactor or in multiple SMR of different sizes drawing information from project's Internal Rate of Return stochastic distribution. multiple SMR deployment on a single site with total power installed, equivalent to a single LR. Uncertain scenario conditions and stochastic input assumptions are included in the analysis, representing investment uncertainty and risk. Results show that, despite the combination of much larger number of stochastic variables in SMR fleets, uncertainty of project profitability is not increased, as compared to LR: SMR have features able to smooth IRR variance and control investment risk. Despite dis-economy of scale, SMR represent a limited capital commitment and a scalable investment option that meet investors' interest, even in developed and mature markets, that are traditional marketplace for LR. (authors)« less

Clustering of Multiple Risk Behaviors Among a Sample of 18-Year-Old Australians and Associations With Mental Health Outcomes: A Latent Class Analysis.

PubMed

Champion, Katrina E; Mather, Marius; Spring, Bonnie; Kay-Lambkin, Frances; Teesson, Maree; Newton, Nicola C

2018-01-01

Risk behaviors commonly co-occur, typically emerge in adolescence, and become entrenched by adulthood. This study investigated the clustering of established (physical inactivity, diet, smoking, and alcohol use) and emerging (sedentary behavior and sleep) chronic disease risk factors among young Australian adults, and examined how clusters relate to mental health. The sample was derived from the long-term follow-up of a cohort of Australians. Participants were initially recruited at school as part of a cluster randomized controlled trial. A total of 853 participants (M age  = 18.88 years, SD = 0.42) completed an online self-report survey as part of the 5-year follow-up for the RCT. The survey assessed six behaviors (binge drinking and smoking in the past 6 months, moderate-to-vigorous physical activity/week, sitting time/day, fruit and vegetable intake/day, and sleep duration/night). Each behavior was represented by a dichotomous variable reflecting adherence to national guidelines. Exploratory analyses were conducted. Clusters were identified using latent class analysis. Three classes emerged: "moderate risk" (moderately likely to binge drink and not eat enough fruit, high probability of insufficient vegetable intake; Class 1, 52%); "inactive, non-smokers" (high probabilities of not meeting guidelines for physical activity, sitting time and fruit/vegetable consumption, very low probability of smoking; Class 2, 24%), and "smokers and binge drinkers" (high rates of smoking and binge drinking, poor fruit/vegetable intake; Class 3, 24%). There were significant differences between the classes in terms of psychological distress ( p  = 0.003), depression ( p  < 0.001), and anxiety ( p  = 0.003). Specifically, Class 3 ("smokers and binge drinkers") showed higher levels of distress, depression, and anxiety than Class 1 ("moderate risk"), while Class 2 ("inactive, non-smokers") had greater depression than the "moderate risk" group. Results indicate that risk behaviors are prevalent and clustered in 18-year old Australians. Mental health symptoms were significantly greater among the two classes that were characterized by high probabilities of engaging in multiple risk behaviors (Classes 2 and 3). An examination of the clustering of lifestyle risk behaviors is important to guide the development of preventive interventions. Our findings reinforce the importance of delivering multiple health interventions to reduce disease risk and improve mental well-being.

A systematic review of SNAPO (Smoking, Nutrition, Alcohol, Physical activity and Obesity) randomized controlled trials in young adult men.

PubMed

Ashton, Lee M; Morgan, Philip J; Hutchesson, Melinda J; Rollo, Megan E; Young, Myles D; Collins, Clare E

2015-12-01

To investigate the effectiveness of Smoking, Nutrition, Alcohol, Physical activity and Obesity (SNAPO) interventions in young men exclusively. The secondary aim was to evaluate the recruitment, retention and engagement strategies. A search with no date restrictions was conducted across seven databases. Randomized controlled trials recruiting young men only (aged 18-35 years) into interventions targeting any SNAPO risk factors were included. Ten studies were included (two nutrition, six alcohol use, two targeting multiple SNAPO risk factors). Six studies (two nutrition, three alcohol use and one targeting multiple SNAPO risk factors) demonstrated significant positive short-term intervention effects, but impact was either not assessed beyond the intervention (n=3), had short-term follow-up (≤6 months) (n=2) or not sustained beyond six months (n=1). Overall, a high risk of bias was identified across studies. Only one study undertook a power calculation and recruited the required sample size. Adequate retention was achieved in three studies. Effectiveness of engagement strategies was not reported in any studies. Despite preliminary evidence of short-term effectiveness of SNAPO interventions in young men, few studies characterized by a high risk of bias were identified. High quality SNAPO interventions for young men are warranted. Copyright © 2015 Elsevier Inc. All rights reserved.

Multiplication in egg yolk and survival in egg albumen of genetically and phenotypically characterized Salmonella Enteritidis strains

USDA-ARS?s Scientific Manuscript database

Prompt refrigeration of eggs to prevent the multiplication of Salmonella Enteritidis to high levels during storage is an important practice for reducing the risk of egg-transmitted human illness. The efficacy of egg refrigeration for achieving this goal depends on the location of contamination, the ...

The Ability of American Football Helmets to Manage Linear Acceleration With Repeated High-Energy Impacts.

PubMed

Cournoyer, Janie; Post, Andrew; Rousseau, Philippe; Hoshizaki, Blaine

2016-03-01

Football players can receive up to 1400 head impacts per season, averaging 6.3 impacts per practice and 14.3 impacts per game. A decrease in the capacity of a helmet to manage linear acceleration with multiple impacts could increase the risk of traumatic brain injury. To investigate the ability of football helmets to manage linear acceleration with multiple high-energy impacts. Descriptive laboratory study. Laboratory. We collected linear-acceleration data for 100 impacts at 6 locations on 4 helmets of different models currently used in football. Impacts 11 to 20 were compared with impacts 91 to 100 for each of the 6 locations. Linear acceleration was greater after multiple impacts (91-100) than after the first few impacts (11-20) for the front, front-boss, rear, and top locations. However, these differences are not clinically relevant as they do not affect the risk for head injury. American football helmet performance deteriorated with multiple impacts, but this is unlikely to be a factor in head-injury causation during a game or over a season.

Acculturation, Internalizing Mental Health Symptoms, and Self-Esteem: Cultural Experiences of Latino Adolescents in North Carolina

ERIC Educational Resources Information Center

Smokowski, Paul R.; Bacallao, Martica L.

2007-01-01

This investigation examined acculturation risk factors and cultural assets, internalizing behavioral problems, and self-esteem in 323 Latino adolescents living in North Carolina. Multiple regression analyses revealed two risk factors--perceived discrimination and parent-adolescent conflict--as highly significant predictors of adolescent…

Social anxiety and heavy situational drinking: coping and conformity motives as multiple mediators.

PubMed

Terlecki, Meredith A; Buckner, Julia D

2015-01-01

Individuals with clinically elevated social anxiety are at greater risk for alcohol use disorder, and the relation between social anxiety and drinking problems is at least partially accounted for by drinking more in negative emotional (e.g., feeling sad or angry) and personal/intimate (e.g., before sexual intercourse) situations. Identification of cognitive/motivational factors related to drinking in these high-risk situations could inform the development of treatment and prevention interventions for these high-risk drinkers. The current cross-sectional study examined the mediating effect of drinking motives on the relationship between social anxiety and drinking these high-risk situations among undergraduates (N=232). Clinically elevated social anxiety was associated with greater coping and conformity motives. Both coping and conformity motives mediated the relation between social anxiety and heavier alcohol consumption in negative emotional and personal/intimate contexts. Multiple mediation analyses indicated that these motives work additively to mediate the social anxiety-drinking situations relationship, such that heavy situational drinking among undergraduates with clinically elevated social anxiety can be jointly attributed to desire to cope with negative affect and to avoid social scrutiny. Copyright © 2014 Elsevier Ltd. All rights reserved.

Aquatic Nuisance Species in the Great Lakes and Mississippi River Basin—A Risk Assessment in Support of GLMRIS

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

Grippo, Mark A.; Hlohowskyj, Ihor; Fox, Laura

The U.S. Army Corps of Engineers (USACE) is conducting the Great Lakes and Mississippi River Interbasin Study (GLMRIS) to determine the aquatic nuisance species (ANS) currently established in either the Mississippi River Basin (MRB) or the Great Lakes Basin (GLB) that pose the greatest risk to the other basin. The GLRMIS study focuses specifically on ANS transfer through the Chicago Area Waterway System (CAWS), a multi-use waterway connecting the two basins. In support of GLMRIS, we conducted a qualitative risk assessment for 34 ANS in which we determined overall risk level for four time intervals over a 50-year period ofmore » analysis based on the probability of ANS establishing in a new basin and the environmental, economic, and sociopolitical consequences of their establishment. Probability of establishment and consequences of establishment were assigned qualitative ratings of high, medium, or low and establishment and consequence ratings were then combined into an overall risk rating. Over the 50-year period of analysis, seven species were characterized as posing a medium risk and two species as posing a high risk to the MRB. Three species were characterized as posing a medium risk to the GLB, but no high-risk species were identified for this basin. Based on the time frame in which these species were considered likely to establish in the new basin, risk increased over time for some ANS. Identifying and prioritizing ANS risk supported the development and evaluation of multiple control alternatives that could reduce the probability of interbasin ANS transfer. However, both species traits and the need to balance multiple uses of the CAWS make it difficult to design cost-efficient and socially acceptable controls to reduce the probability of ANS transfer between the two basins.« less

Contamination and health risks of heavy metals in street dust from a coal-mining city in eastern China.

PubMed

Tang, Zhenwu; Chai, Miao; Cheng, Jiali; Jin, Jing; Yang, Yufei; Nie, Zhiqiang; Huang, Qifei; Li, Yanhua

2017-04-01

We collected street dust from Huainan, a typical coal-mining city in China, to investigate the contamination features and health risks of heavy metals. Concentrations of Co, Cr, Cu, Pb, As, and Sb were generally low to moderate, while pollution levels of Cd and Hg were moderate to high. Concentrations of Cd and Hg were associated with considerable health risks at 64.3% and 58.6% of sites, respectively. In particular, about a fifth of samples had associated high risks as a result of Hg contamination levels. Relative to other urban areas, the street dust from the mining area had no more severe metal pollution, which might be partly attributed to the deposition of coal dust onto street dusts. A source assessment indicated that metals in dust form Huainan were mainly derived from vehicular-related activities, industrial emissions, weathering of coal dust and natural soils, and coal combustion. Although the health risk levels from exposure to individual metals in dusts were low, the non-carcinogenic risks from multiple metals to local children exceeded the acceptable level (1.0), suggesting that the overall risk from exposure to multiple metals in dust is concerning. Copyright © 2016 Elsevier Inc. All rights reserved.

High EDSS can predict risk for upper urinary tract damage in patients with multiple sclerosis.

PubMed

Ineichen, Benjamin V; Schneider, Marc P; Hlavica, Martin; Hagenbuch, Niels; Linnebank, Michael; Kessler, Thomas M

2018-04-01

Neurogenic lower urinary tract dysfunction (NLUTD) is very common in patients with multiple sclerosis (MS), and it might jeopardize renal function and thereby increase mortality. Although there are well-known urodynamic risk factors for upper urinary tract damage, no clinical prediction parameters are available. We aimed to assess clinical parameters potentially predicting urodynamic risk factors for upper urinary tract damage. A consecutive series of 141 patients with MS referred from neurologists for primary neuro-urological work-up including urodynamics were prospectively evaluated. Clinical parameters taken into account were age, sex, duration, and clinical course of MS and Expanded Disability Status Scale (EDSS). Multivariate modeling revealed EDSS as a clinical parameter significantly associated with urodynamic risk factors for upper urinary tract damage (odds ratio = 1.34, 95% confidence interval (CI) = 1.06-1.71, p = 0.02). Using receiver operator characteristic (ROC) curves, an EDSS of 5.0 as cutoff showed a sensitivity of 86%-87% and a specificity of 52% for at least one urodynamic risk factor for upper urinary tract damage. High EDSS is significantly associated with urodynamic risk factors for upper urinary tract damage and allows a risk-dependent stratification in daily neurological clinical practice to identify MS patients requiring further neuro-urological assessment and treatment.

Maternal high-risk fertility behavior and association with chronic undernutrition among children under age 5 y in India, Bangladesh, and Nepal: Do poor children have a higher risk?

PubMed

Rahman, Mosiur; Haque, Syed Emdadul; Zahan, Sarwar; Islam, Jahirul; Rahman, Mosfequr; Asaduzzaman, M D; Haque, Nuruzzaman; Islam, Ahmed Zohirul; Huda, Durul; Mostofa, Golam

2018-05-01

We aimed to examine whether an association exists between maternal high-risk fertility behavior and chronic undernutrition among children under 5 y of age. In addition, we explored the relationship between poverty and high-risk fertility behavior and the relative roles they play as obstacles in the reduction of the risk of undernutrition among children. The analysis was based on responses from married women ages 15 to 49 who lived with at least one child under the age of 5; and three cross-sectional, nationally representative samples from India, Bangladesh, and Nepal were considered. Maternal high-risk fertility behavior was associated with an increased risk of chronic undernutrition among children in India, Bangladesh, and Nepal. Multiple high-risk categories appeared to have more profound consequences on the outcomes measured. Findings also demonstrated that with regard to the risk of undernutrition, children of mothers who were either poor or who experienced high-risk fertility were not uniquely disadvantaged. The results suggest that with regard to the risk of chronic undernutrition, the negative effect of high-risk fertility behavior extends across all economic backgrounds and is not limited to children of mothers who were either poor or who experienced high-risk fertility. Copyright © 2017 Elsevier Inc. All rights reserved.

Dilemmas in Treating Smoldering Multiple Myeloma

PubMed Central

Ahn, Inhye E.; Mailankody, Sham; Korde, Neha; Landgren, Ola

2015-01-01

Novel therapies hold promise for high-risk smoldering multiple myeloma (SMM). Recent studies suggest that modern combination approaches can be options for high-risk SMM to obtain deep molecular responses with favorable toxicity profiles. Although pioneering treatment trials based on small numbers of patients suggest progression-free and overall survival benefits, application of the data to real-life practice remains to be validated. Therapeutic modulation of disease tempo, disease burden, clonal evolution, and tumor microenvironment in SMM remains to be understood and calls for reliable biomarkers reflective of disease biology. Here, we review studies that open a new management platform for SMM, address ongoing dilemmas in practice and under investigation, and highlight emerging scientific questions in the era of SMM treatment. PMID:25422486

Perception of risk of HIV and sexual risk behaviors among University students: implication for planning interventions.

PubMed

Shiferaw, Yitayal; Alemu, Abebe; Assefa, Abate; Tesfaye, Berihun; Gibermedhin, Etsegenet; Amare, Misiker

2014-03-19

The university environment offers great opportunity for HIV high-risk behaviors, including unsafe sex and multiple partnerships. Despite recently gained decline of the overall incidence of HIV infection, still significant proportion of youth population are at high risk of HIV infection. The aims of this study were to assess the perception of HIV risk and factors associated with risk perception among students at University of Gondar, Northwest Ethiopia. A cross sectional study was conducted between February and April, 2012 among health science students. A total of 384 students were involved in the study using stratified sampling technique. Chi-square test and logistic regression analysis were employed. P-value < 0.05 was considered statistically significant for all cases. Of the total 384 participated students, 200(52.1%) were females. Out of the total study respondents, 202(52.6%) were sexually experienced. One hundred and nine (59.2%) out of 184 males and 93(46.5%) out of 200 females had had sexual experience. About 23(57.5%) of those age below 20 years, 70(52.2%) of 20-24 years old, and 13(61.9%) of those ages of 25 years or older were perceived themselves as if they have no chance of acquiring HIV infection. Students initiated sexual intercourse at early age (≤8 years) were significantly associated with having multiple partnerships (crude OR =3.6, p = 0.002 for male and crude OR = 1.7, p = 0.04 for female). Statistically significant difference was observed in the distribution of condom use during sexual intercourse among various age groups (p-value = 0.001). Sexual initiation at younger age, having multiple partnerships, inconsistent condom use and alcohol and/or drug abuse were significantly perceived as predictor for an increased risks for HIV infection. Students were engaged in various HIV risk behaviors. Early sexual initiation and alcohol and/or drug abuse were important factors for having multiple partnerships. Poor agreement between having HIV risk behaviors and perception of HIV risk were observed. Attention has to be given on the role of alcohol and/or drug abuse in the participation of HIV risk behaviors in the design and implementation of HIV prevention for university students.

Relationship Factors Associated with Sexual Risk Behavior and High-Risk Alcohol Consumption Among Latino Men Who Have Sex with Men: Challenges and Opportunities to Intervene on HIV Risk.

PubMed

Martinez, Omar; Muñoz-Laboy, Miguel; Levine, Ethan C; Starks, Tyrel; Dolezal, Curtis; Dodge, Brian; Icard, Larry; Moya, Eva; Chavez-Baray, Silvia; Rhodes, Scott D; Fernandez, M Isabel

2017-05-01

The HIV epidemic continues to be a major public health concern, affecting communities with varying prevention and treatment needs. In the U.S., Latino men who have sex with men (MSM) bear a disproportionate burden of HIV incidence. While recent studies have highlighted the relevance of relationship factors for HIV transmission among MSM generally, the unique needs and experiences of Latino MSM have received relatively little attention. Consequently, associations between relationship factors and HIV risk among Latino MSM remain unknown. This mixed-method study examined relationship status and dynamics and potential HIV-related risk behaviors among Latino MSM. Quantitative analyses with 240 Latino MSM investigated associations between relationship status and engagement in condomless anal intercourse (CAI). Focus groups with 20 Latino male couples and 10 health service providers explored the impact of relationship dynamics on sexual behaviors, as well as opportunities to intervene on HIV risk. The majority of participants were predominantly Spanish speaking, most screened positive for high-risk alcohol consumption in the past month, more than half engaged in CAI in the past 3 months, and a majority reported multiple sexual partners in this period. Among participants in same-sex relationships (n = 175), approximately half reported multiple partners in the previous 3 months and more than two-thirds reported CAI in this time period. Being in a same-sex relationship was positively associated with high-risk alcohol consumption and being age 30 or older and negatively associated with having multiple partners. Moreover, being in a same-sex relationship significantly increased the likelihood that participants would report engaging in CAI. Qualitative analyses identified themes related to relationship dynamics and sexual behavior, as well as opportunities to intervene on HIV risk. Despite the challenges encountered by Latino male couples, most participants expressed commitment to and support for their partners. As such, prevention efforts involving Latino male couples must address relationship dynamics and the role they play in sexual health, including safer sex practices.

Relationship Factors Associated with Sexual Risk Behavior and High-Risk Alcohol Consumption among Latino MSM: Challenges and Opportunities to Intervene on HIV Risk

PubMed Central

Martinez, Omar; Muñoz-Laboy, Miguel; Levine, Ethan; Starks, Tyrel; Dolezal, Curtis; Dodge, Brian; Icard, Larry; Moya, Eva; Chavez-Baray, Silvia; Rhodes, Scott D.; Fernandez, M. Isabel

2016-01-01

The HIV epidemic continues to be a major public health concern, affecting communities with varying prevention and treatment needs. In the United States, Latino men who have sex with men (MSM) bear a disproportionate burden of HIV incidence. While recent studies have highlighted the relevance of relationship factors for HIV transmission among MSM generally, the unique needs and experiences of Latino MSM have received relatively little attention. Consequently, associations among relationship factors and HIV risk among Latino MSM remain unknown. This mixed-methods study examined relationship status and dynamics and potential HIV-related risk behaviors among Latino MSM. Quantitative analyses with 240 Latino MSM investigated associations between relationship status and engagement in condomless anal intercourse (CAI). Focus groups with 20 Latino male couples and 10 health service providers explored the impact of relationship dynamics on sexual behaviors, as well as opportunities to intervene on HIV risk. The majority of participants were predominantly Spanish speaking, most screened positive for high-risk alcohol consumption in the past month, more than half engaged in CAI in the past three months, and a majority reported multiple sexual partners in this period. Among participants in same-sex relationships (n=175), approximately half reported multiple partners in the previous three months and more than two-thirds reported CAI in this time period. Being in a same-sex relationship was positively associated with high-risk alcohol consumption and being age 30 or older, and negatively associated with having multiple partners. Moreover, being in a same-sex relationship significantly increased the likelihood that participants would report engaging in CAI. Qualitative analyses identified themes related to relationship dynamics and sexual behavior, as well as opportunities to intervene on HIV risk. Despite the challenges encountered by Latino male couples, most participants expressed commitment to and support for their partners. As such, prevention efforts involving Latino male couples must address relationship dynamics and the role they play in sexual health, including safer sex practices. PMID:27633063

Escalation to Major Depressive Disorder among adolescents with subthreshold depressive symptoms: evidence of distinct subgroups at risk.

PubMed

Hill, Ryan M; Pettit, Jeremy W; Lewinsohn, Peter M; Seeley, John R; Klein, Daniel N

2014-04-01

The presence of subthreshold depressive symptoms (SubD) in adolescence is associated with high prospective risk of developing Major Depressive Disorder (MDD). Little is known about variables that predict escalation from SubD to MDD. This study used a longitudinal prospective design in a community sample of adolescents to identify combinations of risk factors that predicted escalation from SubD to MDD. Classification tree analysis was used to identify combinations of risk factors that improved the sensitivity and specificity of prediction of MDD onset among 424 adolescents with a lifetime history of SubD. Of the 424, 144 developed MDD during the follow-up period. Evidence for multiple subgroups was found: among adolescents with poor friend support, the highest risk of escalation was among participants with lifetime histories of an anxiety or substance use disorder. Among adolescents with high friend support, those reporting multiple major life events in the past year or with a history of an anxiety disorder were at highest risk of escalation. Study findings may not inform prevention efforts for individuals who first develop SubD during adulthood. This study did not examine the temporal ordering of predictors involved in escalation from SubD to MDD. Adolescents with a history of SubD were at highest risk of escalation to MDD in the presence of poor friend support and an anxiety or substance use disorder, or in the presence of better friend support, multiple major life events, and an anxiety disorder. Findings may inform case identification approaches for adolescent depression prevention programs. Copyright © 2014 Elsevier B.V. All rights reserved.

The relationship between health risks and health and productivity costs among employees at Pepsi Bottling Group.

PubMed

Henke, Rachel M; Carls, Ginger S; Short, Meghan E; Pei, Xiaofei; Wang, Shaohung; Moley, Susan; Sullivan, Mark; Goetzel, Ron Z

2010-05-01

To evaluate relationships between modifiable health risks and costs and measure potential cost savings from risk reduction programs. Health risk information from active Pepsi Bottling Group employees who completed health risk assessments between 2004 and 2006 (N = 11,217) were linked to medical care, workers' compensation, and short-term disability cost data. Ten health risks were examined. Multivariate analyses were performed to estimate costs associated with having high risk, holding demographics, and other risks constant. Potential savings from risk reduction were estimated. High risk for weight, blood pressure, glucose, and cholesterol had the greatest impact on total costs. A one-percentage point annual reduction in the health risks assessed would yield annual per capita savings of $83.02 to $103.39. Targeted programs that address modifiable health risks are expected to produce substantial cost reductions in multiple benefit categories.

Risk factors of suicide mortality among multiple attempters: A national registry study in Taiwan.

PubMed

Chen, I-Ming; Liao, Shih-Cheng; Lee, Ming-Been; Wu, Chia-Yi; Lin, Po-Hsien; Chen, Wei J

2016-05-01

Little is known about the risk factors of suicide mortality among multiple attempters. This study aims to investigate the predictors of suicidal mortality in a prospective cohort of attempters in Taiwan, focusing on the time interval and suicide method change between the last two nonfatal attempts. The representative data retrieved from the National Suicide Surveillance System (NSSS) was linked with National Mortality Database to identify the causes of death in multiple attempters during 2006-2008. Cox-proportional hazard models were applied to calculate the hazard ratios for the predictors of suicide. Among the 55,560 attempters, 6485 (11.7%) had survived attempts ranging from one to 11 times; 861 (1.5%) eventually died by suicide. Multiple attempters were characterized by female (OR = 1.56, p < 0.0001), nonrecipient of national aftercare service (OR = 1.62, p < 0.0001), and current contact with mental health services (OR = 3.17, p < 0.0001). Most multiple attempters who survived from hanging (68.1%) and gas poisoning (61.9%) chose the same method in the following fatal episode. Predictors of suicidal death were identified as male, older age (≥ 45 years), shorter interval and not maintaining methods of low lethality in the last two nonfatal attempts. Receipt of nationwide aftercare was associated with lower risk of suicide but the effect was insignificant. The time interval of the last two nonfatal attempts and alteration in the lethality of suicide method were significant factors for completed suicide. Risk assessment involving these two factors may be necessary for multiple attempters in different clinical settings. Effective strategies for suicide prevention emphasizing this high risk population should be developed in the future. Copyright © 2015. Published by Elsevier B.V.

Too attractive: the growing problem of magnet ingestions in children.

PubMed

Brown, Julie C; Otjen, Jeffrey P; Drugas, George T

2013-11-01

Small, powerful magnets are increasingly available in toys and other products and pose a health risk. Small spherical neodymium magnets marketed since 2008 are of particular concern. The objective of this study was to determine the incidence, characteristics, and management of single and multiple-magnet ingestions over time. Magnet ingestion cases at a tertiary children's hospital were identified using radiology reports from June 2002 to December 2012. Cases were verified by chart and imaging review. Relative risk regressions were used to determine changes in the incidence of ingestions and interventions over time. Of 56 cases of magnet ingestion, 98% occurred in 2006 or later, and 57% involved multiple magnets. Median age was 8 years (range, 0-18 years). Overall, 21% of single and 88% of multiple ingestions had 2 or more imaging series obtained, whereas no single and 56.3% of multiple ingestions required intervention (25.0% endoscopy, 18.8% surgery, 12.5% both). Magnet ingestions increased in 2010 to 2012 compared with 2007 to 2009 (relative risk, 1.9; 95% confidence interval, 1.2-3.0). Small, spherical magnets likely from magnet sets comprised 27% of ingestions, all ingested 2010 or later: 86% involved multiple magnets, 50% of which required intervention. Excluding these cases, ingestions of other magnets did not increase in 2010 to 2012 compared with 2007 to 2009 (relative risk, 0.94; 95% confidence interval, 0.6-1.4). The incidence of pediatric magnet ingestions and subsequent interventions has increased over time. Multiple-magnet ingestions result in high utilization of radiological imaging and surgical interventions. Recent increases parallel the increased availability of small, spherical magnet sets. Young and at-risk children should not have access to these and other small magnets. Improved regulation and magnet safety standards are needed.

Detection of high-risk mucosal human papillomavirus DNA in human specimens by a novel and sensitive multiplex PCR method combined with DNA microarray.

PubMed

Gheit, Tarik; Tommasino, Massimo

2011-01-01

Epidemiological and functional studies have clearly demonstrated that certain types of human papillomavirus (HPV) from the genus alpha of the HPV phylogenetic tree, referred to as high-risk (HR) types, are the etiological cause of cervical cancer. Several methods for HPV detection and typing have been developed, and their importance in clinical and epidemiological studies has been well demonstrated. However, comparative studies have shown that several assays have different sensitivities for the detection of specific HPV types, particularly in the case of multiple infections. In this chapter, we describe a novel one-shot method for the detection and typing of 19 mucosal HR HPV types (types 16, 18, 26, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66, 68, 70, 73, and 82). The assay combines the advantages of the multiplex PCR methods, i.e., high sensitivity and the possibility to perform multiple amplifications in a single reaction, with an array primer extension (APEX) assay. The latter method offers the benefits of Sanger dideoxy sequencing with the high-throughput potential of the microarray. Initial studies have revealed that the assay is very sensitive in detecting multiple HPV infections.

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

PubMed

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

2017-07-01

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

Developmental Patterns of Adolescent Marijuana and Alcohol Use and Their Joint Association with Sexual Risk Behavior and Outcomes in Young Adulthood.

PubMed

Green, Kerry M; Musci, Rashelle J; Matson, Pamela A; Johnson, Renee M; Reboussin, Beth A; Ialongo, Nicholas S

2017-02-01

Urban populations disproportionately experience poor sexual outcomes, including high rates of teenage pregnancy and sexually transmitted infections. However, the contribution of substance use across adolescence to poor sexual outcomes in young adulthood has not been investigated in depth, despite offering opportunities for more targeted prevention. This study aimed to estimate joint trajectories of adolescent alcohol and marijuana use to determine if they relate differently to four sexual outcomes: multiple sexual partners, sex without a condom, teenage pregnancy, and contraction of a sexually transmitted infection in young adulthood (by age 25). Data came from a longitudinal study of urban youth followed from age 6 to age 25, with annual assessments during adolescence and young adulthood (n = 608). The sample showed high levels of sexual risk, with young adults on average having sex without a condom once in the past month, 28.5% having multiple sexual partners in the past month, one quarter having contracted a sexually transmitted infection, and over 60% of the women being pregnant as a teenager and 36% of the men having gotten a partner pregnant. Applying longitudinal latent profile analysis to estimate joint trajectories of alcohol and marijuana use from grades 8-12, we identified four classes representing high dual use, moderate alcohol use, moderate alcohol use with increasing marijuana use, and non-use. Class membership differently predicted all four outcomes investigated with high dual users having the highest level of teenage pregnancy and the increasing marijuana trajectory having the highest risk of engaging with multiple sexual partners in the past month. Results suggest implications for both sexual risk and substance use prevention for urban youth.

Morphological characteristics associated with rupture risk of multiple intracranial aneurysms.

PubMed

Wang, Guang-Xian; Liu, Lan-Lan; Wen, Li; Cao, Yun-Xing; Pei, Yu-Chun; Zhang, Dong

2017-10-01

To identify the morphological parameters that are related to intracranial aneurysms (IAs) rupture using a case-control model. A total of 107 patients with multiple IAs and aneurysmal subarachnoid hemorrhage between August 2011 and February 2017 were enrolled in this study. Characteristics of IAs location, shape, neck width, perpendicular height, depth, maximum size, flow angle, parent vessel diameter (PVD), aspect ratio (AR) and size ratio (SR) were evaluated using CT angiography. Multiple logistic regression analysis was used to identify the independent risk factors associated with IAs rupture. Receiver operating characteristic curve analysis was performed on the final model, and the optimal thresholds were obtained. IAs located in the internal carotid artery (ICA) was associated with a negative risk of rupture, whereas AR, SR1 (height/PVD) and SR2 (depth/PVD) were associated with increased risk of rupture. When SR was calculated differently, the odds ratio values of these factors were also different. The receiver operating characteristic curve showed that AR, SR1 and SR2 had cut-off values of 1.01, 1.48 and 1.40, respectively. SR3 (maximum size/PVD) was not associated with IAs rupture. IAs located in the ICA are associated with a negative risk of rupture, while high AR (>1.01), SR1 (>1.48) or SR2 (>1.40) are risk factors for multiple IAs rupture. Copyright © 2017 Hainan Medical University. Production and hosting by Elsevier B.V. All rights reserved.

Applying clinical guidelines in general practice: a qualitative study of potential complications.

PubMed

Austad, Bjarne; Hetlevik, Irene; Mjølstad, Bente Prytz; Helvik, Anne-Sofie

2016-07-22

Clinical guidelines for single diseases often pose problems in general practice work with multimorbid patients. However, little research focuses on how general practice is affected by the demand to follow multiple guidelines. This study explored Norwegian general practitioners' (GPs') experiences with and reflections upon the consequences for general practice of applying multiple guidelines. Qualitative focus group study carried out in Mid-Norway. The study involved a purposeful sample of 25 Norwegian GPs from four pre-existing groups. Interviews were audio-recorded, transcribed and analyzed using systematic text condensation, i.e. applying a phenomenological approach. The GPs' responses clustered around two major topics: 1) Complications for the GPs of applying multiple guidelines; and, 2) Complications for their patients when GPs apply multiple guidelines. For the GPs, applying multiple guidelines created a highly problematic situation as they felt obliged to implement guidelines that were not suited to their patients: too often, the map and the terrain did not match. They also experienced greater insecurity regarding their own practice which, they admitted, resulted in an increased tendency to practice 'defensive medicine'. For their patients, the GPs experienced that applying multiple guidelines increased the risk of polypharmacy, excessive non-pharmacological recommendations, a tendency toward medicalization and, for some, a reduction in quality of life. The GPs experienced negative consequences when obliged to apply a variety of single disease guidelines to multimorbid patients, including increased risk of polypharmacy and overtreatment. We believe patient-centered care and the GPs' courage to non-comply when necessary may aid in reducing these risks. Health care authorities and guideline developers need to be aware of the potential negative effects of applying a single disease focus in general practice, where multimorbidity is highly prevalent.

Incidence of neutropenia and use of granulocyte colony-stimulating factors in multiple myeloma: is current clinical practice adequate?

PubMed

Leleu, Xavier; Gay, Francesca; Flament, Anne; Allcott, Kim; Delforge, Michel

2018-03-01

Although immunomodulatory drugs, alkylating agents, corticosteroids, protease inhibitors, and therapeutic monoclonal antibodies improve multiple myeloma outcomes, treatment burden is still an issue. Neutropenia is a known complication of cytotoxic cancer therapy and is often associated with infections; it is an important consideration in myeloma given the fact that patients often have a weakened immune system. The risk of febrile neutropenia increases with severe and persisting neutropenia. Recombinant granulocyte colony-stimulating factors (G-CSFs) are commonly used to reduce the incidence, duration, and severity of febrile neutropenia. Here, we review the risk and management of neutropenia associated with new and commonly used anti-myeloma agents. Few papers report the use of G-CSF in patients with multiple myeloma receiving anti-cancer treatments, and fewer describe whether G-CSF was beneficial. None of the identified studies reported G-CSF primary prophylaxis. Further studies are warranted to evaluate the need for G-CSF prophylaxis in multiple myeloma. Prophylaxis may be particularly useful in patients at high risk of prolonged severe neutropenia.

Innovative model uses a new brand of specialist to target the high-risk chronically ill.

PubMed

2002-06-01

Some patients simply can't be taken care of in your typical 15-minute office visit. That's why a Houston-based organization developed a new model--and a new specialist--to deal with the growing number of patients affected by multiple diagnoses and other factors putting them at high risk for hospital utilization. With early success, the approach has now attracted the attention of Medicare and other insurers.

A modeling framework for exposing risks in complex systems.

PubMed

Sharit, J

2000-08-01

This article introduces and develops a modeling framework for exposing risks in the form of human errors and adverse consequences in high-risk systems. The modeling framework is based on two components: a two-dimensional theory of accidents in systems developed by Perrow in 1984, and the concept of multiple system perspectives. The theory of accidents differentiates systems on the basis of two sets of attributes. One set characterizes the degree to which systems are interactively complex; the other emphasizes the extent to which systems are tightly coupled. The concept of multiple perspectives provides alternative descriptions of the entire system that serve to enhance insight into system processes. The usefulness of these two model components derives from a modeling framework that cross-links them, enabling a variety of work contexts to be exposed and understood that would otherwise be very difficult or impossible to identify. The model components and the modeling framework are illustrated in the case of a large and comprehensive trauma care system. In addition to its general utility in the area of risk analysis, this methodology may be valuable in applications of current methods of human and system reliability analysis in complex and continually evolving high-risk systems.

Phenomenological Analysis of the Experiences of Underprepared College Students Who Persist

ERIC Educational Resources Information Center

Larsen, Mary Jo

2016-01-01

This study examined the experiences of six college participants who entered college with many risk-factors for drop-out, but who persisted to graduation. The present research was conducted at a private, liberal arts university. All participants possessed multiple risk factors for drop-out including low high school academic performance,…

Prognostic Classification Factors Associated With Development of Multiple Autoantibodies, Dysglycemia, and Type 1 Diabetes—A Recursive Partitioning Analysis

PubMed Central

Krischer, Jeffrey P.

2016-01-01

OBJECTIVE To define prognostic classification factors associated with the progression from single to multiple autoantibodies, multiple autoantibodies to dysglycemia, and dysglycemia to type 1 diabetes onset in relatives of individuals with type 1 diabetes. RESEARCH DESIGN AND METHODS Three distinct cohorts of subjects from the Type 1 Diabetes TrialNet Pathway to Prevention Study were investigated separately. A recursive partitioning analysis (RPA) was used to determine the risk classes. Clinical characteristics, including genotype, antibody titers, and metabolic markers were analyzed. RESULTS Age and GAD65 autoantibody (GAD65Ab) titers defined three risk classes for progression from single to multiple autoantibodies. The 5-year risk was 11% for those subjects >16 years of age with low GAD65Ab titers, 29% for those ≤16 years of age with low GAD65Ab titers, and 45% for those subjects with high GAD65Ab titers regardless of age. Progression to dysglycemia was associated with islet antigen 2 Ab titers, and 2-h glucose and fasting C-peptide levels. The 5-year risk is 28%, 39%, and 51% for respective risk classes defined by the three predictors. Progression to type 1 diabetes was associated with the number of positive autoantibodies, peak C-peptide level, HbA1c level, and age. Four risk classes defined by RPA had a 5-year risk of 9%, 33%, 62%, and 80%, respectively. CONCLUSIONS The use of RPA offered a new classification approach that could predict the timing of transitions from one preclinical stage to the next in the development of type 1 diabetes. Using these RPA classes, new prevention techniques can be tailored based on the individual prognostic risk characteristics at different preclinical stages. PMID:27208341

Migration, multiple sexual partnerships, and sexual concurrency in the Garífuna population of Honduras

PubMed Central

Gandhi, Anisha D.; Pettifor, Audrey; Barrington, Clare; Marshall, Stephen W.; Behets, Frieda; Guardado, Maria Elena; Farach, Nasim; Ardón, Elvia; Paz-Bailey, Gabriela

2015-01-01

The Garífuna, an ethnic minority group in Honduras, have been disproportionately affected by HIV. Previous research suggests that migration and high rates of multiple sexual partnerships are major drivers of the epidemic. Using data from a 2012 population-based survey, we assessed whether temporary migration was associated with 1) multiple sexual partnerships and 2) sexual concurrency among Garífuna men and women in Honduras. Among both men and women, temporary migration in the last year was associated with an increased likelihood of multiple sexual partnerships and with concurrency, though only the association between migration and multiple sexual partnerships among men was statistically significant (Adjusted Prevalence Ratio 1.7, 95% CI 1.2-2.4). Migration may contribute to HIV/STI vulnerability among Garífuna men and women via increases in these sexual risk behaviors. Research conducted among men and women at elevated risk of HIV should continue to incorporate measures of mobility, including history of internal migration. PMID:26242612

Migration, Multiple Sexual Partnerships, and Sexual Concurrency in the Garífuna Population of Honduras.

PubMed

Gandhi, Anisha D; Pettifor, Audrey; Barrington, Clare; Marshall, Stephen W; Behets, Frieda; Guardado, Maria Elena; Farach, Nasim; Ardón, Elvia; Paz-Bailey, Gabriela

2015-09-01

The Garífuna, an ethnic minority group in Honduras, have been disproportionately affected by HIV. Previous research suggests that migration and high rates of multiple sexual partnerships are major drivers of the epidemic. Using data from a 2012 population-based survey, we assessed whether temporary migration was associated with (1) multiple sexual partnerships and (2) sexual concurrency among Garífuna men and women in Honduras. Among both men and women, temporary migration in the last year was associated with an increased likelihood of multiple sexual partnerships and with concurrency, though only the association between migration and multiple sexual partnerships among men was statistically significant (Adjusted Prevalence Ratio 1.7, 95 % CI 1.2-2.4). Migration may contribute to HIV/STI vulnerability among Garífuna men and women via increases in these sexual risk behaviors. Research conducted among men and women at elevated risk of HIV should continue to incorporate measures of mobility, including history of internal migration.

Analysis of immune-related loci identifies 48 new susceptibility variants for multiple sclerosis

PubMed Central

Beecham, Ashley H; Patsopoulos, Nikolaos A; Xifara, Dionysia K; Davis, Mary F; Kemppinen, Anu; Cotsapas, Chris; Shahi, Tejas S; Spencer, Chris; Booth, David; Goris, An; Oturai, Annette; Saarela, Janna; Fontaine, Bertrand; Hemmer, Bernhard; Martin, Claes; Zipp, Frauke; D’alfonso, Sandra; Martinelli-Boneschi, Filippo; Taylor, Bruce; Harbo, Hanne F; Kockum, Ingrid; Hillert, Jan; Olsson, Tomas; Ban, Maria; Oksenberg, Jorge R; Hintzen, Rogier; Barcellos, Lisa F; Agliardi, Cristina; Alfredsson, Lars; Alizadeh, Mehdi; Anderson, Carl; Andrews, Robert; Søndergaard, Helle Bach; Baker, Amie; Band, Gavin; Baranzini, Sergio E; Barizzone, Nadia; Barrett, Jeffrey; Bellenguez, Céline; Bergamaschi, Laura; Bernardinelli, Luisa; Berthele, Achim; Biberacher, Viola; Binder, Thomas M C; Blackburn, Hannah; Bomfim, Izaura L; Brambilla, Paola; Broadley, Simon; Brochet, Bruno; Brundin, Lou; Buck, Dorothea; Butzkueven, Helmut; Caillier, Stacy J; Camu, William; Carpentier, Wassila; Cavalla, Paola; Celius, Elisabeth G; Coman, Irène; Comi, Giancarlo; Corrado, Lucia; Cosemans, Leentje; Cournu-Rebeix, Isabelle; Cree, Bruce A C; Cusi, Daniele; Damotte, Vincent; Defer, Gilles; Delgado, Silvia R; Deloukas, Panos; di Sapio, Alessia; Dilthey, Alexander T; Donnelly, Peter; Dubois, Bénédicte; Duddy, Martin; Edkins, Sarah; Elovaara, Irina; Esposito, Federica; Evangelou, Nikos; Fiddes, Barnaby; Field, Judith; Franke, Andre; Freeman, Colin; Frohlich, Irene Y; Galimberti, Daniela; Gieger, Christian; Gourraud, Pierre-Antoine; Graetz, Christiane; Graham, Andrew; Grummel, Verena; Guaschino, Clara; Hadjixenofontos, Athena; Hakonarson, Hakon; Halfpenny, Christopher; Hall, Gillian; Hall, Per; Hamsten, Anders; Harley, James; Harrower, Timothy; Hawkins, Clive; Hellenthal, Garrett; Hillier, Charles; Hobart, Jeremy; Hoshi, Muni; Hunt, Sarah E; Jagodic, Maja; Jelčić, Ilijas; Jochim, Angela; Kendall, Brian; Kermode, Allan; Kilpatrick, Trevor; Koivisto, Keijo; Konidari, Ioanna; Korn, Thomas; Kronsbein, Helena; Langford, Cordelia; Larsson, Malin; Lathrop, Mark; Lebrun-Frenay, Christine; Lechner-Scott, Jeannette; Lee, Michelle H; Leone, Maurizio A; Leppä, Virpi; Liberatore, Giuseppe; Lie, Benedicte A; Lill, Christina M; Lindén, Magdalena; Link, Jenny; Luessi, Felix; Lycke, Jan; Macciardi, Fabio; Männistö, Satu; Manrique, Clara P; Martin, Roland; Martinelli, Vittorio; Mason, Deborah; Mazibrada, Gordon; McCabe, Cristin; Mero, Inger-Lise; Mescheriakova, Julia; Moutsianas, Loukas; Myhr, Kjell-Morten; Nagels, Guy; Nicholas, Richard; Nilsson, Petra; Piehl, Fredrik; Pirinen, Matti; Price, Siân E; Quach, Hong; Reunanen, Mauri; Robberecht, Wim; Robertson, Neil P; Rodegher, Mariaemma; Rog, David; Salvetti, Marco; Schnetz-Boutaud, Nathalie C; Sellebjerg, Finn; Selter, Rebecca C; Schaefer, Catherine; Shaunak, Sandip; Shen, Ling; Shields, Simon; Siffrin, Volker; Slee, Mark; Sorensen, Per Soelberg; Sorosina, Melissa; Sospedra, Mireia; Spurkland, Anne; Strange, Amy; Sundqvist, Emilie; Thijs, Vincent; Thorpe, John; Ticca, Anna; Tienari, Pentti; van Duijn, Cornelia; Visser, Elizabeth M; Vucic, Steve; Westerlind, Helga; Wiley, James S; Wilkins, Alastair; Wilson, James F; Winkelmann, Juliane; Zajicek, John; Zindler, Eva; Haines, Jonathan L; Pericak-Vance, Margaret A; Ivinson, Adrian J; Stewart, Graeme; Hafler, David; Hauser, Stephen L; Compston, Alastair; McVean, Gil; De Jager, Philip; Sawcer, Stephen; McCauley, Jacob L

2013-01-01

Using the ImmunoChip custom genotyping array, we analysed 14,498 multiple sclerosis subjects and 24,091 healthy controls for 161,311 autosomal variants and identified 135 potentially associated regions (p-value < 1.0 × 10-4). In a replication phase, we combined these data with previous genome-wide association study (GWAS) data from an independent 14,802 multiple sclerosis subjects and 26,703 healthy controls. In these 80,094 individuals of European ancestry we identified 48 new susceptibility variants (p-value < 5.0 × 10-8); three found after conditioning on previously identified variants. Thus, there are now 110 established multiple sclerosis risk variants in 103 discrete loci outside of the Major Histocompatibility Complex. With high resolution Bayesian fine-mapping, we identified five regions where one variant accounted for more than 50% of the posterior probability of association. This study enhances the catalogue of multiple sclerosis risk variants and illustrates the value of fine-mapping in the resolution of GWAS signals. PMID:24076602

The effects of sleep quality, physical activity, and environmental quality on the risk of falls in dementia.

PubMed

Eshkoor, Sima Ataollahi; Hamid, Tengku Aizan; Nudin, Siti Sa'adiah Hassan; Mun, Chan Yoke

2013-06-01

This study aimed to identify the effects of sleep quality, physical activity, environmental quality, age, ethnicity, sex differences, marital status, and educational level on the risk of falls in the elderly individuals with dementia. Data were derived from a group of 1210 Malaysian elderly individuals who were noninstitutionalized and demented. The multiple logistic regression model was applied to estimate the risk of falls in respondents. Approximately the prevalence of falls was 17% among the individuals. The results of multiple logistic regression analysis revealed that age (odds ratio [OR] = 1.03), ethnicity (OR = 1.76), sleep quality (OR = 1.46), and environmental quality (OR = 0.62) significantly affected the risk of falls in individuals (P < .05). Furthermore, sex differences, marital status, educational level, and physical activity were not significant predictors of falls in samples (P > .05). It was found that age, ethnic non-Malay, and sleep disruption increased the risk of falls in respondents, but high environmental quality reduced the risk of falls.

Multiple risk factor interventions for primary prevention of coronary heart disease

PubMed Central

Ebrahim, Shah; Beswick, Andrew; Burke, Margaret; Smith, George Davey

2014-01-01

Background Primary prevention programmes in many countries attempt to reduce mortality and morbidity due to coronary heart disease (CHD) through risk factor modification. It is widely believed that multiple risk factor intervention using counselling and educational methods is efficacious and cost-effective and should be expanded. Recent trials examining risk factor changes have cast considerable doubt on the effectiveness of these multiple risk factor interventions. Objectives To assess the effects of multiple risk factor intervention for reducing cardiovascular risk factors, total mortality, and mortality from CHD among adults without clinical evidence of established cardiovascular disease. Search strategy MEDLINE was searched for the original review to 1995. This was updated by searching the Cochrane Central Register of Controlled Trials on The Cochrane Library Issue 3 2001, MEDLINE(2000 to September 2001) and EMBASE (1998 to September 2001). Selection criteria Intervention studies using counselling or education to modify more than one cardiovascular risk factor in adults from general populations, occupational groups, or high risk groups. Trials of less than 6 months duration were excluded. Data collection and analysis Data were extracted by two reviewers independently. Investigators were contacted to obtain missing information. Main results A total of 39 trials were found of which ten reported clinical event data. In the ten trials with clinical event end-points, the pooled odds ratios for total and CHD mortality were 0.96 (95% confidence intervals (CI) 0.92 to 1.01) and 0.96 (95% CI 0.89 to 1.04) respectively. Net changes in systolic and diastolic blood pressure, and blood cholesterol were (weighted mean differences) −3.6 mmHg (95% CI −3.9 to −3.3 mmHg), −2.8 mmHg (95% CI −2.9 to −2.6 mmHg) and −0.07 mMol/l (95% CI −0.8 to −0.06 mMol/l) respectively. Odds of reduction in smoking prevalence was 20% (95% CI 8% to 31%). Statistical heterogeneity between the studies with respect to mortality and risk factor changes was due to trials focusing on hypertensive participants and those using considerable amounts of drug treatment. Authors’ conclusions The pooled effects suggest multiple risk factor intervention has no effect on mortality. However, a small, but potentially important, benefit of treatment (about a 10% reduction in CHD mortality) may have been missed. Risk factor changes were relatively modest, were related to the amount of pharmacological treatment used, and in some cases may have been over-estimated because of regression to the mean effects, lack of intention to treat analyses, habituation to blood pressure measurement, and use of self-reports of smoking. Interventions using personal or family counselling and education with or without pharmacological treatments appear to be more effective at achieving risk factor reduction and consequent reductions in mortality in high risk hypertensive populations. The evidence suggests that such interventions have limited utility in the general population. PMID:17054138

The prevalence of human papillomavirus genotypes in penile cancers from northern Thailand.

PubMed

Senba, Masachika; Kumatori, Atsushi; Fujita, Shuichi; Jutavijittum, Prapan; Yousukh, Amnat; Moriuchi, Toshiyuki; Nakamura, Tsuyoshi; Toriyama, Kan

2006-10-01

The highest frequency of penile cancer occurs in Asia, Africa, and Latin America, and there have been a few reports concerning the association of penile cancer with human papillomavirus (HPV) infection in these areas. The objective of this study was to determine the relation between penile cancer and the prevalence of HPV genotypes in northern Thailand. Eighty-eight specimens of penile tissue (65 malignant, 1 pre-malignant, and 22 benign cases) were examined to determine the association of HPV infection. An in situ hybridization (ISH) method was used to detect and localize HPV-DNA. Sensitive HPV polymerase chain reaction (PCR) procedure was used for detection of HPV-DNA, and DNA sequencing was used to identify the HPV genotype. HPV-DNA was detected in 53.8% and 81.5% of cases of penile cancer, using ISH and PCR, respectively. The high-risk HPV-16, most commonly associated with penile cancer in previous reports, was found in only one case in this study. The most prevalent genotype was the high-risk HPV-18, found in 55.4% of the cases (32.3% single and 23.1% multiple infection) followed by the low-risk HPV-6, found in 43.1% of the cases (24.6% single and 18.5% multiple infection). In this study, penile cancer was found to be highly correlated with HPV-DNA. Specifically, infection with both the low-risk HPV-6 and the high-risk HPV-18 is the characteristic prevalence of HPV genotypes in penile cancer in this area.

Class II HLA interactions modulate genetic risk for multiple sclerosis

PubMed Central

Dilthey, Alexander T; Xifara, Dionysia K; Ban, Maria; Shah, Tejas S; Patsopoulos, Nikolaos A; Alfredsson, Lars; Anderson, Carl A; Attfield, Katherine E; Baranzini, Sergio E; Barrett, Jeffrey; Binder, Thomas M C; Booth, David; Buck, Dorothea; Celius, Elisabeth G; Cotsapas, Chris; D’Alfonso, Sandra; Dendrou, Calliope A; Donnelly, Peter; Dubois, Bénédicte; Fontaine, Bertrand; Fugger, Lars; Goris, An; Gourraud, Pierre-Antoine; Graetz, Christiane; Hemmer, Bernhard; Hillert, Jan; Kockum, Ingrid; Leslie, Stephen; Lill, Christina M; Martinelli-Boneschi, Filippo; Oksenberg, Jorge R; Olsson, Tomas; Oturai, Annette; Saarela, Janna; Søndergaard, Helle Bach; Spurkland, Anne; Taylor, Bruce; Winkelmann, Juliane; Zipp, Frauke; Haines, Jonathan L; Pericak-Vance, Margaret A; Spencer, Chris C A; Stewart, Graeme; Hafler, David A; Ivinson, Adrian J; Harbo, Hanne F; Hauser, Stephen L; De Jager, Philip L; Compston, Alastair; McCauley, Jacob L; Sawcer, Stephen; McVean, Gil

2016-01-01

Association studies have greatly refined the understanding of how variation within the human leukocyte antigen (HLA) genes influences risk of multiple sclerosis. However, the extent to which major effects are modulated by interactions is poorly characterized. We analyzed high-density SNP data on 17,465 cases and 30,385 controls from 11 cohorts of European ancestry, in combination with imputation of classical HLA alleles, to build a high-resolution map of HLA genetic risk and assess the evidence for interactions involving classical HLA alleles. Among new and previously identified class II risk alleles (HLA-DRB1*15:01, HLA-DRB1*13:03, HLA-DRB1*03:01, HLA-DRB1*08:01 and HLA-DQB1*03:02) and class I protective alleles (HLA-A*02:01, HLA-B*44:02, HLA-B*38:01 and HLA-B*55:01), we find evidence for two interactions involving pairs of class II alleles: HLA-DQA1*01:01–HLA-DRB1*15:01 and HLA-DQB1*03:01–HLA-DQB1*03:02. We find no evidence for interactions between classical HLA alleles and non-HLA risk-associated variants and estimate a minimal effect of polygenic epistasis in modulating major risk alleles. PMID:26343388

The residues and environmental risks of multiple veterinary antibiotics in animal faeces.

PubMed

Li, Yan-Xia; Zhang, Xue-Lian; Li, Wei; Lu, Xiao-Fei; Liu, Bei; Wang, Jing

2013-03-01

To understand the residues and ecological risks of veterinary antibiotics (VAs) in animal faeces from concentrated animal feeding operations in northeastern China, 14 VAs were identified by high performance liquid chromatography, and the preliminary risks of six antibiotics were assessed using the hazard quotient (HQ). The investigated VAs occurred in 7.41 to 57.41 % of the 54 samples, and the levels ranged from 0.08 to 56.81 mg kg(-1). Tetracyclines were predominant with a maximum level of 56.81 mg kg(-1) mostly detected in pig faeces. Sulfonamides were common and detected with the highest concentration of 7.11 mg kg(-1). Fluoroquinolones were more widely detected in chicken faeces rather than in pig or cow faeces, which contained the dominant antibiotic enrofloxacin. In comparison, the residue of tylosin was less frequently found. The risk evaluations of the six antibiotics revealed that tetracyclines, especially oxytetracycline, displayed the greatest ecological risk because of its high HQ value of 15.75. The results of this study imply that multiple kinds of VAs were jointly used in animal feeding processes in the study area. These medicine residues in animal faeces may potentially bring ecological risks if the animal manure is not treated effectively.

Persistent infection with high-risk human papilloma viruses: cohort study, Mérida, Venezuela

PubMed Central

Téllez, Luis; Michelli, Elvia; Mendoza, José Andrés; Vielma, Silvana; Noguera, María-Eugenia; Callejas, Diana; Cavazza, María; Correnti, María

2015-01-01

Cervical lesions have been associated with infection by high-risk human papilloma virus (high-risk HPV). In 409 women aged >15 years high-risk HPV lesions were identified. In a cohort of this population persistent infection was compared with cytological, colposcopic, and histological lesions. Cervical scrapes were taken and DNA was isolated. HPV was detected by PCR in the E6/E7 region. Genotyping was performed by PCR nested multiple E6/E7. HPV was detected in a 37.40% (153/409), high-risk HPV in 86% (153/178), HPV18 46.64% (83/178), HPV16 34.28% (61/178). Among these 53.93% (96/178) were multiple infections, and HPV18/16 (30/96) was the most frequent 31.25%. The cytology showed changes in 15% of positive patients. A 49.67% in women positive for HPV infection showed abnormalities in the colposcopic study, a relationship that turned out to be statistically significant ( p < 0.0019 test χ2). Among all 85% of the women were younger than 45 years of age. Fifty-seven patients were evaluated 15 months after the base study, with initial prevalence of morbidity 49.12% (28/57) and at the end 10.53% (6/57), showing in 89.29% (25/28) negative for HR-HPV infection, 10.34% (3/28) showed persistence of infection, 17.54% (10/57) presented cytological alterations, with 80% of positivity for HPV, and a regression of 100% (10/10) of the previously identified lesions. With colposcopy, 50% (14/28) presented alterations related to HPV, of these 85.71% (12/14) showed regression of such an alteration. The cumulative incidence for HPV was 10.34% (3/29). The incidence rate was 4.23% (3/71), which is equal to 4.23 new cases of HPV infection per 100 people, per year of follow-up. In conclusion, the present work shows a high frequency of infection by high-risk HPV, with predominance of HPV18 and 16 and in general for multiple infections. Colposcopy was better predictor than the Pap smear for infection. The follow-up study revealed a low percentage of persistent infection, and a high frequency of negativity for viral infection, high regression of cytological and colposcopic lesions, a low cumulative and incidence rate similar to that reported by other Latin American countries and higher than the European countries. PMID:26557877

Relationship Between Physiological and Perceived Fall Risk in People With Multiple Sclerosis: Implications for Assessment and Management.

PubMed

Gunn, Hilary; Cameron, Michelle; Hoang, Phu; Lord, Stephen; Shaw, Steve; Freeman, Jennifer

2018-04-24

This study evaluated the relationship between physiological and perceived fall risk in people with multiple sclerosis (MS). Secondary analysis of data from prospective cohort studies undertaken in Australia, the United Kingdom, and the United States. Community. Ambulatory people with MS (N=416) (age 51.5±12.0 years; 73% female; 62% relapsing-remitting MS; 13.7±9.9 years disease duration). Not applicable. All participants completed measures of physiological (Physiological Profile Assessment [PPA]) and perceived (Falls Efficacy Scale-international [FESi]) fall risk and prospectively recorded falls for 3 months. 155 (37%) of the participants were recurrent fallers (≥2 falls). Mean PPA and FESi scores were high (PPA 2.14±1.87, FESi 34.27±11.18). The PPA and the FESi independently predicted faller classification in logistic regression, which indicated that the odds of being classified as a recurrent faller significantly increased with increasing scores (PPA odds ratio [OR] 1.30 [95% CI 1.17-1.46], FESi OR 1.05 [95% CI 1.03-1.07]). Classification and regression tree analysis divided the sample into four groups based on cutoff values for the PPA: (1) low physiological/low perceived risk (PPA <2.83, FESi <27.5), (2) low physiological/high perceived risk (PPA <2.83, FESi >27.5), (3) high physiological/low perceived risk (PPA >2.83, FESi <35.5), and (4) high physiological/high perceived risk (PPA <2.83, FESi >35.5). Over 50% of participants had a disparity between perceived and physiological fall risk; most were in group 2. It is possible that physiological risk factors not detected by the PPA may also be influential. This study highlights the importance of considering both physiological and perceived fall risk in MS and the need for further research to explore the complex interrelationships of perceptual and physiological risk factors in this population. This study also supports the importance of developing behavioral and physical interventions that can be tailored to the individual's needs. Copyright © 2018 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Grandparents, parents, and grandchildren at high risk for depression: a three-generation study.

PubMed

Warner, V; Weissman, M M; Mufson, L; Wickramaratne, P J

1999-03-01

High-risk studies of psychiatric disorders in parents and offspring that include 3 generations are uncommon. Multigenerational studies can be clinically useful as they can provide information for risk prediction from one generation to another for the development of empirically based interventions. Using a high-risk design, this study examines the association of grandparent major depressive disorder (MDD) and parent MDD with psychopathology in grandchildren. Using Cox proportional hazards in a sample of 90 grandchildren at high and low risk for depression by virtue of their grandparents' and parents' depression status, the authors examined the risk for offspring depression and anxiety. Grandparent and parent MDD were associated with grandchild anxiety (relative risk [RR] = 5.51 and R = 3.09, respectively). Grandchildren with both a depressed parent and grandparent had the highest risk for anxiety. Parental MDD is associated with an increased risk for grandchild disruptive disorder (RR = 10.77). Forty-nine percent of the grandchildren in families in which both the parent and grandparent were depressed had some form of psychopathology. The grandchildren from those families were the most impaired. Prepubertal-onset anxiety disorder is a risk factor for the later development of clinically significant recurrent MDD across several generations of families at high risk for depression. Parental impaired functioning increases the risk for disruptive disorders. Children in families with multiple generations of depression are at particularly high risk for some form of psychopathology.

Relationship between physical activity, physical fitness and multiple metabolic risk in youths from Muzambinho's study.

PubMed

Barbosa, João Paulo Dos Anjos Souza; Basso, Luciano; Seabra, André; Prista, Antonio; Tani, Go; Maia, José António Ribeiro; Forjaz, Cláudia Lúcia De Moraes

2016-08-01

Negative associations between physical activity (PA), physical fitness and multiple metabolic risk factors (MMRF) in youths from populations with low PA are reported. The persistence of this association in moderately-to highly active populations is not, however, well established. The aim of the present study was to investigate this association in a Brazilian city with high frequency of active youths. We assessed 122 subjects (9.9 ± 1.3 years) from Muzambinho city. Body mass index, waist circumference, glycaemia, cholesterolaemia, systolic and diastolic blood pressures were measured. Maximal handgrip strength and one-mile walk/run test were used. Leisure time PA was assessed by interview. Poisson regression was used in the analysis. The model explained 11% of the total variance. Only relative muscular strength and one-mile walk/run were statistically significant (p < .05). Those who needed more time to cover the one-mile walk/run test had an increased in metabolic risk of 11%, and those with greater strength reduced the risk by about 82%. In conclusion, children and youths from an active population who need less time to cover the one-mile walk/run test or who had greater muscular strength showed a reduced metabolic risk. These results suggest that even in children and youths with high leisure time PA, a greater aerobic fitness and strength might help to further reduce their MMRF.

Comparative analysis of Multiple risks in the Western part of Georgia

NASA Astrophysics Data System (ADS)

Tsereteli, N.; Chelidze, T.; Varazanashvili, O.; Amiranashvili, A.

2009-04-01

Georgia is prone to catastrophes. In the last two decades, there have occurred the following natural disasters: (a) Avalanches in Svaneti and Khevsureti, (b) landslides in the mountainous Achara, floods, (c) hurricane and drought in West and East Georgia, (d) Racha earthquake of 1991 and (e) the Tbilisi Earthquake of 2002. These phenomena are very special both from ecological and from social-economical points of view. By the disaster risk index obtained by the UNDP, Georgia is similar to countries with medium and high level risk. Therefore, natural disasters in Georgia are considered as a negative factor in the development process of the country. This implies the necessity of more active actions by all possible means to reduce the risk of natural disasters at each level and maintain the sustainable economic development of the country, including good education at the universities and schools for real understanding of natural hazards. The main goal of the work here is the assessment of 12 widespread natural disasters and multiple risks for political districts in West Georgia. These natural disasters include earthquakes, landslides, avalanches, floods, mudflows, droughts, hurricanes, lightning, hail, glaze, freezes, mists. The research was based on the following steps: (a) Creation of electronic detailed databases of natural disasters that occurred in Georgia. These databases consist of the parameters of such hazardous phenomena class that caused natural disasters. (b) Quantitative investigation of energetic and spatial-time regularities of 12 natural disasters for the territory of Georgia. Estimation of people and environment (technosphere) vulnerability. (c) Elaboration of mathematical models and algorithms of disasters multiple risks taking into account the concrete conditions: (i) Sharing and generalization of gathered experience in the world. This allows more proper and wide comparison of the multiple risks of Caucasus countries; (ii) Taking into account the general formula of risk = hazard x damage, transfer from analyze of separate risk to its complex one; (iii) Taking into account the reality of Georgia and complex scheme of revealed risk in separate district of the country during the construction of multiple risk models. Investigation of each step reveals problem according to essential parts in the multiple risks assessments, such as communication between scientists, engineers, civil protection and other agencies. A big gap in such kind of relationship leads to lack of important information, such as economic loss according to each hazard. Low level in education according in natural hazards cause bad management and sometimes increase economic and mortality loss.

Patterns of multiple health risk–behaviours in university students and their association with mental health: application of latent class analysis

PubMed Central

Kwan, M. Y.; Arbour-Nicitopoulos, K. P.; Duku, E.; Faulkner, G.

2016-01-01

Abstract Introduction: University and college campuses may be the last setting where it is possible to comprehensively address the health of a large proportion of the young adult population. It is important that health promoters understand the collective challenges students are facing, and to better understand the broader lifestyle behavioural patterning evident during this life stage. The purpose of this study was to examine the clustering of modifiable health-risk behaviours and to explore the relationship between these identified clusters and mental health outcomes among a large Canadian university sample. Methods: Undergraduate students (n = 837; mean age = 21 years) from the University of Toronto completed the National College Health Assessment survey. The survey consists of approximately 300 items, including assessments of student health status, mental health and health-risk behaviours. Latent class analysis was used to identify patterning based on eight salient health-risk behaviours (marijuana use, other illicit drug use, risky sex, smoking, binge drinking, poor diet, physical inactivity, and insufficient sleep). Results: A three-class model based on student behavioural patterns emerged: “typical,” “high-risk” and “moderately healthy.” Results also found high-risk students reporting significantly higher levels of stress than typical students (χ2(1671) = 7.26, p < .01). Conclusion: Students with the highest likelihood of engaging in multiple health-risk behaviours reported poorer mental health, particularly as it relates to stress. Although these findings should be interpreted with caution due to the 28% response rate, they do suggest that interventions targeting specific student groups with similar patterning of multiple health-risk behaviours may be needed. PMID:27556920

A new multiple regression model to identify multi-family houses with a high prevalence of sick building symptoms "SBS", within the healthy sustainable house study in Stockholm (3H).

PubMed

Engvall, Karin; Hult, M; Corner, R; Lampa, E; Norbäck, D; Emenius, G

2010-01-01

The aim was to develop a new model to identify residential buildings with higher frequencies of "SBS" than expected, "risk buildings". In 2005, 481 multi-family buildings with 10,506 dwellings in Stockholm were studied by a new stratified random sampling. A standardised self-administered questionnaire was used to assess "SBS", atopy and personal factors. The response rate was 73%. Statistical analysis was performed by multiple logistic regressions. Dwellers owning their building reported less "SBS" than those renting. There was a strong relationship between socio-economic factors and ownership. The regression model, ended up with high explanatory values for age, gender, atopy and ownership. Applying our model, 9% of all residential buildings in Stockholm were classified as "risk buildings" with the highest proportion in houses built 1961-1975 (26%) and lowest in houses built 1985-1990 (4%). To identify "risk buildings", it is necessary to adjust for ownership and population characteristics.

Diagnostic value of stool DNA testing for multiple markers of colorectal cancer and advanced adenoma: a meta-analysis.

PubMed

Yang, Hua; Xia, Bing-Qing; Jiang, Bo; Wang, Guozhen; Yang, Yi-Peng; Chen, Hao; Li, Bing-Sheng; Xu, An-Gao; Huang, Yun-Bo; Wang, Xin-Ying

2013-08-01

The diagnostic value of stool DNA (sDNA) testing for colorectal neoplasms remains controversial. To compensate for the lack of large-scale unbiased population studies, a meta-analysis was performed to evaluate the diagnostic value of sDNA testing for multiple markers of colorectal cancer (CRC) and advanced adenoma. The PubMed, Science Direct, Biosis Review, Cochrane Library and Embase databases were systematically searched in January 2012 without time restriction. Meta-analysis was performed using a random-effects model using sensitivity, specificity, diagnostic OR (DOR), summary ROC curves, area under the curve (AUC), and 95% CIs as effect measures. Heterogeneity was measured using the χ(2) test and Q statistic; subgroup analysis was also conducted. A total of 20 studies comprising 5876 individuals were eligible. There was no heterogeneity for CRC, but adenoma and advanced adenoma harboured considerable heterogeneity influenced by risk classification and various detection markers. Stratification analysis according to risk classification showed that multiple markers had a high DOR for the high-risk subgroups of both CRC (sensitivity 0.759 [95% CI 0.711 to 0.804]; specificity 0.883 [95% CI 0.846 to 0.913]; AUC 0.906) and advanced adenoma (sensitivity 0.683 [95% CI 0.584 to 0.771]; specificity 0.918 [95% CI 0.866 to 0.954]; AUC 0.946) but not for the average-risk subgroups of either. In the methylation subgroup, sDNA testing had significantly higher DOR for CRC (sensitivity 0.753 [95% CI 0.685 to 0.812]; specificity 0.913 [95% CI 0.860 to 0.950]; AUC 0.918) and advanced adenoma (sensitivity 0.623 [95% CI 0.527 to 0.712]; specificity 0.926 [95% CI 0.882 to 0.958]; AUC 0.910) compared with the mutation subgroup. There was no significant heterogeneity among studies for subgroup analysis. sDNA testing for multiple markers had strong diagnostic significance for CRC and advanced adenoma in high-risk subjects. Methylation makers had more diagnostic value than mutation markers.

Epidemiologic evidence for multiple sclerosis as an infection.

PubMed Central

Kurtzke, J F

1993-01-01

The worldwide distribution of multiple sclerosis (MS) can be described within three zones of frequency: high, medium, and low. The disease has a predilection for white races and for women. Migration studies show that changing residence changes MS risk. Studies of persons moving from high- to low-risk areas indicate that in the high-risk areas, MS is acquired by about age 15. Moves from low- to high-risk areas suggest that susceptibility is limited to persons between about ages 11 and 45. MS on the Faroe Islands has occurred as four successive epidemics beginning in 1943. The disease appears to have been introduced by British troops who occupied the islands for 5 years from 1940, and it has remained geographically localized within the Faroes for half a century. What was introduced must have been an infection, called the primary MS affection (PMSA), that was spread to and from successive cohorts of Faroese. In this concept, PMSA is a single widespread systemic infectious disease (perhaps asymptomatic) that only seldom leads to clinical neurologic MS. PMSA is also characterized by a need for prolonged exposure, limited age of susceptibility, and prolonged incubation. I believe that clinical MS is the rare late outcome of a specific, but unknown, infectious disease of adolescence and young adulthood and that this infection could well be caused by a thus-far-unidentified (retro)virus. Images PMID:8269393

Management of optic neuritis

PubMed Central

Menon, Vimla; Saxena, Rohit; Misra, Ruby; Phuljhele, Swati

2011-01-01

Optic neuritis is an inflammatory condition of the optic nerve characterized by a sudden onset of unilateral visual loss, usually affecting young females. Demyelination associated with multiple sclerosis (MS) is the most common cause in regions where MS is prevalent; while in other places, there are a substantial proportion of cases where infective or autoimmune causes are seen. Optic Neuritis Treatment Trial (ONTT) was the first major study that provided information on the natural history, role of steroids in treatment and risk of development of MS. Subsequently, numerous clinical trials have evaluated different modalities of management of optic neuritis and MS. The Controlled High-Risk Subjects Avonex Multiple Sclerosis Prevention Study (CHAMPS); the Prevention of Relapses and Disability by Interferon β-1a Subcutaneously in Multiple Sclerosis (PRISMS) Trial; and, most recently, the Betaferon in Newly Emerging Multiple Sclerosis for Initial Treatment (BENEFIT) Study have provided large amount of information on the natural history of optic neuritis and management options available. However, due to the low prevalence of MS reported in Asian studies, high cost of therapy and indefinite time period of treatment, it may not be cost effective to start interferon therapy in most cases. PMID:21350281

Early problem behavior among children from low-income, mother-headed families: a multiple risk perspective.

PubMed

Olson, Sheryl L; Ceballo, Rosario; Park, Curie

2002-12-01

Examined proximal and contextual factors most strongly related to externalizing behavior among young children growing up in low-income, mother-headed families. Participants were 50 low-income single mothers and their preschool-age children who were visited twice in the home setting. Measures of proximal (low levels of supportive parenting, high levels of punitive disciplinary practices, low levels of maternal emotional well-being) and contextual (low maternal support, high levels of family stress) risk were assessed in relation to maternal reports of child externalizing behavior and an index of negative child behavior during a clean-up task. Child defiance during the clean-up task was highly associated with punitive maternal control in the same situation but had no other direct correlates. However, multiple risk factors representing both proximal and contextual variables were associated with variations in children's behavior problem scores. Mothers of children with high behavior problem scores reported lower feelings of self-efficacy in handling child care and emotional stressors, more frequent use of punitive child disciplinary practices, and lower feelings of satisfaction with the quality of their supportive resources than others. Maternal self-evaluations of coping efficacy mediated the relation between perceived support and child behavior problems, suggesting that constructs of personal control are important to represent in future studies of highly stressed parents.

Female undergraduate fine arts students: a high-risk population for multiple sexual partners, unwanted pregnancy and sexually transmitted infections in China.

PubMed

Zou, Yuliang; Yan, Hong; Wu, Haocheng; Chen, Rucheng; Huang, Danqin; Li, Shiyue

2013-04-01

To compare risky sexual behaviour and risk factors associated with unwanted pregnancy and sexually transmitted infections (STIs) among female fine arts undergraduates and students of other disciplines in China. Anonymously completed questionnaires were received from 4769 unmarried female undergraduates, recruited using randomised cluster sampling. Multiple regression analyses were used to examine factors associated with lifetime number of sex partners, self-reported pregnancy, and STIs. The proportion of students who had ever had sex was higher among female fine arts majors (35%) than among other females (15%). Not using a condom at first sex (87%), multiple lifetime partners (44%), and extramarital lover now or ever in lifetime (9%) were more common in sexually experienced fine arts students. Self-reported pregnancy (23%) and STIs (33%) were also more common in fine arts students. Years spent in school, understanding or approval of multiple sex partners, younger age at first sex and coercive first sex were associated with multiple lifetime partners, which was a risk factor for both unintended pregnancy and STIs. Female fine arts students hold more tolerant attitudes toward sex than other female students. They were more inclined to risky sexual behaviours, and thus more vulnerable to unwanted pregnancy and STIs.

Adverse adolescent relationship histories and young adult health: Cumulative effects of loneliness, low parental support, relationship instability, intimate partner violence and loss

PubMed Central

Adam, Emma K.; Chyu, Laura; Hoyt, Lindsay; Doane, Leah D.; Boisjoly, Johanne; Duncan, Greg; Chase-Lansdale, Lindsay; McDade, Thomas W.

2011-01-01

Purpose To examine the associations between adverse interpersonal relationship histories experienced during adolescence and health in young adulthood in a large, nationally representative sample. Methods Using data from Waves I, II and III of the National Longitudinal Study of Adolescent Health, multiple adverse relationship experiences are examined, including high loneliness, low perceived parental support, frequent transitions in romantic relationships (relationship instability), exposure to intimate partner violence, and loss by death of important relationship figures. These histories are assessed, both individually and in a relationship risk index, as predictors of self-reported general health and depressive symptoms at Wave III (ages 18 to 27), controlling for baseline (Wave I) health and for demographic and health behavior covariates. Results Net of baseline health and covariates, each type of relationship risk (experienced between Wave I and Wave III) was related to either depression or general health at Wave III, with the strongest effects seen for exposure to intimate partner violence. In addition, a cumulative relationship risk index examining the extent to which youth experienced high levels of multiple relationship risk factors revealed that each additional adverse relationship experience increased the odds of reporting poor mental and general health at Wave III, with increases occurring in an additive manner. Conclusions Multiple types of adverse relationship experiences predicted increases in poor general health and depressive symptoms from adolescence to early adulthood. Consistent with a cumulative risk hypothesis, the more types of adverse relationship experiences a youth experienced, the worse their young adult health outcomes. PMID:21856520

Exploring the multiple-hit hypothesis of preterm white matter damage using diffusion MRI.

PubMed

Barnett, Madeleine L; Tusor, Nora; Ball, Gareth; Chew, Andrew; Falconer, Shona; Aljabar, Paul; Kimpton, Jessica A; Kennea, Nigel; Rutherford, Mary; David Edwards, A; Counsell, Serena J

2018-01-01

Preterm infants are at high risk of diffuse white matter injury and adverse neurodevelopmental outcome. The multiple hit hypothesis suggests that the risk of white matter injury increases with cumulative exposure to multiple perinatal risk factors. Our aim was to test this hypothesis in a large cohort of preterm infants using diffusion weighted magnetic resonance imaging (dMRI). We studied 491 infants (52% male) without focal destructive brain lesions born at < 34 weeks, who underwent structural and dMRI at a specialist Neonatal Imaging Centre. The median (range) gestational age (GA) at birth was 30 + 1 (23 + 2 -33 + 5 ) weeks and median postmenstrual age at scan was 42 + 1 (38-45) weeks. dMRI data were analyzed using tract based spatial statistics and the relationship between dMRI measures in white matter and individual perinatal risk factors was assessed. We tested the hypothesis that increased exposure to perinatal risk factors was associated with lower fractional anisotropy (FA), and higher radial, axial and mean diffusivity (RD, AD, MD) in white matter. Neurodevelopmental performance was investigated using the Bayley Scales of Infant and Toddler Development, Third Edition (BSITD-III) in a subset of 381 infants at 20 months corrected age. We tested the hypothesis that lower FA and higher RD, AD and MD in white matter were associated with poorer neurodevelopmental performance. Identified risk factors for diffuse white matter injury were lower GA at birth, fetal growth restriction, increased number of days requiring ventilation and parenteral nutrition, necrotizing enterocolitis and male sex. Clinical chorioamnionitis and patent ductus arteriosus were not associated with white matter injury. Multivariate analysis demonstrated that fetal growth restriction, increased number of days requiring ventilation and parenteral nutrition were independently associated with lower FA values. Exposure to cumulative risk factors was associated with reduced white matter FA and FA values at term equivalent age were associated with subsequent neurodevelopmental performance. This study suggests multiple perinatal risk factors have an independent association with diffuse white matter injury at term equivalent age and exposure to multiple perinatal risk factors exacerbates dMRI defined, clinically significant white matter injury. Our findings support the multiple hit hypothesis for preterm white matter injury.

Application of High-Throughput In Vitro Assays for Risk-Based Chemical Safety Decisions of Environmental and Industrial Chemicals (SOT presentation)

EPA Science Inventory

Multiple drivers shape the types of human-health assessments performed on chemicals by U.S. EPA resulting in chemical assessments are “fit-for-purpose” ranging from prioritization for further testing to full risk assessments. Layered on top of the diverse assessment needs are the...

Youth Risk Behavior Survey Results, 1995. Executive Summary.

ERIC Educational Resources Information Center

New Hampshire State Dept. of Education, Concord.

An 84-item multiple choice Youth Risk Behavior Survey was administered to 2,092 students in 62 public high schools in New Hampshire during the spring of 1995. The survey covered behaviors in six categories: (1) behaviors that result in unintentional or intentional injuries; (2) tobacco use; (3) alcohol and other drug use; (4) sexual behaviors that…

The Linkages among Childhood Maltreatment, Adolescent Mental Health, and Self-Compassion in Child Welfare Adolescents

ERIC Educational Resources Information Center

Tanaka, Masako; Wekerle, Christine; Schmuck, Mary Lou; Paglia-Boak, Angela

2011-01-01

Objectives: Childhood maltreatment is a robust risk factor for poor physical and mental health. Child welfare youths represent a high-risk group, given the greater likelihood of severe or multiple types of maltreatment. This study examined the relationship between childhood maltreatment and self-compassion--a concept of positive acceptance of…

Preventing Conduct Problems and Improving School Readiness: Evaluation of the Incredible Years Teacher and Child Training Programs in High-Risk Schools

ERIC Educational Resources Information Center

Webster-Stratton, Carolyn; Reid, M. Jamila; Stoolmiller, Mike

2008-01-01

Background: School readiness, conceptualized as three components including emotional self-regulation, social competence, and family/school involvement, as well as absence of conduct problems play a key role in young children's future interpersonal adjustment and academic success. Unfortunately, exposure to multiple poverty-related risks increases…

Managing wildfire events: risk-based decision making among a group of federal fire managers

Treesearch

Robyn S. Wilson; Patricia L. Winter; Lynn A. Maguire; Timothy Ascher

2011-01-01

Managing wildfire events to achieve multiple management objectives involves a high degree of decision complexity and uncertainty, increasing the likelihood that decisions will be informed by experience-based heuristics triggered by available cues at the time of the decision. The research reported here tests the prevalence of three risk-based biases among 206...

Bullying and HIV Risk Among High School Teenagers: The Mediating Role of Teen Dating Violence.

PubMed

Okumu, Moses; Mengo, Cecilia; Ombayo, Bernadette; Small, Eusebius

2017-10-01

Teen dating violence (TDV), bullying, and HIV risk behaviors are public health concerns that impact adolescents in the United States. National estimates reveal high rates of these risk behaviors among high school students. Based on theoretical and empirical evidence, we hypothesized that experiencing teen dating violence (sexual and physical) would mediate the impact of bullying on HIV risk. Data were from the 2013 National Youth Behavior Risk Surveillance Survey (YRBSS) among students who answered questions on bullying, TDV, and HIV risk (N = 13,571). The YRBSS is conducted biennially among 9th- to 12th-grade students nationally. We used multiple regression analysis and Hayes' SPSS process macro to examine the 2 study hypotheses. Findings from bivariate analysis suggest an association between bullying and HIV risk. The study also found associations between physical, sexual teen dating violence and HIV risk. Results also indicate that both physical and sexual teen dating violence mediate the association between bullying and HIV risk. Our findings suggest that multidimensional interventions should be developed to reduce the rate of teen dating violence and combat bullying as a preventative method for HIV risk among high school students. © 2017, American School Health Association.

Biomechanical Factors and Injury Risk in High-Severity Rollovers

PubMed Central

Moore, Tara L. A.; Vijayakumar, Vinod; Steffey, Duane L.; Ramachandran, Karuna; Corrigan, Catherine Ford

2005-01-01

The number of rolls, as well as other factors, has been associated with increased injury risk in rollovers. Data from NASS-CDS from 1995–2003 were used to evaluate the biomechanical implications of vehicle kinematics during multiple rolls and to evaluate the risk of injuries to different body regions during rollovers. The data showed that the risk of injury increased with increasing number of rolls. The rate of increase in risk varied by the region of the body affected and injury severity. The increased risk was particularly great when a vehicle rolled more than two complete rolls. PMID:16179145

Very-high-risk localized prostate cancer: definition and outcomes.

PubMed

Sundi, D; Wang, V M; Pierorazio, P M; Han, M; Bivalacqua, T J; Ball, M W; Antonarakis, E S; Partin, A W; Schaeffer, E M; Ross, A E

2014-03-01

Outcomes in men with National Comprehensive Cancer Network (NCCN) high-risk prostate cancer (PCa) can vary substantially-some will have excellent cancer-specific survival, whereas others will experience early metastasis even after aggressive local treatments. Current nomograms, which yield continuous risk probabilities, do not separate high-risk PCa into distinct sub-strata. Here, we derive a binary definition of very-high-risk (VHR) localized PCa to aid in risk stratification at diagnosis and selection of therapy. We queried the Johns Hopkins radical prostatectomy database to identify 753 men with NCCN high-risk localized PCa (Gleason sum 8-10, PSA >20 ng ml(-1), or clinical stage ≥T3). Twenty-eight alternate permutations of adverse grade, stage and cancer volume were compared by their hazard ratios for metastasis and cancer-specific mortality. VHR criteria with top-ranking hazard ratios were further evaluated by multivariable analyses and inclusion of a clinically meaningful proportion of the high-risk cohort. The VHR cohort was best defined by primary pattern 5 present on biopsy, or ≥5 cores with Gleason sum 8-10, or multiple NCCN high-risk features. These criteria encompassed 15.1% of the NCCN high-risk cohort. Compared with other high-risk men, VHR men were at significantly higher risk for metastasis (hazard ratio 2.75) and cancer-specific mortality (hazard ratio 3.44) (P<0.001 for both). Among high-risk men, VHR men also had significantly worse 10-year metastasis-free survival (37% vs 78%) and cancer-specific survival (62% vs 90%). Men who meet VHR criteria form a subgroup within the current NCCN high-risk classification who have particularly poor oncological outcomes. Use of these characteristics to distinguish VHR localized PCa may help in counseling and selection optimal candidates for multimodal treatments or clinical trials.

The role of HIV-related knowledge and ethnicity in determining HIV risk perception and willingness to undergo HIV testing among rural women in Burkina Faso.

PubMed

Sarker, Malabika; Milkowski, Andrea; Slanger, Tracy; Gondos, Adam; Sanou, Aboubakary; Kouyate, Bocar; Snow, Rachel

2005-06-01

We conducted a random community based survey of 300 young (15-29 years) rural women in Nouna, Burkina Faso. Only one-third of women were aware that a person could have HIV without having symptoms and these women were significantly more likely to classify themselves to be at high risk for getting HIV. Furthermore, multiple partners, Bwaba ethnicity and having mentioned a health worker as a source of HIV information were significantly associated with perceived high personal risk. Perceived willingness to participate in VCT was high (69%). The dissemination of information on the asymptomatic nature of HIV infection could potentially be very important in forming risk perception, awareness, and their willingness to participate in HIV interventions.

Pharmacogenomic prediction of anthracycline-induced cardiotoxicity in children.

PubMed

Visscher, Henk; Ross, Colin J D; Rassekh, S Rod; Barhdadi, Amina; Dubé, Marie-Pierre; Al-Saloos, Hesham; Sandor, George S; Caron, Huib N; van Dalen, Elvira C; Kremer, Leontien C; van der Pal, Helena J; Brown, Andrew M K; Rogers, Paul C; Phillips, Michael S; Rieder, Michael J; Carleton, Bruce C; Hayden, Michael R

2012-05-01

Anthracycline-induced cardiotoxicity (ACT) is a serious adverse drug reaction limiting anthracycline use and causing substantial morbidity and mortality. Our aim was to identify genetic variants associated with ACT in patients treated for childhood cancer. We carried out a study of 2,977 single-nucleotide polymorphisms (SNPs) in 220 key drug biotransformation genes in a discovery cohort of 156 anthracycline-treated children from British Columbia, with replication in a second cohort of 188 children from across Canada and further replication of the top SNP in a third cohort of 96 patients from Amsterdam, the Netherlands. We identified a highly significant association of a synonymous coding variant rs7853758 (L461L) within the SLC28A3 gene with ACT (odds ratio, 0.35; P = 1.8 × 10(-5) for all cohorts combined). Additional associations (P < .01) with risk and protective variants in other genes including SLC28A1 and several adenosine triphosphate-binding cassette transporters (ABCB1, ABCB4, and ABCC1) were present. We further explored combining multiple variants into a single-prediction model together with clinical risk factors and classification of patients into three risk groups. In the high-risk group, 75% of patients were accurately predicted to develop ACT, with 36% developing this within the first year alone, whereas in the low-risk group, 96% of patients were accurately predicted not to develop ACT. We have identified multiple genetic variants in SLC28A3 and other genes associated with ACT. Combined with clinical risk factors, genetic risk profiling might be used to identify high-risk patients who can then be provided with safer treatment options.

Depressive symptoms in adolescence: the association with multiple health risk behaviors.

PubMed

Katon, Wayne; Richardson, Laura; Russo, Joan; McCarty, Carolyn A; Rockhill, Carol; McCauley, Elizabeth; Richards, Julie; Grossman, David C

2010-01-01

Although multiple studies of adolescents have examined the association of depression with individual health risk behaviors such as obesity or smoking, this is one of the few studies that examined the association between depression and multiple risk behaviors. A brief mail questionnaire, which screened for age, gender, weight, height, sedentary behaviors, physical activity, perception of general health, functional impairment and depressive symptoms, was completed by a sample of 2291 youth (60.7% response rate) aged 13-17 enrolled in a health care plan. A subset of youth who screened positive on the two-item depression screen and a random sample of those screening negative were approached to participate in a telephone interview with more in-depth information obtained on smoking and at-risk behaviors associated with drug and alcohol use. Youth screening positive for high levels of depressive symptoms compared to those with few or no depressive symptoms were significantly more likely to meet criteria for obesity, had a poorer perception of health, spent more time on the computer, got along less well with parents and friends, had more problems completing school work and were more likely to have experimented with smoking and a wide array of behaviors associated with drug and alcohol use. Because many adverse health behaviors that develop in adolescence continue into adulthood, the association of depressive symptoms with multiple risk behaviors and poor functioning suggest that early interventions are needed at an individual, school, community and primary care level. Copyright 2010 Elsevier Inc. All rights reserved.

Intimate Partner Violence, Relationship Power Inequity and the Role of Sexual and Social Risk Factors in the Production of Violence among Young Women Who Have Multiple Sexual Partners in a Peri-Urban Setting in South Africa

PubMed Central

Zembe, Yanga Z.; Townsend, Loraine; Thorson, Anna; Silberschmidt, Margrethe; Ekstrom, Anna Mia

2015-01-01

Introduction This paper aims to assess the extent and correlates of intimate partner violence (IPV), explore relationship power inequity and the role of sexual and social risk factors in the production of violence among young women aged 16–24 reporting more than one partner in the past three months in a peri-urban setting in the Western Cape, South Africa. Recent estimates suggest that every six hours a woman is killed by an intimate partner in South Africa, making IPV a leading public health problem in the country. While there is mounting evidence that levels of IPV are high in peri-urban settings in South Africa, not much is known about how it manifests among women who engage in concomitantly high HIV risk behaviours such as multiple sexual partnering, transactional sex and age mixing. We know even less about how such women negotiate power and control if exposed to violence in such sexual networks. Methods Two hundred and fifty nine women with multiple sexual partners, residing in a predominantly Black peri-urban community in the Western Cape, South Africa, were recruited into a bio-behavioural survey using Respondent Driven Sampling (RDS). After the survey, focus group discussions and individual interviews were conducted among young women and men to understand the underlying factors informing their risk behaviours and experiences of violence. Findings 86% of the young women experienced IPV in the past 12 months. Sexual IPV was significantly correlated with sex with a man who was 5 years or older than the index female partner (OR 1.7, 95% CI 1.0–3.2) and transactional sex with most recent casual partner (OR 2.1, 95% CI 1.1–3.8). Predictably, women experienced high levels of relationship power inequity. However, they also identified areas in their controlling relationships where they shared decision making power. Discussion Levels of IPV among young women with multiple sexual partners were much higher than what is reported among women in the general population and shown to be associated with sexual risk taking. Interventions targeting IPV need to address sexual risk taking as it heightens vulnerability to violence. PMID:26599394

Big data and high-performance analytics in structural health monitoring for bridge management

NASA Astrophysics Data System (ADS)

Alampalli, Sharada; Alampalli, Sandeep; Ettouney, Mohammed

2016-04-01

Structural Health Monitoring (SHM) can be a vital tool for effective bridge management. Combining large data sets from multiple sources to create a data-driven decision-making framework is crucial for the success of SHM. This paper presents a big data analytics framework that combines multiple data sets correlated with functional relatedness to convert data into actionable information that empowers risk-based decision-making. The integrated data environment incorporates near real-time streams of semi-structured data from remote sensors, historical visual inspection data, and observations from structural analysis models to monitor, assess, and manage risks associated with the aging bridge inventories. Accelerated processing of dataset is made possible by four technologies: cloud computing, relational database processing, support from NOSQL database, and in-memory analytics. The framework is being validated on a railroad corridor that can be subjected to multiple hazards. The framework enables to compute reliability indices for critical bridge components and individual bridge spans. In addition, framework includes a risk-based decision-making process that enumerate costs and consequences of poor bridge performance at span- and network-levels when rail networks are exposed to natural hazard events such as floods and earthquakes. Big data and high-performance analytics enable insights to assist bridge owners to address problems faster.

Influencing factors on high-risk sexual behaviors in young people: an ecological perspective.

PubMed

Arabi-Mianrood, Hoda; Hamzehgardeshi, Zeinab; Khoori, Elham; Moosazadeh, Mahmood; Shahhosseini, Zohreh

2017-04-19

Background In recent years, high-risk sexual behaviors due to their negative consequences both for the individual and society have received more attention than other high-risk behaviors. Objective The aim of this study was to review the influencing factors of high-risk sexual behaviors among young people from an ecological point of view. Methods This review was conducted through searching databases including PubMed, Web of Science, Scopus, Google Scholar and the Cochrane Library with keywords such as sexual risk-taking behavior, high-risk sex, unprotected sex and unsafe sex. The relevant papers published between 1995 and 2016 were extracted. After reviewing the abstract and full text of the articles, 45 papers were used to write this article. Results From an ecological theory approach, factors which influence high-risk sexual behaviors are divided into three categories - the microsystem, the mesosystem and the macrosystem. The microsystem includes factors such as age, gender, race, marital status, place of residence, religion, level of education, personality traits, psychological problems, childhood experiences, body image and coincidence of high-risk behaviors; the mesosystem includes factors such as family structure, peers and sex education; in the macrosystem, the impact of culture and traditions of the society, economic status and the media are presented. Conclusion Given that high-risk sexual behaviors often have multiple causes, it seems that health policymakers must consider multi-dimensional interventions to influence high-risk sexual behaviors based on the ecological approach.

"Controlling ourselves, by ourselves": risk assemblages on Malaysia's assembly lines.

PubMed

Root, Robin

2008-01-01

Since the early 1990s, the Malaysian government has identified factories as high risk for HIV and AIDS. Signaling epidemiological concerns over the rising rates of HIV among factory workers, a significant proportion of whom are women, the label also appeared to reconstitute stereotypes of factory women as dangerously sexual and of factories as immoral spaces. Drawing on ethnographic research in the export processing zones of Penang, Malaysia in the mid-1990s, I examine the meanings and experiences of HIV risk among factory women themselves. Data were analyzed using discourse and grounded theory methods, the former to identify women's multiple modes of rationalizing HIV risks, and the latter to theorize the sources and significance of women's HIV risk assemblages. The heuristic of assemblages as localized knowledge spaces helped to show that biomedical and socioreligious risk lexica operated not as fixed epistemological categories but as situational resources in women's risk scripts. Overall, women desired multiple risk knowledges to help them "control themselves by themselves," a project of reflexive self-shaping mediated by the diverse and discordant discourses of gender, ethnicity, and modernity in Malaysia that shaped how HIV risks were engendered and experienced.

Quantification of Circulating Clonal Plasma Cells via Multiparametric Flow Cytometry Identifies Patients with Smoldering Multiple Myeloma at High Risk of Progression

PubMed Central

Gonsalves, Wilson I.; Rajkumar, S. Vincent; Dispenzieri, Angela; Dingli, David; Timm, Michael M.; Morice, William G.; Lacy, Martha Q.; Buadi, Francis K.; Go, Ronald S.; Leung, Nelson; Kapoor, Prashant; Hayman, Suzanne R.; Lust, John A.; Russell, Stephen J.; Zeldenrust, Steven R.; Hwa, Lisa; Kourelis, Taxiarchis V.; Kyle, Robert A.; Gertz, Morie A.; Kumar, Shaji K.

2017-01-01

The presence of high numbers of circulating clonal plasma cells (cPCs) in patients with smoldering multiple myeloma (SMM), detected by a slide-based immunofluorescence assay, has been associated with a shorter time to progression (TTP) to multiple myeloma (MM). The significance of quantifying cPCs via multiparameter flow cytometry, a much more readily available diagnostic modality, in patients with SMM has not been evaluated. This study evaluated 100 patients with a known or new diagnosis of SMM who were seen at the Mayo Clinic, Rochester from January 2008 until December 2013. Patients with ≥ 150 cPCs (N = 9) were considered to have high number of cPCs based on the 97% specificity and 78% PPV of progression to MM within 2 years of cPC assessment. The median TTP of patients with ≥ 150 cPCs was 9 months compared to not reached for patients with < 150 cPCs (P < 0.001). Thus, quantification of cPCs via multiparametric flow cytometry identifies patients with SMM at very high risk of progression to MM within 2 years and warrants confirmation in larger studies. In the future, this may allow reclassification of such patients as having MM requiring therapy prior to them enduring end-organ damage. PMID:27457702

Qualitative exploration of HIV-related sexual behaviours and multiple partnerships among Chinese men who have sex with men living in a rural area of Yunnan Province, China.

PubMed

Chow, Eric P F; Gao, Liangmin; Koo, Fung Kuen; Chen, Liang; Fu, Xiaoxing; Jing, Jun; Wilson, David P; Zhang, Lei

2013-12-01

The HIV epidemic has been spreading rapidly among men who have sex with men (MSM) in China. The present study explored the pattern of HIV-related high-risk sexual practices among MSM in a rural Chinese setting. Data were collected by semistructured in-depth interviews conducted among 15 MSM in Yuxi Prefecture, Yunnan Province, China. Fifteen respondents were recruited through a local non-governmental organisation via purposive sampling. Thematic analysis was used. Technological changes, risk behaviours, social stigma and high migration rates have played a significant role in the spread of HIV among MSM in rural China. The Internet has become the primary channel for soliciting casual sex partners in the MSM community. Bisexuality and having concurrent and multiple sexual partners were common among rural MSM. A large number of sexual partners and low condom use in all MSM partnership types were noted. Due to Chinese cultural traditions and social stigma, Chinese rural MSM were reluctant to disclose their homosexuality. Rural-to-urban migrant MSM were often engaged in the commercial sex trade. Rural MSM is a distinctive and complex population with multiple identities in China. Concurrent multiple sexual partnerships, high mobility and low disclosure rate are the major challenges for HIV prevention and intervention programs in MSM.

Psychosocial risks associated with multiple births resulting from assisted reproduction: a Spanish sample.

PubMed

Roca de Bes, Montserrat; Gutierrez Maldonado, José; Gris Martínez, José M

2009-09-01

To determine the psychosocial risks associated with multiple births (twins or triplets) resulting from assisted reproductive technology (ART). Transverse study. Infertility units of a university hospital and a private hospital. Mothers and fathers of children between 6 months and 4 years conceived by ART (n = 123). The sample was divided into three groups: parents of singletons (n = 77), twins (n = 37), and triplets (n = 9). The questionnaire was self-administered by patients. It was either completed at the hospital or mailed to participants' homes. Scales measured material needs, quality of life, social stigma, depression, stress, and marital satisfaction. Logistic regression models were applied. Significant odds ratios were obtained for the number of children, material needs, social stigma, quality of life, and marital satisfaction. The results were more significant for data provided by mothers than by fathers. The informed consent form handed out at the beginning of ART should include information on the high risk of conceiving twins and triplets and on the possible psychosocial consequences of multiple births. As soon as a multiple pregnancy is confirmed, it would be useful to provide information on support groups and institutions. Psychological advice should also be given to the parents.

Step On It! - Workplace cardiovascular risk assessment of New York City yellow taxi drivers

PubMed Central

Gany, Francesca; Bari, Sehrish; Gill, Pavan; Ramirez, Julia; Ayash, Claudia; Loeb, Rebecca; Aragones, Abraham; Leng, Jennifer

2015-01-01

Background Multiple factors associated with taxi driving can increase the risk of cardiovascular disease (CVD) in taxi drivers. Methods This paper describes the results of Step On It!, which assessed CVD risk factors among New York City taxi drivers at John F. Kennedy International Airport. Drivers completed an intake questionnaire and free screenings for blood pressure, glucose and body mass index (BMI). Results 466 drivers participated. 9% had random plasma glucose values >200 mg/dl. 77% had elevated BMIs. Immigrants who lived in the U.S. for >10 years had 2.5 times the odds (CI: 1.1–5.9) of having high blood pressure compared to newer immigrants. Discussion Abnormalities documented in this study were significant, especially for immigrants with greater duration of residence in the U.S., and underscore the potential for elevated CVD risk in this vulnerable population, and the need to address this risk through frameworks that utilize multiple levels of intervention. PMID:25680879

Associations between hypo-HDL cholesterolemia and cardiometabolic risk factors in middle-aged men and women: Independence of habitual alcohol drinking, smoking and regular exercise.

PubMed

Wakabayashi, Ichiro; Daimon, Takashi

Hypo-HDL cholesterolemia is a potent cardiovascular risk factor, and HDL cholesterol level is influenced by lifestyles including alcohol drinking, smoking and regular exercise. The aim of this study was to clarify the relationships between hypo-HDL cholesterolemia and cardiovascular risk factors and to determine whether or not these relationships depend on the above-mentioned lifestyles. The subjects were 3456 men and 2510 women (35-60 years of age) showing low HDL cholesterol levels (<40mg/dl for men and <50mg/dl for women) and their age-matched control subjects showing normal HDL cholesterol levels. Each cardiometabolic risk factor was compared between the groups with and without hypo-HDL cholesterolemia. Data for hypo-HDL cholesterolemic subjects not having habits of alcohol drinking, smoking and regular exercise (men, n=333; women, n=1410) and their age-matched control subjects were also analysed. Both in men and in women of overall subjects and subjects without histories of alcohol drinking, smoking and regular exercise, odds ratios of subjects with hypo-HDL cholesterolemia vs. subjects with normo-HDL cholesterolemia for high body mass index, high waist-to-height ratio, high triglycerides, high lipid accumulation product and multiple risk factors (three or more out of obesity, hypertension, dyslipidaemia and diabetes) were significantly higher than the reference level of 1.00. These associations in overall subjects were found when the above habits were adjusted. Hypo-HDL cholesterolemic men and women have adverse cardiovascular profiles, such as obesity, hypertriglyceridemia and multiple risk factors, independently of age, alcohol drinking, smoking and regular exercise. Copyright © 2016 Asia Oceania Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.

Characteristics of first suicide attempts in single versus multiple suicide attempters with bipolar disorder.

PubMed

Michaelis, Benjamin H; Goldberg, Joseph F; Singer, Tara M; Garno, Jessica L; Ernst, Carrie L; Davis, Glen P

2003-01-01

Although suicidality remains highly prevalent among patients with bipolar disorder, little research exists examining the characteristics of successive attempts among individuals who make and survive a first suicide attempt. We compared bipolar subjects with a history of one suicide attempt to those with multiple attempts and assessed demographic characteristics, family histories, psychopathology, and clinical dimensions of suicidal behavior. Fifty-two DSM-IV bipolar patients (age 21 to 74 years) with a history of at least one suicide attempt were consecutively evaluated in the Bipolar Disorders Research Clinic of the New York Presbyterian Hospital. Circumstances surrounding each lifetime suicide attempt were assessed by direct interviews, questionnaires, and chart reviews along with family psychiatric histories, substance abuse histories, current psychopathology, and features of impulsivity and aggression. Multiple suicide attempts occurred in approximately two thirds of the study group. Single attempters were significantly more likely than multiple attempters to show high seriousness of intent at their first attempt (OR = 0.65, 95% CI = 0.43 to 0.99), and tended to be less likely than multiple attempters to exhibit mixed states at their first attempt (OR = 0.54, 95% CI = 0.28 to 1.01). Seriousness of intent was consistent across the first and second attempts (r =.48, P <.01) and second and third attempts (r =.74, P <.05). Single and multiple attempters differed in no other clinical or demographic characteristics studied. We conclude that multiple suicide attempts are common among bipolar patients. Those who survive an initial suicide attempt involving high seriousness of intent appear less likely than those with low intent to make subsequent attempts. Consequently, single attempters may represent a group more closely resembling those who complete suicide on a first attempt, in terms of the risk for death associated with their first attempt. However, multiple suicide attempts among bipolar patients are not necessarily associated with a higher risk for lethality in first suicide attempt survivors. Copyright 2003, Elsevier Science (USA). All rights reserved.

The HPV-16 E7 oncoprotein induces centriole multiplication through deregulation of Polo-like kinase 4 expression

PubMed Central

2011-01-01

Background Infection with high-risk human papillomaviruses (HPVs) such as HPV-16 is intimately associated with squamous cell carcinomas (SCCs) of the anogenital tract and a subset of oropharyngeal carcinomas. Such lesions, including pre-invasive precursors, frequently show multipolar mitoses and aneuploidy. The high-risk HPV-16-encoded E7 oncoprotein has been shown to rapidly induce centrosome abnormalities thereby causing the formation of supernumerary mitotic spindle poles and increasing the risk for chromosome missegregation. HPV-16 E7 has been found to rapidly induce centriole overduplication, in part, through the simultaneous formation of more than one daughter centriole at single maternal centrioles (centriole multiplication). The precise molecular mechanism that underlies HPV-16 E7-induced centriole multiplication, however, remains poorly understood. Findings Here, we show that human keratinocytes engineered to stably express the HPV-16 E7 oncoprotein exhibit aberrant Polo-like kinase 4 (PLK4) protein expression at maternal centrioles. Real-time quantitative reverse transcriptase (qRT-PCR) analysis of these cells revealed an increase of PLK4 mRNA levels compared to control cells. Importantly, the ability of the HPV-16 E7 oncoprotein to induce centriole multiplication was found to correlate with its ability to activate the PLK4 promoter and to up-regulate PLK4 mRNA. Conclusions These results highlight the critical role of PLK4 transcriptional deregulation in centriole multiplication in HPV-16 E7-expressing cells. Our findings encourage further experiments to test transcriptional inhibitors or small molecules targeting PLK4 to prevent centriole abnormalities, mitotic infidelity and malignant progression in HPV-associated neoplasms and other tumors in which PLK4 regulation is disrupted. PMID:21609466

Integration of multiple cues allows threat-sensitive anti-intraguild predator responses in predatory mites

PubMed Central

Walzer, Andreas; Schausberger, Peter

2013-01-01

Intraguild (IG) prey is commonly confronted with multiple IG predator species. However, the IG predation (IGP) risk for prey is not only dependent on the predator species, but also on inherent (intraspecific) characteristics of a given IG predator such as its life-stage, sex or gravidity and the associated prey needs. Thus, IG prey should have evolved the ability to integrate multiple IG predator cues, which should allow both inter- and intraspecific threat-sensitive anti-predator responses. Using a guild of plant-inhabiting predatory mites sharing spider mites as prey, we evaluated the effects of single and combined cues (eggs and/or chemical traces left by a predator female on the substrate) of the low risk IG predator Neoseiulus californicus and the high risk IG predator Amblyseius andersoni on time, distance and path shape parameters of the larval IG prey Phytoseiulus persimilis. IG prey discriminated between traces of the low and high risk IG predator, with and without additional presence of their eggs, indicating interspecific threat-sensitivity. The behavioural changes were manifest in distance moved, activity and path shape of IG prey. The cue combination of traces and eggs of the IG predators conveyed other information than each cue alone, allowing intraspecific threat-sensitive responses by IG prey apparent in changed velocities and distances moved. We argue that graded responses to single and combined IG predator cues are adaptive due to minimization of acceptance errors in IG prey decision making. PMID:23750040

Impact of the Prevention Plan on Employee Health Risk Reduction

PubMed Central

Edington, Dee W.; Bég, Sami

2010-01-01

Abstract This study evaluated the impact of The Prevention Plan™ on employee health risks after 1 year of integrated primary prevention (wellness and health promotion) and secondary prevention (biometric and lab screening as well as early detection) interventions. The Prevention Plan is an innovative prevention benefit that provides members with the high-tech/high-touch support and encouragement they need to adopt healthy behaviors. Support services include 24/7 nurse hotlines, one-on-one health coaching, contests, group events, and employer incentives. Specifically, we analyzed changes in 15 health risk measures among a cohort of 2606 employees from multiple employer groups who completed a baseline health risk appraisal, blood tests, and biometric screening in 2008 and who were reassessed in 2009. We then compared the data to the Edington Natural Flow of risks. The cohort showed significant reduction in 10 of the health risks measured (9 at P ≤ 0.01 and 1 at P ≤ 0.05). The most noticeable changes in health risks were a reduction in the proportion of employees with high-risk blood pressure (42.78%), high-risk fasting blood sugar (31.13%), and high-risk stress (24.94%). There was an overall health risk transition among the cohort with net movement from higher risk levels to lower risk levels (P < 0.01). There was a net increase of 9.40% of people in the low-risk category, a decrease of 3.61% in the moderate-risk category, and a 5.79% decrease in the high-risk category. Compared to Edington's Natural Flow model, 48.70% of individuals in the high-risk category moved from high risk to moderate risk (Natural Flow 31%), 46.35% moved from moderate risk to low risk (Natural Flow 35%), 15.65% moved from high risk to low risk (Natural Flow 6%), and 87.33% remained in the low-risk category (Natural Flow 70%) (P < 0.001). (Population Health Management 2010;13:275–284) PMID:20879909

Impact of the prevention plan on employee health risk reduction.

PubMed

Loeppke, Ronald; Edington, Dee W; Bég, Sami

2010-10-01

This study evaluated the impact of The Prevention Plan™ on employee health risks after 1 year of integrated primary prevention (wellness and health promotion) and secondary prevention (biometric and lab screening as well as early detection) interventions. The Prevention Plan is an innovative prevention benefit that provides members with the high-tech/high-touch support and encouragement they need to adopt healthy behaviors. Support services include 24/7 nurse hotlines, one-on-one health coaching, contests, group events, and employer incentives. Specifically, we analyzed changes in 15 health risk measures among a cohort of 2606 employees from multiple employer groups who completed a baseline health risk appraisal, blood tests, and biometric screening in 2008 and who were reassessed in 2009. We then compared the data to the Edington Natural Flow of risks. The cohort showed significant reduction in 10 of the health risks measured (9 at P≤ 0.01 and 1 at P≤0.05). The most noticeable changes in health risks were a reduction in the proportion of employees with high-risk blood pressure (42.78%), high-risk fasting blood sugar (31.13%), and high-risk stress (24.94%). There was an overall health risk transition among the cohort with net movement from higher risk levels to lower risk levels (P<0.01). There was a net increase of 9.40% of people in the low-risk category, a decrease of 3.61% in the moderate-risk category, and a 5.79% decrease in the high-risk category. Compared to Edington's Natural Flow model, 48.70% of individuals in the high-risk category moved from high risk to moderate risk (Natural Flow 31%), 46.35% moved from moderate risk to low risk (Natural Flow 35%), 15.65% moved from high risk to low risk (Natural Flow 6%), and 87.33% remained in the low-risk category (Natural Flow 70%) (P<0.001).

Priority setting for invasive species management: risk assessment of Ponto-Caspian invasive species into Great Britain.

PubMed

Gallardo, Belinda; Aldridge, David C

2013-03-01

Invasive species drive important ecological and economic losses across wide geographies, with some regions supporting especially large numbers of nonnative species and consequently suffering relatively high impacts. For this reason, integrated risk assessments able to screen a suite of multiple invaders over large geographic areas are needed for prioritizing the allocation of limited resources. A total of 16 Ponto-Caspian aquatic species (10 gammarids, one isopod, two mysids, and three fishes) have been short-listed as recent or potential future invaders of British waters, whose introduction and spread is of high concern. In this study, we use multiple modeling techniques to assess their risk of establishment and spread into Great Britain. Climate suitability maps for these 16 species differed depending on the eastern and western distribution of species in continental Europe, which was related to their respective migration corridor: southern (Danube-Rhine rivers), and northern (Don and Volga rivers and Baltic lakes). Species whose suitability was high across large parts of Great Britain included four gammarids (Cheliorophium robustum, Dikerogammarus bispinosus, D. villosus, and Echinogammarus trichiatus) and a mysid (Hemimysis anomala). A climatic "heat map" combining the results of all 16 species together pointed to the southeast of England as the area most vulnerable to multiple invasions, particularly the Thames, Anglian, Severn, and Humber river basin districts. Regression models further suggested that alkalinity concentration > 120 mg/L in southeast England may favor the establishment of Ponto-Caspian invaders. The production of integrated risk maps for future invaders provides a means for the scientifically informed prioritization of resources toward particular species and geographic regions. Such tools have great utility in helping environmental managers focus efforts on the most effective prevention, management, and monitoring programs.

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.

Response inhibition moderates the association between drug use and risky sexual behavior.

PubMed

Nydegger, Liesl A; Ames, Susan L; Stacy, Alan W; Grenard, Jerry L

2014-09-01

HIV infection is problematic among all drug users, not only injection drug users. Drug users are at risk for contracting HIV by engaging in risky sexual behaviors. The present study sought to determine whether inhibitory processes moderate the relationship between problematic drug use and HIV-risk behaviors (unprotected sex and multiple sex partners). One hundred ninety-six drug offenders enrolled in drug education programs were administered a battery of computer-based assessments. Measures included a cued go/no-go assessment of inhibitory processes, the Drug Abuse Screening Test (DAST) assessment of problematic drug use, and self-report assessment of condom use and multiple sex partners. Findings revealed that response inhibition assessed by the proportion of false alarms on the cued go/no-go moderated the relationship between problematic drug use and an important measure of HIV risk (condom nonuse) among drug offenders. However, response inhibition did not moderate the relationship between problematic drug use and another measure of HIV risk: multiple sex partners. Among this sample of drug offenders, we have found a relationship between problematic drug use and condom nonuse, which is exacerbated by poor control of inhibition. These findings have implications for the development of HIV intervention components among high-risk populations.

Co-occurring risk factors for current cigarette smoking in a U.S. nationally representative sample

PubMed Central

Higgins, Stephen T.; Kurti, Allison N.; Redner, Ryan; White, Thomas J.; Keith, Diana R.; Gaalema, Diann E.; Sprague, Brian L.; Stanton, Cassandra A.; Roberts, Megan E.; Doogan, Nathan J.; Priest, Jeff S.

2016-01-01

Introduction Relatively little has been reported characterizing cumulative risk associated with co-occurring risk factors for cigarette smoking. The purpose of the present study was to address that knowledge gap in a U.S. nationally representative sample. Methods Data were obtained from 114,426 adults (≥ 18 years) in the U.S. National Survey on Drug Use and Health (years 2011–13). Multiple logistic regression and classification and regression tree (CART) modeling were used to examine risk of current smoking associated with eight co-occurring risk factors (age, gender, race/ethnicity, educational attainment, poverty, drug abuse/dependence, alcohol abuse/dependence, mental illness). Results Each of these eight risk factors was independently associated with significant increases in the odds of smoking when concurrently present in a multiple logistic regression model. Effects of risk-factor combinations were typically summative. Exceptions to that pattern were in the direction of less-than-summative effects when one of the combined risk factors was associated with generally high or low rates of smoking (e.g., drug abuse/dependence, age ≥65). CART modeling identified subpopulation risk profiles wherein smoking prevalence varied from a low of 11% to a high of 74% depending on particular risk factor combinations. Being a college graduate was the strongest independent predictor of smoking status, classifying 30% of the adult population. Conclusions These results offer strong evidence that the effects associated with common risk factors for cigarette smoking are independent, cumulative, and generally summative. The results also offer potentially useful insights into national population risk profiles around which U.S. tobacco policies can be developed or refined. PMID:26902875

Space Radiation Risks for Astronauts on Multiple International Space Station Missions

PubMed Central

Cucinotta, Francis A.

2014-01-01

Mortality and morbidity risks from space radiation exposure are an important concern for astronauts participating in International Space Station (ISS) missions. NASA’s radiation limits set a 3% cancer fatality probability as the upper bound of acceptable risk and considers uncertainties in risk predictions using the upper 95% confidence level (CL) of the assessment. In addition to risk limitation, an important question arises as to the likelihood of a causal association between a crew-members’ radiation exposure in the past and a diagnosis of cancer. For the first time, we report on predictions of age and sex specific cancer risks, expected years of life-loss for specific diseases, and probability of causation (PC) at different post-mission times for participants in 1-year or multiple ISS missions. Risk projections with uncertainty estimates are within NASA acceptable radiation standards for mission lengths of 1-year or less for likely crew demographics. However, for solar minimum conditions upper 95% CL exceed 3% risk of exposure induced death (REID) by 18 months or 24 months for females and males, respectively. Median PC and upper 95%-confidence intervals are found to exceed 50% for several cancers for participation in two or more ISS missions of 18 months or longer total duration near solar minimum, or for longer ISS missions at other phases of the solar cycle. However, current risk models only consider estimates of quantitative differences between high and low linear energy transfer (LET) radiation. We also make predictions of risk and uncertainties that would result from an increase in tumor lethality for highly ionizing radiation reported in animal studies, and the additional risks from circulatory diseases. These additional concerns could further reduce the maximum duration of ISS missions within acceptable risk levels, and will require new knowledge to properly evaluate. PMID:24759903

Space radiation risks for astronauts on multiple International Space Station missions.

PubMed

Cucinotta, Francis A

2014-01-01

Mortality and morbidity risks from space radiation exposure are an important concern for astronauts participating in International Space Station (ISS) missions. NASA's radiation limits set a 3% cancer fatality probability as the upper bound of acceptable risk and considers uncertainties in risk predictions using the upper 95% confidence level (CL) of the assessment. In addition to risk limitation, an important question arises as to the likelihood of a causal association between a crew-members' radiation exposure in the past and a diagnosis of cancer. For the first time, we report on predictions of age and sex specific cancer risks, expected years of life-loss for specific diseases, and probability of causation (PC) at different post-mission times for participants in 1-year or multiple ISS missions. Risk projections with uncertainty estimates are within NASA acceptable radiation standards for mission lengths of 1-year or less for likely crew demographics. However, for solar minimum conditions upper 95% CL exceed 3% risk of exposure induced death (REID) by 18 months or 24 months for females and males, respectively. Median PC and upper 95%-confidence intervals are found to exceed 50% for several cancers for participation in two or more ISS missions of 18 months or longer total duration near solar minimum, or for longer ISS missions at other phases of the solar cycle. However, current risk models only consider estimates of quantitative differences between high and low linear energy transfer (LET) radiation. We also make predictions of risk and uncertainties that would result from an increase in tumor lethality for highly ionizing radiation reported in animal studies, and the additional risks from circulatory diseases. These additional concerns could further reduce the maximum duration of ISS missions within acceptable risk levels, and will require new knowledge to properly evaluate.

Gender Differences in Factors Related to HIV Risk Behaviors among People Who Inject Drugs in North-East India

PubMed Central

McFall, Allison M.; Solomon, Sunil S.; Srikrishnan, Aylur K.; Vasudevan, Canjeevaram K.; Anand, Santhanam; Celentano, David D.; Mehta, Shruti H.; Kumar, Suresh; Lucas, Gregory M.

2017-01-01

People who inject drugs (PWID) in India are at high risk for HIV, with women being at elevated risk. Using a socio-ecological framework, this study assessed whether factors associated with HIV transmission risk behaviors differed across men and women PWID. Data for this cross-sectional study were collected from 6449 PWID in 7 cities in Northeast India. Men (n = 5653) and women (n = 796) PWID were recruited using respondent-driven sampling (RDS). We assessed sex differences in two recent HIV transmission risk behaviors: multiple sex partners and needle/syringe sharing. We used multi-level logistic regression models, which incorporated sampling weights and random intercepts for city, to assess factors associated with these HIV risks, separately among men and women. The prevalence of HIV was significantly higher among women than men (53% vs 18.4%, p<0.01). Nearly 13% of men and 8% of women (p = .30) had multiple partners. Employment in men and relationship status and stigma in women were significantly associated with multiple partners. Approximately 25% of men and 19% of women engaged in needle sharing (p = .16). Younger age in women and depression symptoms in men were significantly associated with increased risk for sharing needles. We found that sexual and drug related risk behaviors were common among PWID in Northeast India, and there were differences between men and women in the socio-ecologic correlates of these behaviors. Contextually-integrated and gender-specific HIV prevention and intervention efforts are needed that consider factors at individual, interpersonal- and community-levels that uniquely impact HIV risks among PWID. PMID:28099458

Risk factors of carotid plaque and carotid common artery intima-media thickening in a high-stroke-risk population.

PubMed

Wang, ChunFang; Lv, GaoPeng; Zang, DaWei

2017-11-01

To analyze the risk factors of carotid plaque (CP) and carotid common artery intima-media thickening (CCAIMT) and the association between the risk factors and CP numbers and the side of the CCAIMT in a high-stroke-risk population. Carotid ultrasonography was conducted in 2025 participants with high stroke risk. Participants were divided into different groups according to the results of the ultrasound. The risk factors and blood biochemical indices were recorded. The presence of CP and CCAIMT were 38.9% and 24.8% respectively. Multivariate logistic regression indicated that the risk factors of CP were age, high LDL-C and FBG levels, male gender, stroke, diabetes, hypertension, and tobacco use. Compared with participants without CPs, the participants who were male, and older in age, with risk factors of tobacco use, diabetes, high LDL-C levels, and a family history of hypertension were likely to have a single CP, whereas the participants with risk factors of tobacco use, diabetes, hypertension, male gender, older age, high LDL-C levels, stroke and AF or valvulopathy were prone to have multiple CPs. The risk factors of CCAIMT were male gender, stroke, hypertension, diabetes, AF or valvulopathy, tobacco use and age. Compared with the N-CCAIMT subgroup, the risk factors of left CCAIMT were tobacco use, diabetes, male gender, and age. The risk factors of right CCAIMT were male gender, high FBG levels, age, AF or valvulopathy. The risk factors of dual CCAIMT were high frequency of drinking milk, tobacco use, male gender, age, stroke, and hypertension. These findings revealed the risk factors of CP and CCAIMT, and an association between the risk factors and the CP numbers and the side of the CCAIMT.

Book Reviews.

ERIC Educational Resources Information Center

Colman, Andrew M.; And Others

1993-01-01

Reviews "Cooperation and Prosocial Behaviour" (Hinde and Groebel); "Psychological Development of High Risk Multiple Birth Children" (Krall and Feinstein); "Early Prediction and Prevention of Child Abuse" (Browne and others); "Strategies des joueurs d'Awale" (Reitschitzki); "Children's Understanding of…

High-risk cutaneous squamous cell carcinoma in a Japanese allogeneic bone marrow transplant recipient on long-term voriconazole.

PubMed

Ng, William; Takahashi, Akira; Muto, Yusuke; Yamazaki, Naoya

2017-10-01

Cutaneous squamous cell carcinomas arise as secondary cancers in hematopoietic stem cell transplant survivors. They have been documented primarily in Western cohorts and relatively little is known about their occurrence in Asian hematopoietic stem cell transplant recipients, with no reports of squamous cell carcinomas with high-risk features in Asian patients. We describe a case of a cutaneous squamous cell carcinoma with high-risk features on the scalp of a Japanese bone marrow transplant recipient approximately 6.5 years post-transplant, who was on long-term voriconazole. The history of a photodistributed erythema followed by the appearance of multiple actinic keratoses and solar lentigines, together with the rarity of cutaneous squamous cell carcinomas in Asian hematopoietic stem cell transplant cohorts revealed in our literature review, suggest that voriconazole use contributed to the development of high-risk squamous cell carcinoma in our patient. © 2017 Japanese Dermatological Association.

Multiple-time scales analysis of physiological time series under neural control

NASA Technical Reports Server (NTRS)

Peng, C. K.; Hausdorff, J. M.; Havlin, S.; Mietus, J. E.; Stanley, H. E.; Goldberger, A. L.

1998-01-01

We discuss multiple-time scale properties of neurophysiological control mechanisms, using heart rate and gait regulation as model systems. We find that scaling exponents can be used as prognostic indicators. Furthermore, detection of more subtle degradation of scaling properties may provide a novel early warning system in subjects with a variety of pathologies including those at high risk of sudden death.

Prelingual sensorineural hearing loss and infants at risk: Western Sicily report.

PubMed

Martines, Francesco; Martines, Enrico; Mucia, Marianna; Sciacca, Vincenzo; Salvago, Pietro

2013-04-01

To evaluate independent etiologic factor associated with sensorineural hearing loss (SNHL) in newborn at risk; to study the role of their interaction especially in NICU infants who present often multiple risk factors for SNHL. The main risk factors for SNHL reported by JCIH 2007 were evaluated on 508 infant at risk ranging from 4 to 20 weeks of life, transferred to the Audiology Department of Palermo from the main births centers of Western Sicily. After a global audiological assessment, performed with TEOAE, tympanometry and ABR, the prevalence and the effect of risk factors was statistically studied through univariate and multivariate analysis on the total population (normal and deaf subjects). Fifty-one infants (10.03%) were diagnosed with SNHL (45 bilateral and 6 monolateral) with a mean hearing threshold of 87.39 ± 28.25 dB HL; from logistic regression analysis family history of hearing impairment (HI) and TORCH infections resulted independent significant risk factors (P<0.00001 and P=0.024 respectively). High SNHL percentages were evidenced also in NICU babies, due to the various pathologies and risk factors presented by these infants, and among newborns who suffered from hyperbilirubinemia requiring exchange transfusion (11.97% and 9.52% respectively). Craniofacial abnormalities (CFA) and syndromes associated to HI showed an important relationship (P<0.00001) with conductive hearing loss (CHL). Multiple regression analysis of the variation in SNHL among NICU infants evidenced an increased risk for SNHL of 21.24% and of 19.33% respectively in preterm infants and in case of hyperbilirubinemia if respiratory distress is concomitant with these risk factors. It was also observed an higher risk of SNHL (99.66%) in case of coexistence of prematurity and hyperbilirubinemia. Finally among infants with very low birth weight (VLBW) it was evidenced a statistically difference between the mean weight of SNHL infants respect to NHL newborns (P=0.048). The high SNHL prevalence (10.03%) in our cohort underlines how infants at risk are more susceptible to suffer from SNHL; in particular NICU newborns have a 33% greater chance of developing SNHL, because of the presence of multiple risk factors (or=1.33) and their interaction. As the number of coexisting risk factors increases, the prevalence of SNHL also increases (r(2)=0.93). Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Interactive effects of obesity and physical fitness on risk of ischemic heart disease.

PubMed

Crump, C; Sundquist, J; Winkleby, M A; Sundquist, K

2017-02-01

Obesity and low physical fitness are known risk factors for ischemic heart disease (IHD), but their interactive effects are unclear. Elucidation of interactions between these common, modifiable risk factors may help inform more effective preventive strategies. We examined interactive effects of obesity, aerobic fitness and muscular strength in late adolescence on risk of IHD in adulthood in a large national cohort. We conducted a national cohort study of all 1 547 407 military conscripts in Sweden during 1969-1997 (97-98% of all 18-year-old males each year). Aerobic fitness, muscular strength and body mass index (BMI) measurements were examined in relation to IHD identified from outpatient and inpatient diagnoses through 2012 (maximum age 62 years). There were 38 142 men diagnosed with IHD in 39.7 million person years of follow-up. High BMI or low aerobic fitness (but not muscular strength) was associated with higher risk of IHD, adjusting for family history and socioeconomic factors. The combination of high BMI (overweight/obese vs normal) and low aerobic fitness (lowest vs highest tertile) was associated with highest IHD risk (incidence rate ratio, 3.11; 95% confidence interval (CI), 2.91-3.31; P<0.001). These exposures had no additive and a negative multiplicative interaction (that is, their combined effect was less than the product of their separate effects). Low aerobic fitness was a strong risk factor even among those with normal BMI. In this large cohort study, low aerobic fitness or high BMI at age 18 was associated with higher risk of IHD in adulthood, with a negative multiplicative interaction. Low aerobic fitness appeared to account for a similar number of IHD cases among those with normal vs high BMI (that is, no additive interaction). These findings suggest that interventions to prevent IHD should begin early in life and include not only weight control but aerobic fitness, even among persons of normal weight.

Research on the nutrition and cognition of high-risk stroke groups in community and the relevant factors.

PubMed

Zhao, N-N; Zeng, K-X; Wang, Y-L; Sheng, P-J; Tang, C-Z; Xiao, P; Liu, X-W

2017-12-01

To investigate the prevalence rate of nutritional risk in high-risk stroke groups in community, analyze its influencing factors, and analyze and compare the relationship between nutritional risk or malnutrition assessed by different nutritional evaluation methods and cognitive function, so as to provide the basis and guidance for clinical nutritional assessment and support. A cross-sectional survey was performed for 1196 cases in high-risk stroke groups in community from December 2015 to January 2017. At the same time, the nutritional status of patients was evaluated using the mini nutritional assessment (MNA) and MNA-short form (MNA-SF), and the cognitive status of patients was evaluated using the mini-mental state examination (MMSE). Moreover, the relevant influencing factors of nutritional risk and MMSE score were analyzed and compared. High-risk stroke groups in community suffered from a high risk of malnutrition. MNA-SF had a higher specificity and lower false positive rate than MNA. Nutritional risk occurred more easily in high-risk stroke groups in community with a history of diabetes mellitus, less physical exercise or light manual labor, daily use of multiple drugs, and higher age. Those with a higher nutritional risk were more prone to cognitive impairment. High-risk stroke groups in community, complicated with hyperhomocysteinemia, daily use of three or more kinds of prescription drugs, and a previous history of stroke, were accompanied by cognitive impairment easily. MNA-SF can be used for the nutritional screening of high-risk stroke groups in community. For the high-risk stroke groups in community, the rational nutritional diet should be publicized, blood sugar should be controlled in a scientific manner and physical exercise should be moderately increased.

Human papillomavirus genotype distribution and cervical squamous intraepithelial lesions among high-risk women with and without HIV-1 infection in Burkina Faso

PubMed Central

Didelot-Rousseau, M-N; Nagot, N; Costes-Martineau, V; Vallès, X; Ouedraogo, A; Konate, I; Weiss, H A; Van de Perre, P; Mayaud, P; Segondy, M

2006-01-01

Human papillomavirus (HPV) infection and cervical squamous intraepithelial lesions (SILs) were studied in 379 high-risk women. Human papillomavirus DNA was detected in 238 of 360 (66.1%) of the beta-globin-positive cervical samples, and 467 HPV isolates belonging to 35 types were identified. Multiple (2–7 types) HPV infections were observed in 52.9% of HPV-infected women. The most prevalent HPV types were HPV-52 (14.7%), HPV-35 (9.4%), HPV-58 (9.4%), HPV-51 (8.6%), HPV-16 (7.8%), HPV-31 (7.5%), HPV-53 (6.7%), and HPV-18 (6.4%). Human immunodeficiency virus type 1 (HIV-1) seroprevalence was 36.0%. Human papillomavirus prevalence was significantly higher in HIV-1-infected women (87 vs 54%, prevalence ratio (PR)=1.61, 95% confidence interval (CI): 1.4–1.8). High-risk HPV types (71 vs 40%, PR=1.79, 95% CI: 1.5–2.2), in particular HPV-16+18 (22 vs 9%, PR=2.35, 95% CI: 1.4–4.0), and multiple HPV infections (56 vs 23%, PR=2.45, 95% CI: 1.8–3.3) were more prevalent in HIV-1-infected women. High-grade SIL (HSIL) was identified in 3.8% of the women. Human immunodeficiency virus type 1 infection was strongly associated with presence of HSIL (adjusted odds ratio=17.0; 95% CI 2.2–134.1, P=0.007) after controlling for high-risk HPV infection and other risk factors for HSIL. Nine of 14 (63%) HSIL cases were associated with HPV-16 or HPV-18 infection, and might have been prevented by an effective HPV-16/18 vaccine. PMID:16832413

Volumetry based biomarker speed of growth: Quantifying the change of total tumor volume in whole-body magnetic resonance imaging over time improves risk stratification of smoldering multiple myeloma patients

PubMed Central

Piraud, Marie; Menze, Bjoern H.; Hielscher, Thomas; Hofmanninger, Johannes; Wagner, Barbara; Kauczor, Hans-Ulrich; Merz, Maximilian; Hillengass, Jens; Langs, Georg; Weber, Marc-André

2018-01-01

The purpose of this study was to improve risk stratification of smoldering multiple myeloma patients, introducing new 3D-volumetry based imaging biomarkers derived from whole-body MRI. Two-hundred twenty whole-body MRIs from 63 patients with smoldering multiple myeloma were retrospectively analyzed and all focal lesions >5mm were manually segmented for volume quantification. The imaging biomarkers total tumor volume, speed of growth (development of the total tumor volume over time), number of focal lesions, development of the number of focal lesions over time and the recent imaging biomarker ‘>1 focal lesion’ of the International Myeloma Working Group were compared, taking 2-year progression rate, sensitivity and false positive rate into account. Speed of growth, using a cutoff of 114mm3/month, was able to isolate a high-risk group with a 2-year progression rate of 82.5%. Additionally, it showed by far the highest sensitivity in this study and in comparison to other biomarkers in the literature, detecting 63.2% of patients who progress within 2 years. Furthermore, its false positive rate (8.7%) was much lower compared to the recent imaging biomarker ‘>1 focal lesion’ of the International Myeloma Working Group. Therefore, speed of growth is the preferable imaging biomarker for risk stratification of smoldering multiple myeloma patients. PMID:29861868

Volumetry based biomarker speed of growth: Quantifying the change of total tumor volume in whole-body magnetic resonance imaging over time improves risk stratification of smoldering multiple myeloma patients.

PubMed

Wennmann, Markus; Kintzelé, Laurent; Piraud, Marie; Menze, Bjoern H; Hielscher, Thomas; Hofmanninger, Johannes; Wagner, Barbara; Kauczor, Hans-Ulrich; Merz, Maximilian; Hillengass, Jens; Langs, Georg; Weber, Marc-André

2018-05-18

The purpose of this study was to improve risk stratification of smoldering multiple myeloma patients, introducing new 3D-volumetry based imaging biomarkers derived from whole-body MRI. Two-hundred twenty whole-body MRIs from 63 patients with smoldering multiple myeloma were retrospectively analyzed and all focal lesions >5mm were manually segmented for volume quantification. The imaging biomarkers total tumor volume, speed of growth (development of the total tumor volume over time), number of focal lesions, development of the number of focal lesions over time and the recent imaging biomarker '>1 focal lesion' of the International Myeloma Working Group were compared, taking 2-year progression rate, sensitivity and false positive rate into account. Speed of growth, using a cutoff of 114mm 3 /month, was able to isolate a high-risk group with a 2-year progression rate of 82.5%. Additionally, it showed by far the highest sensitivity in this study and in comparison to other biomarkers in the literature, detecting 63.2% of patients who progress within 2 years. Furthermore, its false positive rate (8.7%) was much lower compared to the recent imaging biomarker '>1 focal lesion' of the International Myeloma Working Group. Therefore, speed of growth is the preferable imaging biomarker for risk stratification of smoldering multiple myeloma patients.

Improving the evidence base for services working with youth at-risk of involvement in the criminal justice system: developing a standardised program approach.

PubMed

Knight, Alice; Maple, Myfanwy; Shakeshaft, Anthony; Shakehsaft, Bernie; Pearce, Tania

2018-04-16

Young people who engage in multiple risk behaviour (high-risk young people) such as substance abuse, antisocial behaviour, low engagement in education and employment, self-harm or suicide ideation are more likely to experience serious harms later in life including homelessness, incarceration, violence and premature death. In addition to personal disadvantage, these harms represent an avoidable social and economic cost to society. Despite these harms, there is insufficient evidence about how to improve outcomes for high-risk young people. A key reason for this is a lack of standardisation in the way in which programs provided by services are defined and evaluated. This paper describes the development of a standardised intervention model for high-risk young people. The model can be used by service providers to achieve greater standardisation across their programs, outcomes and outcome measures. To demonstrate its feasibility, the model is applied to an existing program for high-risk young people. The development and uptake of a standardised intervention model for these programs will help to more rapidly develop a larger and more rigorous evidence-base to improve outcomes for high-risk young people.

Factors Associated with Sexual Behavior among Adolescents: A Multivariate Analysis.

ERIC Educational Resources Information Center

Harvey, S. Marie; Spigner, Clarence

1995-01-01

A self-administered survey examining multiple factors associated with engaging in sexual intercourse was completed by 1,026 high school students in a classroom setting. Findings suggest that effective interventions to address teenage pregnancy need to utilize a multifaceted approach to the prevention of high-risk behaviors. (JPS)

Aggressive Students and High School Dropout: An Event History Analysis

ERIC Educational Resources Information Center

Orozco, Steven R.

2016-01-01

Aggressive students often struggle in multiple domains of their school functioning and are at increased risk for high school dropout. Research has identified a variety of warning flags which are strong predictors of high school dropout. While it is known that aggressive students exhibit many of these warning flags, there is little research which…

Using impedance cardiography to detect subclinical cardiovascular disease in women with multiple risk factors: a pilot study.

PubMed

Demarzo, Arthur P

2009-01-01

Early detection of cardiovascular disease (CVD) could initiate appropriate treatment and prevent progression. This study used impedance cardiography (ICG) waveform analysis with postural change to detect functional CVD in women older than 40 years with no history of CVD and >or=2 of the following risk factors: cigarette smoking, poor diet, physical inactivity, central adiposity, family history of premature CVD, hypertension, and dyslipidemia. A study group of 32 women underwent ICG in standing and supine positions. An age-matched control group had 20 women with an active lifestyle, no risk factors, and no history of CVD. All women in the control group had normal ICG data. All women in the study group had some abnormal ICG data, with 28 (87.5%) having multiple ICG abnormalities. ICG data indicated that 13 (40.6%) had ventricular dysfunction, 14 (43.8%) had high vascular resistive load, and 30 (93.8%) had elevated vascular pulsatile load. The data suggest that subclinical CVD, detectable by ICG, is prevalent in women older than 40 years with multiple risk factors. Abnormal ICG results could expedite the initiation of customized treatment as part of a preventive approach to CVD. (c) 2009 Wiley Periodicals, Inc.

Stressors in Multiple Life-Domains and the Risk for Externalizing and Internalizing Behaviors among African Americans during Emerging Adulthood

ERIC Educational Resources Information Center

Estrada-Martanez, Lorena M.; Caldwell, Cleopatra H.; Bauermeister, Jose A.; Zimmerman, Marc A.

2012-01-01

Behavioral and mental health outcomes have been associated with experiencing high levels of stress. Yet, little is known about the link between the nature of stressors, their accumulation over time, and the risk for externalizing and internalizing outcomes. Compared to the general population, African Americans are exposed to a disproportionate…

A Prevention Program for Preschool C.O.A.s: Design and Early Effects.

ERIC Educational Resources Information Center

Zucker, Robert A.; And Others

This report addresses three levels of questions about the effectiveness of the Michigan State University Multiple Risk Outreach Program (MROP). The MROP was designed to recruit families from this high-risk population and test the implementation of an intervention protocol in a population-based program for 3- to 6-year-olds and their families. This…

Adolescent Substance Abuse: Risk Factors and Prevention Strategies. Maternal & Child Health Technical Information Bulletin.

ERIC Educational Resources Information Center

Werner, Mark J.

The high prevalence of alcohol and substance abuse by adolescents poses a significant threat to the wellness of youth. Adolescents appear to use drugs for a variety of reasons. In addition to the multiple etiologic and risk factors present for substance abuse, there are many pathways teenagers may follow on their way to substance abuse. The…

Probabilistic risk models for multiple disturbances: an example of forest insects and wildfires

Treesearch

Haiganoush K. Preisler; Alan A. Ager; Jane L. Hayes

2010-01-01

Building probabilistic risk models for highly random forest disturbances like wildfire and forest insect outbreaks is a challenging. Modeling the interactions among natural disturbances is even more difficult. In the case of wildfire and forest insects, we looked at the probability of a large fire given an insect outbreak and also the incidence of insect outbreaks...

Creating Nurturing Environments: A Science-Based Framework for Promoting Child Health and Development within High-Poverty Neighborhoods

ERIC Educational Resources Information Center

Komro, Kelli A.; Flay, Brian R.; Biglan, Anthony

2011-01-01

Living in poverty and living in areas of concentrated poverty pose multiple risks for child development and for overall health and wellbeing. Poverty is a major risk factor for several mental, emotional, and behavioral disorders, as well as for other developmental challenges and physical health problems. In this paper, the Promise Neighborhoods…

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.

Relationships as Risk: High risk sex, Substance Abuse, and Violence among Hispanic Men who have Sex with Men

PubMed Central

De Santis, Joseph P.; Vasquez, Elias Provencio; Deleon, Diego A.; Gonzalez-Guarda, Rosa M.

2012-01-01

Background Men who have sex with men (MSM) experience a number of health disparities including high rates of HIV from high risk sex. High rates of HIV infection are related to high risk sexual behaviors and multiple sexual partners. High rates of HIV infection in this population also may be related to high risk sexual behaviors that occur within the context of primary relationships. However, relatively little is know about about relationships among Hispanic MSM. In addition, little is known about the factors that contribute to risk within these primary relationships. Aims The purpose of this study is to use qualitative methods to explore the factors responsible for high risk sexual behavior within primary relationships among Hispanic MSM. Methods Twenty Hispanic MSM were recruited from various community sites in South Florida to participate in auditotaped focus groups. Data from the focus groups were transcribed and analyzed using content analysis. Data were collected until saturation was achieved. Results Participants identified a number of topics that contribute to risk: drugs/alcohol as risk, outside sex as risk, concealment of HIV infection, violence as risk, consensual and non-consensual sexual violence, and absent family support. Participants also described the relationship of sexual risk, substance abuse, and violence in the context of Hispanic MSM relationships. Conclusions The results of the study provided some important clinical implications for clinicians providing care to Hispanic MSM. From the results of this study, directions for future research focused on the relationships of Hispanic MSM are evident. PMID:25242861

Child Maltreatment Among Singletons and Multiple Births in Japan: A Population-Based Study.

PubMed

Yokoyama, Yoshie; Oda, Terumi; Nagai, Noriyo; Sugimoto, Masako; Mizukami, Kenji

2015-12-01

The occurrence of multiple births has been recognized as a risk factor for child maltreatment. However, few population-based studies have examined the relationship between multiple births and child maltreatment. This study aimed to evaluate the degree of risk of child maltreatment among singletons and multiple births in Japan and to identify factors associated with increased risk. Using population-based data, we analyzed the database of records on child maltreatment and medical checkups for infants aged 1.5 years filed at Nishinomiya City Public Health Center between April 2007 and March 2011. To protect personal information, the data were transferred to anonymized electronic files for analysis. After adjusting by logistic regression for each associated factor and gestation number, multiples themselves were not associated with the risk of child maltreatment. However, compared with singletons, multiples had a significantly higher rate of risk factors for child maltreatment, including low birth weight and neural abnormality. Moreover, compared with mothers of singleton, mothers of twins had a significantly higher rate of poor health, which is a risk factor of child maltreatment. Multiples were not associated with the risk of child maltreatment. However, compared with singletons, multiples and their mothers had a significantly higher rate of risk factors of child maltreatment.

Impact of marriage on HIV/AIDS risk behaviors among impoverished, at-risk couples: a multilevel latent variable approach.

PubMed

Stein, Judith A; Nyamathi, Adeline; Ullman, Jodie B; Bentler, Peter M

2007-01-01

Studies among normative samples generally demonstrate a positive impact of marriage on health behaviors and other related attitudes. In this study, we examine the impact of marriage on HIV/AIDS risk behaviors and attitudes among impoverished, highly stressed, homeless couples, many with severe substance abuse problems. A multilevel analysis of 368 high-risk sexually intimate married and unmarried heterosexual couples assessed individual and couple-level effects on social support, substance use problems, HIV/AIDS knowledge, perceived HIV/AIDS risk, needle-sharing, condom use, multiple sex partners, and HIV/AIDS testing. More variance was explained in the protective and risk variables by couple-level latent variable predictors than by individual latent variable predictors, although some gender effects were found (e.g., more alcohol problems among men). The couple-level variable of marriage predicted lower perceived risk, less deviant social support, and fewer sex partners but predicted more needle-sharing.

Multiple risk behaviors and suicidal ideation and behavior among Israeli and Palestinian adolescents.

PubMed

Harel-Fisch, Yossi; Abdeen, Ziad; Walsh, Sophie D; Radwan, Qasrowi; Fogel-Grinvald, Haya

2012-07-01

Based conceptually on Problem Behavior Theory, Normalization Theory and theories of adolescent ethnic identity formation this study explores relationships between individual and cumulative multiple risk behaviors and suicidal ideation and behavior among mid-adolescents in three different populations in the Middle East. Data from the 2004 Health Behavior in School-Aged Children in the Middle-East (HBSC-ME) study included 8345 10th-grade pupils in three populations: Jewish Israelis (1770), Arab Israelis (2185), and Palestinians in Gaza and the West Bank (4390). We considered risk behaviors and factors including tobacco use, bullying, medically-attended injuries, excessive time with friends, parental disconnectedness, negative school experience, truancy and poor academic performance. Substantial population differences for suicidal tendency and risk behaviors were observed, with notably high levels of suicidal ideation and behavior among Arab-Israeli youth and higher levels of risk behaviors among the Jewish and Arab-Israeli youth. For all populations suicidal tendency was at least 4 times higher among adolescents reporting 4+ risk behaviors, suggesting that similar psychosocial determinants affect patterns of risk behaviors and suicidal tendency. Results highlight the importance of understanding cultural contexts of risk behaviors and suicidal ideation and behavior. Copyright © 2012 Elsevier Ltd. All rights reserved.

Using multiple lines of evidence to assess the risk of ecosystem collapse

PubMed Central

Regan, Tracey J.; Dinh, Minh Ngoc; Ferrari, Renata; Keith, David A.; Lester, Rebecca; Mouillot, David; Murray, Nicholas J.; Nguyen, Hoang Anh; Nicholson, Emily

2017-01-01

Effective ecosystem risk assessment relies on a conceptual understanding of ecosystem dynamics and the synthesis of multiple lines of evidence. Risk assessment protocols and ecosystem models integrate limited observational data with threat scenarios, making them valuable tools for monitoring ecosystem status and diagnosing key mechanisms of decline to be addressed by management. We applied the IUCN Red List of Ecosystems criteria to quantify the risk of collapse of the Meso-American Reef, a unique ecosystem containing the second longest barrier reef in the world. We collated a wide array of empirical data (field and remotely sensed), and used a stochastic ecosystem model to backcast past ecosystem dynamics, as well as forecast future ecosystem dynamics under 11 scenarios of threat. The ecosystem is at high risk from mass bleaching in the coming decades, with compounding effects of ocean acidification, hurricanes, pollution and fishing. The overall status of the ecosystem is Critically Endangered (plausibly Vulnerable to Critically Endangered), with notable differences among Red List criteria and data types in detecting the most severe symptoms of risk. Our case study provides a template for assessing risks to coral reefs and for further application of ecosystem models in risk assessment. PMID:28931744

Traffic, Air Pollution, Minority and Socio-Economic Status: Addressing Inequities in Exposure and Risk

PubMed Central

Pratt, Gregory C.; Vadali, Monika L.; Kvale, Dorian L.; Ellickson, Kristie M.

2015-01-01

Higher levels of nearby traffic increase exposure to air pollution and adversely affect health outcomes. Populations with lower socio-economic status (SES) are particularly vulnerable to stressors like air pollution. We investigated cumulative exposures and risks from traffic and from MNRiskS-modeled air pollution in multiple source categories across demographic groups. Exposures and risks, especially from on-road sources, were higher than the mean for minorities and low SES populations and lower than the mean for white and high SES populations. Owning multiple vehicles and driving alone were linked to lower household exposures and risks. Those not owning a vehicle and walking or using transit had higher household exposures and risks. These results confirm for our study location that populations on the lower end of the socio-economic spectrum and minorities are disproportionately exposed to traffic and air pollution and at higher risk for adverse health outcomes. A major source of disparities appears to be the transportation infrastructure. Those outside the urban core had lower risks but drove more, while those living nearer the urban core tended to drive less but had higher exposures and risks from on-road sources. We suggest policy considerations for addressing these inequities. PMID:25996888

Using multiple lines of evidence to assess the risk of ecosystem collapse.

PubMed

Bland, Lucie M; Regan, Tracey J; Dinh, Minh Ngoc; Ferrari, Renata; Keith, David A; Lester, Rebecca; Mouillot, David; Murray, Nicholas J; Nguyen, Hoang Anh; Nicholson, Emily

2017-09-27

Effective ecosystem risk assessment relies on a conceptual understanding of ecosystem dynamics and the synthesis of multiple lines of evidence. Risk assessment protocols and ecosystem models integrate limited observational data with threat scenarios, making them valuable tools for monitoring ecosystem status and diagnosing key mechanisms of decline to be addressed by management. We applied the IUCN Red List of Ecosystems criteria to quantify the risk of collapse of the Meso-American Reef, a unique ecosystem containing the second longest barrier reef in the world. We collated a wide array of empirical data (field and remotely sensed), and used a stochastic ecosystem model to backcast past ecosystem dynamics, as well as forecast future ecosystem dynamics under 11 scenarios of threat. The ecosystem is at high risk from mass bleaching in the coming decades, with compounding effects of ocean acidification, hurricanes, pollution and fishing. The overall status of the ecosystem is Critically Endangered (plausibly Vulnerable to Critically Endangered), with notable differences among Red List criteria and data types in detecting the most severe symptoms of risk. Our case study provides a template for assessing risks to coral reefs and for further application of ecosystem models in risk assessment. © 2017 The Authors.

Screening adolescents for substance use-related high-risk sexual behaviors

PubMed Central

Levy, Sharon; Sherritt, Lon; Gabrielli, Joy; Shrier, Lydia A.; Knight, John R.

2010-01-01

Background: This analysis was undertaken to determine whether adolescents who screened positive for high-risk substance use with the CRAFFT questions were also more likely to engage in risky sexual behaviors than their peers, and to determine the test-retest reliability of a substance use related sexual risk behaviors inventory. Methods: 12- to 18-year-old clinic patients completed a multi-part questionnaire that included 8 demographic items, the CRAFFT substance use screen, and a 14-item scale assessing sexual behaviors associated with substance use. Participants were invited to return one week later to complete an identical assessment battery. Results: Of the 305 study participants, 49 (16.1%) had a positive CRAFFT screen (score of 2 or greater, indicating high risk for substance abuse/dependence) and 101 (33.9%) reported sexual contact during the past 90 days. After controlling for gender, age, race, and number of parents in household, adolescents with a positive CRAFFT screen had significantly greater odds of having sexual contact after using alcohol or other drugs, of having a sexual partner who used alcohol or other drugs, of having sex without a condom, and of having multiple sexual partners within the past year, compared to their CRAFFT negative peers. The substance use related sexual risk behaviors inventory has acceptable test-retest reliability and the 10 frequency questions have scale-like properties with acceptable internal consistency (standardized Cronbach's Alpha = .79). Conclusion: Clinicians should pay special attention to counseling CRAFFT-positive adolescents regarding use of condoms, and the risks associated with sexual activity with multiple partners, while intoxicated, or with an intoxicated partner. PMID:19837353

Characteristics of the pre-diabetic period in children with high risk of type 1 diabetes recruited from the general Swedish population-The ABIS study.

PubMed

Åkerman, Linda; Ludvigsson, Johnny; Swartling, Ulrica; Casas, Rosaura

2017-09-01

There is a need for increased understanding of the pre-diabetic period in individuals with high risk of type 1 diabetes from the general population. High-risk children (n = 21) positive for multiple islet autoantibodies were identified by autoantibody screening within the All Babies in Southeast Sweden study. The children and their parents were enrolled in a 2-year prospective follow-up study aiming to characterize the pre-diabetic period. Blood samples were collected every 6 months for measurement of C-peptide, HbA1c, fasting glucose, and autoantibodies. Human leukocyte antigen-genotype was determined, and oral glucose tolerance test was performed every 12 months. Despite positivity for multiple autoantibodies, 9 out of 21 individuals had low-risk human leukocyte antigen-genotypes. Children who progressed to manifest diabetes (progressors, n = 12) had higher levels of IA2A and ZnT8A than children who did not (non-progressors, n = 9). Impaired glucose tolerance and impaired fasting glucose was observed to the same extent in progressors and non-progressors, but HbA1c increased over time in progressors in spite of increased C-peptide. Autoantibodies to IA2 and ZnT8 may be useful discriminators for disease progression in at-risk children from the general population. Dysglycemia was observed long before diagnosis, and difficulties in maintaining glucose homeostasis despite increased C-peptide indicate that insulin resistance might be an important accelerator of disease in risk individuals. Copyright © 2017 John Wiley & Sons, Ltd.

Sudden cardiac death: epidemiology and risk factors

PubMed Central

Adabag, A. Selcuk; Luepker, Russell V.; Roger, Véronique L.; Gersh, Bernard J.

2016-01-01

Sudden cardiac death (SCD) is an important public-health problem with multiple etiologies, risk factors, and changing temporal trends. Substantial progress has been made over the past few decades in identifying markers that confer increased SCD risk at the population level. However, the quest for predicting the high-risk individual who could be a candidate for an implantable cardioverter-defibrillator, or other therapy, continues. In this article, we review the incidence, temporal trends, and triggers of SCD, and its demographic, clinical, and genetic risk factors. We also discuss the available evidence supporting the use of public-access defibrillators. PMID:20142817

Multiple transitions and HIV risk among orphaned Kenyan schoolgirls.

PubMed

Mojola, Sanyu A

2011-03-01

Why are orphaned girls at particular risk of acquiring HIV infection? Using a transition-to-adulthood framework, this study employs qualitative data from Nyanza Province, Kenya, to explore pathways to HIV risk among orphaned and nonorphaned high-school girls. It shows how simultaneous processes such as leaving their parental home, negotiating financial access, and relationship transitions interact to produce disproportionate risk for orphaned girls. The role of financial provision and parental love in modifying girls' trajectories to risk are also explored. A testable theoretical model is proposed based on the qualitative findings, and policy implications are suggested.

MULTIPLE TRANSITIONS AND HIV RISK AMONG AFRICAN SCHOOL GIRLS

PubMed Central

Mojola, Sanyu A

2012-01-01

Why are orphaned girls at particular risk of contracting HIV? Using a transition to adulthood framework, this paper uses qualitative data from Nyanza province, Kenya to explore pathways to HIV risk among orphaned and non-orphaned high school girls. I show how co-occurring processes such as residential transition out of the parental home, negotiating financial access and relationship transitions interact to produce disproportionate risk for orphan girls. I also explore the role of financial provision and parental love in modifying girls’ trajectories to risk. I propose a testable theoretical model based on the qualitative findings and suggest policy implications. PMID:21500699

Estimating the lifetime risk of cancer associated with multiple CT scans.

PubMed

Ivanov, V K; Kashcheev, V V; Chekin, S Yu; Menyaylo, A N; Pryakhin, E A; Tsyb, A F; Mettler, F A

2014-12-01

Multiple CT scans are often done on the same patient resulting in an increased risk of cancer. Prior publications have estimated risks on a population basis and often using an effective dose. Simply adding up the risks from single scans does not correctly account for the survival function. A methodology for estimating personal radiation risks attributed to multiple CT imaging using organ doses is presented in this article. The estimated magnitude of the attributable risk fraction for the possible development of radiation-induced cancer indicates the necessity for strong clinical justification when ordering multiple CT scans.

Developmental dyslexia: predicting individual risk

PubMed Central

Thompson, Paul A; Hulme, Charles; Nash, Hannah M; Gooch, Debbie; Hayiou-Thomas, Emma; Snowling, Margaret J

2015-01-01

Background Causal theories of dyslexia suggest that it is a heritable disorder, which is the outcome of multiple risk factors. However, whether early screening for dyslexia is viable is not yet known. Methods The study followed children at high risk of dyslexia from preschool through the early primary years assessing them from age 3 years and 6 months (T1) at approximately annual intervals on tasks tapping cognitive, language, and executive-motor skills. The children were recruited to three groups: children at family risk of dyslexia, children with concerns regarding speech, and language development at 3;06 years and controls considered to be typically developing. At 8 years, children were classified as ‘dyslexic’ or not. Logistic regression models were used to predict the individual risk of dyslexia and to investigate how risk factors accumulate to predict poor literacy outcomes. Results Family-risk status was a stronger predictor of dyslexia at 8 years than low language in preschool. Additional predictors in the preschool years include letter knowledge, phonological awareness, rapid automatized naming, and executive skills. At the time of school entry, language skills become significant predictors, and motor skills add a small but significant increase to the prediction probability. We present classification accuracy using different probability cutoffs for logistic regression models and ROC curves to highlight the accumulation of risk factors at the individual level. Conclusions Dyslexia is the outcome of multiple risk factors and children with language difficulties at school entry are at high risk. Family history of dyslexia is a predictor of literacy outcome from the preschool years. However, screening does not reach an acceptable clinical level until close to school entry when letter knowledge, phonological awareness, and RAN, rather than family risk, together provide good sensitivity and specificity as a screening battery. PMID:25832320

Prevalence and Determinants of High-Risk Human Papillomavirus Infection in Male Genital Warts

PubMed Central

Park, Sung Jin; Seo, Juhyung; Ha, Seong-Heon

2014-01-01

Purpose To evaluate the prevalence and type distribution of high-risk human papillomavirus (HPV) infection in genital warts of Korean men, and for the first time, to describe the risk factors associated with high-risk HPV infection in male genital warts. Materials and Methods In a single private clinic, 150 consecutive male patients with histopathologic-confirmed genital warts who underwent HPV genotyping by use of polymerase chain reaction (PCR) were included in this study. We detected HPV DNA in male genital warts and evaluated HPV type distribution, especially high-risk HPV types, by use of PCR. The associations between HPV prevalence and various characteristics, such as age, circumcision status, type of genital warts diagnosis (new vs. recurrent), number of lesions, site of lesions, and gross morphology, were assessed by use of unconditional multiple logistic regression. Results High-risk HPV types were detected in 31 cases (23.5%), and of these, 27 cases (20.5%) contained both high-risk and low-risk HPV types. The most frequently detected high-risk HPV types were HPV16 (6.8%), HPV33 (4.5%), HPV18 (2.3%), and HPV68 (2.3%). In particular, the prevalence of infection with HPV16 and/or HPV18 was 8.3% (11 of 132). In the multivariate analysis, lesions located at sites including the base of the penis or the pubic area, papular or mixed genital warts, and lack of circumcision significantly increased the association with high-risk HPV infection in male genital warts. Conclusions The prevalence of high-risk HPV infection was substantial in male genital warts. The site and morphology of lesions and circumcision status were significantly associated with the prevalence of high-risk HPV infection. PMID:24648877

Prevalence and determinants of high-risk human papillomavirus infection in male genital warts.

PubMed

Park, Sung Jin; Seo, Juhyung; Ha, Seong-Heon; Jung, Gyung-Woo

2014-03-01

To evaluate the prevalence and type distribution of high-risk human papillomavirus (HPV) infection in genital warts of Korean men, and for the first time, to describe the risk factors associated with high-risk HPV infection in male genital warts. In a single private clinic, 150 consecutive male patients with histopathologic-confirmed genital warts who underwent HPV genotyping by use of polymerase chain reaction (PCR) were included in this study. We detected HPV DNA in male genital warts and evaluated HPV type distribution, especially high-risk HPV types, by use of PCR. The associations between HPV prevalence and various characteristics, such as age, circumcision status, type of genital warts diagnosis (new vs. recurrent), number of lesions, site of lesions, and gross morphology, were assessed by use of unconditional multiple logistic regression. High-risk HPV types were detected in 31 cases (23.5%), and of these, 27 cases (20.5%) contained both high-risk and low-risk HPV types. The most frequently detected high-risk HPV types were HPV16 (6.8%), HPV33 (4.5%), HPV18 (2.3%), and HPV68 (2.3%). In particular, the prevalence of infection with HPV16 and/or HPV18 was 8.3% (11 of 132). In the multivariate analysis, lesions located at sites including the base of the penis or the pubic area, papular or mixed genital warts, and lack of circumcision significantly increased the association with high-risk HPV infection in male genital warts. The prevalence of high-risk HPV infection was substantial in male genital warts. The site and morphology of lesions and circumcision status were significantly associated with the prevalence of high-risk HPV infection.

Preseason screening of shoulder range of motion and humeral retrotorsion does not predict injury in high school baseball players.

PubMed

Oyama, Sakiko; Hibberd, Elizabeth E; Myers, Joseph B

2017-07-01

Shoulder and elbow injuries are commonplace in high school baseball. Although altered shoulder range of motion (ROM) and humeral retrotorsion angles have been associated with injuries, the efficacy of preseason screening of these characteristics remains controversial. We conducted preseason screenings for shoulder internal and external rotation ROM and humeral retrotorsion on 832 high school baseball players and tracked their exposure and incidence on throwing-related shoulder and elbow injuries during a subsequent season. Poisson regression with robust error variance was used to determine whether preseason screening could identify injury risk in baseball players and whether the injury risk was higher for pitchers compared with players who do not pitch. Shoulder rotation ROM or humeral retrotorsion at preseason did not predict the risk of throwing-related upper extremity injury (P = .15-.89). Injury risk was 3.84 higher for baseball players who pitched compared with those who did not (95% confidence interval, 1.72-8.56; P = .001). Preseason measures of shoulder ROM and humeral retrotorsion may not be effective in identifying players who are at increased injury risk. Because shoulder ROM is a measure that fluctuates under a variety of influences, future study should investigate whether taking multiple measurements during a season can identify at-risk players. The usefulness of preseason screening may also depend on rigor of participation in sports. Future studies should investigate how preseason shoulder characteristics and participation factors (ie, pitch count and frequency, competitive level, pitching in multiple leagues) interact to predict injury risk in baseball players. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

The construction of an idealised urban masculinity among men with concurrent sexual partners in a South African township

PubMed Central

Ragnarsson, Anders; Townsend, Loraine; Ekström, Anna Mia; Chopra, Mickey; Thorson, Anna

2010-01-01

Background The perspectives of heterosexual males who have large sexual networks comprising concurrent sexual partners and who engage in high-risk sexual behaviours are scarcely documented. Yet these perspectives are crucial to understanding the high HIV prevalence in South Africa where domestic violence, sexual assault and rape are alarmingly high, suggesting problematic gender dynamics. Objective To explore the construction of masculinities and men's perceptions of women and their sexual relationships, among men with large sexual networks and concurrent partners. Design This qualitative study was conducted in conjunction with a larger quantitative survey among men at high risk of HIV, using respondent-driven sampling to recruit participants, where long referral chains allowed us to reach far into social networks. Twenty in-depth, open-ended interviews with South African men who had multiple and concurrent sexual partners were conducted. A latent content analysis was used to explore the characteristics and dynamics of social and sexual relationships. Results We found dominant masculine ideals characterised by overt economic power and multiple sexual partners. Reasons for large concurrent sexual networks were the perception that women were too empowered, could not be trusted, and lack of control over women. Existing masculine norms encourage concurrent sexual networks, ignoring the high risk of HIV transmission. Biological explanations and determinism further reinforced strong and negative perceptions of women and female sexuality, which helped polarise men's interpretation of gender constructions. Conclusions Our results highlight the need to address sexuality and gender dynamics among men in growing, informal urban areas where HIV prevalence is strikingly high. Traditional structures that could work as focal entry points should be explored for effective HIV prevention aimed at normative change among hard-to-reach men in high-risk urban and largely informal contexts. PMID:20644656

Partner aggression in high-risk families from birth to age 3 years: associations with harsh parenting and child maladjustment.

PubMed

Graham, Alice M; Kim, Hyoun K; Fisher, Philip A

2012-02-01

Aggression between partners represents a potential guiding force in family dynamics. However, research examining the influence of partner aggression (physically and psychologically aggressive acts by both partners) on harsh parenting and young child adjustment has been limited by a frequent focus on low-risk samples and by the examination of partner aggression at a single time point. Especially in the context of multiple risk factors and around transitions such as childbirth, partner aggression might be better understood as a dynamic process. In the present study, longitudinal trajectories of partner aggression from birth to age 3 years in a large, high-risk, and ethnically diverse sample (N = 461) were examined. Specific risk factors were tested as predictors of aggression over time, and the longitudinal effects of partner aggression on maternal harsh parenting and child maladjustment were examined. Partner aggression decreased over time, with higher maternal depression and lower maternal age predicting greater decreases in partner aggression. While taking into account contextual and psychosocial risk factors, higher partner aggression measured at birth and a smaller decrease over time independently predicted higher levels of maternal harsh parenting at age 3 years. Initial level of partner aggression and change over time predicted child maladjustment indirectly (via maternal harsh parenting). The implications of understanding change in partner aggression over time as a path to harsh parenting and young children's maladjustment in the context of multiple risk factors are discussed.

Partner Aggression in High-Risk Families From Birth to Age 3: Associations With Harsh Parenting and Child Maladjustment

PubMed Central

Graham, Alice M.; Kim, Hyoun K.; Fisher, Philip A.

2012-01-01

Aggression between partners represents a potential guiding force in family dynamics. However, research examining the influence of partner aggression (physically and psychologically aggressive acts by both partners) on harsh parenting and young child adjustment has been limited by a frequent focus on low risk samples and by the examination of partner aggression at a single time point. Especially in the context of multiple risk factors and around transitions such as childbirth, partner aggression might be better understood as a dynamic process. In the present study, longitudinal trajectories of partner aggression from birth to age 3 years in a large, high-risk, and ethnically diverse sample (N = 461) were examined. Specific risk factors were tested as predictors of aggression over time, and the longitudinal effects of partner aggression on maternal harsh parenting and child maladjustment were examined. Partner aggression decreased over time, with higher maternal depression and lower maternal age predicting greater decreases in partner aggression. While taking into account contextual and psychosocial risk factors, higher partner aggression measured at birth and a smaller decrease over time independently predicted higher levels of maternal harsh parenting at age 3 years. Initial level of partner aggression and change over time predicted child maladjustment indirectly (via maternal harsh parenting). The implications of understanding change in partner aggression over time as a path to harsh parenting and young children's maladjustment in the context of multiple risk factors are discussed. PMID:22201248

Unmetabolized Folic Acid, Tetrahydrofolate, and Colorectal Adenoma Risk.

PubMed

Rees, Judy R; Morris, Carolyn B; Peacock, Janet L; Ueland, Per M; Barry, Elizabeth L; McKeown-Eyssen, Gail E; Figueiredo, Jane C; Snover, Dale C; Baron, John A

2017-08-01

In a randomized trial of folic acid supplementation for the prevention of colorectal adenomas, we previously found indications of increased risk during later treatment and follow-up. This could have been due to the unmetabolized folic acid (UFA) or natural reduced and methylated folates (mF) to which it is metabolized. In post hoc analyses, we measured mF (the sum of 5-methyl-tetrahydrofolate and 4-alfa-hydroxy-5-methyl-THF) and UFA concentrations in the serum of 924 participants. Using binomial regression models with a log link, we assessed the associations between plasma mF or UFA and adenoma occurrence. We found no association between plasma mF or UFA and overall adenoma risk. However, during later follow-up, the prespecified, composite endpoint of high-risk findings (advanced or multiple adenomas) was positively associated with plasma mF ( P linear trend = 0.009), with a 58% increased risk for participants in the upper versus lowest quartile. An irregular association was seen with plasma UFA, with suggestions of an inverse trend ( P linear trend =0.049). A modest, significant inverse association was also seen between mF and risk of serrated lesions, with a 39% lower risk for upper versus lower quartile participants ( P linear trend = 0.03). In conclusion, during the later follow-up period in which folic acid supplementation was previously seen to increase the risk of advanced and multiple adenomas, higher serum mF was associated with a higher risk of multiple and/or advanced adenomas, but no clear indication that UFA played a direct role. There were indications that higher mF was associated with reduced risk of serrated polyps. Cancer Prev Res; 10(8); 451-8. ©2017 AACR . ©2017 American Association for Cancer Research.

Management of atrial fibrillation.

PubMed

Moukabary, Talal; Gonzalez, Mario D

2015-07-01

Atrial fibrillation is a very common clinical problem with a high prevalence that is expected to rise over time because of increasing risk factors (eg, age, obesity, hypertension). This high prevalence is also associated with high cost, because atrial fibrillation represents about 1% of overall health care spending. The management of atrial fibrillation involves multiple facets: (1) management of underlying disease if present and the management of atrial fibrillation risk factors, (2) prevention of thromboembolism, (3) control of the ventricular rate during atrial fibrillation, and (4) restoration and maintenance of normal sinus rhythm. Copyright © 2015 Elsevier Inc. All rights reserved.

Contextual Risk Profiles and Trajectories of Adolescent Dating Violence Perpetration.

PubMed

Reyes, H Luz McNaughton; Foshee, Vangie A; Markiewitz, Nathan; Chen, May S; Ennett, Susan T

2018-04-09

Social ecological and developmental system perspectives suggest that interactions among factors within and across multiple contexts (e.g., neighborhood, peer, family) must be considered in explaining dating violence perpetration. Yet, to date, most extant research on dating violence has focused on individual, rather than contextual predictors, and used variable-centered approaches that fail to capture the configurations of factors that may jointly explain involvement in dating violence. The current study used a person-centered approach, latent profile analysis, to identify key configurations (or profiles) of contextual risk and protective factors for dating violence perpetration across the neighborhood, school, friend and family contexts. We then examine the longitudinal associations between these contextual risk profiles, assessed during middle school, and trajectories of psychological and physical dating violence perpetration across grades 8 through 12. Five contextual risk profiles were identified: school, neighborhood, and family risk; school and family risk; school and friend risk; school and neighborhood risk; and low risk. The highest levels of psychological and physical perpetration across grades 8 through 12 were among adolescents in the profile characterized by high levels of school, neighborhood, and family risk. Results suggest that early interventions to reduce violence exposure and increase social regulation across multiple social contexts may be effective in reducing dating violence perpetration across adolescence.

A risk-based decision support framework for selection of appropriate safety measure system for underground coal mines.

PubMed

Samantra, Chitrasen; Datta, Saurav; Mahapatra, Siba Sankar

2017-03-01

In the context of underground coal mining industry, the increased economic issues regarding implementation of additional safety measure systems, along with growing public awareness to ensure high level of workers safety, have put great pressure on the managers towards finding the best solution to ensure safe as well as economically viable alternative selection. Risk-based decision support system plays an important role in finding such solutions amongst candidate alternatives with respect to multiple decision criteria. Therefore, in this paper, a unified risk-based decision-making methodology has been proposed for selecting an appropriate safety measure system in relation to an underground coal mining industry with respect to multiple risk criteria such as financial risk, operating risk, and maintenance risk. The proposed methodology uses interval-valued fuzzy set theory for modelling vagueness and subjectivity in the estimates of fuzzy risk ratings for making appropriate decision. The methodology is based on the aggregative fuzzy risk analysis and multi-criteria decision making. The selection decisions are made within the context of understanding the total integrated risk that is likely to incur while adapting the particular safety system alternative. Effectiveness of the proposed methodology has been validated through a real-time case study. The result in the context of final priority ranking is seemed fairly consistent.

Why are there gaps in our management of those with high cardiovascular risk?

PubMed

Doolan-Noble, Fiona; Tracey, Jocelyn; Mann, Stewart

2012-03-01

Multiple New Zealand and other international studies have identified gaps in the management of those identified at high risk of a future cardiovascular (CV) event. This study sought to explore the views of health professionals about the barriers and facilitators present within the current primary health care system to the optimal management of those at high CV risk. This qualitative study utilised a focus group methodology to examine the barriers and facilitators within primary health care (PHC), and employed a general inductive approach to analyse the text data. The analysis of text data resulted in the emergence of interrelated themes, underpinned by subthemes. The patient, their circumstances and their characteristics and perceptions provided the first key theme and subthemes. The next key theme was primary health care providers, with subthemes of communication and values and beliefs. The general practice was the third theme and included multiple subthemes: implementation planning and pathway development, time and workload and roles and responsibilities. The final main theme was the health system with the subthemes linking to funding and leadership. This study determined the factors that act as barriers and facilitators to the effective management of those at high CV risk within the New Zealand PHC sector. General practice has a pivotal role in preventive health care, but to succeed there needs to be a refocusing of the PHC sector, requiring support from policy makers, District Health Boards and Primary Health Organisations, as well as those working in the sector.

Fall risk and incidence reduction in high risk individuals with multiple sclerosis: a pilot randomized control trial.

PubMed

Sosnoff, Jacob J; Moon, Yaejin; Wajda, Douglas A; Finlayson, Marcia L; McAuley, Edward; Peterson, Elizabeth W; Morrison, Steve; Motl, Robert W

2015-10-01

To determine the feasibility of three fall prevention programs delivered over 12 weeks among individuals with multiple sclerosis: (A) a home-based exercise program targeting physiological risk factors; (B) an educational program targeting behavioral risk factors; and (C) a combined exercise-and-education program targeting both factors. Randomized controlled trial. Home-based training with assessments at research laboratory. A total of 103 individuals inquired about the investigation. After screening, 37 individuals with multiple sclerosis who had fallen in the last year and ranged in age from 45-75 years volunteered for the investigation. A total of 34 participants completed postassessment following the 12-week intervention. Participants were randomly assigned into one of four conditions: (1) wait-list control (n = 9); (2) home-based exercise (n = 11); (3) education (n = 9); or (4) a combined exercise and education (n = 8) group. Before and after the 12-week interventions, participants underwent a fall risk assessment as determined by the physiological profile assessment and provided information on their fall prevention behaviors as indexed by the Falls Prevention Strategy Survey. Participants completed falls diaries during the three-months postintervention. A total of 34 participants completed postintervention testing. Procedures and processes were found to be feasible. Overall, fall risk scores were lower in the exercise groups (1.15 SD 1.31) compared with the non-exercise groups (2.04 SD 1.04) following the intervention (p < 0.01). There was no group difference in fall prevention behaviors (p > 0.05). Further examination of home-based exercise/education programs for reducing falls in individuals with multiple sclerosis is warranted. A total of 108 participants would be needed in a larger randomized controlled trial.ClinicalTrials.org #NCT01956227. © The Author(s) 2014.

Diagnosis-based Cost Groups in the Dutch Risk-equalization Model: Effects of Clustering Diagnoses and of Allowing Patients to be Classified into Multiple Risk-classes.

PubMed

Eijkenaar, Frank; van Vliet, René C J A; van Kleef, Richard C

2018-01-01

The risk-equalization (RE) model in the Dutch health insurance market has evolved to a sophisticated model containing direct proxies for health. However, it still has important imperfections, leaving incentives for risk selection. This paper focuses on refining an important health-based risk-adjuster in this model: the diagnosis-based costs groups (DCGs). The current (2017) DCGs are calibrated on "old" data of 2011/2012, are mutually exclusive, and are essentially clusters of about 200 diagnosis-groups ("dxgroups"). Hospital claims data (2013), administrative data (2014) on costs and risk-characteristics for the entire Dutch population (N≈16.9 million), and health survey data (2012, N≈387,000) are used. The survey data are used to identify subgroups of individuals in poor or in good health. The claims and administrative data are used to develop alternative DCG-modalities to examine the impact on individual-level and group-level fit of recalibrating the DCGs based on new data, of allowing patients to be classified in multiple DCGs, and of refraining from clustering. Recalibrating the DCGs and allowing enrolees to be classified into multiple DCGs lead to nontrivial improvements in individual-level and group-level fit (especially for cancer patients and people with comorbid conditions). The improvement resulting from refraining from clustering does not seem to justify the increase in model complexity this would entail. The performance of the sophisticated Dutch RE-model can be improved by allowing classification in multiple (clustered) DCGs and using new data. Irrespective of the modality used, however, various subgroups remain significantly undercompensated. Further improvement of the RE-model merits high priority.

The impact of youth, family, peer and neighborhood risk factors on developmental trajectories of risk involvement from early through middle adolescence.

PubMed

Wang, Bo; Deveaux, Lynette; Li, Xiaoming; Marshall, Sharon; Chen, Xinguang; Stanton, Bonita

2014-04-01

Few studies have analyzed the development course beginning in pre-/early adolescence of overall engagement in health-risk behaviors and associated social risk factors that place individuals in different health-risk trajectories through mid-adolescence. The current longitudinal study identified 1276 adolescents in grade six and followed them for three years to investigate their developmental trajectories of risk behaviors and to examine the association of personal and social risk factors with each trajectory. Group-based trajectory modeling was applied to identify distinctive trajectory patterns of risk behaviors. Multivariate multinomial logistic regression analyses were performed to examine the effects of the personal and social risk factors on adolescents' trajectories. Three gender-specific behavioral trajectories were identified for males (55.3% low-risk, 37.6% moderate-risk, increasing, and 7.1% high-risk, increasing) and females (41.4% no-risk, 53.4% low-risk, increasing and 5.2% moderate to high-risk, increasing). Sensation-seeking, family, peer, and neighborhood factors at baseline predicted following the moderate-risk, increasing trajectory and the high-risk, increasing trajectory in males; these risk factors predicted following the moderate to high-risk, increasing trajectory in females. The presence of all three social risk factors (high-risk neighborhood, high-risk peers and low parental monitoring) had a dramatic impact on increased probability of being in a high-risk trajectory group. These findings highlight the developmental significance of early personal and social risk factors on subsequent risk behaviors in early to middle adolescence. Future adolescent health behavior promotion interventions might consider offering additional prevention resources to pre- and early adolescent youth who are exposed to multiple contextual risk factors (even in the absence of risk behaviors) or youth who are early-starters of delinquency and substance use behaviors in early adolescence. Copyright © 2014. Published by Elsevier Ltd.

Estimation of HPV prevalence in young women in Scotland; monitoring of future vaccine impact

PubMed Central

2013-01-01

Background Estimation of pre-immunisation prevalence of HPV and distribution of HPV types is fundamental to understanding the subsequent impact of HPV vaccination. We describe the type specific prevalence of HPV in females aged 20–21 in Scotland who attended or defaulted from cervical screening using three specimen types; from attenders liquid based cytology and from defaulters urine or self-taken swabs. Methods Residual liquid based cytology samples (n = 2148), collected from women aged 20–21 attending for their first smear were genotyped for HPV. A sample (n = 709) from women who had defaulted from screening was also made available for HPV testing through the use of postal testing kits (either urine samples (n = 378) or self-taken swabs (n = 331)). Estimates of prevalence weighted by deprivation, and for the postal testing kit, also by reminder status and specimen type were calculated for each HPV type. The distribution of HPV types were compared between specimen types and the occurrence of multiple high-risk infections examined. The influence of demographic factors on high-risk HPV positivity and multiple infections was examined via logistic regression. Results The prevalence of any HPV in young women aged 20–21 was 32.2% for urine, 39.5% for self-taken swab, and 49.4% for LBC specimens. Infection with vaccine specific types (HPV 16, 18) or those associated with cross-protection (HPV 31, 33, 45, 51) was common. Individuals were more likely to test positive for high-risk HPV if they resided in an area of high deprivation or in a rural area. The overall distribution of HPV types did not vary between defaulters and attenders. Multiple infections occurred in 48.1% of high-risk HPV positive individuals. Excluding vaccine types the most common pairing was HPV 56 and 66. Conclusions Understanding of the pre-immunisation prevalence of HPV in young women puts Scotland in a prime position to assess the early effect of vaccination as the first highly vaccinated cohorts of individuals enter the screening programme. Differences in results with different specimen types must be taken into account when monitoring the impact of vaccination programmes. PMID:24188790

Estimation of HPV prevalence in young women in Scotland; monitoring of future vaccine impact.

PubMed

Kavanagh, Kimberley; Sinka, Katy; Cuschieri, Kate; Love, John; Potts, Alison; Pollock, Kevin G J; Cubie, Heather; Donaghy, Martin; Robertson, Chris

2013-11-05

Estimation of pre-immunisation prevalence of HPV and distribution of HPV types is fundamental to understanding the subsequent impact of HPV vaccination. We describe the type specific prevalence of HPV in females aged 20-21 in Scotland who attended or defaulted from cervical screening using three specimen types; from attenders liquid based cytology and from defaulters urine or self-taken swabs. Residual liquid based cytology samples (n = 2148), collected from women aged 20-21 attending for their first smear were genotyped for HPV. A sample (n = 709) from women who had defaulted from screening was also made available for HPV testing through the use of postal testing kits (either urine samples (n = 378) or self-taken swabs (n = 331)). Estimates of prevalence weighted by deprivation, and for the postal testing kit, also by reminder status and specimen type were calculated for each HPV type. The distribution of HPV types were compared between specimen types and the occurrence of multiple high-risk infections examined. The influence of demographic factors on high-risk HPV positivity and multiple infections was examined via logistic regression. The prevalence of any HPV in young women aged 20-21 was 32.2% for urine, 39.5% for self-taken swab, and 49.4% for LBC specimens. Infection with vaccine specific types (HPV 16, 18) or those associated with cross-protection (HPV 31, 33, 45, 51) was common. Individuals were more likely to test positive for high-risk HPV if they resided in an area of high deprivation or in a rural area. The overall distribution of HPV types did not vary between defaulters and attenders. Multiple infections occurred in 48.1% of high-risk HPV positive individuals. Excluding vaccine types the most common pairing was HPV 56 and 66. Understanding of the pre-immunisation prevalence of HPV in young women puts Scotland in a prime position to assess the early effect of vaccination as the first highly vaccinated cohorts of individuals enter the screening programme. Differences in results with different specimen types must be taken into account when monitoring the impact of vaccination programmes.

Prognostic Classification Factors Associated With Development of Multiple Autoantibodies, Dysglycemia, and Type 1 Diabetes-A Recursive Partitioning Analysis.

PubMed

Xu, Ping; Krischer, Jeffrey P

2016-06-01

To define prognostic classification factors associated with the progression from single to multiple autoantibodies, multiple autoantibodies to dysglycemia, and dysglycemia to type 1 diabetes onset in relatives of individuals with type 1 diabetes. Three distinct cohorts of subjects from the Type 1 Diabetes TrialNet Pathway to Prevention Study were investigated separately. A recursive partitioning analysis (RPA) was used to determine the risk classes. Clinical characteristics, including genotype, antibody titers, and metabolic markers were analyzed. Age and GAD65 autoantibody (GAD65Ab) titers defined three risk classes for progression from single to multiple autoantibodies. The 5-year risk was 11% for those subjects >16 years of age with low GAD65Ab titers, 29% for those ≤16 years of age with low GAD65Ab titers, and 45% for those subjects with high GAD65Ab titers regardless of age. Progression to dysglycemia was associated with islet antigen 2 Ab titers, and 2-h glucose and fasting C-peptide levels. The 5-year risk is 28%, 39%, and 51% for respective risk classes defined by the three predictors. Progression to type 1 diabetes was associated with the number of positive autoantibodies, peak C-peptide level, HbA1c level, and age. Four risk classes defined by RPA had a 5-year risk of 9%, 33%, 62%, and 80%, respectively. The use of RPA offered a new classification approach that could predict the timing of transitions from one preclinical stage to the next in the development of type 1 diabetes. Using these RPA classes, new prevention techniques can be tailored based on the individual prognostic risk characteristics at different preclinical stages. © 2016 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

Lenalidomide and the risk of serious infection in patients with multiple myeloma: a systematic review and meta-analysis

PubMed Central

Ying, Li; Yunliang, Zheng; Sun, Haozhen

2017-01-01

The immunomodulatory drug lenalidomide is highly effective against newly diagnosed and relapsed/refractory multiple myeloma (MM), but serious and even fatal infections have been associated with its use. In this meta-analysis, we assessed the overall risk of infection to MM patients treated with lenalidomide. Eleven phase II or III clinical trials, comprising 3,210 subjects, were selected from the Embase, Pubmed, and Cochrane Library databases, from the Clinical Trial Registration website, and from meeting abstracts and virtual presentations at the American Society of Clinical Oncology. Main outcome measures were overall incidence, relative risk (RR), and 95% confidence intervals (CIs) of reported infection events. Fixed-effect or random-effect models were used in the statistical analyses, depending on the between-study heterogeneity. The overall incidence of high-grade infection was 14.32% (95% CI: 12.08%-16.90%) and high-grade infection's pooled RR was 2.23 (95% CI: 1.71-2.91, P < 0.0001) for all 11 studies evaluated. No evidence of publication bias for the incidence of high-grade infection was detected using Begg's funnel plot and Egger's test (P = 0.2; 95% CI: -1.70, 1.23). From this meta-analysis, it appears lenalidomide use is associated with an increased risk of high-grade infection. Moreover, fatal infection events occurred only in patients treated with lenalidomide; no infection-related deaths were observed among controls. These data indicate that accurate diagnosis and optimal management of infection in MM patients treated with lenalidomide could be critical for treatment efficacy. PMID:28423741

Cerebellum volume in high-risk offspring from multiplex alcohol dependence families: Association with allelic variation in GABRA2 and BDNF

PubMed Central

Hill, Shirley Y.; Wang, Shuhui; Carter, Howard; Tessner, Kevin; Holmes, Brian; McDermott, Michael; Zezza, Nicholas; Stiffler, Scott

2012-01-01

Offspring from families with multiple cases of alcohol dependence have a greater likelihood of developing alcohol dependence (AD) and related substance use disorders. Greater susceptibility for developing these disorders may be related to structural differences in brain circuits that influence the salience of rewards or modify the efficiency of information processing and AD susceptibility. We examined the cerebellum of 71 adolescent/young adult high-risk (HR) offspring from families with multiple cases of alcohol dependence (multiplex families), and 60 low-risk (LR) controls with no family history of alcohol or drug dependence who were matched for age, gender, socioeconomic status and IQ, with attention given to possible effects of personal use of substances and maternal use during pregnancy. Magnetic resonance images were acquired on a General Electric 1.5-Tesla scanner and manually traced (BRAINS2) blind to clinical information. GABRA2 and BDNF variation were tested for their association with cerebellar volumes. High-risk offspring from multiplex AD families showed greater total volume of the cerebellum and total gray matter (GM), in comparison with LR controls. An interaction between allelic variation in GABRA2 and BDNF genes was associated with GM volumes, suggesting that inherited variation in these genes may promote early developmental differences in neuronal proliferation of the cerebellum. PMID:22047728

Multifactorial discrimination as a fundamental cause of mental health inequities.

PubMed

Khan, Mariam; Ilcisin, Misja; Saxton, Katherine

2017-03-04

The theory of fundamental causes explains why health disparities persist over time, even as risk factors, mechanisms, and diseases change. Using an intersectional framework, we evaluated multifactorial discrimination as a fundamental cause of mental health disparities. Using baseline data from the Project STRIDE: Stress, Identity, and Mental Health study, we examined the health effects of discrimination among individuals who self-identified as lesbian, gay, or bisexual. We used logistic and linear regression to assess whether multifactorial discrimination met the four criteria designating a fundamental cause, namely that the cause: 1) influences multiple health outcomes, 2) affects multiple risk factors, 3) involves access to resources that can be leveraged to reduce consequences of disease, and 4) reproduces itself in varied contexts through changing mechanisms. Multifactorial discrimination predicted high depression scores, psychological well-being, and substance use disorder diagnosis. Discrimination was positively associated with risk factors for high depression scores: chronic strain and total number of stressful life events. Discrimination was associated with significantly lower levels of mastery and self-esteem, protective factors for depressive symptomatology. Even after controlling for risk factors, discrimination remained a significant predictor for high depression scores. Among subjects with low depression scores, multifactorial discrimination also predicted anxiety and aggregate mental health scores. Multifactorial discrimination should be considered a fundamental cause of mental health inequities and may be an important cause of broad health disparities among populations with intersecting social identities.

[Analysis of HIV/AIDS related risk behaviors and their impact factors among out-of-school adolescents in outflow areas].

PubMed

Sun, Xiao; Zhu, Guang-rong; Ji, Cheng-ye; Wang, Zhen-zhen

2012-06-18

To analyze HIV/AIDS related risk behaviors among unmarried outside school adolescents and the impact factors in outflow areas, in order to provide basis for related health education. Using cluster sampling method, we investigated a vocational training center for all 15- to 24-year-old unmarried outside school youths in one county. The structured questionnaire based on the Theory of Reasoned Action was anonymous, which filled envelopes on the spot. A total of 1 800 questionnaires were recovered, and 1 712 questionnaires were valid. Epidata 3.0 was used for establishing a database and SPSS 13.0 for statistical analysis. (1) The incidence of HIV/AIDS risk behaviors of the outside school adolescents was high: 18.0% of the respondents had sexual behavior, 27.3% had never used condom when sexed in the past three months, 31.0% had multiple sexual partners, and 9.7% had drug abuse experience; the rate of HIV/AIDS-related knowledge was only 25.1%; peer environment of respondents was poor. (2) The use of condoms was correlated with those who had higher score of AIDS knowledge, and who could talk about condoms in sexual intercourse; The multiple sexual partners' behavior was correlated with age, friends who were themselves multiple sexual partners, high score of the attitude, and the subjective norm; The commercial sex was correlated with the family address, high score of the HIV/AIDS-related knowledge, friends who had commercial sex, the subjective norm and the intention of behavior, The drug abuse behavior was correlated with age, high score of the HIV/AIDS-related knowledge, drug abuse among their friends, the subjective norm, and the intention of behavior. (3) Subjective norms and behavioral intentions could better predict the occurrence of HIV/AIDS risk behaviors. The outside school adolescents are at risk in lack of HIV/AIDS-related knowledge and coping skills of negative peer pressure, so providing the related health education before they go and work outside their home is the "critical period".

Caries risk assessment in schoolchildren - a form based on Cariogram® software

PubMed Central

CABRAL, Renata Nunes; HILGERT, Leandro Augusto; FABER, Jorge; LEAL, Soraya Coelho

2014-01-01

Identifying caries risk factors is an important measure which contributes to best understanding of the cariogenic profile of the patient. The Cariogram® software provides this analysis, and protocols simplifying the method were suggested. Objectives The aim of this study was to determine whether a newly developed Caries Risk Assessment (CRA) form based on the Cariogram® software could classify schoolchildren according to their caries risk and to evaluate relationships between caries risk and the variables in the form. Material and Methods 150 schoolchildren aged 5 to 7 years old were included in this survey. Caries prevalence was obtained according to International Caries Detection and Assessment System (ICDAS) II. Information for filling in the form based on Cariogram® was collected clinically and from questionnaires sent to parents. Linear regression and a forward stepwise multiple regression model were applied to correlate the variables included in the form with the caries risk. Results Caries prevalence, in primary dentition, including enamel and dentine carious lesions was 98.6%, and 77.3% when only dentine lesions were considered. Eighty-six percent of the children were classified as at moderate caries risk. The forward stepwise multiple regression model result was significant (R2=0.904; p<0.00001), showing that the most significant factors influencing caries risk were caries experience, oral hygiene, frequency of food consumption, sugar consumption and fluoride sources. Conclusion The use of the form based on the Cariogram® software enabled classification of the schoolchildren at low, moderate and high caries risk. Caries experience, oral hygiene, frequency of food consumption, sugar consumption and fluoride sources are the variables that were shown to be highly correlated with caries risk. PMID:25466473

Preseason Workload Volume and High-Risk Periods for Noncontact Injury Across Multiple Australian Football League Seasons.

PubMed

Colby, Marcus J; Dawson, Brian; Heasman, Jarryd; Rogalski, Brent; Rosenberg, Michael; Lester, Leanne; Peeling, Peter

2017-07-01

Colby, MJ, Dawson, B, Heasman, J, Rogalski, B, Rosenberg, M, Lester, L, and Peeling, P. Preseason workload volume and high-risk periods for noncontact injury across multiple Australian Football League seasons. J Strength Cond Res 31(7): 1821-1829, 2017-The purpose of this study was to assess the association between preseason workloads and noncontact injury risk in Australian football players. Individual player injury data were recorded over 4 full seasons (2012-15) from one professional club. Noncontact injury incidence (per 1,000 "on legs" field training and game hours) was compared across the preseason, precompetition, and in-season phases to determine relative noncontact injury risk. Preseason workloads (global positioning system-derived total distance run and sprint distance) and individual (fixed) injury risk factors (age, previous injury history) were incorporated into the analysis. A generalized estimating equation with a binary logistic function modeled potential risk factors with noncontact injury for selected periods across the annual cycle. Odds ratios were calculated to determine the relative injury risk. The (preseason) precompetition phase (19.1 injuries per 1,000 hours) and (in-season) rounds 12-17 (16.0 injuries per 1,000 hours) resulted in the highest injury incidence. Low cumulative total distances in late preseason (<108 km) and precompetition (76-88 km) periods were associated with significantly (p ≤ 0.05) greater injury risk during the in-season phase. In conclusion, these results suggest players are at the greatest injury risk during the precompetition period, with low preseason cumulative workloads associated with increased in-season injury risk. Therefore, strength and conditioning staff should place particular emphasis on achieving at least moderate training loads during and leading into this phase, where competitive game play is first introduced.

'I've had unsafe sex so many times why bother being safe now?': the role of cognitions in sexual risk among American Indian/Alaska Native men who have sex with men.

PubMed

Nelson, Kimberly M; Simoni, Jane M; Pearson, Cynthia R; Walters, Karina L

2011-12-01

American Indian/Alaska Native (AI/AN) men who have sex with men (MSM) are at high risk of human immunodeficiency virus (HIV) acquisition and transmission. This study aimed to investigate a potential area of focus for HIV prevention interventions by assessing the impact of sexual risk cognitions on sexual risk-taking among AI/AN MSM. AI/AN MSM (N = 173) from a national cross-sectional survey were analyzed. Reporting more frequent sexual risk cognitions overall (high sexual risk cognitions) was associated with multiple HIV risk factors including unprotected anal intercourse and serodiscordant unprotected anal intercourse. Participants with high sexual risk cognitions had a 2.3 (95% Confidence Interval: 1.1, 4.7) times greater odds of engaging in unprotected anal intercourse regardless of childhood sexual abuse, depression, and alcohol dependence. Most individual sexual risk cognitions were associated with unprotected anal intercourse, serodiscordant unprotected anal intercourse, or both. Results suggest that sexual risk cognitions may be a productive area for further work on HIV prevention among AI/AN MSM.

Development of Multiple Primary Cancers in Lung Cancer Patients: Appalachian Versus Non-Appalachian Populations of Kentucky.

PubMed

Pravosud, Vira; Huang, Bin; Tucker, Thomas; Vanderford, Nathan L

2017-12-01

The aim of this study was to investigate whether patients with lung cancer in Appalachian Kentucky are more likely to develop multiple primary cancers than patients in non-Appalachian Kentucky. Additional analyses were conducted to identify other factors that may be associated with an increased hazard of developing multiple primary cancers in patients with lung cancer. The data for this retrospective, population-based cohort study of 26,456 primary lung cancer patients were drawn from the Kentucky Cancer Registry. For inclusion in the study, patients must have been diagnosed between January 1, 2000 and December 31, 2013 and they must either have continually resided in Appalachian Kentucky or continually resided in non-Appalachian Kentucky. Cases were excluded if the patient was diagnosed as having additional primary cancers within 3 months of the initial diagnosis of primary lung cancer. The medical records for each case were examined to determine whether the patient was subsequently diagnosed as having additional primary cancers. The Cox proportional hazards model was then used to assess whether there was an association between the region in which the patients live and the likelihood of developing multiple primary cancers. Time to event was considered as the time from diagnosis to either death or development of a second primary cancer. The results presented here indicate that the risk of developing multiple primary cancers is the same for patients with lung cancer throughout Kentucky (hazard ratio [HR] 1.002, P = 0.9713). We found no evidence for a greater hazard in patients from Appalachia; however, additional analyses revealed several high-risk groups. Male patients and older patients had a significantly greater hazard of developing multiple primary cancers (HR 1.169, P = 0.012 and 1.015, P = 0.0001, respectively). In addition, patients who underwent surgery and those who were diagnosed initially as having an earlier stage of cancer also were more likely to develop multiple primary cancers (HR 1.446, P = 0.0003 and 0.684, P = 0.0015, respectively). This is a negative study. Patients with primary lung cancer living in Appalachian Kentucky are not at a greater risk of developing multiple primary cancers than those residing in non-Appalachian Kentucky. High-risk groups identified in this study are male patients and older patients. The increased hazard seen in patients who underwent surgery or those who were diagnosed as having earlier stages of lung cancer are likely an artifact of these patients living longer and, therefore, having more time to develop additional primary cancers.

Association between environmental exposure to pesticides and neurodegenerative diseases

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

Parron, Tesifon; Andalusian Council of Health at Almeria province, Almeria; Requena, Mar

Preliminary studies have shown associations between chronic pesticide exposure in occupational settings and neurological disorders. However, data on the effects of long-term non-occupational exposures are too sparse to allow any conclusions. This study examines the influence of environmental pesticide exposure on a number of neuropsychiatric conditions and discusses their underlying pathologic mechanisms. An ecological study was conducted using averaged prevalence rates of Alzheimer's disease, Parkinson's disease, multiple sclerosis, cerebral degeneration, polyneuropathies, affective psychosis and suicide attempts in selected Andalusian health districts categorized into areas of high and low environmental pesticide exposure based on the number of hectares devoted to intensivemore » agriculture and pesticide sales per capita. A total of 17,429 cases were collected from computerized hospital records (minimum dataset) between 1998 and 2005. Prevalence rates and the risk of having Alzheimer's disease, Parkinson's disease, multiple sclerosis and suicide were significantly higher in districts with greater pesticide use as compared to those with lower pesticide use. The multivariate analyses showed that the population living in areas with high pesticide use had an increased risk for Alzheimer's disease and suicide attempts and that males living in these areas had increased risks for polyneuropathies, affective disorders and suicide attempts. In conclusion, this study supports and extends previous findings and provides an indication that environmental exposure to pesticides may affect the human health by increasing the incidence of certain neurological disorders at the level of the general population. -- Highlights: Black-Right-Pointing-Pointer Environmental exposure to pesticides and neurodegenerative-psychiatric disorders. Black-Right-Pointing-Pointer Increased risk for Alzheimer's disease and suicide attempts in high exposure areas. Black-Right-Pointing-Pointer Males from areas with high pesticide exposure had a higher risk of polyneuropathy. Black-Right-Pointing-Pointer Males from high exposure areas had a higher risk of affective psychosis and suicide. Black-Right-Pointing-Pointer Nerve tissue degeneration due to oxidative damage may underlie the pathomechanism.« less

Optimal groundwater security management policies by control of inexact health risks under dual uncertainty in slope factors.

PubMed

Lu, Hongwei; Li, Jing; Ren, Lixia; Chen, Yizhong

2018-05-01

Groundwater remediation is a complicated system with time-consuming and costly challenges, which should be carefully controlled by appropriate groundwater management. This study develops an integrated optimization method for groundwater remediation management regarding cost, contamination distribution and health risk under multiple uncertainties. The integration of health risk into groundwater remediation optimization management is capable of not only adequately considering the influence of health risk on optimal remediation strategies, but also simultaneously completing remediation optimization design and risk assessment. A fuzzy chance-constrained programming approach is presented to handle multiple uncertain properties in the process of health risk assessment. The capabilities and effectiveness of the developed method are illustrated through an application of a naphthalene contaminated case in Anhui, China. Results indicate that (a) the pump-and-treat remediation system leads to a low naphthalene contamination but high remediation cost for a short-time remediation, and natural attenuation significantly affects naphthalene removal from groundwater for a long-time remediation; (b) the weighting coefficients have significant influences on the remediation cost and the performances both for naphthalene concentrations and health risks; (c) an increased level of slope factor (sf) for naphthalene corresponds to more optimal strategies characterized by higher environmental benefits and lower economic sacrifice. The developed method could be simultaneously beneficial for public health and environmental protection. Decision makers could obtain the most appropriate remediation strategies according to their specific requirements with high flexibility of economic, environmental, and risk concerns. Copyright © 2018 Elsevier Ltd. All rights reserved.

Frequent Detection of Pancreatic Lesions in Asymptomatic High-Risk Individuals

PubMed Central

Canto, Marcia Irene; Hruban, Ralph H.; Fishman, Elliot K.; Kamel, Ihab R.; Schulick, Richard; Zhang, Zhe; Topazian, Mark; Takahashi, Naoki; Fletcher, Joel; Petersen, Gloria; Klein, Alison P.; Axilbund, Jennifer; Griffin, Constance; Syngal, Sapna; Saltzman, John R.; Mortele, Koenraad J.; Lee, Jeffrey; Tamm, Eric; Vikram, Raghunandan; Bhosale, Priya; Margolis, Daniel; Farrell, James; Goggins, Michael

2012-01-01

BACKGROUND & AIMS The risk of pancreatic cancer is increased in patients with a strong family history of pancreatic cancer or a predisposing germline mutation. Screening can detect curable, non-invasive pancreatic neoplasms, but the optimal imaging approach is not known. We determined the baseline prevalence and characteristics of pancreatic abnormalities using 3 imaging tests to screen asymptomatic, high-risk individuals (HRI). METHODS We screened 225 asymptomatic adult HRI at 5 academic US medical centers once, using computed tomography (CT), magnetic resonance imaging (MRI), and endoscopic ultrasonography (EUS). We compared results in a blinded, independent fashion. RESULTS Ninety-two of 216 HRI (42%) were found to have at least 1 pancreatic mass (84 cystic, 3 solid) or a dilated pancreatic duct (n=5) by any of the imaging modalities. Fifty-one of the 84 HRI with a cyst (60.7%) had multiple lesions, typically small (mean 0.55 cm, range 2–39 mm), in multiple locations. The prevalence of pancreatic lesions increased with age; they were detected in 14% of subjects <50 years old, 34% of subjects 50–59 years old, and 53% of subjects 60–69 years old (P<.0001). CT, MRI, and EUS detected a pancreatic abnormality in 11%, 33.3%, and 42.6% of the HRI, respectively. Among these abnormalities, proven or suspected neoplasms were identified in 85 HRI (82 intraductal papillary mucinous neoplasms [IPMN] and 3 pancreatic endocrine tumors). Three of 5 HRI who underwent pancreatic resection had high-grade dysplasia in <3 cm IPMNs and in multiple intraepithelial neoplasias. CONCLUSIONS Screening of asymptomatic HRI frequently detects small pancreatic cysts, including curable, non-invasive high-grade neoplasms. EUS and MRI detect pancreatic lesions better than CT. PMID:22245846

Identification of multiple sclerosis patients at highest risk of cognitive impairment using an integrated brain magnetic resonance imaging assessment approach.

PubMed

Uher, T; Vaneckova, M; Sormani, M P; Krasensky, J; Sobisek, L; Dusankova, J Blahova; Seidl, Z; Havrdova, E; Kalincik, T; Benedict, R H B; Horakova, D

2017-02-01

While impaired cognitive performance is common in multiple sclerosis (MS), it has been largely underdiagnosed. Here a magnetic resonance imaging (MRI) screening algorithm is proposed to identify patients at highest risk of cognitive impairment. The objective was to examine whether assessment of lesion burden together with whole brain atrophy on MRI improves our ability to identify cognitively impaired MS patients. Of the 1253 patients enrolled in the study, 1052 patients with all cognitive, volumetric MRI and clinical data available were included in the analysis. Brain MRI and neuropsychological assessment with the Brief International Cognitive Assessment for Multiple Sclerosis were performed. Multivariable logistic regression and individual prediction analysis were used to investigate the associations between MRI markers and cognitive impairment. The results of the primary analysis were validated at two subsequent time points (months 12 and 24). The prevalence of cognitive impairment was greater in patients with low brain parenchymal fraction (BPF) (<0.85) and high T2 lesion volume (T2-LV) (>3.5 ml) than in patients with high BPF (>0.85) and low T2-LV (<3.5 ml), with an odds ratio (OR) of 6.5 (95% CI 4.4-9.5). Low BPF together with high T2-LV identified in 270 (25.7%) patients predicted cognitive impairment with 83% specificity, 82% negative predictive value, 51% sensitivity and 75% overall accuracy. The risk of confirmed cognitive decline over the follow-up was greater in patients with high T2-LV (OR 2.1; 95% CI 1.1-3.8) and low BPF (OR 2.6; 95% CI 1.4-4.7). The integrated MRI assessment of lesion burden and brain atrophy may improve the stratification of MS patients who may benefit from cognitive assessment. © 2016 EAN.

Creating Resilient Children and Empowering Families Using a Multifamily Group Process.

ERIC Educational Resources Information Center

Sayger, Thomas V.

1996-01-01

Presents a model for prevention and early intervention using a multifamily group counseling process to increase the resiliency of children and to empower families living with multiple stressors in high-risk environments. (Author)

War-related trauma exposure and multiple risk behaviors among school-going adolescents in Northern Uganda: the mediating role of depression symptoms.

PubMed

Okello, James; Nakimuli-Mpungu, Etheldreda; Musisi, Seggane; Broekaert, Eric; Derluyn, Ilse

2013-11-01

The relationship between war-related trauma exposure, depressive symptoms and multiple risk behaviors among adolescents is less clear in sub-Saharan Africa. We analyzed data collected from a sample of school-going adolescents four years postwar. Participants completed interviews assessing various risk behaviors defined by the Youth Self Report (YSR) and a sexual risk behavior survey, and were screened for post-traumatic stress, anxiety and depression symptoms based on the Impact of Events Scale Revised (IESR) and Hopkins Symptom Checklist for Adolescents (HSCL-37A) respectively. Multivariate logistic regression was used to assess factors independently associated with multiple risk behaviors. The logistic regression model of Baron and Kenny (1986) was used to evaluate the mediating role of depression in the relationship between stressful war events and multiple risk behaviors. Of 551 participants, 139 (25%) reported multiple (three or more) risk behaviors in the past year. In the multivariate analyses, depression symptoms remained uniquely associated with multiple risk behavior after adjusting for potential confounders including socio-demographic characteristics, war-related trauma exposure variables, anxiety and post-traumatic stress symptoms. In mediation analysis, depression symptoms mediated the associations between stressful war events and multiple risk behaviors. The psychometric properties of the questionnaires used in this study are not well established in war affected African samples thus ethno cultural variation may decrease the validity of our measures. Adolescents with depression may be at a greater risk of increased engagement in multiple risk behaviors. Culturally sensitive and integrated interventions to treat and prevent depression among adolescents in post-conflict settings are urgently needed. © 2013 Elsevier B.V. All rights reserved.

Smoldering Multiple Myeloma

PubMed Central

Gao, Minjie; Yang, Guang; Kong, Yuanyuan; Wu, Xiaosong; Shi, Jumei

2015-01-01

Smoldering multiple myeloma (SMM) is an asymptomatic precursor stage of multiple myeloma (MM) characterized by clonal bone marrow plasma cells (BMPC) ≥ 10% and/or M protein level ≥ 30 g/L in the absence of end organ damage. It represents an intermediate stage between monoclonal gammopathy of undetermined significance (MGUS) and symptomatic MM. The risk of progression to symptomatic MM is not uniform, and several parameters have been reported to predict the risk of progression. These include the level of M protein and the percentage of BMPC, the proportion of immunophenotypically aberrant plasma cells, and the presence of immunoparesis, free light-chain (FLC) ratio, peripheral blood plasma cells (PBPC), pattern of serum M protein evolution, abnormal magnetic resonance imaging (MRI), cytogenetic abnormalities, IgA isotype, and Bence Jones proteinuria. So far treatment is still not recommended for SMM, because several trials suggested that patients with SMM do not benefit from early treatment. However, the Mateos et al. trial showed a survival benefit after early treatment with lenalidomide plus dexamethasone in patients with high-risk SMM. This trial has prompted a reevaluation of early treatment in an asymptomatic patient population. PMID:26000300

3D Printing Provides a Precise Approach in the Treatment of Tetralogy of Fallot, Pulmonary Atresia with Major Aortopulmonary Collateral Arteries.

PubMed

Anwar, Shafkat; Rockefeller, Toby; Raptis, Demetrios A; Woodard, Pamela K; Eghtesady, Pirooz

2018-02-03

Patients with tetralogy of Fallot, pulmonary atresia, and multiple aortopulmonary collateral arteries (Tet PA MAPCAs) have a wide spectrum of anatomy and disease severity. Management of these patients can be challenging and often require multiple high-risk surgical and interventional catheterization procedures. These interventions are made challenging by complex anatomy that require the proceduralist to mentally reconstruct three-dimensional anatomic relationships from two-dimensional images. Three-dimensional (3D) printing is an emerging medical technology that provides added benefits in the management of patients with Tet PA MAPCAs. When used in combination with current diagnostic modalities and procedures, 3D printing provides a precise approach to the management of these challenging, high-risk patients. Specifically, 3D printing enables detailed surgical and interventional planning prior to the procedure, which may improve procedural outcomes, decrease complications, and reduce procedure-related radiation dose and contrast load.

Multiple Logistic Regression Analysis of Cigarette Use among High School Students

ERIC Educational Resources Information Center

Adwere-Boamah, Joseph

2011-01-01

A binary logistic regression analysis was performed to predict high school students' cigarette smoking behavior from selected predictors from 2009 CDC Youth Risk Behavior Surveillance Survey. The specific target student behavior of interest was frequent cigarette use. Five predictor variables included in the model were: a) race, b) frequency of…

Multiple Methods for Identifying Outcomes of a High Challenge Adventure Activity

ERIC Educational Resources Information Center

Davidson, Curt; Ewert, Alan; Chang, Yun

2016-01-01

The purpose of this study was to provide insight into what occurs in moments of high challenge within participants during an outdoor adventure education (OAE) program. Given the inherent risk and remote locations often associated with OAE programs, it has remained challenging to measure selected psychological constructs while the program is taking…

Self-Reported Weight Perceptions, Dieting Behavior, and Breakfast Eating among High School Adolescents

ERIC Educational Resources Information Center

Zullig, Keith; Ubbes, Valerie A.; Pyle, Jennifer; Valois, Robert F.

2006-01-01

This study explored the relationships among weight perceptions, dieting behavior, and breakfast eating in 4597 public high school adolescents using the Centers for Disease Control and Prevention Youth Risk Behavior Survey. Adjusted multiple logistic regression models were constructed separately for race and gender groups via SUDAAN (Survey Data…

Intolerance to Delayed Reward in Girls with Multiple Suicide Attempts

PubMed Central

Mathias, Charles W.; Dougherty, Donald M.; James, Lisa M.; Richard, Dawn M.; Dawes, Michael A.; Acheson, Ashley; Hill-Kapturczak, Nathalie

2011-01-01

Impulsivity has been conceptualized as influencing the expression of suicidal behavior. Adolescence is a developmental period characterized both by a relatively high rate of suicide attempts and a high level of impulsivity. The current study examined two behavioral measures (delay reward and disinhibition) and one self-report measure of impulsivity among girls with suicide attempt histories. Girls with multiple suicide attempts performed more impulsively on measures of delayed reward, and had higher self-ratings of depression and aggression than girls with either one or no suicide attempts. The multiple attempter girl's preference for immediate gratification may directly increase vulnerability to suicidal acts in the context of distressing states or indirectly increase risk by creating poor life experiences over time. PMID:21463352

Is Hypovitaminosis D One of the Environmental Risk Factors for Multiple Sclerosis?

ERIC Educational Resources Information Center

Pierrot-Deseilligny, Charles; Souberbielle, Jean-Claude

2010-01-01

The role of hypovitaminosis D as a possible risk factor for multiple sclerosis is reviewed. First, it is emphasized that hypovitaminosis D could be only one of the risk factors for multiple sclerosis and that numerous other environmental and genetic risk factors appear to interact and combine to trigger the disease. Secondly, the classical…

The implications of autoantibodies to a single islet antigen in relatives with normal glucose tolerance: development of other autoantibodies and progression to type 1 diabetes.

PubMed

Bingley, Polly J; Boulware, David C; Krischer, Jeffrey P

2016-03-01

Autoantibodies directed at single islet autoantigens are associated with lower overall risk of type 1 diabetes than multiple autoantibodies, but individuals with one autoantibody may progress to higher risk categories. We examined the characteristics of this progression in relatives followed prospectively in the TrialNet Pathway to Prevention. The study population comprised 983 relatives who were single autoantibody positive with normal baseline glucose tolerance (median age 16.2 years). Samples were screened for antibodies to GAD, insulinoma-associated antigen 2 (IA-2) and insulin, and all positive samples tested for antibodies to zinc transporter 8 and islet cell antibodies. Antibodies to at least one additional islet autoantigen appeared in 118 of 983 relatives (overall 5 year risk 22%, 95% CI [17.9, 26.1]). At baseline, antibodies to GAD alone (68%) were more frequent than antibodies to insulin (26%) or IA-2 (6%), but all were associated with a similar risk of developing additional autoantibodies. Risk was associated with younger age (p = 0.002) and HLA class II genotype, but was similar in high and intermediate genetic risk groups (p = 0.65). Relatives who became multiple autoantibody positive during the follow-up had increased risk of developing diabetes comparable with the risk in relatives with multiple autoantibodies at study entry. Progression of islet autoimmunity in single autoantibody positive relatives in late childhood/adult life is associated with a predominance of autoantibodies to GAD and a distinct HLA risk profile. This heterogeneity in type 1 diabetes autoimmunity has potentially important implications for disease prevention.

Using multiple decrement models to estimate risk and morbidity from specific AIDS illnesses. Multicenter AIDS Cohort Study (MACS).

PubMed

Hoover, D R; Peng, Y; Saah, A J; Detels, R R; Day, R S; Phair, J P

A simple non-parametric approach is developed to simultaneously estimate net incidence and morbidity time from specific AIDS illnesses in populations at high risk for death from these illnesses and other causes. The disease-death process has four-stages that can be recast as two sandwiching three-state multiple decrement processes. Non-parametric estimation of net incidence and morbidity time with error bounds are achieved from these sandwiching models through modification of methods from Aalen and Greenwood, and bootstrapping. An application to immunosuppressed HIV-1 infected homosexual men reveals that cytomegalovirus disease, Kaposi's sarcoma and Pneumocystis pneumonia are likely to occur and cause significant morbidity time.

Protective personality traits: High openness and low neuroticism linked to better memory in multiple sclerosis.

PubMed

Leavitt, Victoria M; Buyukturkoglu, Korhan; Inglese, Matilde; Sumowski, James F

2017-11-01

Memory impairment in multiple sclerosis (MS) is common, although few risk/protective factors are known. To examine relationships of personality to memory/non-memory cognition in MS. 80 patients completed a cognitive battery and a personality scale measuring the "Big 5" traits: openness, neuroticism, agreeableness, extraversion, and conscientiousness. Memory was most related to openness, with higher openness linked to better memory and lower risk for memory impairment, controlling for age, atrophy, education, and intelligence quotient (IQ). Lower neuroticism was also related to better memory, and lower conscientiousness to memory impairment. Non-memory cognition was unrelated to personality. Personality may inform predictive models of memory impairment in MS.

Novice drivers' risky driving behavior, risk perception, and crash risk: findings from the DRIVE study.

PubMed

Ivers, Rebecca; Senserrick, Teresa; Boufous, Soufiane; Stevenson, Mark; Chen, Huei-Yang; Woodward, Mark; Norton, Robyn

2009-09-01

We explored the risky driving behaviors and risk perceptions of a cohort of young novice drivers and sought to determine their associations with crash risk. Provisional drivers aged 17 to 24 (n = 20 822) completed a detailed questionnaire that included measures of risk perception and behaviors; 2 years following recruitment, survey data were linked to licensing and police-reported crash data. Poisson regression models that adjusted for multiple confounders were created to explore crash risk. High scores on questionnaire items for risky driving were associated with a 50% increased crash risk (adjusted relative risk = 1.51; 95% confidence interval = 1.25, 1.81). High scores for risk perception (poorer perceptions of safety) were also associated with increased crash risk in univariate and multivariate models; however, significance was not sustained after adjustment for risky driving. The overrepresentation of youths in crashes involving casualties is a significant public health issue. Risky driving behavior is strongly linked to crash risk among young drivers and overrides the importance of risk perceptions. Systemwide intervention, including licensing reform, is warranted.

Antibiotic treatment of bacterial vaginosis in pregnancy: multiple meta-analyses and dilemmas in interpretation.

PubMed

Varma, Rajesh; Gupta, Janesh K

2006-01-01

There is considerable evidence to show an association between genital tract infections, such as bacterial vaginosis (BV), and preterm delivery (PTD). Meta-analyses to date have shown screening and treating BV in pregnancy does not prevent PTD. This casts doubt on a cause and effect relationship between BV and PTD. However, the meta-analyses reported significant clinical, methodological and statistical heterogeneity of the included studies. We therefore undertook a repeat meta-analysis, included recently published trials, and applied strict criteria on data extraction. We meta-analysed low and high-risk pregnancies separately. We found that screening and treating BV in low-risk pregnancies produced a statistically significant reduction in spontaneous PTD (RR 0.73; 95% CI 0.55-0.98). This beneficial effect was not observed in high-risk or combined risk groups. The differences in antibiotic sensitivity between high and low risk groups may suggest differing causal contributions of the infectious process to PTD. The evidence, along with prior knowledge of differing predisposing factors and prognosis between these risk groups, supports the hypothesis that PTD in high and low risk pregnant women are different entities and not linear extremes of the same syndrome.

Stroke prevention in the elderly atrial fibrillation patient with comorbid conditions: focus on non-vitamin K antagonist oral anticoagulants

PubMed Central

Turagam, Mohit K; Velagapudi, Poonam; Flaker, Greg C

2015-01-01

Stroke prevention in elderly atrial fibrillation patients remains a challenge. There is a high risk of stroke and systemic thromboembolism but also a high risk of bleeding if anticoagulants are prescribed. The elderly have increased chronic kidney disease, coronary artery disease, polypharmacy, and overall frailty. For all these reasons, anticoagulant use is underutilized in the elderly. In this manuscript, the benefits of non-vitamin K antagonist oral anticoagulants compared with warfarin in the elderly patient population with multiple comorbid conditions are reviewed. PMID:26366064

A multiple indicator, multiple cause method for representing social capital with an application to psychological distress

NASA Astrophysics Data System (ADS)

Congdon, Peter

2010-03-01

This paper describes a structural equation methodology for obtaining social capital scores for survey subjects from multiple indicators of social support, neighbourhood and trust perceptions, and memberships of organizations. It adjusts for variation that is likely to occur in levels of social capital according to geographic context (e.g. level of area deprivation, geographic region, level of urbanity) and demographic group. Social capital is used as an explanatory factor for psychological distress using data from the 2006 Health Survey for England. A highly significant effect of social capital in reducing the chance of psychiatric caseness is obtained after controlling for other individual and geographic risk factors. Allowing for social capital has considerable effects on the impacts on psychiatric health of other risk factors. In particular, the impact of area deprivation category is much reduced. There is also evidence of significant differentiation in social capital between population categories and geographic contexts.

Repeated Cross-Sectional Assessment of Commercial Truck Driver Health.

PubMed

Thiese, Matthew S; Moffitt, Gary; Hanowski, Richard J; Kales, Stefanos N; Porter, Richard J; Hegmann, Kurt T

2015-09-01

To assess relationships and trends over time in individual conditions and multiple conditions among a large sample of independent, nonoverlapping truck drivers using a repeated cross-sectional study design. Commercial driver medical examinations were conducted on 95,567 commercial drivers between January 1, 2005, and October 31, 2012. Specific medical conditions that have been identified by the Federal Motor Carrier Safety Administration's Medical Review Board as possibly increasing crash risk were examined. Prevalence and trends over time were analyzed. A total of 8 of the 13 conditions significantly increased from 2005 to 2012. Prevalence of multiple concomitant conditions also increased, with prevalence odds ratios as high as 7.39 (95% confidence interval, 3.92 to 13.98) for four or more conditions in 2012 as compared with 2005. Individual and multiple conditions thought to be associated with increased crash risk significantly increased between 2005 and 2012.

Monoclonal gammopathy of undetermined significance (MGUS) and smoldering myeloma (SMM): a practical guide to management.

PubMed

Maciocia, Nicola; Wechalekar, Ashutosh; Yong, Kwee

2017-12-01

Monoclonal gammopathy of undetermined significance and smoldering multiple myeloma are precursor conditions of symptomatic multiple myeloma (MM). Diagnostic principles are aimed at excluding MM requiring therapy, other conditions associated with paraproteins that may require different management, and risk stratifying patients for the purposes of tailored follow-up and investigation. The International Myeloma Working Group have recently published a revised definition of MM, which singles out a small group of patients with smoldering multiple myeloma who are at very high risk of progression and organ damage; such patients are now included under the definition of MM and recommended to start anti-myeloma treatment. Furthermore, the recently published National Institute of Health and Care Excellence guideline recommends cross-sectional imaging techniques in place of skeletal survey. These recent recommendations are discussed, and practical guidance for investigation and management are presented. Copyright © 2016 John Wiley & Sons, Ltd.

Using agent-based modeling to study multiple risk factors and multiple health outcomes at multiple levels.

PubMed

Yang, Yong

2017-11-01

Most health studies focus on one health outcome and examine the influence of one or multiple risk factors. However, in reality, various pathways, interactions, and associations exist not only between risk factors and health outcomes but also among the risk factors and among health outcomes. The advance of system science methods, Big Data, and accumulated knowledge allows us to examine how multiple risk factors influence multiple health outcomes at multiple levels (termed a 3M study). Using the study of neighborhood environment and health as an example, I elaborate on the significance of 3M studies. 3M studies may lead to a significantly deeper understanding of the dynamic interactions among risk factors and outcomes and could help us design better interventions that may be of particular relevance for upstream interventions. Agent-based modeling (ABM) is a promising method in the 3M study, although its potentials are far from being fully explored. Future challenges include the gap of epidemiologic knowledge and evidence, lack of empirical data sources, and the technical challenges of ABM. © 2017 New York Academy of Sciences.

Drug use, sexual risk behaviour and sexually transmitted infections among swingers: a cross-sectional study in The Netherlands.

PubMed

Spauwen, Laura W L; Niekamp, Anne-Marie; Hoebe, Christian J P A; Dukers-Muijrers, Nicole H T M

2015-02-01

Recreational drug use has been found to be associated with high-risk sexual behaviour and with sexually transmitted infections (STI). This study is the first to assess the prevalence of drug use among swingers (heterosexuals who, as a couple, practise mate swapping or group sex, and/or visit sex clubs for couples), and its association with high-risk sexual behaviour and STI. We recruited individuals who self-identified as swingers and visited our STI clinic (from 2009 to 2012, South Limburg, The Netherlands). Participants (n=289; median age 45 years; 49% female) filled in a self-administered questionnaire on their sexual and drug use behaviour while swinging, over the preceding 6 months. We assessed associations between sexual behaviour, drug use and STI diagnoses (Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), syphilis, HIV and hepatitis B) using logistic regression analyses. Overall, the prevalence of CT and/or NG was 13%. No other STIs were observed. Seventy-nine percent of swingers reported recreational drug use (including alcohol and use of erectile dysfunction drugs); 46% of them reported multiple drug use. Recreational drug use excluding alcohol and erectile dysfunction drugs (reported by 48%) was associated with high-risk behaviours in men and women. Drug use was independently associated with STI in female swingers, especially those who practice group sex. High rates of multiple drug use, as well as risky sexual behaviour and STIs among swingers, warrant paying more attention to this key population in prevention and care, as they are a risk group that is generally under-recognised and underserved in care. 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.

HIV health center affiliation networks of black men who have sex with men: disentangling fragmented patterns of HIV prevention service utilization.

PubMed

Schneider, John A; Walsh, Tim; Cornwell, Benjamin; Ostrow, David; Michaels, Stuart; Laumann, Edward O

2012-08-01

In the United States, black men who have sex with men (BMSM) are at highest risk for HIV infection and are at high risk for limited health service utilization. We describe HIV health center (HHC) affiliation network patterns and their potential determinants among urban BMSM. The Men's Assessment of Social and Risk Network instrument was used to elicit HHC utilization, as reported by study respondents recruited through respondent-driven sampling. In 2010, 204 BMSM were systematically recruited from diverse venues in Chicago, IL. A 2-mode data set was constructed that included study participants and 9 diverse HHCs. Associations between individual-level characteristics and HHC utilization were analyzed using Multiple Regression Quadratic Assignment Procedure. Visualization analyses included computation of HHC centrality and faction membership. High utilization of HHCs (45.9%-70.3%) was evident among BMSM, 44.4% who were HIV infected. Multiple Regression Quadratic Assignment Procedure revealed that age, social network size, and HIV status were associated with HHC affiliation patterns (coeff., 0.13-0.27; all P < 0.05). With the exception of one HHC, HHCs offering HIV prevention services to HIV-infected participants occupied peripheral positions within the network of health centers. High-risk HIV-uninfected participants affiliated most with an HHC that offers only treatment services. Subcategories of BMSM in this sample affiliated with HHCs that may not provide appropriate HIV prevention services. Using 2-mode data, public health authorities may be better able to match prevention services to BMSM need; in particular, HIV prevention services for high-risk HIV-uninfected men and HIV "prevention for positives" services for HIV-infected men.

Prevalence of upper gastrointestinal bleeding risk factors among the general population and osteoarthritis patients.

PubMed

Kim, Sang Hyuck; Yun, Jae Moon; Chang, Chong Bum; Piao, Heng; Yu, Su Jong; Shin, Dong Wook

2016-12-28

To assess the prevalence of possible risk factors of upper gastrointestinal bleeding (UGIB) and their age-group specific trend among the general population and osteoarthritis patients. We utilized data from the National Health Insurance Service that included claims data and results of the national health check-up program. Comorbid conditions (peptic ulcer, diabetes, liver disease, chronic renal failure, and gastroesophageal reflux disease), concomitant drugs (aspirin, clopidogrel, cilostazol, non-steroidal anti-inflammatory drugs, steroid, anticoagulants, and SSRI), personal habits (smoking, and alcohol consumption) were considered as possible UGIB risk factors. We randomly imputed the prevalence of infection in the data considering the age-specific prevalence of Helicobacter pylori ( H. pylori ) infection in Korea. The prevalence of various UGIB risk factors and the age-group specific trend of the prevalence were identified. Prevalence was compared between osteoarthritis patients and others. A total of 801926 subjects (93855 osteoarthritis patients) aged 20 and above were included. The prevalence of individual and concurrent multiple risk factors became higher as the age increased. The prevalence of each comorbid condition and concomitant drug were higher in osteoarthritis patients. Thirty-five point zero two percent of the overall population and 68.50% of osteoarthritis patients had at least one or more risk factors of UGIB. The prevalence of individual and concurrent multiple risk factors in younger age groups were also substantial. Furthermore, when personal habits (smoking, and alcohol consumption) and H. pylori infection were included, the prevalence of concurrent multiple risk factors increased greatly even in younger age groups. Prevalence of UGIB risk factors was high in elderly population, but was also considerable in younger population. Patient with osteoarthritis was at higher UGIB risk than those without osteoarthritis. Physicians should consider individualized risk assessment regardless of age when prescribing drugs or performing procedures that may increase the risk of UGIB, and take necessary measures to reduce modifiable risk factors such as H. pylori eradication or lifestyle counseling.

Long-term effects of self-control on alcohol use and sexual behavior among urban minority young women.

PubMed

Griffin, Kenneth W; Scheier, Lawrence M; Acevedo, Bianca; Grenard, Jerry L; Botvin, Gilbert J

2012-01-01

High risk alcohol use and sexual behaviors peak in young adulthood and often occur in the same individuals. Alcohol use has been found to impair decision-making and contribute to high risk sexual activity. However, the association between alcohol use and risky sexual behavior may also reflect enduring individual differences in risk taking, sociability, self-control, and related variables. Both behaviors can serve similar functions related to recreation, interpersonal connection, and the pursuit of excitement or pleasure. The present study examined the extent to which high risk drinking and sexual behavior clustered together in a sample of urban minority young adult women, a demographic group at elevated risk for negative outcomes related to sexual health. We tested whether psychosocial functioning measured at the beginning of high school predicted classes of risk behaviors when girls were tracked longitudinally into young adulthood. Latent class analysis indicated three distinct profiles based on high risk drinking and sexual behavior (i.e., multiple sex partners) in young adulthood. The largest class (73% of the sample) reported low levels of risky drinking and sexual behavior. The next largest class (19%) reported high risk drinking and low risk sexual behavior, and the smallest class (8%) reported high levels of both behaviors. Compared to women from other racial/ethnic groups, black women were more likely to be categorized in the high risk drinking/low risk sex class. Multinomial logistic regression indicated that self-control in adolescence had a broad and enduring protective effect on risk behaviors eight years later and was associated with a greater probability of being in the low risk drinking/low risk sex class. Findings are discussed in terms of understanding the phenotypic expressions of risk behavior as they relate to early psychosocial development and the long-term protective function of self-control in reducing high risk drinking and sexual behaviors.

Long-Term Effects of Self-Control on Alcohol Use and Sexual Behavior among Urban Minority Young Women

PubMed Central

Griffin, Kenneth W.; Scheier, Lawrence M.; Acevedo, Bianca; Grenard, Jerry L.; Botvin, Gilbert J.

2011-01-01

High risk alcohol use and sexual behaviors peak in young adulthood and often occur in the same individuals. Alcohol use has been found to impair decision-making and contribute to high risk sexual activity. However, the association between alcohol use and risky sexual behavior may also reflect enduring individual differences in risk taking, sociability, self-control, and related variables. Both behaviors can serve similar functions related to recreation, interpersonal connection, and the pursuit of excitement or pleasure. The present study examined the extent to which high risk drinking and sexual behavior clustered together in a sample of urban minority young adult women, a demographic group at elevated risk for negative outcomes related to sexual health. We tested whether psychosocial functioning measured at the beginning of high school predicted classes of risk behaviors when girls were tracked longitudinally into young adulthood. Latent class analysis indicated three distinct profiles based on high risk drinking and sexual behavior (i.e., multiple sex partners) in young adulthood. The largest class (73% of the sample) reported low levels of risky drinking and sexual behavior. The next largest class (19%) reported high risk drinking and low risk sexual behavior, and the smallest class (8%) reported high levels of both behaviors. Compared to women from other racial/ethnic groups, black women were more likely to be categorized in the high risk drinking/low risk sex class. Multinomial logistic regression indicated that self-control in adolescence had a broad and enduring protective effect on risk behaviors eight years later and was associated with a greater probability of being in the low risk drinking/low risk sex class. Findings are discussed in terms of understanding the phenotypic expressions of risk behavior as they relate to early psychosocial development and the long-term protective function of self-control in reducing high risk drinking and sexual behaviors. PMID:22470274

Are High-Lethality Suicide Attempters With Bipolar Disorder a Distinct Phenotype?

PubMed Central

Oquendo, Maria A.; Carballo, Juan Jose; Rajouria, Namita; Currier, Dianne; Tin, Adrienne; Merville, Jessica; Galfalvy, Hanga C.; Sher, Leo; Grunebaum, Michael F.; Burke, Ainsley K.; Mann, J. John

2013-01-01

Because Bipolar Disorder (BD) individuals making highly lethal suicide attempts have greater injury burden and risk for suicide, early identification is critical. BD patients were classified as high- or low-lethality attempters. High-lethality attempts required inpatient medical treatment. Mixed effects logistic regression models and permutation analyses examined correlations between lethality, number, and order of attempts. High-lethality attempters reported greater suicidal intent and more previous attempts. Multiple attempters showed no pattern of incremental lethality increase with subsequent attempts, but individuals with early high-lethality attempts more often made high-lethality attempts later. A subset of high-lethality attempters make only high-lethality attempts. However, presence of previous low-lethality attempts does not indicate that risk for more lethal, possibly successful, attempts is reduced. PMID:19590998

Accumulated workloads and the acute:chronic workload ratio relate to injury risk in elite youth football players

PubMed Central

Bowen, Laura; Gross, Aleksander Stefan; Gimpel, Mo; Li, François-Xavier

2017-01-01

Aim The purpose of this study was to investigate the relationship between physical workload and injury risk in elite youth football players. Methods The workload data and injury incidence of 32 players were monitored throughout 2 seasons. Multiple regression was used to compare cumulative (1, 2, 3 and 4-weekly) loads and acute:chronic (A:C) workload ratios (acute workload divided by chronic workload) between injured and non-injured players for specific GPS and accelerometer-derived variables:total distance (TD), high-speed distance (HSD), accelerations (ACC) and total load. Workloads were classified into discrete ranges by z-scores and the relative risk was determined. Results A very high number of ACC (≥9254) over 3 weeks was associated with the highest significant overall (relative risk (RR)=3.84) and non-contact injury risk (RR=5.11). Non-contact injury risk was significantly increased when a high acute HSD was combined with low chronic HSD (RR=2.55), but not with high chronic HSD (RR=0.47). Contact injury risk was greatest when A:C TD and ACC ratios were very high (1.76 and 1.77, respectively) (RR=4.98). Conclusions In general, higher accumulated and acute workloads were associated with a greater injury risk. However, progressive increases in chronic workload may develop the players' physical tolerance to higher acute loads and resilience to injury risk. PMID:27450360

The prevalence of insulin resistance and other cardiovascular disease risk factors in healthy elderly southwestern Nigerians.

PubMed

Ezenwaka, C E; Akanji, A O; Akanji, B O; Unwin, N C; Adejuwon, C A

1997-02-10

We assessed the prevalence of coronary heart disease (CHD) risk factors including insulin resistance in 500 (205 males, 295 females) healthy elderly (age > 55 years) indigenous, low socioeconomic group Yorubas residents in either an urban slum (n = 240) or a rural town (n = 260) in southwestern Nigeria. Anthropometric indices, blood pressure and fasting plasma levels of glucose, lipids, insulin and insulin resistance were measured. The results indicated that: (i) gross obesity (4.4%), diabetes (1.6%), hyperlipidaemia (0.2%) and cigarette smoking (4.8%) were relatively uncommon in the population, although the prevalence of hypertension (30%) was higher than previously reported from this population; (ii). the subjects had a relatively high prevalence of multiple CHD risk factors (about 20% had > 4 risk factors), an observation considered paradoxical in view of the reportedly low CHD prevalence in this population; (iii) these CHD risk factors (increased body mass and blood pressure (BP), hyperinsulinaemia and insulin resistance) were more prevalent in the women and in urban residents; (iv) hyperinsulinaemia (20%) and insulin resistance (35%) were common in the population, and were associated, on regression analyses, to such other CHD risk factors as BP and body mass, particularly in women, suggesting, as in Caucasians, that insulin resistance could be an important index of CHD risk; and (v) the excess of multiple CHD risk factors in the women, is due at least in part, to their increased tendency to obesity (8%) and reduced physical activity (83%). This study concludes that: (i) despite the high prevalence of multiple risk factors in this population, CHD prevalence is low, indicating the supremacy of such major risk factors as diabetes and hyperlipidaemia (relatively uncommon here) in the development of CHD; and (ii) potentially the greatest CHD risk is in the elderly women especially if relatively overweight, physically inactive and resident in an urban centre. While further confirmatory studies are necessary in younger subjects and across societal socioeconomic strata, our results nonetheless suggest that attempts to maintain the CHD prevalence at low levels in this population should include efforts directed at reducing excess body weight particularly in women, and advice on maintenance of a traditional diet to keep lipid levels and diabetes prevalence low.

Multiple Risks, Emotion Regulation Skill, and Cortisol in Low-Income African American Youth: A Prospective Study

ERIC Educational Resources Information Center

Kliewer, Wendy; Reid-Quinones, Kathryn; Shields, Brian J.; Foutz, Lauren

2009-01-01

Associations between multiple risks, emotion regulation skill, and basal cortisol levels were examined in a community sample of 69 African American youth (mean age = 11.30 years; 49% male) living in an urban setting. Multiple risks were assessed at Time 1 and consisted of 10 demographic and psychosocial risk factors including parent, child, and…

Meta-Analysis of Longitudinal Cohort Studies of Suicide Risk Assessment among Psychiatric Patients: Heterogeneity in Results and Lack of Improvement over Time

PubMed Central

Large, Matthew; Kaneson, Muthusamy; Myles, Nicholas; Myles, Hannah; Gunaratne, Pramudie; Ryan, Christopher

2016-01-01

Objective It is widely assumed that the clinical care of psychiatric patients can be guided by estimates of suicide risk and by using patient characteristics to define a group of high-risk patients. However, the statistical strength and reliability of suicide risk categorization is unknown. Our objective was to investigate the odds of suicide in high-risk compared to lower-risk categories and the suicide rates in high-risk and lower-risk groups. Method We located longitudinal cohort studies where psychiatric patients or people who had made suicide attempts were stratified into high-risk and lower-risk groups for suicide with suicide mortality as the outcome by searching for peer reviewed publications indexed in PubMed or PsychINFO. Electronic searches were supplemented by hand searching of included studies and relevant review articles. Two authors independently extracted data regarding effect size, study population and study design from 53 samples of risk-assessed patients reported in 37 studies. Results The pooled odds of suicide among high-risk patients compared to lower-risk patients calculated by random effects meta-analysis was of 4.84 (95% Confidence Interval (CI) 3.79–6.20). Between-study heterogeneity was very high (I2 = 93.3). There was no evidence that more recent studies had greater statistical strength than older studies. Over an average follow up period of 63 months the proportion of suicides among the high-risk patients was 5.5% and was 0.9% among lower-risk patients. The meta-analytically derived sensitivity and specificity of a high-risk categorization were 56% and 79% respectively. There was evidence of publication bias in favour of studies that inflated the pooled odds of suicide in high-risk patients. Conclusions The strength of suicide risk categorizations based on the presence of multiple risk factors does not greatly exceed the association between individual suicide risk factors and suicide. A statistically strong and reliable method to usefully distinguish patients with a high-risk of suicide remains elusive. PMID:27285387

Fruit and vegetable intakes and risk of colorectal cancer and incident and recurrent adenomas in the PLCO cancer screening trial.

PubMed

Kunzmann, Andrew T; Coleman, Helen G; Huang, Wen-Yi; Cantwell, Marie M; Kitahara, Cari M; Berndt, Sonja I

2016-04-15

The roles of fruits and vegetables in colorectal cancer development are unclear. Few prospective studies have assessed the association with adenoma, a known precursor to colorectal cancer. Our aim was to evaluate the association between fruit and vegetable intake and colorectal cancer development by evaluating the risk of incident and recurrent colorectal adenoma and colorectal cancer. Study participants were identified from the intervention arm of the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. Fruit and vegetable intake was measured using a self-reported dietary questionnaire. Total fruit and vegetable intake was not associated with reduced incident or recurrent adenoma risk overall, but a protective association was observed for multiple adenomas (Odds ratio 3rd tertile vs. 1st tertile = 0.61, 95% confidence interval (CI): 0.38, 1.00). Higher fruit and vegetable intakes were associated with a borderline reduced risk of colorectal cancer (Hazard ratio (HR) 3rd tertile vs. 1st tertile = 0.82, 95% CI: 0.67, 1.01), which reached significance amongst individuals with high processed meat intakes (HR = 0.74, 95% CI: 0.55, 0.99). Our results suggest that increased fruit and vegetable intake may protect against multiple adenoma development and may reduce the detrimental effects of high processed meat intakes on colorectal cancer risk. © 2015 UICC.

Relationships between youth sport participation and selected health risk behaviors from 1999 to 2007.

PubMed

Taliaferro, Lindsay A; Rienzo, Barbara A; Donovan, Kristine A

2010-08-01

How adolescents spend their out-of-school time represents one of the most important factors for predicting positive youth development. Sport participation relates to many beneficial outcomes. However, current economic conditions threaten high school sport programs around the United States. This investigation examined relationships by year between sport participation and numerous health risk behaviors among high school students. Data were derived from the Centers for Disease Control and Prevention's Youth Risk Behavior Surveys administered every 2 years from 1999 through 2007. Items assessed were sport participation, vigorous physical activity, dietary habits, weight loss, sexual activity, interpersonal violence and suicidality, and substance use. Multiple logistic regression analyses were used to examine relationships between sport participation and each health behavior. Interaction effects tested whether relationships varied by year, sex, age, and/or race/ethnicity. Analyses revealed some consistencies across years in relationships between sport participation and health risk behaviors for both sexes. However, most relationships varied by race/ethnicity. Among White students, sport participation related to multiple positive health behaviors. Conversely, African American, Hispanic, and Other athletes showed fewer positive health behaviors and some negative behaviors. Findings suggest that participation in organized sports affords many health benefits to most adolescents, but relates to some negative health behaviors in certain subgroups. Information regarding sport participation and health risk behaviors among subgroups across years can inform school policy, practice, and future research.

Combined impact of lead, cadmium, polychlorinated biphenyls and non-chemical risk factors on blood pressure in NHANES

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

Peters, Junenette L., E-mail: petersj@bu.edu; Patricia Fabian, M., E-mail: pfabian@bu.edu; Levy, Jonathan I., E-mail: jonlevy@bu.edu

High blood pressure is associated with exposure to multiple chemical and non-chemical risk factors, but epidemiological analyses to date have not assessed the combined effects of both chemical and non-chemical stressors on human populations in the context of cumulative risk assessment. We developed a novel modeling approach to evaluate the combined impact of lead, cadmium, polychlorinated biphenyls (PCBs), and multiple non-chemical risk factors on four blood pressure measures using data for adults aged ≥20 years from the National Health and Nutrition Examination Survey (1999–2008). We developed predictive models for chemical and other stressors. Structural equation models were applied to accountmore » for complex associations among predictors of stressors as well as blood pressure. Models showed that blood lead, serum PCBs, and established non-chemical stressors were significantly associated with blood pressure. Lead was the chemical stressor most predictive of diastolic blood pressure and mean arterial pressure, while PCBs had a greater influence on systolic blood pressure and pulse pressure, and blood cadmium was not a significant predictor of blood pressure. The simultaneously fit exposure models explained 34%, 43% and 52% of the variance for lead, cadmium and PCBs, respectively. The structural equation models were developed using predictors available from public data streams (e.g., U.S. Census), which would allow the models to be applied to any U.S. population exposed to these multiple stressors in order to identify high risk subpopulations, direct intervention strategies, and inform public policy. - Highlights: • We evaluated joint impact of chemical and non-chemical stressors on blood pressure. • We built predictive models for lead, cadmium and polychlorinated biphenyls (PCBs). • Our approach allows joint evaluation of predictors from population-specific data. • Lead, PCBs and established non-chemical stressors were related to blood pressure. • Framework allows cumulative risk assessment in specific geographic settings.« less

Method and apparatus for multiple-projection, dual-energy x-ray absorptiometry scanning

NASA Technical Reports Server (NTRS)

Feldmesser, Howard S. (Inventor); Magee, Thomas C. (Inventor); Charles, Jr., Harry K. (Inventor); Beck, Thomas J. (Inventor)

2007-01-01

Methods and apparatuses for advanced, multiple-projection, dual-energy X-ray absorptiometry scanning systems include combinations of a conical collimator; a high-resolution two-dimensional detector; a portable, power-capped, variable-exposure-time power supply; an exposure-time control element; calibration monitoring; a three-dimensional anti-scatter-grid; and a gantry-gantry base assembly that permits up to seven projection angles for overlapping beams. Such systems are capable of high precision bone structure measurements that can support three dimensional bone modeling and derivations of bone strength, risk of injury, and efficacy of countermeasures among other properties.

Dynamic Modeling of Systemic Risk in Financial Networks

NASA Astrophysics Data System (ADS)

Avakian, Adam

Modern financial networks are complicated structures that can contain multiple types of nodes and connections between those nodes. Banks, governments and even individual people weave into an intricate network of debt, risk correlations and many other forms of interconnectedness. We explore multiple types of financial network models with a focus on understanding the dynamics and causes of cascading failures in such systems. In particular, we apply real-world data from multiple sources to these models to better understand real-world financial networks. We use the results of the Federal Reserve "Banking Organization Systemic Risk Report" (FR Y-15), which surveys the largest US banks on their level of interconnectedness, to find relationships between various measures of network connectivity and systemic risk in the US financial sector. This network model is then stress-tested under a number of scenarios to determine systemic risks inherent in the various network structures. We also use detailed historical balance sheet data from the Venezuelan banking system to build a bipartite network model and find relationships between the changing network structure over time and the response of the system to various shocks. We find that the relationship between interconnectedness and systemic risk is highly dependent on the system and model but that it is always a significant one. These models are useful tools that add value to regulators in creating new measurements of systemic risk in financial networks. These models could be used as macroprudential tools for monitoring the health of the entire banking system as a whole rather than only of individual banks.

Development of in Vivo Biomarkers for Progressive Tau Pathology after Traumatic Brain Injury

DTIC Science & Technology

2015-02-01

Athletes in contact sports who have sustained multiple concussive traumatic brain injuries are at high risk for delayed, progressive neurological and...11 or ‘punch drunk’ syndrome 9, 12. US military personnel 13, 14 and others who have sustained multiple concussive traumatic brain injuries 15-17...To date, none of the attempts to model progressive tau pathology after repetitive concussive TBI in mice has been optimal. Ongoing efforts include

Development of in Vivo Biomarkers for Progressive Tau Pathology after Traumatic Brain Injury

DTIC Science & Technology

2016-02-01

14. ABSTRACT Athletes in contact sports who have sustained multiple concussive traumatic brain injuries are at high risk for delayed, progressive...pugilistica 3, 11 or ‘punch drunk’ syndrome 9, 12. US military personnel 13, 14 and others who have sustained multiple concussive traumatic brain...Progress to date: To date, none of the attempts to model progressive tau pathology after repetitive concussive TBI in mice has been optimal. Ongoing

Club drug use among young men who have sex with men in NYC: a preliminary epidemiological profile.

PubMed

Clatts, Michael C; Goldsamt, Lloyd A; Yi, Huso

2005-01-01

This paper describes findings from a study of young men who have sex with men (YMSM) in New York City. Using a cross-sectional design and a community-based targeted sampling approach, a total of 569 YMSM were recruited during 2000 and 2001 for a structured survey interview. High rates of lifetime exposure to a variety of club drugs (including methamphetamine, ketamine, and MDMA) are observed in the overall sample. Among those who use club drugs on a chronic basis (N=145), we found high rates of a prior suicide attempt (including high rates of multiple suicide attempts), high rates of lifetime exposure to multiple types of drugs, high rates of current poly drug use (including multiple types of club drugs), and high rates of current depressive symptoms. Chronic club drug users had a mean CES-D score of 8.5 and nearly two-thirds had a score of 7 or more. Although high rates of condom use are reported in some types of sexual exchanges, data show multiple types of sexual risk among chronic club drug users, including high rates of unprotected anal intercourse (UAI) with most frequent partners and comorbid drug use among both YMSM and their sexual partners.

Club Drug Use Among Young Men Who Have Sex with Men in NYC: A Preliminary Epidemiological Profile

PubMed Central

CLATTS, MICHAEL C.; GOLDSAMT, LLOYD A.; YI, HUSO

2009-01-01

This paper describes findings from a study of young men who have sex with men (YMSM) in New York City. Using a cross-sectional design and a community-based targeted sampling approach, a total of 569 YMSM were recruited during 2000 and 2001 for a structured survey interview. High rates of lifetime exposure to a variety of club drugs (including methamphetamine, ketamine, and MDMA) are observed in the overall sample. Among those who use club drugs on a chronic basis (N = 145), we found high rates of a prior suicide attempt (including high rates of multiple suicide attempts), high rates of lifetime exposure to multiple types of drugs, high rates of current poly drug use (including multiple types of club drugs), and high rates of current depressive symptoms. Chronic club drug users had a mean CES-D score of 8.5 and nearly two-thirds had a score of 7 or more. Although high rates of condom use are reported in some types of sexual exchanges, data show multiple types of sexual risk among chronic club drug users, including high rates of unprotected anal intercourse (UAI) with most frequent partners and comorbid drug use among both YMSM and their sexual partners. PMID:16048819

Sexual risk and bridging behaviors among young people in Hai Phong, Vietnam.

PubMed

Duong, Cong Thanh; Nguyen, Tran Hien; Hoang, Thi Thanh Ha; Nguyen, Van Vi; Do, Thi Minh Nguyet; Pham, Van Han; Detels, Roger

2008-07-01

The risk of the HIV epidemic spreading from high-risk groups to the general population in Vietnam depends on sexual risk and bridging behaviors between high- and low-risk individuals. A cross-sectional study was used to describe sexual activities of youth aged 18-29 years. Nearly half (41.4%) were sexually active. Premarital sex was reported by 43.3% of them; 78.3% of sexually active males and 13.5% of sexually active females. Multiple sex partners were reported by 31.0%; 56.7% of males and 9.2% of females. Almost 27% of males and 5% of females engaged in sexual bridging behaviors. Being unmarried was significantly associated with having sex with non-regular partners. Being unmarried and early age at first intercourse were associated with having sex with a sex worker. Consistent condom use was high with commercial sex workers but low with regular partners. Education to delay early sexual debut, increased employment, and strategies to inform young sexually active people to adopt safer behaviors are urgently needed.

On the association between sexual attraction and adolescent risk behavior involvement: Examining mediation and moderation.

PubMed

Busseri, Michael A; Willoughby, Teena; Chalmers, Heather; Bogaert, Anthony F

2008-01-01

On the basis of a large-scale survey of high-school youth, the authors compared adolescents reporting exclusively heterosexual, mostly heterosexual, bisexual, and predominately same-sex attraction based on high-risk involvement across a range of risk behaviors. Bisexual and same-sex attracted groups were characterized by heightened high-risk involvement relative to the other two groups. Mediation analysis was used to determine whether these group disparities were explained by a set of normative predictive factors spanning multiple life domains. Differences among a combined exclusively/mostly heterosexual attraction group and both the bisexual and same-sex attraction groups were attenuated (66% and 50%, respectively) after incorporating the hypothesized intervening predictive factors, providing evidence of partial mediation. Primary mediators included intrapersonal (attitudes toward risk-taking; academic orientation), interpersonal (peer victimization; parental relationships; unstructured activities), and environmental (substance availability) factors. Mediation results were consistent across participant age and sex. Implications, limitations, and directions for future research are discussed. Copyright (c) 2008 APA.

High-risk PCI: how to define it today?

PubMed

DE Marzo, Vincenzo; D'Amario, Domenico; Galli, Mattia; Vergallo, Rocco; Porto, Italo

2018-04-11

Before the percutaneous spread, the mortality rate of patients with coronary heart disease not suitable for cardiac surgery was markedly high. This limit has been progressively exceeded with the advent of minimally invasive approaches, which, although was initially intended exclusively for low risk patients, was then employed in complex patients often too compromised to undergo cardiac surgery. Given to the rising of high-risk population, due to an increase of patients with multiple chronic conditions linked to the best care offered, we are witnessing an expansion of the high-risk percutaneous coronary interventions (PCI) population. Despite defining what high-risk is remains still unclear, all proposed definitions of high-risk PCI combine features related to three clinical areas: 1) patient risk factors and comorbidities (incorporating those which preclude surgical or percutaneous revascularization such as diabetes, COPD, CKD, lung disease, frailty, advanced age); 2) location of the disease and complexity of coronary anatomy (including multi-vessel disease, left main disease, CTO, bifurcations); 3) hemodynamic clinical status (ventricular dysfunction, concomitant valvular disease or unstable characteristics). Since cardiologists have ascertained the encouraging results in terms of efficacy and rewards compared to the low-risks patients, the important role of treating high-risk patients is becoming more and more relevant to the point that current guidelines have now changed the appropriateness of percutaneous interventions indications. Considering the complexity in managing higher-risk patients with coronary artery disease, the next step to ensure the best care for this type of patients is to create a team-based model of cooperation in order to properly establish the right treatment for the right patient.

Physics of cardiac imaging with multiple-row detector CT.

PubMed

Mahesh, Mahadevappa; Cody, Dianna D

2007-01-01

Cardiac imaging with multiple-row detector computed tomography (CT) has become possible due to rapid advances in CT technologies. Images with high temporal and spatial resolution can be obtained with multiple-row detector CT scanners; however, the radiation dose associated with cardiac imaging is high. Understanding the physics of cardiac imaging with multiple-row detector CT scanners allows optimization of cardiac CT protocols in terms of image quality and radiation dose. Knowledge of the trade-offs between various scan parameters that affect image quality--such as temporal resolution, spatial resolution, and pitch--is the key to optimized cardiac CT protocols, which can minimize the radiation risks associated with these studies. Factors affecting temporal resolution include gantry rotation time, acquisition mode, and reconstruction method; factors affecting spatial resolution include detector size and reconstruction interval. Cardiac CT has the potential to become a reliable tool for noninvasive diagnosis and prevention of cardiac and coronary artery disease. (c) RSNA, 2007.

Health Risks of an Inactive Lifestyle - Multiple Languages

MedlinePlus

... Are Here: Home → Multiple Languages → All Health Topics → Health Risks of an Inactive Lifestyle URL of this page: https://medlineplus.gov/languages/ ... V W XYZ List of All Topics All Health Risks of an Inactive Lifestyle - Multiple Languages To use the sharing features on ...

The association between multiple sources of information and risk perceptions of tuberculosis, Ntcheu district, Malawi.

PubMed

Chizimba, Robert; Christofides, Nicola; Chirwa, Tobias; Singini, Isaac; Ozumba, Chineme; Sikwese, Simon; Banda, Hastings T; Banda, Rhoda; Chimbali, Henry; Ngwira, Bagrey; Munthali, Alister; Nyasulu, Peter

2015-01-01

Tuberculosis (TB) is one of the main causes of death in developing countries. Awareness and perception of risk of TB could influence early detection, diagnosis and care seeking at treatment centers. However, perceptions about TB are influenced by sources of information. This study aimed to determine the association between multiple sources of information, and perceptions of risk of TB among adults aged 18-49 years. A cross-sectional study was conducted in Ntcheu district in Malawi. A total of 121 adults were sampled in a three-stage simple random sampling technique. Data were collected using a structured questionnaire. Perceptions of risk were measured using specific statements that reflected common myths and misconceptions. Low risk perception implied a person having strong belief in myths and misconceptions about TB and high risk perception meant a person having no belief in myths or misconceptions and demonstrated understanding of the disease. Females were more likely to have low risk perceptions about TB compared to males (67.7% vs. 32.5%, p = 0.01). The higher the household asset index the more likely an individual had higher risk perceptions about TB (p = 0.006). The perception of risk of TB was associated with sources of information (p = 0.03). Use of both interpersonal communication and mass media was 2.8 times more likely to be associated with increased perception of risk of TB (Odds Ratio [OR] = 2.8; 95% Confidence interva1[CI]: 3.1-15. 6; p = 0.01). After adjusting for sex and asset ownership, use of interpersonal communication and mass media were more likely to be associated with higher perception of risk of TB (OR, 2.0; 95% CI: 1.65-10.72; p = 0.003) compared with interpersonal communication only (OR 1.6, 95%; CI: 1.13-8.98, p = 0.027). The study found that there was association between multiple sources of information, and higher perceptions of risk of TB among adults aged 18-49 years.

Non communicable disease and risky behaviour in an urban university community Nigeria.

PubMed

Ige, O K; Owoaje, E T; Adebiyi, O A

2013-03-01

Most developing countries have only limited information on the burden of Non Communicable Diseases (NCDs) even though rapid transitions in these NCDs have been predicted. To describe the burden of selected NCDs and associated risk behaviours in an urban university community in Nigeria. A cross-sectional survey of 525 representative staff of a University in a large city in Nigeria was conducted. In all, 27.6% were already diagnosed with at least one NCD (hypertension-21.5%, diabetes-11%, cancer 2.9%) while 67.4% reported at least one risk behaviour (unhealthy diet- 96%, sedentary living- 27.4% excessive alcohol use-5.1% and smoking- 1.9%). Multiple risk behaviours were observed in 29.9% with no significant variation by sex or age. Those 40 years and above had significantly higher prevalence of NCD, particularly for hypertension (p<0.05). Only 7%, considered themselves to be at risk of NCDs. Those whose parents had NCDs OR: 5.9 (2.4-14.5) and those who currently had NCDs OR: 3.9(1.8-8.1) perceived themselves at risk of one or more NCDs, but not those with multiple risk behaviours. The high burden of NCDs and risk behaviours in the face of limited self-perceived risk has been demonstrated and calls for urgent intervention.

The broader autism phenotype in infancy: when does it emerge?

PubMed

Ozonoff, Sally; Young, Gregory S; Belding, Ashleigh; Hill, Monique; Hill, Alesha; Hutman, Ted; Johnson, Scott; Miller, Meghan; Rogers, Sally J; Schwichtenberg, A J; Steinfeld, Marybeth; Iosif, Ana-Maria

2014-04-01

This study had 3 goals, which were to examine the following: the frequency of atypical development, consistent with the broader autism phenotype, in high-risk infant siblings of children with autism spectrum disorder (ASD); the age at which atypical development is first evident; and which developmental domains are affected. A prospective longitudinal design was used to compare 294 high-risk infants and 116 low-risk infants. Participants were tested at 6, 12, 18, 24, and 36 months of age. At the final visit, outcome was classified as ASD, Typical Development (TD), or Non-TD (defined as elevated Autism Diagnostic Observation Schedule [ADOS] score, low Mullen Scale scores, or both). Of the high-risk group, 28% were classified as Non-TD at 36 months of age. Growth curve models demonstrated that the Non-TD group could not be distinguished from the other groups at 6 months of age, but differed significantly from the Low-Risk TD group by 12 months on multiple measures. The Non-TD group demonstrated atypical development in cognitive, motor, language, and social domains, with differences particularly prominent in the social-communication domain. These results demonstrate that features of atypical development, consistent with the broader autism phenotype, are detectable by the first birthday and affect development in multiple domains. This highlights the necessity for close developmental surveillance of infant siblings of children with ASD, along with implementation of appropriate interventions as needed. Copyright © 2014 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

Prostate cancer-specific mortality after radical prostatectomy or external beam radiation therapy in men with 1 or more high-risk factors.

PubMed

D'Amico, Anthony V; Chen, Ming-Hui; Catalona, William J; Sun, Leon; Roehl, Kimberly A; Moul, Judd W

2007-07-01

Estimates of prostate cancer-specific mortality (PCSM) were determined after radical prostatectomy (RP) or radiation therapy (RT) in men with >or=1 high-risk factors. The study cohort comprised 948 men who underwent RP (N = 660) or RT (N = 288) for localized prostate cancer between 1988 and 2004 and had at least 1 of the following high-risk factors: a prostate-specific antigen (PSA) velocity >2 ng/mL/year during the year before diagnosis, a biopsy Gleason score of >or=7, a PSA level of >or=10 ng/mL, or clinical category T2b or high disease. Grays regression was used to evaluate whether the number and type of high-risk factors were associated with time to PCSM. Multiple determinants of high risk were found to be significantly associated with a shorter time to PCSM after RP (P < .001) or RT (P 2 ng/mL/year was associated with an increased risk of PCSM after RP (hazards ratio [HR] of 7.3; 95% confidence interval [95% CI], 1.0-59 [P = .05]) or RT (HR of 12.1; 95% CI, 1.4-105 [P = .02]) when compared with men with any other single high-risk factor. Men with a PSA velocity >2 ng/mL/year had a significantly higher risk of PCSM compared with men who had any other single high-risk factor. These men should be considered for randomized trials evaluating the impact on PCSM from adding systemic agents to standards of care for men with high-risk PC. Copyright (c) 2007 American Cancer Society.

An assessment of risk behaviours to HIV/AIDS vulnerability among young female garment workers in Bangladesh.

PubMed

Sayem, A; Popsci, M

2010-02-01

This study attempted to assess the risk behaviours for HIV/AIDS among female garment workers aged 15-24 years.A total of 300 garment workers in Dhaka city were assessed with a semi-structured interview. Their knowledge of HIV/AIDS was moderate with high rates of misperception regarding modes of transmission. Further, symptoms of possible sexually transmitted infections (STIs) such as genital ulcer disease and vaginal discharge were prevalent, and risk behaviours such as low use of condoms, multiple sex partners and drug abuse were also found. Logistic regression identified that women who sourced information through radio/television, health service providers or friends had higher age at first intercourse and higher HIV/AIDS knowledge scores and were more likely to use condoms. Those who gained information through radio/television or health service providers and those who abused drugs were more likely to have sex with multiple sex partners, while information gained through health service providers, and higher HIV/AIDS knowledge were protective against drug abuse, whereas sex with multiple partners was a predictor of drug abuse. We conclude that in Bangladesh, female garment workers are at risk of HIV/AIDS due to low education, lack of knowledge, STIs and risky behaviour.

Sociodemographic characteristics and sexual behavior as risk factors for human papillomavirus infection in Saudi Arabia.

PubMed

Alhamlan, F S; Khayat, H H; Ramisetty-Mikler, S; Al-Muammar, T A; Tulbah, A M; Al-Badawi, I A; Kurdi, W I; Tulbah, M I; Alkhenizan, A A; Hussain, A N; Ahmed, M; Al-Ahdal, M N

2016-05-01

To determine the prevalence and the sociodemographic characteristics and sexual behavior risk factors for human papillomavirus (HPV) infection in a hospital-based cohort of women in Saudi Arabia. Cervical specimens and questionnaire data were collected from women attending clinics in Riyadh, Saudi Arabia. Cervical specimens were examined for abnormal cytology using a standard Pap test and for the presence of HPV-DNA using PCR and reverse line blot hybridization tests. Approximately 73% of the 400 women tested were Saudi nationals. Nearly 50% were under 40 years old (range 22-80 years, mean±standard deviation 41.20±10.43 years). Approximately 17% of the women were HPV-positive. The most commonly detected HPV types were HPV-18 (34%) and HPV-16 (19%), with multiple infections detected in 10% of positive specimens. Multivariate analyses revealed that smoking and multiple partners were significant risk factors for HPV infection (p<0.01). Because of societal challenges and an unsubstantiated assumption of low HPV prevalence, few studies have examined sociodemographic characteristics or sexual behaviors associated with HPV in Saudi women. However, a high prevalence of HPV infection was found, with smoking and multiple partners as significant risk factors, in this hospital-based cohort of predominantly Saudi women. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Legionnaires' disease as an occupational risk related to decontamination work after the Fukushima nuclear disaster: A case report.

PubMed

Sawano, Toyoaki; Tsubokura, Masaharu; Ozaki, Akihiko; Leppold, Claire; Kato, Shigeaki; Kambe, Toshiyuki

2018-05-25

Legionnaires' disease (LD), which is atypical pneumonia with a broad variety of clinical symptoms, can lead to death despite its low incidence. There are multiple risk factors for LD, yet little information is available concerning what kind of environmental factors are linked to higher risk of LD development. We have experienced a fatal case of LD, which occurred in a decontamination worker after the Fukushima nuclear disaster. A 53-year-old Japanese male visited our hospital with symptoms of fever, vomiting, diarrhea, and altered mental status, but not with respiratory manifestations. He was engaged in decontamination work, which generally includes operations such as the removal of topsoil in mountainous areas and cleaning roads and roofs of residential buildings with high-pressure water. He was required to wear specific equipment to prevent radiation exposure, and lived in a workers' dormitory or shared house, thereby sharing spaces with other workers. Normal antibiotic therapy did not improve his symptoms following his diagnosis with pneumonia. A urinary antigen detection test was then conducted, leading to a diagnosis of LD. Despite the change of antibiotic to levofloxacin, multiple organ failure led to his death. Decontamination workers may be at a high risk for developing LD and living and working conditions among them are possible contributors.

High Risk Aortic Valve Replacement - The Challenges of Multiple Treatment Strategies with an Evolving Technology.

PubMed

Booth, K; Beattie, R; McBride, M; Manoharan, G; Spence, M; Jones, J M

2016-01-01

Deciding on the optimal treatment strategy for high risk aortic valve replacement is challenging. Transcatheter Aortic Valve implantation (TAVI) has been available in our centre as an alternative treatment modality for patients since 2008. We present our early experience of TAVI and SAVR (surgical Aortic Valve Replacement) in high risk patients who required SAVR because TAVI could not be performed. The database for Surgical aortic valve and Transcatheter aortic valve replacement referrals was interrogated to identify relevant patients. Survival to hospital discharge was 95.5% in the forty five patients who had SAVR when TAVI was deemed technically unsuitable. One year survival was 86%. Defining who is appropriate for TAVI or high risk SAVR is challenging and multidisciplinary team discussion has never been more prudent in this field of evolving technology with ever decreasing risks of surgery. The introduction of TAVI at our institution has seen a rise in our surgical caseload by approximately by 25%. Overall, the option of aortic valve intervention is being offered to more patients in general which is a substantial benefit in the treatment of aortic valve disease.

Assessment of the Casualty Risk of Multiple Meteorological Hazards in China

PubMed Central

Xu, Wei; Zhuo, Li; Zheng, Jing; Ge, Yi; Gu, Zhihui; Tian, Yugang

2016-01-01

A study of the frequency, intensity, and risk of extreme climatic events or natural hazards is important for assessing the impacts of climate change. Many models have been developed to assess the risk of multiple hazards, however, most of the existing approaches can only model the relative levels of risk. This paper reports the development of a method for the quantitative assessment of the risk of multiple hazards based on information diffusion. This method was used to assess the risks of loss of human lives from 11 types of meteorological hazards in China at the prefectural and provincial levels. Risk curves of multiple hazards were obtained for each province and the risks of 10-year, 20-year, 50-year, and 100-year return periods were mapped. The results show that the provinces (municipalities, autonomous regions) in southeastern China are at higher risk of multiple meteorological hazards as a result of their geographical location and topography. The results of this study can be used as references for the management of meteorological disasters in China. The model can be used to quantitatively calculate the risks of casualty, direct economic losses, building collapse, and agricultural losses for any hazards at different spatial scales. PMID:26901210

Assessment of the Casualty Risk of Multiple Meteorological Hazards in China.

PubMed

Xu, Wei; Zhuo, Li; Zheng, Jing; Ge, Yi; Gu, Zhihui; Tian, Yugang

2016-02-17

A study of the frequency, intensity, and risk of extreme climatic events or natural hazards is important for assessing the impacts of climate change. Many models have been developed to assess the risk of multiple hazards, however, most of the existing approaches can only model the relative levels of risk. This paper reports the development of a method for the quantitative assessment of the risk of multiple hazards based on information diffusion. This method was used to assess the risks of loss of human lives from 11 types of meteorological hazards in China at the prefectural and provincial levels. Risk curves of multiple hazards were obtained for each province and the risks of 10-year, 20-year, 50-year, and 100-year return periods were mapped. The results show that the provinces (municipalities, autonomous regions) in southeastern China are at higher risk of multiple meteorological hazards as a result of their geographical location and topography. The results of this study can be used as references for the management of meteorological disasters in China. The model can be used to quantitatively calculate the risks of casualty, direct economic losses, building collapse, and agricultural losses for any hazards at different spatial scales.

Relationships Among Substance Use, Multiple Sexual Partners, and Condomless Sex.

PubMed

Zhao, Yunchuan Lucy; Kim, Heejung; Peltzer, Jill

2017-04-01

Male and female students manifest different behaviors in condomless sex. This cross-sectional, exploratory, correlational study examined the differences in risk factors for condomless sex between male and female high school students, using secondary data from 4,968 sexually active males and females participating in the 2011 National Youth Risk Behavior Survey. Results in descriptive statistics and multivariate binary logistic regressions revealed that condomless sex was reported as 39.70% in general. A greater proportion of females engaged in condomless sex (23.26%) than did males (16.44%). Physical abuse by sex partners was a common reason for failure to use condoms regardless of gender. Lower condom use was found in (1) those experiencing forced sex by a partner in males, (2) female smokers, and (3) female with multiple sex partners. Thus, sexual health education should address the different risk factors and consider gender characteristics to reduce condomless sex.

Risk factors for multiple myeloma: a hospital-based case-control study in Northwest China.

PubMed

Wang, Qixia; Wang, Yiwei; Ji, Zhaohua; Chen, Xiequn; Pan, Yaozhu; Gao, Guangxun; Gu, Hongtao; Yang, Yang; Choi, Bernard C K; Yan, Yongping

2012-10-01

The distinctive racial/ethnic and geographic distribution of multiple myeloma (MM) suggests that both family history and environmental factors may contribute to its development. A hospital-based case-control study consisting of 220 confirmed MM cases and 220 individually matched patient controls, by sex, age and hospital was carried out at 5 major hospitals in Northwest China. A questionnaire was used to obtain information on demographics, family history, and the frequency of food items consumed. Based on multivariate analysis, a significant association between the risk of MM and family history of cancers in first degree relatives was observed (OR=4.03, 95% CI: 2.50-6.52). Fried food, cured/smoked food, black tea, and fish were not significantly associated with the risk of MM. Intake of shallot and garlic (OR=0.60, 95% CI: 0.43-0.85), soy food (OR=0.52, 95% CI: 0.36-0.75) and green tea (OR=0.38, 95% CI: 0.27-0.53) was significantly associated with a reduced risk of MM. In contrast, intake of brined vegetables and pickle was significantly associated with an increased risk (OR=2.03, 95% CI: 1.41-2.93). A more than multiplicative interaction on the decreased risk of MM was found between shallot/garlic and soy food. Our study in Northwest China found an increased risk of MM with a family history of cancer, a diet characterized by low consumption of garlic, green tea and soy foods, and high consumption of pickled vegetables. The effect of green tea in reducing the risk of MM is an interesting new finding which should be further confirmed. Copyright © 2012 Elsevier Ltd. All rights reserved.

Young Adult and Usual Adult Body Mass Index and Multiple Myeloma Risk: A Pooled Analysis in the International Multiple Myeloma Consortium (IMMC).

PubMed

Birmann, Brenda M; Andreotti, Gabriella; De Roos, Anneclaire J; Camp, Nicola J; Chiu, Brian C H; Spinelli, John J; Becker, Nikolaus; Benhaim-Luzon, Véronique; Bhatti, Parveen; Boffetta, Paolo; Brennan, Paul; Brown, Elizabeth E; Cocco, Pierluigi; Costas, Laura; Cozen, Wendy; de Sanjosé, Silvia; Foretová, Lenka; Giles, Graham G; Maynadié, Marc; Moysich, Kirsten; Nieters, Alexandra; Staines, Anthony; Tricot, Guido; Weisenburger, Dennis; Zhang, Yawei; Baris, Dalsu; Purdue, Mark P

2017-06-01

Background: Multiple myeloma risk increases with higher adult body mass index (BMI). Emerging evidence also supports an association of young adult BMI with multiple myeloma. We undertook a pooled analysis of eight case-control studies to further evaluate anthropometric multiple myeloma risk factors, including young adult BMI. Methods: We conducted multivariable logistic regression analysis of usual adult anthropometric measures of 2,318 multiple myeloma cases and 9,609 controls, and of young adult BMI (age 25 or 30 years) for 1,164 cases and 3,629 controls. Results: In the pooled sample, multiple myeloma risk was positively associated with usual adult BMI; risk increased 9% per 5-kg/m 2 increase in BMI [OR, 1.09; 95% confidence interval (CI), 1.04-1.14; P = 0.007]. We observed significant heterogeneity by study design ( P = 0.04), noting the BMI-multiple myeloma association only for population-based studies ( P trend = 0.0003). Young adult BMI was also positively associated with multiple myeloma (per 5-kg/m 2 ; OR, 1.2; 95% CI, 1.1-1.3; P = 0.0002). Furthermore, we observed strong evidence of interaction between younger and usual adult BMI ( P interaction <0.0001); we noted statistically significant associations with multiple myeloma for persons overweight (25-<30 kg/m 2 ) or obese (30+ kg/m 2 ) in both younger and usual adulthood (vs. individuals consistently <25 kg/m 2 ), but not for those overweight or obese at only one time period. Conclusions: BMI-associated increases in multiple myeloma risk were highest for individuals who were overweight or obese throughout adulthood. Impact: These findings provide the strongest evidence to date that earlier and later adult BMI may increase multiple myeloma risk and suggest that healthy BMI maintenance throughout life may confer an added benefit of multiple myeloma prevention. Cancer Epidemiol Biomarkers Prev; 26(6); 876-85. ©2017 AACR . ©2017 American Association for Cancer Research.

Application of High-Throughput In Vitro Assays for Risk-Based ...

EPA Pesticide Factsheets

Multiple drivers shape the types of human-health assessments performed on chemicals by U.S. EPA resulting in chemical assessments are “fit-for-purpose” ranging from prioritization for further testing to full risk assessments. Layered on top of the diverse assessment needs are the resource intensive nature of traditional toxicological studies used to test chemicals and the lack of toxicity information on many chemicals. To address these challenges, the Agency initiated the ToxCast program to screen thousands of chemicals across hundreds of high-throughput screening assays in concentrations-response format. One of the findings of the project has been that the majority of chemicals interact with multiple biological targets within a narrow concentration range and the extent of interactions increases rapidly near the concentration causing cytotoxicity. This means that application of high-throughput in vitro assays to chemical assessments will need to identify both the relative selectivity at chemicals interact with biological targets and the concentration at which these interactions perturb signaling pathways. The integrated analyses will be used to both define a point-of-departure for comparison with human exposure estimates and identify which chemicals may benefit from further studies in a mode-of-action or adverse outcome pathway framework. The application of new technologies in a risk-based, tiered manner provides flexibility in matching throughput and cos

Estimating Herd Immunity to Amphibian Chytridiomycosis in Madagascar Based on the Defensive Function of Amphibian Skin Bacteria

PubMed Central

Bletz, Molly C.; Myers, Jillian; Woodhams, Douglas C.; Rabemananjara, Falitiana C. E.; Rakotonirina, Angela; Weldon, Che; Edmonds, Devin; Vences, Miguel; Harris, Reid N.

2017-01-01

For decades, Amphibians have been globally threatened by the still expanding infectious disease, chytridiomycosis. Madagascar is an amphibian biodiversity hotspot where Batrachochytrium dendrobatidis (Bd) has only recently been detected. While no Bd-associated population declines have been reported, the risk of declines is high when invasive virulent lineages become involved. Cutaneous bacteria contribute to host innate immunity by providing defense against pathogens for numerous animals, including amphibians. Little is known, however, about the cutaneous bacterial residents of Malagasy amphibians and the functional capacity they have against Bd. We cultured 3179 skin bacterial isolates from over 90 frog species across Madagascar, identified them via Sanger sequencing of approximately 700 bp of the 16S rRNA gene, and characterized their functional capacity against Bd. A subset of isolates was also tested against multiple Bd genotypes. In addition, we applied the concept of herd immunity to estimate Bd-associated risk for amphibian communities across Madagascar based on bacterial antifungal activity. We found that multiple bacterial isolates (39% of all isolates) cultured from the skin of Malagasy frogs were able to inhibit Bd. Mean inhibition was weakly correlated with bacterial phylogeny, and certain taxonomic groups appear to have a high proportion of inhibitory isolates, such as the Enterobacteriaceae, Pseudomonadaceae, and Xanthamonadaceae (84, 80, and 75% respectively). Functional capacity of bacteria against Bd varied among Bd genotypes; however, there were some bacteria that showed broad spectrum inhibition against all tested Bd genotypes, suggesting that these bacteria would be good candidates for probiotic therapies. We estimated Bd-associated risk for sampled amphibian communities based on the concept of herd immunity. Multiple amphibian communities, including those in the amphibian diversity hotspots, Andasibe and Ranomafana, were estimated to be below the 80% herd immunity threshold, suggesting they may be at higher risk to chytridiomycosis if a lethal Bd genotype emerges in Madagascar. While this predictive approach rests on multiple assumptions, and incorporates only one component of hosts' defense against Bd, their culturable cutaneous bacterial defense, it can serve as a foundation for continued research on Bd-associated risk for the endemic frogs of Madagascar. PMID:28959244

Glucagon gene polymorphism modifies the effects of smoking and physical activity on risk of type 2 diabetes mellitus in Han Chinese.

PubMed

Li, Linlin; Gao, Kaiping; Zhao, Jingzhi; Feng, Tianping; Yin, Lei; Wang, Jinjin; Wang, Chongjian; Li, Chunyang; Wang, Yan; Wang, Qian; Zhai, Yujia; You, Haifei; Ren, Yongcheng; Wang, Bingyuan; Hu, Dongsheng

2014-01-25

Few genome-wide association studies have considered interactions between multiple genetic variants and environmental factors associated with disease. The interaction was examined between a glucagon gene (GCG) polymorphism and smoking, alcohol consumption and physical activity and the association with risk of type 2 diabetes mellitus (T2DM) in a case-control study of Chinese Han subjects. The rs12104705 polymorphism of GCG and interactions with environmental variables were analyzed for 9619 participants by binary multiple logistic regression. Smoking with the C-C haplotype of rs12104705 was associated with increased risk of T2DM (OR=1.174, 95% CI=1.013-1.361). Moderate and high physical activity with the C-C genotype was associated with decreased risk of T2DM as compared with low physical activity with the genotype (OR=0.251, 95% CI=0.206-0.306 and OR=0.190, 95% CI=0.164-0.220). However, the interaction of drinking and genotype was not associated with risk of T2DM. Genetic polymorphism in rs12104705 of GCG may interact with smoking and physical activity to modify the risk of T2DM. © 2013.

Association of urinary sodium/creatinine ratio with bone mineral density in postmenopausal women: KNHANES 2008-2011.

PubMed

Kim, Sung-Woo; Jeon, Jae-Han; Choi, Yeon-Kyung; Lee, Won-Kee; Hwang, In-Ryang; Kim, Jung-Guk; Lee, In-Kyu; Park, Keun-Gyu

2015-08-01

Accumulating evidence shows that high sodium chloride intake increases urinary calcium excretion and may be a risk factor for osteoporosis. However, the effect of oral sodium chloride intake on bone mineral density (BMD) and risk of osteoporosis has been inadequately researched. The aim of the present study was to determine whether urinary sodium excretion (reflecting oral sodium chloride intake) associates with BMD and prevalence of osteoporosis in postmenopausal women. This cross-sectional study involved a nationally representative sample consisting of 2,779 postmenopausal women who participated in the Korea National Health and Nutritional Examination Surveys in 2008-2011. The association of urinary sodium/creatinine ratio with BMD and other osteoporosis risk factors was assessed. In addition, the prevalence of osteoporosis was assessed in four groups with different urinary sodium/creatinine ratios. Participants with osteoporosis had significantly higher urinary sodium/creatinine ratios than the participants without osteoporosis. After adjusting for multiple confounding factors, urinary sodium/creatinine ratio correlated inversely with lumbar spine BMD (P = 0.001). Similarly, when participants were divided into quartile groups according to urinary sodium/creatinine ratio, the average BMD dropped as the urinary sodium/creatinine ratio increased. Multiple logistic regression analysis revealed that compared to quartile 1, quartile 4 had a significantly increased prevalence of lumbar spine osteoporosis (odds ratios 1.346, P for trend = 0.044). High urinary sodium excretion was significantly associated with low BMD and high prevalence of osteoporosis in lumbar spine. These results suggest that high sodium chloride intake decreases lumbar spine BMD and increases the risk of osteoporosis in postmenopausal women.

High Risk, but Also High Potential: The Plight and the Promise of Children with Attention Deficit Disorders.

ERIC Educational Resources Information Center

Whalen, Carol K.

In a discussion of children with attention deficit disorders (ADD), a nutritional metaphor is applied to make the following four observations: (1) hyperactivity requires multiple interventions; (2) treatment must be individualized; (3) management of ADD is a lifelong endeavor; and (4) evaluation must be multidimensional. Children with ADD are…

Enhanced virulence of clade 2.3.2.1 highly pathogenic avian influenza A(H5N1) viruses in ferrets

USDA-ARS?s Scientific Manuscript database

Sporadic avian to human transmission of highly pathogenic avian influenza (HPAI) A (H5N1) viruses necessitates the analysis of currently circulating and evolving clades to assess their potential risk. Following the spread and sustained circulation of clade 2 viruses across multiple continents, num...

Single Parents and the Work Setting: The Impact of Multiple Job and Homelife Responsibilities.

ERIC Educational Resources Information Center

Burden, Dianne S.

1986-01-01

Examines the impact of combined work/family responsibilities on single-parent employees. Results indicated that parent employees, but particularly single female parents, were at risk for high job-family role strain and reduced levels of well-being. In spite of increased strain, however, single parents exhibited high levels of job satisfaction and…

A Qualitative Approach on Motives and Aspects of Risks in Freeriding

PubMed Central

Frühauf, Anika; Hardy, Will A. S.; Pfoestl, Daniel; Hoellen, Franz-Georg; Kopp, Martin

2017-01-01

Recent research has shown that there are multiple motives for participation in high-risk sport; however these results have come from studies that consider a number of different sports. Therefore, the aim of the present study was to better understand the motives and risk-related aspects of freeriding, using a qualitative approach. Semi-structured interviews were conducted with 40 professional and semi-professional freeride skiers and snowboarders. All freeriders were highly experienced, of different age (19–44 years; 27.5 ± 4.5 years), gender (female = 13), and profession (professional athletes = 11). Analyses were done using MAXQDA software following a code theme approach. Mixed methods analyses using χ2-tests were computed for age (<25 years ≥) and gender (female/male) on motives and risk factors. Five emerging themes were found, namely Challenge (n = 36), Friends (n = 31), Nature (n = 27), Balance (n = 26), and Freedom (n = 26). A sixth theme Habit (n = 13) was allocated as a subtheme due to minor responses. With regard to risk management, participants decided upon a risk calculation strategy which included multiple factors (e.g., planning, conditions, current situation, knowledge, and experience). Trusting in one's own abilities, avoiding negative fear and having trusted partners were among the risk factors. Deliberately seeking out dangerous situations was not a motive. χ2-tests revealed no gender or age differences regarding aspects of risk (range of p-scores: p = 0.17–1.00) or motives (p = 0.16–1.00). Freeriding was shown to provide positive effects through participation. Some important factors seem to be motivational drivers for freeriders: challenging oneself, experiencing nature, contributing to deep friendships, freeriding as a counterbalance to everyday life and escape from restrictions. Contrary to prior research reports on sensation seeking, experienced freeriders do not search the risk; they seem to minimize it based on knowledge and experience. Analyses of the present data did not show any gender or age differences, which may suggest that experience plays a more important role in high-risk sports than age or gender. Future research should qualitatively investigate further terrain based activities and implement motives and risk-related factors in quantitative research. PMID:29184524

Prevalence of Fracture and Osteoporosis Risk Factors in American Indian and Alaska Native People

PubMed Central

Frech, Tracy; Ma, Khe-ni; Ferrucci, Elizabeth D.; Lanier, Anne P.; McFadden, Molly; Tom-Orme, Lillian; Slattery, Martha L.; Murtaugh, Maureen A.

2012-01-01

Objective Little is known about prevalence of osteoporosis risk factors among American Indians and Alaska Natives (AIAN). Methods We included AIAN people (n = 8,039) enrolled in the Education and Research Towards Health (EARTH) Study. Prevalence ratios were used to determine cross-sectional associations of risk factors with self-reported bone fractures. Results There is a high prevalence of multiple risk factors for osteoporosis in AIAN, although the factors that are associated with past fracture vary by gender and geographical area. In general, women who reported a fracture reported more risk behaviors, more than two medical conditions, and low physical activity. Men with higher BMI were less likely to report a fracture. Smoking history was associated with fracture for both genders, though not significantly in all sub-groups. Conclusion We prevent a high prevalence of risk factors for osteoporosis for AIAN. Future research for osteoporosis risk reduction and prevention in AIAN people is indicated. PMID:24212166

Male Labor Migrants in Russia: HIV Risk Behavior Levels, Contextual Factors, and Prevention Needs

PubMed Central

Amirkhanian, Yuri A.; Kuznetsova, Anna V.; Kelly, Jeffrey A.; DiFranceisco, Wayne J; Musatov, Vladimir B.; Avsukevich, Natalya A.; Chaika, Nikolay A.; McAuliffe, Timothy L.

2015-01-01

Background Although the dire life circumstances of labor migrants working in Russia are well-known, their HIV risk vulnerability and prevention needs are understudied. Low socioeconomic status, lack of access to services, separation from family, and limited risk awareness all contribute to migrants’ HIV vulnerability. Methods Male labor migrants in St. Petersburg (n=499) were administered assessments of their sexual behavior practices, substance use, and psychosocial characteristics related to risk and well-being. Results Thirty percent of migrants reported multiple female partners in the past 3 months. Condom use was low, ranging from 35% with permanent to 52% with casual partners. Central Asian migrants had very low AIDS knowledge, low levels of substance use, moderate sexual risk, high depression, and poor social supports. Eastern European migrants had higher AIDS knowledge, alcohol and drug use, and sexual risk. Discussion Improved HIV prevention efforts are needed to reduce the risk vulnerability of migrants who relocate to high disease prevalence areas. PMID:20690041

Childhood obesity patterns and relation to middle-age sleep apnoea risk: the Bogalusa Heart Study.

PubMed

Bazzano, L A; Hu, T; Bertisch, S M; Yao, L; Harville, E W; Gustat, J; Chen, W; Webber, L S; Shu, T; Redline, S

2016-12-01

Obese adults have a higher risk of obstructive sleep apnoea (OSA); however, the relationship between childhood obesity and adult OSA risk is unclear. Objectives This study aimed to examine overweight/obesity (OW) in childhood and risk of OSA in middle age. Childhood OW status was classified as never OW, weight cycling, persistent OW and incident OW. After 35 years of follow-up, high risk for OSA was determined by a positive score in ≥2 domains on the Berlin Questionnaire with obesity removed from scoring. At initial assessment, mean (SD) age was 9.9 (2.9) years, and 23.9% were OW. Overall, 25.7% had scores indicating a high risk for OSA. Compared with participants who were never OW, those with persistent OW and incident OW were 1.36 (95%CI: 1.04-1.77) and 1.47 (1.11-1.96) times more likely to be high risk for OSA, after adjustment for multiple risk factors and adult OW status. Participants with an OW duration of 1-4 years, 5-8 years, and 8+ years were 0.96 (0.44-2.09), 1.20 (0.70-2.04) and 1.52 (1.22-1.90) times more likely to be high risk for OSA compared with those who were never OW (P for trend: 0.0002). These results suggest that childhood OW is associated with a high risk of OSA in middle age. © 2016 World Obesity Federation.

Latent Class Analysis of HIV Risk Behaviors Among Russian Women at Risk for Alcohol-Exposed Pregnancies.

PubMed

Bohora, Som; Chaffin, Mark; Shaboltas, Alla; Bonner, Barbara; Isurina, Galina; Batluk, Julia; Bard, David; Tsvetkova, Larissa; Skitnevskaya, Larissa; Volkova, Elena; Balachova, Tatiana

2017-11-01

The number of HIV cases attributed to heterosexual contact and the proportion of women among HIV positive individuals has increased worldwide. Russia is a country with the highest rates of newly diagnosed HIV infections in the region, and the infection spreads beyond traditional risk groups. While young women are affected disproportionately, knowledge of HIV risk behaviors in women in the general population remains limited. The objectives of this study were to identify patterns of behaviors that place women of childbearing age at high risk for HIV transmission and determine whether socio-demographic characteristics and alcohol use are predictive of the risk pattern. A total of 708 non-pregnant women, aged between 18 and 44 years, who were at risk for an alcohol-exposed pregnancy were enrolled in two regions in Russia. Participants completed a structured interview focused on HIV risk behaviors, including risky sexual behavior and alcohol and drug use. Latent class analysis was utilized to examine associations between HIV risk and other demographic and alcohol use characteristics and to identify patterns of risk among women. Three classes were identified. 34.93% of participants were at high risk, combining their risk behaviors, e.g., having multiple sexual partners, with high partner's risk associated with partner's drug use (class I). Despite reporting self-perceived risk for HIV/STI, this class of participants was unlikely to utilize adequate protection (i.e., condom use). The second high risk class included 13.19% of participants who combined their risky sexual behaviors, i.e., multiple sexual partners and having STDs, with partner's risk that included partner's imprisonment and partner's sex with other women (class II). Participants in this class were likely to utilize protection/condoms. Finally, 51.88% of participants were at lower risk, which was associated primarily with their partners' risk, and these participants utilized protection (class III). The odds of being in class I compared with class III were 3.3 (95% CI [1.06, 10.38]) times higher for those women who had Alcohol Use Disorders Identification Test scores ≥ 8 than those who had lower scores, and were 3.9 (95% CI [1.69, 8.97]) times higher for those who used alcohol before sex than those who did not. In addition, women who drank more days per week were 1.36 times more likely to be in class II than in class III. The study informs prevention by identifying specific population groups and targets for interventions. Alcohol use is a significant predictor and an overarching factor of HIV risk in women. Since at-risk drinking is common among young Russian women, alcohol risk reduction should be an essential component of HIV prevention efforts.

Identification of Risk Factors for Intravenous Infiltration among Hospitalized Children: A Retrospective Study

PubMed Central

2016-01-01

This retrospective study was aimed to identify risk factors of intravenous (IV) infiltration for hospitalized children. The participants were 1,174 children admitted to a general hospital, who received peripheral intravenous injection therapy at least once, and had complete records. Data were analyzed with frequency and percentage or mean and standard deviation were calculated, and odds ratio (OR) from univariate and multiple logistic regressions. The number and % of infiltrations were 92 and 7.8%, respectively. IV infiltration risk factors were lower limb (OR = 1.72), phenytoin (OR = 11.03), 10% dextrose (OR = 6.55), steroids (OR = 6.21), vancomycin (OR = 4.10), high-concentration electrolytes (OR = 3.49), and ampicillin/sulbactam combination (OR = 3.37). Nurses working at children’s hospitals should consider the risk of IV infiltration for children receiving IV infusion therapy and make a preventive effort to identify IV infiltration in high-risk children at an early stage. PMID:27351488

Risk factors for suicide in Taiwanese college students.

PubMed

Gau, Susan Shur-Fen; Chen, Ying-Yeh; Tsai, Fang-Ju; Lee, Ming-Been; Chiu, Yen-Nan; Soong, Wei-Tsuen; Hwu, Hai-Gwo

2008-01-01

The authors investigated the personality characteristics, psychopathology, parenting style, and family function among Taiwanese college students with high, moderate, and low suicidal risks. The sample included 2,919 first-year college students (1,414 men, 1,505 women) from a university in Taipei, Taiwan. A self-administered questionnaire assessed domains covering demographics, personality, psychopathology, frequency of substance use, parenting style, family functioning, and suicidal behaviors. The authors used mixed models for data analysis. The authors observed a positive linear trend between increased suicidal tendency and levels of neuroticism, harm avoidance, novelty seeking, psychopathology, and parenting styles of low affection, overprotection, and authoritarian controlling. Use of tobacco and alcohol and impaired family adaptation and cohesion were associated with high and moderate suicidal risks. Personality, psychopathology, substance use, and familial factors are important correlates of suicidal risks among college students in Taiwan. Optimal suicide prevention strategies in the college setting should incorporate the multiple facets of suicidal risks.

Assessment of human papilloma virus infection in adult laryngeal papilloma using a screening test.

PubMed

Makiyama, Kiyoshi; Hirai, Ryoji; Matsuzaki, Hiroumi; Ikeda, Minoru

2013-03-01

Human papilloma virus (HPV) infection is involved in both juvenile and adult laryngeal papilloma. We wished to determine which types of adult laryngeal papilloma were clinically related to HPV infection. We hypothesized that multiple-site and recurrent papillomas would have a strong relationship to HPV and conducted the present study to test this hypothesis. Thirteen male patients with adult laryngeal papilloma who underwent resection of papilloma between August 2006 and September 2009 were studied. We examined the relationships between whether the tumor was solitary or multiple, presence or absence of recurrence after surgery, and HPV infection. High-risk HPV types (HPV-DNA types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68) and low-risk HPV types (6, 11, 42, 43, and 44) were tested by a liquid-phase hybridization method. In addition, HPV typing was performed for patients positive for low-risk HPV types. Twenty patients with laryngeal carcinoma or laryngeal leukoplakia were enrolled as the control group. In the laryngeal papilloma group, all patients tested were negative for high-risk HPV and 69.2% were positive for low-risk HPV. Typing performed for seven of the patients who tested positive for low-risk HPV showed that one patient was positive for HPV-11, whereas the remaining six patients were positive for HPV-6. All patients with recurrent laryngeal papillomatosis (RLP) were positive for low-risk HPV. All patients who were positive for low-risk HPV had RLP. Tumor samples from repeat operations were positive for low-risk HPV in all patients tested. HPV was not detected in the control group. The relationship between RLP and low-risk HPV was strong, with all cases that were positive for low-risk HPV showing recurrence. Tumor tissue resected at the time of repeat surgery was positive for low-risk HPV in all cases tested. Copyright © 2013 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Experiences in anti-tuberculosis treatment in patients with multiple previous treatments and its impact on drug resistant tuberculosis epidemics

PubMed Central

Xu, Biao; Zhao, Qi; Hu, Yi; Shi, Ying; Wang, Weibing; Diwan, Vinod K.

2014-01-01

Background Tuberculosis (TB) patients with a history of multiple anti-TB treatments are the ‘neglected’ group to the free anti-TB treatment policy in China. Objective To understand the experiences of TB patients with multiple previous treatments with regard to bacteriological diagnosis and treatment regimens, especially for second-line anti-TB drugs, and how this might influence the risks of multidrug and extensively drug-resistant TB (M/XDR-TB). Design A cross-sectional study was conducted in 10 county/district TB clinics in five provinces of China. The study participants were TB patients that had at least two previous treatment episodes that lasted longer than 1 month each. Face-to-face interviews and drug susceptibility testing (DST) were conducted with the consenting participants. Results A total of 328 TB patients were recruited. The proportion of multidrug-resistant tuberculosis (MDR-TB) was 58.2% in the 287 DST-confirmed patients. Forty-two percent of the patients did not complete their first treatment course. About 23.8% of the participants had a history of taking second-line drugs, and more than 77.8% of them were treated in county TB dispensaries where only sputum microscopy was applied. Multivariate analysis found that the use of second-line drugs was significantly associated with frequency of previous treatments (p<0.01), but not with drug resistance profiles of patients. Conclusions Patients with multiple previous treatments are at extremely high risk of MDR-TB in China. The unregulated use of second-line drugs bring about the threat of XDR-TB epidemic. DST-guided treatment and strict regulations of anti-TB treatment should be assured for the high-risk TB patients for the prevention and control of M/XDR-TB. PMID:25138531

Energy homeostasis genes and breast cancer risk: The influence of ancestry, body size, and menopausal status, the breast cancer health disparities study.

PubMed

Slattery, Martha L; Lundgreen, Abbie; Hines, Lisa; Wolff, Roger K; Torres-Mejia, Gabriella; Baumgartner, Kathy N; John, Esther M

2015-12-01

Obesity and breast cancer risk is multifaceted and genes associated with energy homeostasis may modify this relationship. We evaluated 10 genes that have been associated with obesity and energy homeostasis to determine their association with breast cancer risk in Hispanic/Native American (2111 cases, 2597 controls) and non-Hispanic white (1481 cases, 1585 controls) women. Cholecystokinin (CCK) rs747455 and proopiomelanocortin (POMC) rs6713532 and rs7565877 (for low Indigenous American (IA) ancestry); CCK rs8192472 and neuropeptide Y (NYP) rs16141 and rs14129 (intermediate IA ancestry); and leptin receptor (LEPR) rs11585329 (high IA ancestry) were strongly associated with multiple indicators of body size. There were no significant associations with breast cancer risk between genes and SNPs overall. However, LEPR was significantly associated with breast cancer risk among women with low IA ancestry (PARTP=0.024); POMC was significantly associated with breast cancer risk among women with intermediate (PARTP=0.015) and high (PARTP=0.012) IA ancestry. The overall pathway was statistically significant for pre-menopausal women with low IA ancestry (PARTP=0.05), as was cocaine and amphetamine regulated transcript protein (CARTPT) (PARTP=0.014) and ghrelin (GHRL) (PARTP=0.007). POMC was significantly associated with breast cancer risk among post-menopausal women with higher IA ancestry (PARTP=0.005). Three SNPs in LEPR (rs6704167, rs17412175, and rs7626141), and adiponectin (ADIPOQ); rs822391) showed significant 4-way interactions (GxExMenopausexAncestry) for multiple indicators of body size among pre-menopausal women. Energy homeostasis genes were associated with breast cancer risk; menopausal status, body size, and genetic ancestry influenced this relationship. Copyright © 2015 Elsevier Ltd. All rights reserved.

Energy homeostasis genes and breast cancer risk: The influence of ancestry, body size, and menopausal status, the breast cancer health disparities study

PubMed Central

Slattery, Martha L.; Lundgreen, Abbie; Hines, Lisa; Wolff, Roger K.; Torres-Mejia, Gabriella; Baumgartner, Kathy N.; John, Esther M.

2015-01-01

Background Obesity and breast cancer risk is multifaceted and genes associated with energy homeostasis may modify this relationship. Methods We evaluated 10 genes that have been associated with obesity and energy homeostasis to determine their association with breast cancer risk in Hispanic/Native American (2111 cases, 2597 controls) and non-Hispanic white (1481 cases, 1585 controls) women. Results Cholecystokinin (CCK) rs747455 and proopiomelanocortin (POMC) rs6713532 and rs7565877 (for low Indigenous American (IA) ancestry); CCK rs8192472 and neuropeptide Y (NYP) rs16141 and rs14129 (intermediate IA ancestry); and leptin receptor (LEPR) rs11585329 (high IA ancestry) were strongly associated with multiple indicators of body size. There were no significant associations with breast cancer risk between genes and SNPs overall. However, LEPR was significantly associated with breast cancer risk among women with low IA ancestry (PARTP = 0.024); POMC was significantly associated with breast cancer risk among women with intermediate (PARTP = 0.015) and high (PARTP = 0.012) IA ancestry. The overall pathway was statistically significant for pre-menopausal women with low IA ancestry (PARTP = 0.05), as was cocaine and amphetamine regulated transcript protein (CARTPT) (PARTP = 0.014) and ghrelin (GHRL) (PARTP = 0.007). POMC was significantly associated with breast cancer risk among post-menopausal women with higher IA ancestry (PARTP = 0.005). Three SNPs in LEPR (rs6704167, rs17412175, and rs7626141), and adiponectin (ADIPOQ); rs822391) showed significant 4-way interactions (GxExMenopausexAncestry) for multiple indicators of body size among pre-menopausal women. Conclusions Energy homeostasis genes were associated with breast cancer risk; menopausal status, body size, and genetic ancestry influenced this relationship. PMID:26395295

Gender and age-specific focus needed for cardiovascular outcome measures to improve life-time prevention in high risk women.

PubMed

Maas, Angela H E M; Leiner, Tim

2016-04-01

Cardiovascular diseases (CVD) have a large variety of clinical manifestations with multiple medical professionals involved. The focus of clinical endpoint trials has often been restricted to limited vascular territories, ignoring many other common manifestations of CVD. In addition, the lack of sex and gender- awareness among healthcare professionals has contributed to the underestimation of CVD risk in especially younger women. We plead for a more multidisciplinary and life-course approach to CVD risk assessment. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Development and Validation of a Video Measure for Assessing Women’s Risk Perception for Alcohol-Related Sexual Assault

PubMed Central

Parks, Kathleen A.; Levonyan-Radloff, Kristine; Dearing, Ronda L.; Hequembourg, Amy; Testa, Maria

2016-01-01

Objective Using an iterative process, a series of three video scenarios were developed for use as a standardized measure for assessing women’s perception of risks for alcohol-related sexual assault (SA). The videos included ambiguous and clear behavioral and environmental risk cues. Method Focus group discussions with young, female heavy drinkers (N = 42) were used to develop three videos at different risk levels (low, moderate, and high) in Study 1. Realism, reliability, and validity of the videos were assessed using multiple methods in Studies 2 and 3. One hundred-four women were used to compare differences in risk perception across the video risk level in Study 2. In Study 3 (N = 60), we assessed women’s perceptions of the low and high risk videos under conditions of no alcohol and alcohol. Results The realism and reliability of the videos were good. Women who viewed the low risk video compared to women who viewed the moderate and high risk videos perceived less risk for SA. We found an interaction between alcohol and risk perception such that, women in the alcohol condition were less likely to perceive risk when watching the high risk video. Conclusions As the video risk level increased, women’s perception of risk increased. These findings provide convergent evidence for the validity of the video measure. Given the limited number of standardized scenarios for assessing risk perception for sexual assault, our findings suggest that these videos may provide a needed standardized measure. PMID:27747131

Physical work demands and physical fitness in low social classes--30-year ischemic heart disease and all-cause mortality in the Copenhagen Male Study.

PubMed

Holtermann, Andreas; Mortensen, Ole Steen; Burr, Hermann; Søgaard, Karen; Gyntelberg, Finn; Suadicani, Poul

2011-11-01

Investigate whether high physical work demands increase risk of ischemic heart disease (IHD) mortality among men of low social class with low physical fitness. Thirty-year follow-up in the Copenhagen Male Study of 5249 men aged 40 to 59 years without cardiovascular disease. Physical fitness was estimated using the Åstrand cycling test, and physical work demands determined by two self-reported questions. Among 2707 low social class men, multiple-adjusted Cox proportional hazard ratios showed an almost threefold increased risk of IHD mortality among men with high physical work demands and low physical fitness, but not among men with a high physical fitness, referencing men with low physical work demands. These findings among low social class men support that high physical work demands increases the risk of IHD mortality among those with low physical fitness.

Systematic Review: The Effectiveness of Interventions to Reduce Falls and Improve Balance in Adults With Multiple Sclerosis.

PubMed

Gunn, Hilary; Markevics, Sophie; Haas, Bernhard; Marsden, Jonathan; Freeman, Jennifer

2015-10-01

To evaluate the effectiveness of interventions in reducing falls and/or improving balance as a falls risk in multiple sclerosis (MS). Computer-based and manual searches included the following medical subject heading keywords: "Multiple Sclerosis AND accidental falls" OR "Multiple Sclerosis AND postural balance" OR "Multiple Sclerosis AND exercise" OR "Multiple Sclerosis AND physical/physio therapy" NOT animals. All literature published to November 2014 with available full-text details were included. Studies were reviewed against the PICO (participants, interventions, comparisons, outcomes) selection criteria: P, adults with MS; I, falls management/balance rehabilitation interventions; C, randomized/quasi-randomized studies comparing intervention with usual care or placebo control; O, falls outcomes and measures of balance. Fifteen articles of the original 529 search results were included. Two reviewers independently extracted data and assessed methodological quality using the Cochrane Risk of Bias tool. Random-effects meta-analysis indicated a small decrease in falls risk (risk ratio, .74), although the 95% confidence interval (CI) crossed 1 (95% CI, .12-4.38). The pooled standardized mean difference (SMD) for balance outcomes was .55 (95% CI, .35-.74). SMD varied significantly between exercise subgroupings; gait, balance, and functional training interventions yielded the greatest pooled effect size (ES) (SMD=.82; 95% CI, 0.55-1.10). There was a moderate positive correlation between program volume (min/wk) and ES (Cohen's d) (r=.70, P=.009), and a moderate negative correlation between program duration in weeks and ES (r=-.62, P=.03). Variations in interventions and outcomes and methodological limitations mean that results must be viewed with caution. This review suggests that balance may improve through exercise interventions, but that the magnitude of the improvements achieved in existing programs may not be sufficient to impact falls outcomes. Supporting participants to achieve an appropriate intensity of practice of highly challenging balance activities appears to be critical to maximizing effectiveness. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Iron deficiency and anemia are prevalent in women with multiple gestations.

PubMed

Ru, Yuan; Pressman, Eva K; Cooper, Elizabeth M; Guillet, Ronnie; Katzman, Philip J; Kent, Tera R; Bacak, Stephen J; O'Brien, Kimberly O

2016-10-01

Little attention has been placed on the unique iron demands that may exist in women with multiple gestations. This merits attention because iron deficiency (ID) during pregnancy is associated with adverse pregnancy outcomes that are known to be more prevalent in multiple births. We characterized longitudinal changes in iron status across pregnancy in a cohort of healthy women with multiple gestations and identified determinants of maternal ID and anemia. A group of 83 women carrying twins, triplets, or quadruplets (aged 20-46 y) was recruited from 2011 to 2014. Blood samples obtained during pregnancy (∼24 wk; n = 73) and at delivery (∼35 wk; n = 61) were used to assess hemoglobin, serum ferritin (SF), soluble transferrin receptor (sTfR), hepcidin, serum iron, erythropoietin, serum folate, vitamin B-12, C-reactive protein, and interleukin-6. The prevalence of tissue ID (sTfR >8.5 mg/L) increased significantly from pregnancy to delivery (9.6% compared with 23%, P = 0.03). Women with depleted iron stores (SF <12 μg/L, n = 20) during pregnancy had a 2-fold greater risk of anemia at delivery, and 25% (n = 5) developed iron deficiency anemia (IDA). Overall, 44.6% of women studied (n = 37/83) were anemic at delivery, and 18% of women (n = 11/61) had IDA. Erythropoietin during pregnancy was significantly negatively associated with hemoglobin at delivery. Women with erythropoietin >75th percentile during pregnancy exhibited a 3-fold greater risk of anemia, suggesting that erythropoietin is a sensitive predictor of anemia at delivery. Inflammation was present at delivery, which limited the utility of ferritin or hepcidin as iron-status indicators at delivery. ID and anemia are highly prevalent in women with multiple gestations. Additional screening and iron supplementation may be warranted in this high-risk population given the known associations between ID anemia and adverse maternal and neonatal outcomes. This trial was registered at clinicaltrials.gov as NCT01582802. © 2016 American Society for Nutrition.

Community males show multiple-perpetrator rape proclivity: development and preliminary validation of an interest scale.

PubMed

Alleyne, Emma; Gannon, Theresa A; Ó Ciardha, Caoilte; Wood, Jane L

2014-02-01

The literature on Multiple Perpetrator Rape (MPR) is scant; however, a significant proportion of sexual offending involves multiple perpetrators. In addition to the need for research with apprehended offenders of MPR, there is also a need to conduct research with members of the general public. Recent advances in the forensic literature have led to the development of self-report proclivity scales. These scales have enabled researchers to conduct evaluative studies sampling from members of the general public who may be perpetrators of sexual offenses and have remained undetected, or at highest risk of engaging in sexual offending. The current study describes the development and preliminary validation of the Multiple-Perpetrator Rape Interest Scale (M-PRIS), a vignette-based measure assessing community males' sexual arousal to MPR, behavioral propensity toward MPR and enjoyment of MPR. The findings show that the M-PRIS is a reliable measure of community males' sexual interest in MPR with high internal reliability and temporal stability. In a sample of university males we found that a large proportion (66%) did not emphatically reject an interest in MPR. We also found that rape-supportive cognitive distortions, antisocial attitudes, and high-risk sexual fantasies were predictors of sexual interest in MPR. We discuss these findings and the implications for further research employing proclivity measures referencing theory development and clinical practice.

Left thoracotomy HeartWare implantation with outflow graft anastomosis to the descending aorta: a simplified bridge for patients with multiple previous sternotomies.

PubMed

Umakanthan, Ramanan; Haglund, Nicholas A; Stulak, John M; Joyce, Lyle D; Ahmad, Rashid; Keebler, Mary E; Maltais, Simon

2013-01-01

Advances in mechanical circulatory support have been critical in bridging patients awaiting heart transplantation. In addition, improvement in device durability has enabled left ventricular assist device therapy to be applied as destination therapy in those not felt to be transplant candidate. Because of the increasing complexity of patients, there continues to be a need for alternative strategies for device implantation to bridge high-risk patients awaiting heart transplantation, wherein the risks of numerous previous sternotomies may be prohibitive. We present a unique technique for placement of the HeartWare ventricular assist device via left anterior thoracotomy to the descending aorta in a patient awaiting heart transplantation with a history of multiple previous sternotomies.

[Constitutional mismatch repair deficiency syndrome].

PubMed

Jongmans, Marjolijn C; Gidding, Corrie E; Loeffen, Jan; Wesseling, Pieter; Mensenkamp, Arjen; Hoogerbrugge, Nicoline

2015-01-01

Constitutional mismatch repair deficiency (CMMR-D) syndrome is characterised by a significantly increased risk for developing cancer in childhood. It arises when both parents have a mutation in the same mismatch repair gene and pass it on to their child. An 8-year-old girl was diagnosed with CMMR-D syndrome after she developed a brain tumour at the age of 4 and a T-cell non-Hodgkin lymphoma at the age of 6. She had multiple hyperpigmented skin lesions and died of myelodysplastic syndrome at the age of 11. In children with cancer CMMR-D syndrome can be recognized particularly if there are multiple primary malignancies and skin hyperpigmentations and hypopigmentations. The parents of these children are at high risk for colorectal and endometrial cancer (Lynch syndrome), amongst others.

Multiple Intravenous Infusions Phase 1b

PubMed Central

Cassano-Piché, A; Fan, M; Sabovitch, S; Masino, C; Easty, AC

2012-01-01

Background Minimal research has been conducted into the potential patient safety issues related to administering multiple intravenous (IV) infusions to a single patient. Previous research has highlighted that there are a number of related safety risks. In Phase 1a of this study, an analysis of 2 national incident-reporting databases (Institute for Safe Medical Practices Canada and United States Food and Drug Administration MAUDE) found that a high percentage of incidents associated with the administration of multiple IV infusions resulted in patient harm. Objectives The primary objectives of Phase 1b of this study were to identify safety issues with the potential to cause patient harm stemming from the administration of multiple IV infusions; and to identify how nurses are being educated on key principles required to safely administer multiple IV infusions. Data Sources and Review Methods A field study was conducted at 12 hospital clinical units (sites) across Ontario, and telephone interviews were conducted with program coordinators or instructors from both the Ontario baccalaureate nursing degree programs and the Ontario postgraduate Critical Care Nursing Certificate programs. Data were analyzed using Rasmussen’s 1997 Risk Management Framework and a Health Care Failure Modes and Effects Analysis. Results Twenty-two primary patient safety issues were identified with the potential to directly cause patient harm. Seventeen of these (critical issues) were categorized into 6 themes. A cause-consequence tree was established to outline all possible contributing factors for each critical issue. Clinical recommendations were identified for immediate distribution to, and implementation by, Ontario hospitals. Future investigation efforts were planned for Phase 2 of the study. Limitations This exploratory field study identifies the potential for errors, but does not describe the direct observation of such errors, except in a few cases where errors were observed. Not all issues are known in advance, and the frequency of errors is too low to be observed in the time allotted and with the limited sample of observations. Conclusions The administration of multiple IV infusions to a single patient is a complex task with many potential associated patient safety risks. Improvements to infusion and infusion-related technology, education standards, clinical best practice guidelines, hospital policies, and unit work practices are required to reduce the risk potential. This report makes several recommendations to Ontario hospitals so that they can develop an awareness of the issues highlighted in this report and minimize some of the risks. Further investigation of mitigating strategies is required and will be undertaken in Phase 2 of this research. Plain Language Summary Patients, particularly in critical care environments, often require multiple intravenous (IV) medications via large volumetric or syringe infusion pumps. The infusion of multiple IV medications is not without risk; unintended errors during these complex procedures have resulted in patient harm. However, the range of associated risks and the factors contributing to these risks are not well understood. Health Quality Ontario’s Ontario Health Technology Advisory Committee commissioned the Health Technology Safety Research Team at the University Health Network to conduct a multi-phase study to identify and mitigate the risks associated with multiple IV infusions. Some of the questions addressed by the team were as follows: What is needed to reduce the risk of errors for individuals who are receiving a lot of medications? What strategies work best? The initial report, Multiple Intravenous Infusions Phase 1a: Situation Scan Summary Report, summarizes the interim findings based on a literature review, an incident database review, and a technology scan. The Health Technology Safety Research Team worked in close collaboration with the Institute for Safe Medication Practices Canada on an exploratory study to understand the risks associated with multiple IV infusions and the degree to which nurses are educated to help mitigate them. The current report, Multiple Intravenous Infusions Phase 1b: Practice and Training Scan, presents the findings of a field study of 12 hospital clinical units across Ontario, as well as 13 interviews with educators from baccalaureate-level nursing degree programs and postgraduate Critical Care Nursing Certificate programs. It makes 9 recommendations that emphasize best practices for the administration of multiple IV infusions and pertain to secondary infusions, line identification, line set-up and removal, and administering IV bolus medications. The Health Technology Safety Research Team has also produced an associated report for hospitals entitled Mitigating the Risks Associated With Multiple IV Infusions: Recommendations Based on a Field Study of Twelve Ontario Hospitals, which highlights the 9 interim recommendations and provides a brief rationale for each one. PMID:23074426

Adolescents with high periodontal risk in Public Dental Service.

PubMed

Jansson, Leif; Adler, Lottie; Jonés, Catarina

2013-01-01

The purpose of the present study was to investigate the prevalence of adolescents with high periodontal risk and to identify factors with influence on the decision to refer a patient to a specialist clinic of Periodontology, on compliance rate and on treatment outcome. The investigation was conducted as a retrospective study on adolescents at age 13-17. In total, clinical examinations and risk evaluations according to caries- and periodontal risk were performed on 50347 adolescents in general dentistry at ages 13, 15 and 17 in 2007. Individuals with a high periodontal risk were included in the present investigation. A high periodontal risk was defined as presence of sites with periodontal pocket depths >6mm and loss of periodontal tissue support. Multiple logistic regression analyses were adopted to calculate the influence of the potential predictors on the investigated dependent variables. In total, 0.5% of the adolescents were found to have high periodontal risk. The diagnosis local periodontitis and the number of periodontal pockets with probing depths >6 mm were positively and significantly correlated to referral to a periodontist. Eighteen percent dropped out before the treatment was completed. Smokers had a significantly lower compliance than non-smokers. The success rate was significantly lower for individuals with many periodontal pockets and for those with the diagnosis local periodontitis. The prevalence of adolescents classified as having high periodontal risk was low. A large frequency of subjects dropped out before the periodontal treatment was completed, especially at the specialist clinics.

Framingham risk score for estimation of 10-years of cardiovascular diseases risk in patients with metabolic syndrome.

PubMed

Jahangiry, Leila; Farhangi, Mahdieh Abbasalizad; Rezaei, Fatemeh

2017-11-13

There are a few studies evaluating the predictive value of Framingham risk score (FRS) for cardiovascular disease (CVD) risk assessment in patients with metabolic syndrome in Iran. Because of the emerging high prevalence of CVD among Iranian population, it is important to predict its risk among populations with potential predictive tools. Therefore, the aim of the current study is to evaluate the FRS and its determinants in patients with metabolic syndrome. In the current cross-sectional study, 160 patients with metabolic syndrome diagnosed according to the National Cholesterol Education Adult Treatment Panel (ATP) III criteria were enrolled. The FRS was calculated using a computer program by a previously suggested algorithm. Totally, 77.5, 16.3, and 6.3% of patients with metabolic syndrome were at low, intermediate, and high risk of CVD according to FRS categorization. The highest prevalence of all of metabolic syndrome components were in low CVD risk according to the FRS grouping (P < 0.05), while the lowest prevalence of these components was in high CVD risk group (P < 0.05). According to multiple logistic regression analysis, high systolic blood pressure (SBP) and fasting serum glucose (FSG) were potent determinants of intermediate and high risk CVD risk of FRS scoring compared with low risk group (P < 0.05). In the current study, significant associations between components of metabolic syndrome and different FRS categorization among patients with metabolic syndrome were identified. High SBP and FSG were associated with meaningfully increased risk of CVD compared with other parameters. The study is not a trial; the registration number is not applicable.

Multimethod prediction of child abuse risk in an at-risk sample of male intimate partner violence offenders.

PubMed

Rodriguez, Christina M; Gracia, Enrique; Lila, Marisol

2016-10-01

The vast majority of research on child abuse potential has concentrated on women demonstrating varying levels of risk of perpetrating physical child abuse. In contrast, the current study considered factors predictive of physical child abuse potential in a group of 70 male intimate partner violence offenders, a group that would represent a likely high risk group. Elements of Social Information Processing theory were evaluated, including pre-existing schemas of empathy, anger, and attitudes approving of parent-child aggression considered as potential moderators of negative attributions of child behavior. To lend methodological rigor, the study also utilized multiple measures and multiple methods, including analog tasks, to predict child abuse risk. Contrary to expectations, findings did not support the role of anger independently predicting child abuse risk in this sample of men. However, preexisting beliefs approving of parent-child aggression, lower empathy, and more negative child behavior attributions independently predicted abuse potential; in addition, greater anger, poorer empathy, and more favorable attitudes toward parent-child aggression also exacerbated men's negative child attributions to further elevate their child abuse risk. Future work is encouraged to consider how factors commonly considered in women parallel or diverge from those observed to elevate child abuse risk in men of varying levels of risk. Copyright © 2016 Elsevier Ltd. All rights reserved.

[Burnout syndrome and suicide risk among primary care nurses].

PubMed

Tomás-Sábado, Joaquín; Maynegre-Santaulària, Montserrat; Pérez-Bartolomé, Meritxell; Alsina-Rodríguez, Marta; Quinta-Barbero, Roser; Granell-Navas, Sergi

2010-01-01

To observe the prevalence of the burnout syndrome and the relationship with suicide risk, self-esteem, anxiety and depression, in a sample of primary care nurses. Observational, cross-sectional and correlational study. The sample consisted of 146 nursing professionals, 131 women and 15 men, with an average age of 44.02 years (SD=10.89). Participants responded to a questionnaire which included the Spanish forms of the Maslach burnout inventory (MBI), the Plutchik Suicide Risk Scale (SR), the Kuwait University Anxiety Scale (KUAS), the Self-Rating Depression Scale (SDS) and the Rosenberg Self-esteem Scale (RSES). In the inferential statistical analysis, Pearson's r coefficients and multiple linear regression were calculated. Significant correlations between suicidal risk and anxiety, depression, self-esteem, emotional exhaustion and personal performance, were obtained. In the multiple regression analysis, depression was the main predictor of suicidal risk, followed by anxiety and emotional exhaustion. The scores obtained in burnout and suicidal risk were, in general, lower than those observed in other studies, emphasising the high level observed in personal performance, which reflects reasonable professional satisfaction. The results show the important role of working atmosphere and early recognition of mental disorders in burnout and suicidal risk prevention. Copyright (c) 2009 Elsevier España, S.L. All rights reserved.

Neonatal systemic inflammation and the risk of low scores on measures of reading and mathematics achievement at age 10 years among children born extremely preterm.

PubMed

Leviton, Alan; Dammann, Olaf; Allred, Elizabeth N; Joseph, Robert M; Fichorova, Raina N; O'Shea, T Michael; Kuban, Karl C K

2018-05-01

Difficulties with reading and math occur more commonly among children born extremely preterm than among children born at term. Reasons for this are unclear. We measured the concentrations of 27 inflammatory-related and neurotrophic/angiogenic proteins (angio-neurotrophic proteins) in multiple blood specimens collected a week apart during the first postnatal month from 660 children born before the 28th week of gestation who at age 10 years had an IQ ≥ 70 and a Wechsler Individual Achievement Test 3rd edition (WIAT-III) assessment. We identified four groups of children, those who had a Z-score ≤ -1 on the Word Reading assessment only, on the Numerical Operations assessment only, on both of these assessments, and on neither, which served as the referent group. We then modeled the risk of each learning limitation associated with a top quartile concentration of each protein, and with high and lower concentrations of multiple proteins. The protein profile of low reading scores was confined to the third and fourth postnatal weeks when increased risks were associated with high concentrations of IL-8 and ICAM-1 in the presence of low concentrations of angio-neurotrophic proteins. The profile of low math scores was very similar, except it did not include ICAM-1. In contrast, the profile of low scores on both assessments was present in each of the first four postnatal weeks. The increased risks associated with high concentrations of TNF-α in the first two weeks and of IL-8 and ICAM-1 in the next two weeks were modulated down by high concentrations of angio-neurotrophic proteins. High concentrations of angio-neurotrophic proteins appear to reduce/moderate the risk of each learning limitation associated with systemic inflammation. The three categories of limitations have protein profiles with some similarities, and yet some differences, too. Copyright © 2018 ISDN. Published by Elsevier Ltd. All rights reserved.

Genetic polymorphisms of alcohol dehydrogense-1B and aldehyde dehydrogenase-2, alcohol flushing, mean corpuscular volume, and aerodigestive tract neoplasia in Japanese drinkers.

PubMed

Yokoyama, Akira; Mizukami, Takeshi; Yokoyama, Tetsuji

2015-01-01

Genetic polymorphisms of alcohol dehydrogenase-1B (ADH1B) and aldehyde dehydrogenase-2 (ALDH2) modulate exposure levels to ethanol/acetaldehyde. Endoscopic screening of 6,014 Japanese alcoholics yielded high detection rates of esophageal squamous cell carcinoma (SCC; 4.1%) and head and neck SCC (1.0%). The risks of upper aerodigestive tract SCC/dysplasia, especially of multiple SCC/dysplasia, were increased in a multiplicative fashion by the presence of a combination of slow-metabolizing ADH1B*1/*1 and inactive heterozygous ALDH2*1/*2 because of prolonged exposure to higher concentrations of ethanol/acetaldehyde. A questionnaire asking about current and past facial flushing after drinking a glass (≈180 mL) of beer is a reliable tool for detecting the presence of inactive ALDH2. We invented a health-risk appraisal (HRA) model including the flushing questionnaire and drinking, smoking, and dietary habits. Esophageal SCC was detected at a high rate by endoscopic mass-screening in high HRA score persons. A total of 5.0% of 4,879 alcoholics had a history of (4.0%) or newly diagnosed (1.0%) gastric cancer. Their high frequency of a history of gastric cancer is partly explained by gastrectomy being a risk factor for alcoholism because of altered ethanol metabolism, e.g., by blood ethanol level overshooting. The combination of H. pylori-associated atrophic gastritis and ALDH2*1/*2 showed the greatest risk of gastric cancer in alcoholics. High detection rates of advanced colorectal adenoma/carcinoma were found in alcoholics, 15.7% of 744 immunochemical fecal occult blood test (IFOBT)-negative alcoholics and 31.5% of the 393 IFOBT-positive alcoholics. Macrocytosis with an MCV≥106 fl increased the risk of neoplasia in the entire aerodigestive tract of alcoholics, suggesting that poor nutrition as well as ethanol/acetaldehyde exposure plays an important role in neoplasia.

Ultra high risk of psychosis on committal to a young offender prison: an unrecognised opportunity for early intervention

PubMed Central

2012-01-01

Background The ultra high risk state for psychosis has not been studied in young offender populations. Prison populations have higher rates of psychiatric morbidity and substance use disorders. Due to the age profile of young offenders one would expect to find a high prevalence of individuals with pre-psychotic or ultra-high risk mental states for psychosis (UHR). Accordingly young offender institutions offer an opportunity for early interventions which could result in improved long term mental health, social and legal outcomes. In the course of establishing a mental health in-reach service into Ireland’s only young offender prison, we sought to estimate unmet mental health needs. Methods Every third new committal to a young offenders prison was interviewed using the Comprehensive Assessment of At-Risk Mental States (CAARMS) to identify the Ultra High Risk (UHR) state and a structured interview for assessing drug and alcohol misuse according to DSM-IV-TR criteria, the Developmental Understanding of Drug Misuse and Dependence - Short Form (DUNDRUM-S). Results Over a twelve month period 171 young male offenders aged 16 to 20 were assessed. Of these 39 (23%, 95% confidence interval 18% to 30%) met UHR criteria. UHR states peaked at 18 years, were associated with lower SOFAS scores for social and occupational function and were also associated with multiple substance misuse. The relationship with lower SOFAS scores persisted even when co-varying for multiple substance misuse. Conclusions Although psychotic symptoms are common in community samples of children and adolescents, the prevalence of the UHR state in young offenders was higher than reported for community samples. The association with impaired function also suggests that this may be part of a developing disorder. Much more attention should be paid to the relationship of UHR states to substance misuse and to the health needs of young offenders. PMID:22863073

Pediatric Multiple Sclerosis: Genes, Environment, and a Comprehensive Therapeutic Approach.

PubMed

Cappa, Ryan; Theroux, Liana; Brenton, J Nicholas

2017-10-01

Pediatric multiple sclerosis is an increasingly recognized and studied disorder that accounts for 3% to 10% of all patients with multiple sclerosis. The risk for pediatric multiple sclerosis is thought to reflect a complex interplay between environmental and genetic risk factors. Environmental exposures, including sunlight (ultraviolet radiation, vitamin D levels), infections (Epstein-Barr virus), passive smoking, and obesity, have been identified as potential risk factors in youth. Genetic predisposition contributes to the risk of multiple sclerosis, and the major histocompatibility complex on chromosome 6 makes the single largest contribution to susceptibility to multiple sclerosis. With the use of large-scale genome-wide association studies, other non-major histocompatibility complex alleles have been identified as independent risk factors for the disease. The bridge between environment and genes likely lies in the study of epigenetic processes, which are environmentally-influenced mechanisms through which gene expression may be modified. This article will review these topics to provide a framework for discussion of a comprehensive approach to counseling and ultimately treating the pediatric patient with multiple sclerosis. Copyright © 2017 Elsevier Inc. All rights reserved.

Male condom use, multiple sexual partners and HIV: a prospective case-control study in Kinshasa (DRC).

PubMed

Carlos, Silvia; Lopez-Del Burgo, Cristina; Burgueño, Eduardo; Martinez-Gonzalez, Miguel Angel; Osorio, Alfonso; Ndarabu, Adolphe; Passabosc, Clément; de Irala, Jokin

2017-06-01

In the Democratic Republic of Congo no previous studies have assessed the factors associated with different patterns of condom use and with multiple sexual partners, and the association between condom use simultaneously taking into account multiple sexual partnerships, and HIV infection. We carried out a prospective case-control study. From December 2010 until June 2012, 1630 participants aged 15-49 getting HIV Voluntary Counseling and Testing in a hospital in Kinshasa were selected. Cases were new HIV diagnosis and controls were HIV-negative participants detected along the study period. We recruited 274 cases and 1340 controls that were interviewed about HIV-related knowledge, attitudes and behaviours. Among cases there was a high prevalence of multiple lifetime and concurrent sexual partnerships (89.8% and 20.4%, respectively) and most cases never used condoms with only 1.5% using them consistently. Condom use and multiple partnerships were associated with male, single and high-educated participants. An association was found between multiple lifetime partners and 'any condom use' (OR = 2.99; 95%CI: 2.14-4.19) but not with consistent use. Both having two or more multiple concurrent sexual partners or not using condoms were variables similarly and highly associated to HIV risk. The association found between having two or more concurrent sexual partners and HIV was slightly higher (OR = 3.58, 95%CI:2.31-5.56) than the association found between never condom use and HIV (OR = 3.38, 95%CI:1.15-9.93). We found a high prevalence of multiple lifetime sexual partners and an extremely high prevalence of inconsistent condom use, both strongly associated with HIV seropositivity. Local programmes would benefit from comprehensive interventions targeting all behavioural and sociocultural determinants.

The Stimulating Nature of Gambling Behaviors: Relationships Between Stimulant Use and Gambling Among Adolescents.

PubMed

Richard, Jérémie; Potenza, Marc N; Ivoska, William; Derevensky, Jeffrey

2018-06-02

Adolescence represents a significant developmental period during which experimentation with high-risk behaviors including substance use and gambling often occurs. These high-risk behaviors have been associated with multiple negative measures of social, academic and psychological functioning. Although associations have been established between alcohol use, marijuana use, mental health problems, and problem gambling in youth, research investigating possible associations between stimulant drug use and gambling is scarce. Questionnaire responses were collected from 6542 high-school students aged 12-19 years. Relationships between types and patterns of gambling with stimulant drugs [including cocaine, methamphetamine, non-medical use of stimulants, and 3,4-methylenedioxymethamphetamine (MDMA)] were examined. Chi square analyses with odds ratio calculations revealed the use of any stimulant was associated with an increased odds of gambling frequency and problem gambling among both males and females. Self-reported use of crack cocaine was associated with a higher risk of frequent gambling and use of methamphetamines was associated with a higher risk of at-risk/problem gambling. Individuals using stimulants six or more times in the past year had high likelihoods of frequent and at-risk/problem gambling behaviors. The results contribute to our understanding of stimulant drug use and its associations with gambling behaviors among high-school youth.

Modest familial risks for multiple sclerosis: a registry-based study of the population of Sweden

PubMed Central

Westerlind, Helga; Ramanujam, Ryan; Uvehag, Daniel; Kuja-Halkola, Ralf; Boman, Marcus; Bottai, Matteo; Lichtenstein, Paul

2014-01-01

Data on familial recurrence rates of complex diseases such as multiple sclerosis give important hints to aetiological factors such as the importance of genes and environment. By linking national registries, we sought to avoid common limitations of clinic-based studies such as low numbers, poor representation of the population and selection bias. Through the Swedish Multiple Sclerosis Registry and a nationwide hospital registry, a total of 28 396 patients with multiple sclerosis were identified. We used the national Multi-Generation Registry to identify first and second degree relatives as well as cousins, and the Swedish Twin Registry to identify twins of patients with multiple sclerosis. Crude and age corrected familial risks were estimated for cases and found to be in the same range as previously published figures. Matched population-based controls were used to calculate relative risks, revealing lower estimates of familial multiple sclerosis risks than previously reported, with a sibling recurrence risk (λs = 7.1; 95% confidence interval: 6.42–7.86). Surprisingly, despite a well-established lower prevalence of multiple sclerosis amongst males, the relative risks were equal among maternal and paternal relations. A previously reported increased risk in maternal relations could thus not be replicated. An observed higher transmission rate from fathers to sons compared with mothers to sons suggested a higher transmission to offspring from the less prevalent sex; therefore, presence of the so-called ‘Carter effect’ could not be excluded. We estimated the heritability of multiple sclerosis using 74 757 twin pairs with known zygosity, of which 315 were affected with multiple sclerosis, and added information from 2.5 million sibling pairs to increase power. The heritability was estimated to be 0.64 (0.36–0.76), whereas the shared environmental component was estimated to be 0.01 (0.00–0.18). In summary, whereas multiple sclerosis is to a great extent an inherited trait, the familial relative risks may be lower than usually reported. PMID:24441172

The Challenges of Measuring Glycemic Variability

PubMed Central

Rodbard, David

2012-01-01

This commentary reviews several of the challenges encountered when attempting to quantify glycemic variability and correlate it with risk of diabetes complications. These challenges include (1) immaturity of the field, including problems of data accuracy, precision, reliability, cost, and availability; (2) larger relative error in the estimates of glycemic variability than in the estimates of the mean glucose; (3) high correlation between glycemic variability and mean glucose level; (4) multiplicity of measures; (5) correlation of the multiple measures; (6) duplication or reinvention of methods; (7) confusion of measures of glycemic variability with measures of quality of glycemic control; (8) the problem of multiple comparisons when assessing relationships among multiple measures of variability and multiple clinical end points; and (9) differing needs for routine clinical practice and clinical research applications. PMID:22768904

Environmental health risk assessment and management for global climate change

NASA Astrophysics Data System (ADS)

Carter, P.

2014-12-01

This environmental health risk assessment and management approach for atmospheric greenhouse gas (GHG) pollution is based almost entirely on IPCC AR5 (2014) content, but the IPCC does not make recommendations. Large climate model uncertainties may be large environmental health risks. In accordance with environmental health risk management, we use the standard (IPCC-endorsed) formula of risk as the product of magnitude times probability, with an extremely high standard of precaution. Atmospheric GHG pollution, causing global warming, climate change and ocean acidification, is increasing as fast as ever. Time is of the essence to inform and make recommendations to governments and the public. While the 2ºC target is the only formally agreed-upon policy limit, for the most vulnerable nations, a 1.5ºC limit is being considered by the UNFCCC Secretariat. The Climate Action Network International (2014), representing civil society, recommends that the 1.5ºC limit be kept open and that emissions decline from 2015. James Hansen et al (2013) have argued that 1ºC is the danger limit. Taking into account committed global warming, its millennial duration, multiple large sources of amplifying climate feedbacks and multiple adverse impacts of global warming and climate change on crops, and population health impacts, all the IPCC AR5 scenarios carry extreme environmental health risks to large human populations and to the future of humanity as a whole. Our risk consideration finds that 2ºC carries high risks of many catastrophic impacts, that 1.5ºC carries high risks of many disastrous impacts, and that 1ºC is the danger limit. IPCC AR4 (2007) showed that emissions must be reversed by 2015 for a 2ºC warming limit. For the IPCC AR5 only the best-case scenario RCP2.6, is projected to stay under 2ºC by 2100 but the upper range is just above 2ºC. It calls for emissions to decline by 2020. We recommend that for catastrophic environmental health risk aversion, emissions decline from 2015 (CAN International 2014), and if policy makers are limited to the IPCC AR5 we recommend RCP2.6, with emissions declining by 2020.

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

PubMed Central

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

2016-01-01

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

HPV Vaccine Effective at Multiple Anatomic Sites

Cancer.gov

A new study from NCI researchers finds that the HPV vaccine protects young women from infection with high-risk HPV types at the three primary anatomic sites where persistent HPV infections can cause cancer. The multi-site protection also was observed at l

MULTIPLE STRESSOR RISKS TO COMMON LOON AND OTHER PISCIVOROUS BIRD POPULATIONS

EPA Science Inventory

Mercury contamination remains a high priority issue for several EPA Program Offices andRegions because of widespread atmospheric deposition and concerns of accumulation through aquatic food webs. Although there is evidence of reduced productivity in some piscivorous birds and wid...

Temporal assessment of radiomic features on clinical mammography in a high-risk population

NASA Astrophysics Data System (ADS)

Mendel, Kayla R.; Li, Hui; Lan, Li; Chan, Chun-Wai; King, Lauren M.; Tayob, Nabihah; Whitman, Gary; El-Zein, Randa; Bedrosian, Isabelle; Giger, Maryellen L.

2018-02-01

Extraction of high-dimensional quantitative data from medical images has become necessary in disease risk assessment, diagnostics and prognostics. Radiomic workflows for mammography typically involve a single medical image for each patient although medical images may exist for multiple imaging exams, especially in screening protocols. Our study takes advantage of the availability of mammograms acquired over multiple years for the prediction of cancer onset. This study included 841 images from 328 patients who developed subsequent mammographic abnormalities, which were confirmed as either cancer (n=173) or non-cancer (n=155) through diagnostic core needle biopsy. Quantitative radiomic analysis was conducted on antecedent FFDMs acquired a year or more prior to diagnostic biopsy. Analysis was limited to the breast contralateral to that in which the abnormality arose. Novel metrics were used to identify robust radiomic features. The most robust features were evaluated in the task of predicting future malignancies on a subset of 72 subjects (23 cancer cases and 49 non-cancer controls) with mammograms over multiple years. Using linear discriminant analysis, the robust radiomic features were merged into predictive signatures by: (i) using features from only the most recent contralateral mammogram, (ii) change in feature values between mammograms, and (iii) ratio of feature values over time, yielding AUCs of 0.57 (SE=0.07), 0.63 (SE=0.06), and 0.66 (SE=0.06), respectively. The AUCs for temporal radiomics (ratio) statistically differed from chance, suggesting that changes in radiomics over time may be critical for risk assessment. Overall, we found that our two-stage process of robustness assessment followed by performance evaluation served well in our investigation on the role of temporal radiomics in risk assessment.

Whose Disease Will Recur After Mastectomy for Early Stage, Node-Negative Breast Cancer? A Systematic Review.

PubMed

Kent, Collin; Horton, Janet; Blitzblau, Rachel; Koontz, Bridget F

2015-12-01

Effective local control is associated with improved overall survival, particularly for women with early-stage cancers. No other local therapy is typically offered to women with T1-2 N0 breast cancer after mastectomy, although in select women the 5-year local recurrence rate can be as high as 20%. Therefore, accurately predicting the women who are at highest risk for recurrence after mastectomy will identify those who might benefit from more aggressive adjuvant treatment. A systematic search was conducted identifying risk factors associated with locoregional recurrence, including age, menopausal status, receptor status, lymphovascular invasion (LVI), margin status, use of systemic therapy, size, grade, and genomic classifer score. Although associations varied among studies, the risk factors most consistently identified were age ≤ 40 years, LVI, positive/close margin, and larger tumor size. In women with multiple high risk factors, risk of local recurrence was as high as 20% at 10 years. Additional multicenter studies are needed to investigate risk factors for locoregional recurrence after mastectomy without radiotherapy in T1-2N0 breast cancer. Consideration of additional adjuvant local therapy might be warranted in a subset of women at high risk of local recurrence. Copyright © 2015 Elsevier Inc. All rights reserved.

Changes in the distribution of high-risk births associated with changes in contraceptive prevalence.

PubMed

Stover, John; Ross, John

2013-01-01

Several birth characteristics are associated with high mortality risk: very young or old mothers, short birth intervals and high birth order. One justification for family planning programs is the health benefits associated with better spacing and timing of births. This study examines the extent to which the prevalence of these risk factors changes as a country transitions from high to low fertility. We use data from 194 national surveys to examine both cross section and within-country variation in these risk factors as they relate to the total fertility rate. Declines in the total fertility rate are associated with large declines in the proportion of high order births, those to mothers over the age of 34 and those with multiple risk factors; as well as to increasing proportions of first order births. There is little change in the proportion of births with short birth intervals except in sub-Saharan Africa. The use of family planning is strongly associated with fertility declines. The proportion of second and higher order births with demographic risk factors declines substantially as fertility declines. This creates a potential for reducing child mortality rates. Some of the reduction comes from modifying the birth interval distribution or by bringing maternal age at the time of birth into the 'safe' range of 18-35 years, and some comes from the actual elimination of births that would have a high mortality risk (high parity births).

School Health Guidelines to Promote Healthy Eating and Physical Activity. Morbidity and Mortality Weekly Report. Recommendations and Reports. Volume 60, Number 5

ERIC Educational Resources Information Center

Rutledge, Teresa F., Ed.

2011-01-01

During the last 3 decades, the prevalence of obesity has tripled among persons aged 6-19 years. Multiple chronic disease risk factors, such as high blood pressure, high cholesterol levels, and high blood glucose levels are related to obesity. Schools have a responsibility to help prevent obesity and promote physical activity and healthy eating…

Developmental dyslexia: predicting individual risk.

PubMed

Thompson, Paul A; Hulme, Charles; Nash, Hannah M; Gooch, Debbie; Hayiou-Thomas, Emma; Snowling, Margaret J

2015-09-01

Causal theories of dyslexia suggest that it is a heritable disorder, which is the outcome of multiple risk factors. However, whether early screening for dyslexia is viable is not yet known. The study followed children at high risk of dyslexia from preschool through the early primary years assessing them from age 3 years and 6 months (T1) at approximately annual intervals on tasks tapping cognitive, language, and executive-motor skills. The children were recruited to three groups: children at family risk of dyslexia, children with concerns regarding speech, and language development at 3;06 years and controls considered to be typically developing. At 8 years, children were classified as 'dyslexic' or not. Logistic regression models were used to predict the individual risk of dyslexia and to investigate how risk factors accumulate to predict poor literacy outcomes. Family-risk status was a stronger predictor of dyslexia at 8 years than low language in preschool. Additional predictors in the preschool years include letter knowledge, phonological awareness, rapid automatized naming, and executive skills. At the time of school entry, language skills become significant predictors, and motor skills add a small but significant increase to the prediction probability. We present classification accuracy using different probability cutoffs for logistic regression models and ROC curves to highlight the accumulation of risk factors at the individual level. Dyslexia is the outcome of multiple risk factors and children with language difficulties at school entry are at high risk. Family history of dyslexia is a predictor of literacy outcome from the preschool years. However, screening does not reach an acceptable clinical level until close to school entry when letter knowledge, phonological awareness, and RAN, rather than family risk, together provide good sensitivity and specificity as a screening battery. © 2015 The Authors. Journal of Child Psychology and Psychiatry published by John Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental Health.

Hazards and Health Risks Encountered by Manual Sand Dredgers from Udupi, India: A Cross-sectional Study

PubMed Central

Shaikh, Alfiya; Nayak, Priyanka; Navada, Rajesh

2017-01-01

Introduction Globalization and urbanization have resulted in an increased demand on sand dredging. Legal and environmental restrictions on automated dredging have led to a rise in manual technique. The working techniques and environment involved in manual sand dredging may expose the workers to multiple work related disorders. Aim To determine the health risks and occupational hazards involved in manual sand dredging. Materials and Methods An assessment schedule was developed and content was validated by five experts for the study. A cross-sectional study was then conducted using this assessment schedule. Thirty manual sand dredgers were recruited from three randomly selected docks on Swarna riverbed in Udupi district, Karnataka, India. A detailed work and worksite assessments were conducted using systematic observation and close-ended questions. Work-related health risk evaluation included onsite-evaluation and self-reported health complains. Results The prevalence of musculoskeletal pain and discomfort was 93.34% with lower back (70%), shoulder (56.7%) and neck (46.7%) involvements being most common regions. Prevalence of sensory deficits at multiple site and ear pain was 66.6% and 76.6% respectively. All the workers recruited, complained of dermatological and ophthalmic involvements. Also, lack of health and safety measures like personal protective devices and security schemes were identified. Conclusion This study shows a high prevalence of multiple work-related disorders and hazards involved in manual sand dredging, a highly demanding job in coastal Karnataka. Lack of health and safety measures were also identified. PMID:28892936

Quantifying Multiple Work-Related Psychosocial Risk Factors: Proposal for a Composite Indicator Based on the COPSOQ II.

PubMed

Stauder, Adrienne; Nistor, Katalin; Zakor, Tünde; Szabó, Anita; Nistor, Anikó; Ádám, Szilvia; Konkolÿ Thege, Barna

2017-12-01

To determine national reference values for the Copenhagen Psychosocial Questionnaire (COPSOQ II) across occupational sectors and develop a composite score to estimate the cumulative effect of multiple work-related stressors, in order to facilitate the implementation of occupational health directives on psychosocial risk assessment. Cross-sectional data was collected via an online questionnaire. The sample included 13,104 individuals and was representative of the general Hungarian adult working population in terms of gender, age, education, and occupation. Mean scores were calculated for 18 scales on work environment and for 5 outcome scales of the COPSOQ II across 18 occupational sectors. We analyzed the association between a composite psychosocial risk score (CPRS), reflecting severity of exposure to multiple risk factors, and high stress, burnout, sleep troubles, and poor self-rated health. We found occupation-related differences in the mean scores on all COPSOQ II scales. Scores on the "Stress" scale ranged from 47.9 to 56.2, with the highest mean score in accommodation and food services sector. Variability was greatest with respect to emotional demands (range 40.3-67.6) and smallest with respect to role clarity (range 70.3-75.7). The prevalence of negative health outcomes increased with the CPRS. Five risk categories were formed, for which the odds ratio of negative outcomes ranged from 1.6 to 56.5. The sector-specific psychosocial risk profiles covering 18 work environmental factors can be used as a reference in organizational surveys and international comparisons. The CPRS proved to be a powerful predictor of self-reported negative health outcomes.

Anal intercourse without condoms among HIV-positive men who have sex with men recruited from a sexual networking web site, United States.

PubMed

Margolis, Andrew D; Joseph, Heather; Hirshfield, Sabina; Chiasson, Mary Ann; Belcher, Lisa; Purcell, David W

2014-12-01

The changing landscape of HIV prevention in the United States underscores the need to improve our ability to efficiently reach HIV-positive men who have sex with men (MSM) who engage in behaviors that could transmit HIV. We examined the prevalence of anal intercourse (AI) without condoms with HIV-negative or unknown serostatus partners ("at-risk partners") among 1319 HIV-positive adult male members of a sexual networking Web site for MSM. Sexual behaviors and substance use were measured over a 60-day recall period. Logistic regression was used to identify correlates of insertive and receptive AI without condoms with at-risk partners. Approximately 25% of the men had been diagnosed as having HIV 12 months or less before study enrollment. Overall, 32% of men engaged in AI without condoms with at-risk partners. Multiple logistic regression identified behavioral predictors of insertive AI without condoms with at-risk partners, including HIV diagnosis within the last 12 months, sex with multiple male partners, substance use in conjunction with sex, and use of phosphodiesterase type 5 inhibitors. Receptive AI without condoms with at-risk partners was associated with younger age (19-24 years), residing outside metropolitan cities, substance use in conjunction with sex, and having multiple male partners. High levels of sexual risk were found among these MSM. Increased Internet-based HIV prevention marketing efforts and prevention strategies should be considered to efficiently reach HIV-positive MSM who engage in serodiscordant AI without condoms.

Metabolic syndrome in family practice in Jordan: a study of high-risk groups.

PubMed

Yasein, N; Masa'd, D

2011-12-01

This study assessed the prevalence of the metabolic syndrome, and its components, as defined by Adult Treatment Panel III criteria in Jordanian patients attending a family practice clinic for management of cardiovascular risk factors. The sample was 730 randomly selected patients aged > or = 25 years. The prevalence of metabolic syndrome was 37.4% (31.7% in men; 41.0% in women). The prevalence increased with age in the total sample and in both sexes. High waist circumference showed the highest prevalence in the total sample (61.6%). Among females it ranked as the first criterion (73.5%). High serum triglyceride level showed the highest prevalence in males (50.2%). Differences between the sexes were significant. Family practitioners should be alerted to the importance of multiple risk factors in the metabolic syndrome.

Organizational Justice and Physiological Coronary Heart Disease Risk Factors in Japanese Employees: a Cross-Sectional Study.

PubMed

Inoue, Akiomi; Kawakami, Norito; Eguchi, Hisashi; Miyaki, Koichi; Tsutsumi, Akizumi

2015-12-01

Growing evidence has shown that lack of organizational justice (i.e., procedural justice and interactional justice) is associated with coronary heart disease (CHD) while biological mechanisms underlying this association have not yet been fully clarified. The purpose of the present study was to investigate the cross-sectional association of organizational justice with physiological CHD risk factors (i.e., blood pressure, high-density lipoprotein [HDL] cholesterol, low-density lipoprotein [LDL] cholesterol, and triglyceride) in Japanese employees. Overall, 3598 male and 901 female employees from two manufacturing companies in Japan completed self-administered questionnaires measuring organizational justice, demographic characteristics, and lifestyle factors. They completed health checkup, which included blood pressure and serum lipid measurements. Multiple logistic regression analyses and trend tests were conducted. Among male employees, multiple logistic regression analyses and trend tests showed significant associations of low procedural justice and low interactional justice with high triglyceride (defined as 150 mg/dL or greater) after adjusting for demographic characteristics and lifestyle factors. Among female employees, trend tests showed significant dose-response relationship between low interactional justice and high LDL cholesterol (defined as 140 mg/dL or greater) while multiple logistic regression analysis showed only marginally significant or insignificant odds ratio of high LDL cholesterol among the low interactional justice group. Neither procedural justice nor interactional justice was associated with blood pressure or HDL cholesterol. Organizational justice may be an important psychosocial factor associated with increased triglyceride at least among Japanese male employees.

Lipid profile, cardiovascular disease and mortality in a Mediterranean high-risk population: The ESCARVAL-RISK study

PubMed Central

Orozco-Beltran, Domingo; Gil-Guillen, Vicente F.; Redon, Josep; Martin-Moreno, Jose M.; Pallares-Carratala, Vicente; Navarro-Perez, Jorge; Valls-Roca, Francisco; Sanchis-Domenech, Carlos; Fernandez-Gimenez, Antonio; Perez-Navarro, Ana; Bertomeu-Martinez, Vicente; Bertomeu-Gonzalez, Vicente; Cordero, Alberto; Pascual de la Torre, Manuel; Trillo, Jose L.; Carratala-Munuera, Concepcion; Pita-Fernandez, Salvador; Uso, Ruth; Durazo-Arvizu, Ramon; Cooper, Richard; Sanz, Gines; Castellano, Jose M.; Ascaso, Juan F.; Carmena, Rafael; Tellez-Plaza, Maria

2017-01-01

Introduction The potential impact of targeting different components of an adverse lipid profile in populations with multiple cardiovascular risk factors is not completely clear. This study aims to assess the association between different components of the standard lipid profile with all-cause mortality and hospitalization due to cardiovascular events in a high-risk population. Methods This prospective registry included high risk adults over 30 years old free of cardiovascular disease (2008–2012). Diagnosis of hypertension, dyslipidemia or diabetes mellitus was inclusion criterion. Lipid biomarkers were evaluated. Primary endpoints were all-cause mortality and hospital admission due to coronary heart disease or stroke. We estimated adjusted rate ratios (aRR), absolute risk differences and population attributable risk associated with adverse lipid profiles. Results 51,462 subjects were included with a mean age of 62.6 years (47.6% men). During an average follow-up of 3.2 years, 919 deaths, 1666 hospitalizations for coronary heart disease and 1510 hospitalizations for stroke were recorded. The parameters that showed an increased rate for total mortality, coronary heart disease and stroke hospitalization were, respectively, low HDL-Cholesterol: aRR 1.25, 1.29 and 1.23; high Total/HDL-Cholesterol: aRR 1.22, 1.38 and 1.25; and high Triglycerides/HDL-Cholesterol: aRR 1.21, 1.30, 1.09. The parameters that showed highest population attributable risk (%) were, respectively, low HDL-Cholesterol: 7.70, 11.42, 8.40; high Total/HDL-Cholesterol: 6.55, 12.47, 8.73; and high Triglycerides/HDL-Cholesterol: 8.94, 15.09, 6.92. Conclusions In a population with cardiovascular risk factors, HDL-cholesterol, Total/HDL-cholesterol and triglycerides/HDL-cholesterol ratios were associated with a higher population attributable risk for cardiovascular disease compared to other common biomarkers. PMID:29045483

Lipid profile, cardiovascular disease and mortality in a Mediterranean high-risk population: The ESCARVAL-RISK study.

PubMed

Orozco-Beltran, Domingo; Gil-Guillen, Vicente F; Redon, Josep; Martin-Moreno, Jose M; Pallares-Carratala, Vicente; Navarro-Perez, Jorge; Valls-Roca, Francisco; Sanchis-Domenech, Carlos; Fernandez-Gimenez, Antonio; Perez-Navarro, Ana; Bertomeu-Martinez, Vicente; Bertomeu-Gonzalez, Vicente; Cordero, Alberto; Pascual de la Torre, Manuel; Trillo, Jose L; Carratala-Munuera, Concepcion; Pita-Fernandez, Salvador; Uso, Ruth; Durazo-Arvizu, Ramon; Cooper, Richard; Sanz, Gines; Castellano, Jose M; Ascaso, Juan F; Carmena, Rafael; Tellez-Plaza, Maria

2017-01-01

The potential impact of targeting different components of an adverse lipid profile in populations with multiple cardiovascular risk factors is not completely clear. This study aims to assess the association between different components of the standard lipid profile with all-cause mortality and hospitalization due to cardiovascular events in a high-risk population. This prospective registry included high risk adults over 30 years old free of cardiovascular disease (2008-2012). Diagnosis of hypertension, dyslipidemia or diabetes mellitus was inclusion criterion. Lipid biomarkers were evaluated. Primary endpoints were all-cause mortality and hospital admission due to coronary heart disease or stroke. We estimated adjusted rate ratios (aRR), absolute risk differences and population attributable risk associated with adverse lipid profiles. 51,462 subjects were included with a mean age of 62.6 years (47.6% men). During an average follow-up of 3.2 years, 919 deaths, 1666 hospitalizations for coronary heart disease and 1510 hospitalizations for stroke were recorded. The parameters that showed an increased rate for total mortality, coronary heart disease and stroke hospitalization were, respectively, low HDL-Cholesterol: aRR 1.25, 1.29 and 1.23; high Total/HDL-Cholesterol: aRR 1.22, 1.38 and 1.25; and high Triglycerides/HDL-Cholesterol: aRR 1.21, 1.30, 1.09. The parameters that showed highest population attributable risk (%) were, respectively, low HDL-Cholesterol: 7.70, 11.42, 8.40; high Total/HDL-Cholesterol: 6.55, 12.47, 8.73; and high Triglycerides/HDL-Cholesterol: 8.94, 15.09, 6.92. In a population with cardiovascular risk factors, HDL-cholesterol, Total/HDL-cholesterol and triglycerides/HDL-cholesterol ratios were associated with a higher population attributable risk for cardiovascular disease compared to other common biomarkers.

Genetic testing for hereditary cancer predisposition: BRCA1/2, Lynch syndrome, and beyond

PubMed Central

Hall, MJ; Obeid, EI; Schwartz, SC; Mantia-Smaldone, G; Forman, AD; Daly, MB

2016-01-01

Obstetrician/gynecologists and gynecologic oncologists serve an integral role in the care of women at increased hereditary risk of cancer. Their contribution includes initial identification of high risk patients, screening procedures like bimanual exam, trans-vaginal ultrasound and endometrial biopsy, prophylaxis via TAH and/or BSO, and chemoprevention. Further, gynecologists also serve a central role in the management of the secondary repercussions of efforts to mitigate increased cancer risks, including vasomotor symptoms, sexual function, bone health, cardiovascular disease, and mental health. The past several years has seen multiple new high and moderate penetrance genes introduced into the clinical care of women at increased risk of gynecologic malignancy. Awareness of these new genes and the availability of new multigene panel tests is critical for providers on the front-line of women’s health. PMID:26812021

Metabolomic analysis of 92 pulmonary embolism patients from a nested case-control study identifies metabolites associated with adverse clinical outcomes.

PubMed

Zeleznik, O A; Poole, E M; Lindstrom, S; Kraft, P; Van Hylckama Vlieg, A; Lasky-Su, J A; Harrington, L B; Hagan, K; Kim, J; Parry, B A; Giordano, N; Kabrhel, C

2018-03-01

Essentials Risk-stratification often fails to predict clinical deterioration in pulmonary embolism (PE). First-ever high-throughput metabolomics analysis of risk-stratified PE patients. Changes in circulating metabolites reflect a compromised energy metabolism in PE. Metabolites play a key role in the pathophysiology and risk stratification of PE. Background Patients with acute pulmonary embolism (PE) exhibit wide variation in clinical presentation and outcomes. Our understanding of the pathophysiologic mechanisms differentiating low-risk and high-risk PE is limited, so current risk-stratification efforts often fail to predict clinical deterioration and are insufficient to guide management. Objectives To improve our understanding of the physiology differentiating low-risk from high-risk PE, we conducted the first-ever high-throughput metabolomics analysis (843 named metabolites) comparing PE patients across risk strata within a nested case-control study. Patients/methods We enrolled 92 patients diagnosed with acute PE and collected plasma within 24 h of PE diagnosis. We used linear regression and pathway analysis to identify metabolites and pathways associated with PE risk-strata. Results When we compared 46 low-risk with 46 intermediate/high-risk PEs, 50 metabolites were significantly different after multiple testing correction. These metabolites were enriched in the following pathways: tricarboxylic acid (TCA) cycle, fatty acid metabolism (acyl carnitine) and purine metabolism, (hypo)xanthine/inosine containing. Additionally, energy, nucleotide and amino acid pathways were downregulated in intermediate/high-risk PE patients. When we compared 28 intermediate-risk with 18 high-risk PE patients, 41 metabolites differed at a nominal P-value level. These metabolites were enriched in fatty acid metabolism (acyl cholines), and hemoglobin and porphyrin metabolism. Conclusion Our results suggest that high-throughput metabolomics can provide insight into the pathophysiology of PE. Specifically, changes in circulating metabolites reflect compromised energy metabolism in intermediate/high-risk PE patients. These findings demonstrate the important role metabolites play in the pathophysiology of PE and highlight metabolomics as a potential tool for risk stratification of PE. © 2017 International Society on Thrombosis and Haemostasis.

Multiple Genetic Modifiers of Bilirubin Metabolism Involvement in Significant Neonatal Hyperbilirubinemia in Patients of Chinese Descent.

PubMed

Yang, Hui; Wang, Qian; Zheng, Lei; Lin, Min; Zheng, Xiang-bin; Lin, Fen; Yang, Li-Ye

2015-01-01

The potential for genetic variation to modulate neonatal hyperbilirubinemia risk is increasingly being recognized. A case-control study was designed to assess comprehensive contributions of the multiple genetic modifiers of bilirubin metabolism on significant neonatal hyperbilirubinemia in Chinese descendents. Eleven common mutations and polymorphisms across five bilirubin metabolism genes, namely those encoding UGT1A1, HMOX1, BLVRA, SLCO1B1 and SLCO1B3, were determined using the high resolution melt (HRM) assay or PCR-capillary electrophoresis analysis. A total of 129 hyperbilirubinemic infants and 108 control subjects were evaluated. Breastfeeding and the presence of the minor A allele of rs4148323 (UGTA*6) were correlated with an increased risk of hyperbilirubinemia (OR=2.17, P=0.02 for breastfeeding; OR=9.776, P=0.000 for UGTA*6 homozygote; OR=3.151, P=0.000 for UGTA*6 heterozygote); whereas, increasing gestational age and the presence of -TA7 repeat variant of UGT1A1 decreased the risk (OR=0.721, P=0.003 for gestational age; OR=0.313, P=0.002 for heterozygote TA6/TA7). In addition, the SLCO1B1 and SLCO1B3 polymorphisms also contributed to an increased risk of hyperbilirubinemia. This detailed analysis revealed the impact of multiple genetic modifiers on neonatal hyperbilirubinemia. This may support the use of genetic tests for clinical risk assessment. Furthermore, the established HRM assay can serve as an effective method for large-scale investigation.

Childhood Trauma and Illicit Drug Use in Adolescence: A Population-Based National Comorbidity Survey Replication–Adolescent Supplement Study

PubMed Central

Carliner, Hannah; Keyes, Katherine M.; McLaughlin, Katie A.; Meyers, Jacquelyn L.; Dunn, Erin C.; Martins, Silvia S.

2016-01-01

Objective Although potentially traumatic events (PTEs) are established risk factors for substance use disorders among adults, little is known about associations with drug use during adolescence, an important developmental stage for drug use prevention. We examined whether childhood PTEs were associated with illicit drug use among a representative sample of US adolescents. Method Data were drawn from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A), which included adolescents aged 13-18 years (N=9,956). Weighted logistic regression models estimated risk ratios for lifetime use of marijuana, cocaine, nonmedical prescription drugs, other drugs, and multiple drugs. Results Exposure to any PTE prior to age 11 was reported by 36% of the sample and was associated with higher risk for use of marijuana (risk ratio [RR] = 1.50), cocaine (RR = 2.78), prescription drugs (RR=1.80), other drugs (RR=1.90), and multiple drugs (RR=1.74). A positive monotonic relationship was observed between number of PTEs and marijuana, other drug, and multiple drug use. Interpersonal violence was associated with all drug use outcomes. Accidents and unspecified events were associated with higher risk for marijuana, cocaine, and prescription drug use. Conclusion Potentially traumatic events in childhood are associated with risk for illicit drug use among US adolescents. These findings add to the literature by illustrating a potentially modifiable health behavior that may be a target for intervention; and that adolescents with a trauma history are a high-risk group for illicit drug use and may benefit from trauma-focused prevention efforts that specifically address traumatic memories and coping strategies for dealing with stressful life events. PMID:27453084

Childhood Trauma and Illicit Drug Use in Adolescence: A Population-Based National Comorbidity Survey Replication-Adolescent Supplement Study.

PubMed

Carliner, Hannah; Keyes, Katherine M; McLaughlin, Katie A; Meyers, Jacquelyn L; Dunn, Erin C; Martins, Silvia S

2016-08-01

Although potentially traumatic events (PTEs) are established risk factors for substance use disorders among adults, little is known about associations with drug use during adolescence, an important developmental stage for drug use prevention. We examined whether childhood PTEs were associated with illicit drug use among a representative sample of US adolescents. Data were drawn from the National Comorbidity Survey Replication-Adolescent Supplement (NCS-A), which included adolescents aged 13 to 18 years (N = 9,956). Weighted logistic regression models estimated risk ratios for lifetime use of marijuana, cocaine, nonmedical prescription drugs, other drugs, and multiple drugs. Exposure to any PTE before age 11 years was reported by 36% of the sample and was associated with higher risk for use of marijuana (risk ratio [RR] = 1.50), cocaine (RR = 2.78), prescription drugs (RR = 1.80), other drugs (RR = 1.90), and multiple drugs (RR = 1.74). A positive monotonic relationship was observed between number of PTEs and marijuana, other drug, and multiple drug use. Interpersonal violence was associated with all drug use outcomes. Accidents and unspecified events were associated with higher risk for marijuana, cocaine, and prescription drug use. Potentially traumatic events in childhood are associated with risk for illicit drug use among US adolescents. These findings add to the literature by illustrating a potentially modifiable health behavior that may be a target for intervention. The results also highlight that adolescents with a trauma history are a high-risk group for illicit drug use and may benefit from trauma-focused prevention efforts that specifically address traumatic memories and coping strategies for dealing with stressful life events. Copyright © 2016 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

Single and Multiple Suicide Attempts and Associated Health Risk Factors in New Hampshire Adolescents

ERIC Educational Resources Information Center

Rosenberg, Harriet J.; Jankowski, Mary K.; Sengupta, Anjana; Wolfe, Rosemarie S.; Wolford, George L., II; Rosenberg, Stanley D.

2005-01-01

In this study we examined self-reported suicide attempts and their relationship to other health risk factors in a community sample of 16,644 adolescents. Fifteen percent endorsed suicide attempts (10% single; 5% multiple attempts). We hypothesized that multiple attempters would show higher prevalence of comorbid health risks than single or…

Multiple Threats: The Co-Occurrence of Teen Health Risk Behaviors.

ERIC Educational Resources Information Center

Lindberg, Laura Duberstein; Boggess, Scott; Williams, Sean

This document presents a portrait of multiple risk-taking among teens. Using recent data from the National Longitudinal Study of Adolescent Health (Add Health) and the 1995 National Survey of Adolescent Males, the report describes the extent to which teens engage in multiple health risk behaviors and contrast it with the extent to which teens…

Personality change at the intersection of autonomic arousal and stress.

PubMed

Hart, Daniel; Eisenberg, Nancy; Valiente, Carlos

2007-06-01

We hypothesized that personality change in children can be predicted by the interaction of family risk with susceptibility to autonomic arousal and that children characterized by both high-risk families and highly reactive autonomic nervous systems tend to show maladaptive change. This hypothesis was tested in a 6-year longitudinal study in which personality-type prototypicality, problem behavior, and negative emotional intensity were measured at 2-year intervals. The results indicated that children who both had exaggerated skin conductance responses (a measure of autonomic reactivity) and were living in families with multiple risk factors were most likely to develop an undercontrolled personality type and to exhibit increases in problem behavior and negative emotional intensity. The implications of the results for understanding personality change are discussed.

Amygdala Volume in Offspring from Multiplex for Alcohol Dependence Families: The Moderating Influence of Childhood Environment and 5-HTTLPR Variation.

PubMed

Hill, Shirley Y; Wang, Shuhui; Carter, Howard; McDermott, Michael D; Zezza, Nicholas; Stiffler, Scott

2013-12-12

The increased susceptibility for developing alcohol dependence seen in offspring from families with alcohol dependence may be related to structural and functional differences in brain circuits that influence emotional processing. Early childhood environment, genetic variation in the serotonin transporter-linked polymorphic region (5-HTTLPR) of the SLCA4 gene and allelic variation in the Brain Derived Neurotrophic Factor (BDNF) gene have each been reported to be related to volumetric differences in the temporal lobe especially the amygdala. Magnetic resonance imaging was used to obtain amygdala volumes for 129 adolescent/young adult individuals who were either High-Risk (HR) offspring from families with multiple cases of alcohol dependence (N=71) or Low-Risk (LR) controls (N=58). Childhood family environment was measured prospectively using age-appropriate versions of the Family Environment Scale during a longitudinal follow-up study. The subjects were genotyped for Brain-Derived Neurotrophic Factor (BDNF) Val66Met and the serotonin transporter polymorphism (5-HTTLPR). Two family environment scale scores (Cohesion and Conflict), genotypic variation, and their interaction were tested for their association with amygdala volumes. Personal and prenatal exposure to alcohol and drugs were considered in statistical analyses in order to more accurately determine the effects of familial risk group differences. Amygdala volume was reduced in offspring from families with multiple alcohol dependent members in comparison to offspring from control families. High-Risk offspring who were carriers of the S variant of the 5-HTTLPR polymorphism had reduced amygdala volume in comparison to those with an LL genotype. Larger amygdala volume was associated with greater family cohesion but only in Low-Risk control offspring. Familial risk for alcohol dependence is an important predictor of amygdala volume even when removing cases with significant personal exposure and covarying for prenatal exposure effects. The present study provides new evidence that amygdala volume is modified by 5-HTTLPR variation in High-Risk families.

Risk factors associated with high prevalence rates of hepatitis C infection in Egypt.

PubMed

Reker, Celeste; Islam, K M

2014-08-01

Egypt has the highest reported prevalence of hepatitis C virus (HCV) globally. Until now, no systematic review has been conducted to understand risk factors associated with these high prevalence rates of HCV. This study attempted to identify the various HCV risk factors in Egypt responsible for the high incidence and prevalence rates. Using systematic literature review methods, we searched databases for eligible manuscripts, selecting cohort and case-control studies published in English. Peer-reviewed papers published between 2008 and February 2013 were included. A total of 11 articles met the study selection criteria. The most examined risk factors found during our review analysis were surgery, transfusion, and age (64-82% of total articles; n = 11). Multiple risk factors held significant association with HCV infection in the included research. Based on this review, the main HCV risk factor categories are unsafe medical practices and familial risk factors. Improving medical safety and encouraging familial education on HCV may help reduce the incidence of the disease. Most risk factors for HCV transmission in Egypt are healthcare-associated. Primary prevention of HCV infection remains important to reduce HCV transmission. Further research should also focus on risk factor dynamics of HCV in Egypt to reduce transmission and HCV disease burden. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

Relationships among Substance Use, Multiple Sexual Partners, and Condomless Sex: Differences between Male and Female U.S. High School Adolescents

ERIC Educational Resources Information Center

Zhao, Yunchuan; Kim, Heejung; Peltzer, Jill

2017-01-01

Male and female students manifest different behaviors in condomless sex. This cross-sectional, exploratory, correlational study examined the differences in risk factors for condomless sex between male and female high school students, using secondary data from 4,968 sexually active males and females participating in the 2011 National Youth Risk…

Association between the MTHFR C677T polymorphism and risk of cancer: evidence from 446 case-control studies.

PubMed

Xie, Shu-Zhe; Liu, Zhi-Zhong; Yu, Jun-hua; Liu, Li; Wang, Wei; Xie, Dao-Lin; Qin, Jiang-Bo

2015-11-01

Many molecular epidemiological studies have been performed to explore the association between MTHFR C677T polymorphism and cancer risk in diverse populations. However, the results were inconsistent. Hence, we performed a meta-analysis to investigate the association between cancer risk and MTHFR C677T (150,086 cases and 200,699 controls from 446 studies) polymorphism. Overall, significantly increased cancer risk was found when all eligible studies were pooled into the meta-analysis. In the further stratified and sensitivity analyses, significantly increased breast cancer risk was found in Asians and Indians, significantly decreased colon cancer risk was found, significantly decreased colorectal cancer risk was found in male population, significantly increased gastric cancer risk was found in Caucasians and Asians, significantly increased hepatocellular cancer risk was found in Asians, significantly decreased adult acute lymphoblastic leukemia (AALL) risk was found in Caucasians, significantly decreased childhood acute lymphoblastic leukemia (CALL) risk was found in Asians, and significantly increased multiple myeloma and NHL risk was found in Caucasians. In summary, this meta-analysis suggests that MTHFR C677T polymorphism is associated with increased breast cancer, gastric cancer, and hepatocellular cancer risk in Asians, is associated with increased gastric cancer, multiple myeloma, and NHL risk in Caucasians, is associated with decreased AALL risk in Caucasians, is associated with decreased CALL risk in Asians, is associated with increased breast cancer risk in Asians, is associated with decreased colon cancer risk, and is associated with decreased colorectal cancer risk in male population. Moreover, this meta-analysis also points out the importance of new studies, such as Asians of HNC, Asians of lung cancer, and Indians of breast cancer, because they had high heterogeneity in this meta-analysis (I(2) > 75%).

Body Mass Index and Physical Activity at Different Ages and Risk of Multiple Myeloma in the NIH-AARP Diet and Health Study

PubMed Central

Hofmann, Jonathan N.; Moore, Steven C.; Lim, Unhee; Park, Yikyung; Baris, Dalsu; Hollenbeck, Albert R.; Matthews, Charles E.; Gibson, Todd M.; Hartge, Patricia; Purdue, Mark P.

2013-01-01

Several studies have reported an increased risk of multiple myeloma associated with excess body weight. We investigated the risk of multiple myeloma in relation to separate measures of adiposity and energy balance at different ages in the National Institutes of Health-AARP Diet and Health Study, a large prospective cohort study in the United States. Participants completed a baseline questionnaire (1995–1996; n = 485,049), and a subset of participants completed a second questionnaire (1996–1997; n = 305,618) in which we solicited more detailed exposure information. Hazard ratios and 95% confidence intervals were estimated for the risk of multiple myeloma (overall, n = 813; subset, n = 489) in relation to several measures of obesity and leisure time physical activity. Multiple myeloma risk was associated with increasing body mass index (BMI) at cohort entry (per 5-kg/m2 increase, hazard ratio (HR) = 1.10, 95% confidence interval (CI): 1.00, 1.22); similar associations were observed for BMI at age 50 years (HR = 1.14, 95% CI: 1.02, 1.28), age 35 years (HR = 1.20, 95% CI: 1.05, 1.36), and age 18 years (HR = 1.13, 95% CI: 0.98, 1.32) without adjustment for baseline BMI. Risk of multiple myeloma was not associated with physical activity level at any age. These findings support the hypothesis that excess body weight, both in early adulthood and later in life, is a risk factor for multiple myeloma and suggest that maintaining a healthy body weight throughout life may reduce multiple myeloma risk. PMID:23543160

Dietary Phosphorus Intake and the Kidney

PubMed Central

Chang, Alex R.; Anderson, Cheryl

2017-01-01

Although phosphorus is an essential nutrient required for multiple physiological functions, recent research raises concerns that high phosphorus intake could have detrimental effects on health. Phosphorus is abundant in the food supply of developed countries, occurring naturally in protein-rich foods and as an additive in processed foods. High phosphorus intake can cause vascular and renal calcification, renal tubular injury, and premature death in multiple animal models. Small studies in human suggest that high phosphorus intake may result in positive phosphorus balance and correlate with renal calcification and albuminuria. Although serum phosphorus is strongly associated with cardiovascular disease, progression of kidney disease, and death, limited data exist linking high phosphorus intake directly to adverse clinical outcomes. Further prospective studies are needed to determine whether phosphorus intake is a modifiable risk factor for kidney disease. PMID:28613982

Mass Spectrometric Immunoassay and Multiple Reaction Monitoring as Targeted MS-based Quantitative Approaches in Biomarker Development: Potential Applications to Cardiovascular Disease and Diabetes

PubMed Central

Yassine, Hussein; Borges, Chad R.; Schaab, Matthew R.; Billheimer, Dean; Stump, Craig; Reaven, Peter; Lau, Serrine S.; Nelson, Randall

2014-01-01

Type 2 diabetes (T2DM) is an important risk factor for cardiovascular disease (CVD)—the leading cause of death in the US. Yet not all subjects with T2DM are at equal risk for CVD complications; the challenge lies in identifying those at greatest risk. Therapies directed towards treating conventional risk factors have failed to significantly reduce this residual risk in T2DM patients. Thus newer targets and markers are needed for the development and testing of novel therapies. Herein we review two complementary mass spectrometry-based approaches—Mass Spectrometric Immunoassay (MSIA) and tandem mass spectrometry as multiple reaction monitoring (MRM)—for the analysis of plasma proteins and post translational modifications (PTMs) of relevance to T2DM and CVD. Together, these complementary approaches allow for high-throughput monitoring of many PTMs and the absolute quantification of proteins near the low picomolar range. In this review article, we discuss the clinical relevance of the HDL proteome and Apolipoprotein A-I PTMs to T2DM and CVD as well as provide illustrative MSIA and MRM data on high density lipoprotein (HDL) proteins from T2DM patients to provide examples of how these mass spectrometry approaches can be applied to gain new insight regarding cardiovascular risk factors. Also discussed are the reproducibility, interpretation and limitations of each technique with an emphasis on their capacities to facilitate the translation of new biomarkers into clinical practice. PMID:23696124

Community narratives about women and HIV risk in 21 high-burden communities in Zambia and South Africa.

PubMed

Viljoen, Lario; Ndubani, Rhoda; Bond, Virginia; Seeley, Janet; Reynolds, Lindsey; Hoddinott, Graeme

2017-01-01

Public health researchers repeatedly represent women as a group vulnerable to ill health. This has been particularly true in the field of HIV research, where women are disproportionately affected by HIV in terms of disease burden and the social effects of the epidemic. Although women have been the focus of many prevention and treatment programs, structural barriers to implementation of these targeted programs persist. In this article we explore how high HIV-burden communities in South Africa and Zambia engage with the concepts of "woman" and "HIV risk". The data are drawn from participatory storytelling activities completed with 604 participants across 78 group discussions between December 2012 and May 2013. During discussions we found that participants made use of the core archetypal caricatures of "goodness," "badness," and "vulnerability" when describing women's HIV risk. Community members shifted between these categories in their characterizations of women, as they acknowledged the multiple roles women play, internalized different stories about women, and sometimes shifted register in the same stories. Findings suggest that health implementers, in consultation with community members, should consider the multiple positions women occupy and how this impacts the wider community's understandings of women and "risk". This approach of taking on board community understandings of the complexity of HIV risk can inform the design and implementation of HIV prevention and care programs by rendering programs more focused and in-line with community needs.

Best practice in the use of natalizumab in multiple sclerosis.

PubMed

Fernández, Oscar

2013-03-01

Natalizumab is approved for the treatment of patients with relapsing-remitting multiple sclerosis who have failed first-line treatment with traditional disease-modifying therapies or who have highly active disease. The drug has proved highly effective, both in a clinical trial setting and in clinical practice, with marked reductions in the rate of clinical relapses and slowed disease progression. These clinical outcomes are mirrored by a marked reduction in disease activity as evidenced by magnetic resonance imaging of the brain. However, natalizumab treatment has been associated with a risk of progressive multifocal leukoencephalopathy (PML), a potentially fatal condition caused by JC virus (JCV) activation. When this condition was detected in a clinical trial shortly after approval, the drug was immediately and voluntarily withdrawn from the market. As a condition of its reinstatement, stringent pharmacovigilance measures and a risk management plan were enforced. The recent availability of a two-step enzyme-linked immunosorbent assay (ELISA) test for the presence of anti-JCV antibodies (free testing is available in a central laboratory for registered centers), along with an ever-improving understanding of other risk factors such as prior immunosuppressant use and duration of treatment, allow an increasingly refined stratification of the risk of PML. This improved stratification of risk can help guide decisions about treatment. This review will also deal with other topics of relevance to clinical practice such as the development of antinatalizumab antibodies and their negative implications in terms of hypersensitivity reactions and loss of efficacy, withdrawal of treatment, and compassionate pediatric use.

Using In Vitro High-Throughput Screening Data for Predicting ...

EPA Pesticide Factsheets

Today there are more than 80,000 chemicals in commerce and the environment. The potential human health risks are unknown for the vast majority of these chemicals as they lack human health risk assessments, toxicity reference values and risk screening values. We aim to use computational toxicology and quantitative high throughput screening (qHTS) technologies to fill these data gaps, and begin to prioritize these chemicals for additional assessment. By coupling qHTS data with adverse outcome pathways (AOPs) we can use ontologies to make predictions about potential hazards and to identify those assays which are sufficient to infer these same hazards. Once those assays are identified, we can use bootstrap natural spline-based metaregression to integrate the evidence across multiple replicates or assays (if a combination of assays are together necessary to be sufficient). In this pilot, we demonstrate how we were able to identify that benzo[k]fluoranthene (B[k]F) may induce DNA damage and steatosis using qHTS data and two separate AOPs. We also demonstrate how bootstrap natural spline-based metaregression can be used to integrate the data across multiple assay replicates to generate a concentration-response curve. We used this analysis to calculate an internal point of departure of 0.751µM and risk-specific concentrations of 0.378µM for both 1:1,000 and 1:10,000 additive risk for B[k]F induced DNA damage based on the p53 assay. Based on the available evidence, we

Novel pedigree analysis implicates DNA repair and chromatin remodeling in multiple myeloma risk

PubMed Central

Curtin, Karen; Rajamanickam, Venkatesh; Jayabalan, David; Atanackovic, Djordje; Rajkumar, S. Vincent; Kumar, Shaji; Slager, Susan; Galia, Perrine; Demangel, Delphine; Salama, Mohamed; Joseph, Vijai; Lipkin, Steven M.; Dumontet, Charles; Vachon, Celine M.

2018-01-01

The high-risk pedigree (HRP) design is an established strategy to discover rare, highly-penetrant, Mendelian-like causal variants. Its success, however, in complex traits has been modest, largely due to challenges of genetic heterogeneity and complex inheritance models. We describe a HRP strategy that addresses intra-familial heterogeneity, and identifies inherited segments important for mapping regulatory risk. We apply this new Shared Genomic Segment (SGS) method in 11 extended, Utah, multiple myeloma (MM) HRPs, and subsequent exome sequencing in SGS regions of interest in 1063 MM / MGUS (monoclonal gammopathy of undetermined significance–a precursor to MM) cases and 964 controls from a jointly-called collaborative resource, including cases from the initial 11 HRPs. One genome-wide significant 1.8 Mb shared segment was found at 6q16. Exome sequencing in this region revealed predicted deleterious variants in USP45 (p.Gln691* and p.Gln621Glu), a gene known to influence DNA repair through endonuclease regulation. Additionally, a 1.2 Mb segment at 1p36.11 is inherited in two Utah HRPs, with coding variants identified in ARID1A (p.Ser90Gly and p.Met890Val), a key gene in the SWI/SNF chromatin remodeling complex. Our results provide compelling statistical and genetic evidence for segregating risk variants for MM. In addition, we demonstrate a novel strategy to use large HRPs for risk-variant discovery more generally in complex traits. PMID:29389935

Novel pedigree analysis implicates DNA repair and chromatin remodeling in multiple myeloma risk.

PubMed

Waller, Rosalie G; Darlington, Todd M; Wei, Xiaomu; Madsen, Michael J; Thomas, Alun; Curtin, Karen; Coon, Hilary; Rajamanickam, Venkatesh; Musinsky, Justin; Jayabalan, David; Atanackovic, Djordje; Rajkumar, S Vincent; Kumar, Shaji; Slager, Susan; Middha, Mridu; Galia, Perrine; Demangel, Delphine; Salama, Mohamed; Joseph, Vijai; McKay, James; Offit, Kenneth; Klein, Robert J; Lipkin, Steven M; Dumontet, Charles; Vachon, Celine M; Camp, Nicola J

2018-02-01

The high-risk pedigree (HRP) design is an established strategy to discover rare, highly-penetrant, Mendelian-like causal variants. Its success, however, in complex traits has been modest, largely due to challenges of genetic heterogeneity and complex inheritance models. We describe a HRP strategy that addresses intra-familial heterogeneity, and identifies inherited segments important for mapping regulatory risk. We apply this new Shared Genomic Segment (SGS) method in 11 extended, Utah, multiple myeloma (MM) HRPs, and subsequent exome sequencing in SGS regions of interest in 1063 MM / MGUS (monoclonal gammopathy of undetermined significance-a precursor to MM) cases and 964 controls from a jointly-called collaborative resource, including cases from the initial 11 HRPs. One genome-wide significant 1.8 Mb shared segment was found at 6q16. Exome sequencing in this region revealed predicted deleterious variants in USP45 (p.Gln691* and p.Gln621Glu), a gene known to influence DNA repair through endonuclease regulation. Additionally, a 1.2 Mb segment at 1p36.11 is inherited in two Utah HRPs, with coding variants identified in ARID1A (p.Ser90Gly and p.Met890Val), a key gene in the SWI/SNF chromatin remodeling complex. Our results provide compelling statistical and genetic evidence for segregating risk variants for MM. In addition, we demonstrate a novel strategy to use large HRPs for risk-variant discovery more generally in complex traits.

Is Geo-Environmental Exposure a Risk Factor for Multiple Sclerosis? A Population-Based Cross-Sectional Study in South-Western Sardinia.

PubMed

Monti, Maria Cristina; Guido, Davide; Montomoli, Cristina; Sardu, Claudia; Sanna, Alessandro; Pretti, Salvatore; Lorefice, Lorena; Marrosu, Maria Giovanna; Valera, Paolo; Cocco, Eleonora

South-Western Sardinia (SWS) is a high risk area for Multiple Sclerosis (MS) with high prevalence and spatial clustering; its population is genetically representative of Sardinians and presents a peculiar environment. We evaluated the MS environmental risk of specific heavy metals (HM) and geographical factors such as solar UV exposure and urbanization by undertaking a population-based cross-sectional study in SWS. Geochemical data on HM, UV exposure, urbanization and epidemiological MS data were available for all SWS municipalities. Principal Component Analysis (PCA) was applied to the geochemical data to reduce multicollinearity and confounding criticalities. Generalized Linear Mixed Models (GLMM) were applied to evaluate the causal effects of the potential risk factors, and a model selection was performed using Akaike Information Criterion. The PCA revealed that copper (Cu) does not cluster, while two component scores were extracted: 'basic rocks', including cobalt, chromium and nickel, and 'ore deposits', including lead and zinc. The selected multivariable GLMM highlighted Cu and sex as MS risk factors, adjusting for age and 'ore deposits'. When the Cu concentration increases by 50 ppm, the MS odds are 2.827 (95% CI: 1.645; 5.07) times higher; females have a MS odds 2.04 times (95% CI: 1.59; 2.60) higher than males. The high frequency of MS in industrialized countries, where pollution by HM and CO poisoning is widespread, suggests a relationship between environmental exposure to metals and MS. Hence, we suggested a role of Cu homeostasis in MS. This is a preliminary study aimed at generating hypotheses that will need to be confirmed further.

Low levels of awareness of suboptimal health conditions in a high-risk working population: the "better health for better Hong Kong" health promotion campaign.

PubMed

Ko, Gary T C; Chan, Juliana C N; Chan, Amy W Y; Wong, Patrick T S; Hui, Stanley S C; Tong, Spencer D Y; Chow, Ferrie; Chan, Cecilia L W

2007-01-01

The incidences of cardiovascular risk factors such as obesity and diabetes are rising in many Asian populations. In April 2000, a 5-year territory-wide health promotion campaign supported by Li Ka Shing Foundation was launched in Hong Kong by the Health InfoWorld of Hospital Authority. From the general working class, 4,832 Chinese people were randomly recruited into this campaign. There were 2,370 men (49.0%) and 2,462 women (51.0%; median age = 43.0 years, range = 17-83 years). Of these, 37.5% were obese (BMI > or = 25 kg/m2 or waist circumference > or = 80 cm in women and > or = 90 cm in men), 22.3% had hypertension, 11.6% were smokers, 31.0% had hypercholesterolaemia (total cholesterol > or = 5.2 mmol/l), 2.2% had diabetes, and 0.7% had a past history of cardiovascular disease. There were 1,338 participants (27.7%) who had 2 or more risk factors (more men than women: 36.9% vs. 18.9%, p < .001). Despite this high prevalence of multiple risk factors, most (83.1%) perceived their health status as satisfactory (more men than women: 85.6% vs. 80.7%, p < .001). In conclusion, the combination of high prevalence of multiple risk factors and low levels of awareness of their suboptimal health status herald a looming epidemic of life-threatening diseases in a group of middle-aged Hong Kong people. Massive public education is an important and essential, although it may not be self-sufficient, factor to reduce the socioeconomic impacts of this epidemic.

Electrochemiluminescence Assays for Insulin and Glutamic Acid Decarboxylase Autoantibodies Improve Prediction of Type 1 Diabetes Risk

PubMed Central

Miao, Dongmei; Steck, Andrea K.; Zhang, Li; Guyer, K. Michelle; Jiang, Ling; Armstrong, Taylor; Muller, Sarah M.; Krischer, Jeffrey; Rewers, Marian

2015-01-01

Abstract We recently developed new electrochemiluminescence (ECL) insulin autoantibody (IAA) and glutamic acid decarboxylase 65 autoantibody (GADA) assays that discriminate high-affinity, high-risk diabetes-specific autoantibodies from low-affinity, low-risk islet autoantibodies (iAbs) detected by radioassay (RAD). Here, we report a further validation of the ECL-IAA and -GADA assays in 3,484 TrialNet study participants. The ECL assay and RAD were congruent in those with prediabetes and in subjects with multiple autoantibodies, but only 24% (P<0.0001) of single RAD-IAA-positive and 46% (P<0.0001) of single RAD-GADA-positive were confirmed by the ECL-IAA and -GADA assays, respectively. During a follow-up (mean, 2.4 years), 51% of RAD-IAA-positive and 63% of RAD-GADA-positive subjects not confirmed by ECL became iAb negative, compared with only 17% of RAD-IAA-positive (P<0.0001) and 15% of RAD-GADA-positive (P<0.0001) subjects confirmed by ECL assays. Among subjects with multiple iAbs, diabetes-free survival was significantly shorter if IAA or GADA was positive by ECL and negative by RAD than if IAA or GADA was negative by ECL and positive by RAD (P<0.019 and P<0.0001, respectively). Both positive and negative predictive values in terms of progression to type 1 diabetes mellitus were superior for ECL-IAA and ECL-GADA, compared with RADs. The prevalence of the high-risk human leukocyte antigen-DR3/4, DQB1*0302 genotype was significantly higher in subjects with RAD-IAA or RAD-GADA confirmed by ECL. In conclusion, both ECL-IAA and -GADA are more disease-specific and better able to predict the risk of progression to type 1 diabetes mellitus than the current standard RADs. PMID:25562486

Electrochemiluminescence assays for insulin and glutamic acid decarboxylase autoantibodies improve prediction of type 1 diabetes risk.

PubMed

Miao, Dongmei; Steck, Andrea K; Zhang, Li; Guyer, K Michelle; Jiang, Ling; Armstrong, Taylor; Muller, Sarah M; Krischer, Jeffrey; Rewers, Marian; Yu, Liping

2015-02-01

We recently developed new electrochemiluminescence (ECL) insulin autoantibody (IAA) and glutamic acid decarboxylase 65 autoantibody (GADA) assays that discriminate high-affinity, high-risk diabetes-specific autoantibodies from low-affinity, low-risk islet autoantibodies (iAbs) detected by radioassay (RAD). Here, we report a further validation of the ECL-IAA and -GADA assays in 3,484 TrialNet study participants. The ECL assay and RAD were congruent in those with prediabetes and in subjects with multiple autoantibodies, but only 24% (P<0.0001) of single RAD-IAA-positive and 46% (P<0.0001) of single RAD-GADA-positive were confirmed by the ECL-IAA and -GADA assays, respectively. During a follow-up (mean, 2.4 years), 51% of RAD-IAA-positive and 63% of RAD-GADA-positive subjects not confirmed by ECL became iAb negative, compared with only 17% of RAD-IAA-positive (P<0.0001) and 15% of RAD-GADA-positive (P<0.0001) subjects confirmed by ECL assays. Among subjects with multiple iAbs, diabetes-free survival was significantly shorter if IAA or GADA was positive by ECL and negative by RAD than if IAA or GADA was negative by ECL and positive by RAD (P<0.019 and P<0.0001, respectively). Both positive and negative predictive values in terms of progression to type 1 diabetes mellitus were superior for ECL-IAA and ECL-GADA, compared with RADs. The prevalence of the high-risk human leukocyte antigen-DR3/4, DQB1*0302 genotype was significantly higher in subjects with RAD-IAA or RAD-GADA confirmed by ECL. In conclusion, both ECL-IAA and -GADA are more disease-specific and better able to predict the risk of progression to type 1 diabetes mellitus than the current standard RADs.

Socioeconomic Status (SES) and Childhood Acute Myeloid Leukemia (AML) Mortality

PubMed Central

Knoble, Naomi B.; Alderfer, Melissa A.; Hossain, Md Jobayer

2016-01-01

Socioeconomic status (SES) is a complex construct of multiple indicators, known to impact cancer outcomes, but has not been adequately examined among pediatric AML patients. This study aimed to identify the patterns of co-occurrence of multiple community-level SES indicators and to explore associations between various patterns of these indicators and pediatric AML mortality risk. A nationally representative US sample of 3,651 pediatric AML patients, aged 0–19 years at diagnosis was drawn from 17 Surveillance, Epidemiology, and End Results (SEER) database registries created between 1973 and 2012. Factor analysis, cluster analysis, stratified univariable and multivariable Cox proportional hazards models were used. Four SES factors accounting for 87% of the variance in SES indicators were identified: F1) economic/educational disadvantage, less immigration; F2) immigration-related features (foreign-born, language-isolation, crowding), less mobility F3) housing instability; and, F4) absence of moving. F1 and F3 showed elevated risk of mortality, adjusted hazards ratios (aHR) (95% CI): 1.07(1.02–1.12) and 1.05(1.00–1.10), respectively. Seven SES-defined cluster groups were identified. Cluster 1: (low economic/educational disadvantage, few immigration-related features, and residential-stability) showed the minimum risk of mortality. Compared to Cluster 1, Cluster 3: (high economic/educational disadvantage, high-mobility) and Cluster 6: (moderately-high economic/educational disadvantages, housing-instability and immigration-related features) exhibited substantially greater risk of mortality, aHR(95% CI) = 1.19(1.0–1.4) and 1.23 (1.1–1.5), respectively. Factors of correlated SES-indicators and their pattern-based groups demonstrated differential risks in the pediatric AML mortality indicating the need of special public-health attention in areas with economic-educational disadvantages, housing-instability and immigration-related features. PMID:27543948

Infectious mononucleosis and multiple sclerosis - Updated review on associated risk.

PubMed

Sheik-Ali, Sharaf

2017-05-01

There has been substantial evidence accumulating on the role of infectious mononucleosis (IM) and the subsequent risk of obtaining Multiple Sclerosis (MS). Up to date studies not previously explored were reviewed by the author to further clarify the association. Medline and Web of Science were searched with no time constraints for articles exploring an association between Multiple Sclerosis and Infectious Mononucleosis. 24 articles were found, totalling 1063 cases and 13,227 cohort/controls. 23/24 (96%) articles reported a significant association of Infectious Mononucleosis on the risk of subsequent multiple sclerosis. Overall, new literature on IM and risk of MS categorically supports the association. Future work should focus on other risk factors such as age and gender on IM and subsequent risk of MS. Crown Copyright © 2017. Published by Elsevier B.V. All rights reserved.

The influence of demographics and working conditions on self-reported injuries among Latino day laborers

PubMed Central

Fernández-Esquer, Maria Eugenia; Fernández-Espada, Natalie; Atkinson, John A; Montano, Cecilia F

2015-01-01

Background: The majority of day laborers in the USA are Latinos. They are engaged in high-risk occupations and suffer high occupational injury rates. Objectives: To describe on-the-job injuries reported by Latino day laborers, explore the extent that demographic and occupational factors predict injuries, and whether summative measures for total job types, job conditions, and personal protective equipment (PPE) predict injuries. Methods: A community survey was conducted with 327 participants at 15 corners in Houston, Texas. Hierarchical and multiple logistic regressions explored predictors of occupational injury odds in the last year. Results: Thirty-four percent of respondents reported an occupational injury in the previous year. Education, exposure to loud noises, cold temperatures, vibrating machinery, use of hard hats, total number of job conditions, and total PPE significantly predicted injury odds. Conclusion: Risk for injury among day laborers is not only the product of a specific hazard, but also the result of their exposure to multiple occupational hazards. PMID:25291983

Daclizumab for the treatment of relapsing-remitting multiple sclerosis.

PubMed

Herwerth, Marina; Hemmer, Bernhard

2017-06-01

Multiple sclerosis (MS) is a common inflammatory disease of the central nervous system. Over the last two decades, the number of therapeutic options for the treatment of relapsing remitting MS (RRMS) has been constantly growing, providing new treatment options to patients. Areas covered: Herein, the authors review the recently approved monoclonal antibody daclizumab for the treatment of RRMS. Based on original articles, they discuss its mode of action and evaluate its efficacy and safety profile compared to other available agents. Expert opinion: The IL-2 receptor modulator daclizumab is a new highly effective agent for the treatment of RRMS with novel immunomodulatory properties. Compared to interferon-beta i.m., daclizumab is more effective in reducing relapse rates and MRI activity. However, its use is limited by the risk of autoimmune disorders and hepatotoxicity. Similar to other monoclonal antibodies for RRMS, therapy with daclizumab needs a strict preselection and monitoring of patients based on individual risk benefit assessment. Given its substantial effectiveness, daclizumab can be an attractive option for patients with highly active MS.

Chemoprevention of Oral Cancer by Topical Application of Black Raspberries on High At-Risk Mucosa

PubMed Central

Warner, Blake M.; Casto, Bruce C.; Knobloch, Thomas J.; Accurso, Brent T.; Weghorst, Christopher M.

2014-01-01

Objective To evaluate the preclinical efficacy of topical administration of freeze-dried black raspberries (BRBs) to inhibit the progression of premalignant oral lesions and modulate biomarkers of cancer development in high at-risk mucosa (HARM). Study Design Hamster cheek pouches (HCPs) were treated with carcinogen for six weeks to initiate a HARM microenvironment. Subsequently, right HCPs were topically administered a BRB suspension in short-term or long-term studies. After 12 weeks, SCC multiplicity, SCC incidence, and cell proliferation rates were evaluated. mRNA expression was measured in short-term treated pouches for selected oral cancer biomarkers. Results SCC multiplicity (−41.3%), tumor incidence (−37.1%), and proliferation rate (−6.9%) were reduced in HCPs receiving BRBs. Topical BRBs correlated with an increase in Rb1 expression in developing oral lesions. Conclusion Topical BRBs inhibit SCC development when targeted to HARM tissues. These results support the translational role of BRBs to prevent oral cancer development in humans. PMID:25457886

Low plasma eicosapentaenoic acid concentration as a possible risk factor for intracerebral hemorrhage.

PubMed

Ikeya, Yoshimori; Fukuyama, Naoto; Mori, Hidezo

2015-03-01

N-3 fatty acids, including eicosapentaenoic acid (EPA), prevent ischemic stroke. The preventive effect has been attributed to an antithrombic effect induced by elevated EPA and reduced arachidonic acid (AA) levels. However, the relationship between intracranial hemorrhage and N-3 fatty acids has not yet been elucidated. In this cross-sectional study, we compared common clinical and lifestyle parameters between 70 patients with intracranial hemorrhages and 66 control subjects. The parameters included blood chemistry data, smoking, alcohol intake, fish consumption, and the incidences of underlying diseases. The comparisons were performed using the Mann-Whitney U test followed by multiple logistic regression analysis. Nonparametric tests revealed that the 70 patients with intracerebral hemorrhages exhibited significantly higher diastolic blood pressures and alcohol intakes and lower body mass indices, high-density lipoprotein (HDL) cholesterol levels, EPA concentrations, EPA/AA ratios, and vegetable consumption compared with the 66 control subjects. A multiple logistic regression analysis revealed that higher diastolic blood pressure and alcohol intake and lower body mass index, HDL cholesterol, EPA/AA ratio, and vegetable consumption were relative risk factors for intracerebral hemorrhage. High HDL cholesterol was a common risk factor in both of the sex-segregated subgroups and the <65-year-old subgroup. However, neither EPA nor the EPA/AA ratio was a risk factor in these subgroups. Eicosapentaenoic acid was relative risk factor only in the ≥65-year-old subgroup. Rather than higher EPA levels, lower EPA concentrations and EPA/AA ratios were found to be risk factors for intracerebral hemorrhage in addition to previously known risk factors such as blood pressure, alcohol consumption, and lifestyle. Copyright © 2015 Elsevier Inc. All rights reserved.

Validation of 1-hour post-thyroidectomy parathyroid hormone level in predicting hypocalcemia

PubMed Central

2014-01-01

Background Prior work by our group suggested that a single one hour post-thyroidectomy parathyroid hormone (1 hr PTH) level could accurately stratify patients into high and low risk groups for the development of hypocalcemia. This study looks to validate the safety and efficacy of a protocol based on a 1 hr PTH threshold of 12 pg/ml. Study design Retrospective analysis of consecutive cohort treated with standardized protocol. Methods One hundred and twenty five consecutive patients underwent total or completion thyroidectomy and their PTH level was drawn 1-hour post operatively. Based on our previous work, patients were stratified into either a low risk group (PTH < 12 pg/ml) or a high risk group (PTH ≥ 12 pg/ml). Patients in the high risk group were immediately started on prophylactic calcium carbonate (5–10 g/d) and calcitriol (0.5-1.0 mcg/d). The outcomes were then reviewed focusing mainly on how many low risk patients developed hypocalcemia (false negative rate), and how many high risk patients failed prophylactic therapy. Results Thirty one patients (25%) were stratified as high risk, and 94 (75%) as low risk. Five (16%) of the high risk patients became hypocalcemic despite prophylactic therapy. Two of the low risk group became hypocalcemic, (negative predictive value = 98%). None of the hypocalcemic patients had anything more than mild symptoms. Conclusions A single 1-hour post-thyroidectomy PTH level is a very useful way to stratify thyroidectomy patients into high and low risk groups for development of hypocalcemia. Early implementation of oral prophylactic calcium and vitamin D in the high risk patients is a very effective way to prevent serious hypocalcemia. Complex protocols requiring multiple calcium and PTH measurements are not required to guide post-thyroidectomy management. PMID:24476535

Study protocol for the recruitment of female sex workers and their non-commercial partners into couple-based HIV research.

PubMed

Syvertsen, Jennifer L; Robertson, Angela M; Abramovitz, Daniela; Rangel, M Gudelia; Martinez, Gustavo; Patterson, Thomas L; Ulibarri, Monica D; Vera, Alicia; El-Bassel, Nabila; Strathdee, Steffanie A

2012-02-20

Researchers are increasingly recognizing the importance of addressing sexual and drug-related HIV risk within the context of intimate relationships rather than solely focusing on individual behaviors. Practical and effective methods are needed to recruit, screen, and enroll the high risk and hard-to-reach couples who would most benefit from HIV interventions, such as drug-using female sex workers (FSWs) and their intimate, non-commercial partners. This paper outlines a bi-national, multidisciplinary effort to develop and implement a study protocol for research on the social context and epidemiology of HIV, sexually transmitted infections (STI), and high risk behaviors among FSWs and their non-commercial male partners in Tijuana and Ciudad Juarez, Mexico. We provide an overview of our study and specifically focus on the sampling, recruitment, screening, and successful enrollment of high risk couples into a public health study in this context. We used targeted and snowball sampling to recruit couples through the female partner first and administered a primary screener to check her initial eligibility. Willing and eligible females then invited their primary male partners for couple-based screening using a couple verification screening (CVS) instrument adapted from previous studies. The CVS rechecked eligibility and separately asked each partner the same questions about their relationship to "test" if the couple was legitimate. We adapted the original protocol to consider issues of gender and power within the local cultural and socioeconomic context and expanded the question pool to create multiple versions of the CVS that were randomly administered to potential couples to determine eligibility and facilitate study enrollment. The protocol successfully enrolled 214 high risk couples into a multi-site public health study. This work suggests the importance of collaborating to construct a study protocol, understanding the local population and context, and drawing on multiple sources of input to determine eligibility and verify the legitimacy of relationships. We provide a practical set of tools that other researchers should find helpful in the study of high risk couples in international settings, with particular relevance to studies of FSWs and their intimate partners.

Study protocol for the recruitment of female sex workers and their non-commercial partners into couple-based HIV research

PubMed Central

2012-01-01

Background Researchers are increasingly recognizing the importance of addressing sexual and drug-related HIV risk within the context of intimate relationships rather than solely focusing on individual behaviors. Practical and effective methods are needed to recruit, screen, and enroll the high risk and hard-to-reach couples who would most benefit from HIV interventions, such as drug-using female sex workers (FSWs) and their intimate, non-commercial partners. This paper outlines a bi-national, multidisciplinary effort to develop and implement a study protocol for research on the social context and epidemiology of HIV, sexually transmitted infections (STI), and high risk behaviors among FSWs and their non-commercial male partners in Tijuana and Ciudad Juarez, Mexico. We provide an overview of our study and specifically focus on the sampling, recruitment, screening, and successful enrollment of high risk couples into a public health study in this context. Methods/Design We used targeted and snowball sampling to recruit couples through the female partner first and administered a primary screener to check her initial eligibility. Willing and eligible females then invited their primary male partners for couple-based screening using a couple verification screening (CVS) instrument adapted from previous studies. The CVS rechecked eligibility and separately asked each partner the same questions about their relationship to "test" if the couple was legitimate. We adapted the original protocol to consider issues of gender and power within the local cultural and socioeconomic context and expanded the question pool to create multiple versions of the CVS that were randomly administered to potential couples to determine eligibility and facilitate study enrollment. Discussion The protocol successfully enrolled 214 high risk couples into a multi-site public health study. This work suggests the importance of collaborating to construct a study protocol, understanding the local population and context, and drawing on multiple sources of input to determine eligibility and verify the legitimacy of relationships. We provide a practical set of tools that other researchers should find helpful in the study of high risk couples in international settings, with particular relevance to studies of FSWs and their intimate partners. PMID:22348625

The association between job strain and coronary heart disease: a meta-analysis of prospective cohort studies.

PubMed

Xu, Shuxian; Huang, Yuli; Xiao, Jiping; Zhu, Wenjing; Wang, Lulu; Tang, Hongfeng; Hu, Yunzhao; Liu, Tiebang

2015-01-01

Studies about work stress and the risk of coronary heart disease (CHD) have yielded inconsistent results. This meta-analysis aimed to investigate the association between job strain and the risk of CHD. We searched PubMed and Embase databases for studies reporting data on job strain and the risk of CHD. Studies were included if they reported multiple-adjusted relative risk (RR) with 95% confidence interval (CI) with respect to CHD from job strain. Fourteen prospective cohort studies comprising 232,767 participants were included. The risk of CHD was increased in high-strain (RR 1.26; 95% CI 1.12-1.41) and passive jobs (RR 1.14; 95% CI 1.02-1.29) but not in active jobs (RR 1.09; 95% CI 0.97-1.22), when compared with low-strain group. The increased risk of CHD in high-strain and passive jobs was mainly driven by studies with a follow-up duration of ≥ 10 years. Neither the low-control (RR 1.06; 95% CI 0.93-1.19) nor high-demand (RR 1.13; 95% CI 0.97-1.32) dimension was independently associated with the risk of CHD. Individuals with high-strain and passive jobs were more likely to experience a CHD event. Intervention programs incorporating individual and organizational levels are crucial for reducing job strain and the risk of CHD.

Achilles tendon injury risk factors associated with running.

PubMed

Lorimer, Anna V; Hume, Patria A

2014-10-01

Research into the nature of overuse Achilles tendon injuries is extensive, yet uncertainty remains around how to identify athletes susceptible to Achilles tendon injury. To identify the strength of evidence for biomechanical risk factors associated with Achilles tendon injuries. SPORTDiscus, CINAHL, Web of Science and PubMed were searched for Achilles tendon injury risk factors and biomechanical measures which are altered in runners with Achilles tendon injuries, excluding ruptures. Fifteen articles were included in the analysis. Two variables, high vertical forces and high arch, showed strong evidence for reduced injury risk. High propulsive forces and running on stiffer surfaces may also be protective. Only one biomechanical variable, high braking force, showed clear evidence for increasing Achilles injury risk. Gait retraining to direct the centre of mass further forward to reduce high braking force could be useful in decreasing the risk of Achilles injury. The majority of biomechanical risk factors examined showed unclear results, which is likely due to the multifactorial nature of Achilles overuse injuries. Many risk factors are related to how the athlete's body interacts with the environment during gait, including ground reaction forces, muscle activity both prior to landing and immediately post ground contact, and joint motion throughout stance. Multiple risk factors have been associated with the development of Achilles tendon injuries in running athletes but most effects remain unclear. Advice for athletes recovering from Achilles tendon injuries could include avoiding soft surfaces and reducing the pace of recovery runs. Orthotic intervention could assist athletes with low arches but modification of pronation should be viewed with caution. Strength training and gait retraining could be beneficial for reducing injury risk.

Medullary Thyroid Carcinoma in MEN2A: ATA Moderate- or High-Risk RET Mutations Do Not Predict Disease Aggressiveness.

PubMed

Voss, Rachel K; Feng, Lei; Lee, Jeffrey E; Perrier, Nancy D; Graham, Paul H; Hyde, Samuel M; Nieves-Munoz, Frances; Cabanillas, Maria E; Waguespack, Steven G; Cote, Gilbert J; Gagel, Robert F; Grubbs, Elizabeth G

2017-08-01

High-risk RET mutations (codon 634) are associated with earlier development of medullary thyroid carcinoma (MTC) and presumed increased aggressiveness compared with moderate-risk RET mutations. To determine whether high-risk RET mutations are more aggressive. Retrospective cohort study using institutional multiple endocrine neoplasia type 2 registry. Tertiary cancer care center. Patients with MTC and moderate- or high-risk germline RET mutation. None (observational study). Proxies for aggressiveness were overall survival (OS) and time to distant metastatic disease (DMD). A total of 127 moderate-risk and 135 high-risk patients were included (n = 262). Median age at diagnosis was 42.3 years (range, 6.4 to 86.4 years; mean, 41.6 years) for moderate-risk mutations and 23.0 years (range, 3.7 to 66.8 years; mean, 25.6 years) for high-risk mutations (P < 0.0001). Moderate-risk patients had more T3/T4 tumors at diagnosis (P = 0.03), but there was no significant difference for N or M stage and no significant difference in OS (P = 0.40). From multivariable analysis for OS, increasing age [hazard ratio (HR), 1.05/y; 95% confidence interval (CI), 1.03 to 1.08], T3/T4 tumor (HR, 2.73; 95% CI, 1.22 to 6.11), and M1 status at diagnosis (HR, 3.93; 95% CI, 1.61 to 9.59) were significantly associated with worse OS but high-risk mutation was not (P = 0.40). No significant difference was observed for development of DMD (P = 0.33). From multivariable analysis for DMD, only N1 status at diagnosis was significant (HR, 2.10; 95% CI, 1.03 to 4.27). Patients with high- and moderate-risk RET mutations had similar OS and development of DMD after MTC diagnosis and therefore similarly aggressive clinical courses. High-risk connotes increased disease aggressiveness; thus, future guidelines should consider RET mutation classification by disease onset (early vs late) rather than by risk (high vs moderate). Copyright © 2017 Endocrine Society

Review of Qualitative Approaches for the Construction Industry: Designing a Risk Management Toolbox

PubMed Central

Spee, Ton; Gillen, Matt; Lentz, Thomas J.; Garrod, Andrew; Evans, Paul; Swuste, Paul

2011-01-01

Objectives This paper presents the framework and protocol design for a construction industry risk management toolbox. The construction industry needs a comprehensive, systematic approach to assess and control occupational risks. These risks span several professional health and safety disciplines, emphasized by multiple international occupational research agenda projects including: falls, electrocution, noise, silica, welding fumes, and musculoskeletal disorders. Yet, the International Social Security Association says, "whereas progress has been made in safety and health, the construction industry is still a high risk sector." Methods Small- and medium-sized enterprises (SMEs) employ about 80% of the world's construction workers. In recent years a strategy for qualitative occupational risk management, known as Control Banding (CB) has gained international attention as a simplified approach for reducing work-related risks. CB groups hazards into stratified risk 'bands', identifying commensurate controls to reduce the level of risk and promote worker health and safety. We review these qualitative solutions-based approaches and identify strengths and weaknesses toward designing a simplified CB 'toolbox' approach for use by SMEs in construction trades. Results This toolbox design proposal includes international input on multidisciplinary approaches for performing a qualitative risk assessment determining a risk 'band' for a given project. Risk bands are used to identify the appropriate level of training to oversee construction work, leading to commensurate and appropriate control methods to perform the work safely. Conclusion The Construction Toolbox presents a review-generated format to harness multiple solutions-based national programs and publications for controlling construction-related risks with simplified approaches across the occupational safety, health and hygiene professions. PMID:22953194

A Risk Score for Predicting Multiple Sclerosis.

PubMed

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

2016-01-01

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

Review of qualitative approaches for the construction industry: designing a risk management toolbox.

PubMed

Zalk, David M; Spee, Ton; Gillen, Matt; Lentz, Thomas J; Garrod, Andrew; Evans, Paul; Swuste, Paul

2011-06-01

This paper presents the framework and protocol design for a construction industry risk management toolbox. The construction industry needs a comprehensive, systematic approach to assess and control occupational risks. These risks span several professional health and safety disciplines, emphasized by multiple international occupational research agenda projects including: falls, electrocution, noise, silica, welding fumes, and musculoskeletal disorders. Yet, the International Social Security Association says, "whereas progress has been made in safety and health, the construction industry is still a high risk sector." Small- and medium-sized enterprises (SMEs) employ about 80% of the world's construction workers. In recent years a strategy for qualitative occupational risk management, known as Control Banding (CB) has gained international attention as a simplified approach for reducing work-related risks. CB groups hazards into stratified risk 'bands', identifying commensurate controls to reduce the level of risk and promote worker health and safety. We review these qualitative solutions-based approaches and identify strengths and weaknesses toward designing a simplified CB 'toolbox' approach for use by SMEs in construction trades. This toolbox design proposal includes international input on multidisciplinary approaches for performing a qualitative risk assessment determining a risk 'band' for a given project. Risk bands are used to identify the appropriate level of training to oversee construction work, leading to commensurate and appropriate control methods to perform the work safely. The Construction Toolbox presents a review-generated format to harness multiple solutions-based national programs and publications for controlling construction-related risks with simplified approaches across the occupational safety, health and hygiene professions.

Risk distribution across multiple health insurance funds in rural Tanzania.

PubMed

Chomi, Eunice Nahyuha; Mujinja, Phares Gamba; Enemark, Ulrika; Hansen, Kristian; Kiwara, Angwara Dennis

2014-01-01

Multiple insurance funds serving different population groups may compromise equity due to differential revenue raising capacity and an unequal distribution of high risk members among the funds. This occurs when the funds exist without mechanisms in place to promote income and risk cross-subsidisation across the funds. This paper analyses whether the risk distribution varies across the Community Health Fund (CHF) and National Health Insurance Fund (NHIF) in two districts in Tanzania. Specifically we aim to 1) identify risk factors associated with increased utilisation of health services and 2) compare the distribution of identified risk factors among the CHF, NHIF and non-member households. Data was collected from a survey of 695 households. A multivariate logisitic regression model was used to identify risk factors for increased health care utilisation. Chi-square tests were performed to test whether the distribution of identified risk factors varied across the CHF, NHIF and non-member households. There was a higher concentration of identified risk factors among CHF households compared to those of the NHIF. Non-member households have a similar wealth status to CHF households, but a lower concentration of identified risk factors. Mechanisms for broader risk spreading and cross-subsidisation across the funds are necessary for the promotion of equity. These include risk equalisation to adjust for differential risk distribution and revenue raising capacity of the funds. Expansion of CHF coverage is equally important, by addressing non-financial barriers to CHF enrolment to encourage wealthy non-members to join, as well as subsidised membership for the poorest.

Risk of error estimated from Palestine pharmacists' knowledge and certainty on the adverse effects and contraindications of active pharmaceutical ingredients and excipients.

PubMed

Shawahna, Ramzi; Al-Rjoub, Mohammed; Al-Horoub, Mohammed M; Al-Hroub, Wasif; Al-Rjoub, Bisan; Al-Nabi, Bashaaer Abd

2016-01-01

This study aimed to investigate community pharmacists' knowledge and certainty of adverse effects and contraindications of pharmaceutical products to estimate the risk of error. Factors influencing their knowledge and certainty were also investigated. The knowledge of community pharmacists was assessed in a cross-sectional design using a multiple-choice questions test on the adverse effects and contraindications of active pharmaceutical ingredients and excipients from May 2014 to March 2015. Self-rated certainty scores were also recorded for each question. Knowledge and certainty scores were combined to estimate the risk of error. Out of 315 subjects, 129 community pharmacists (41.0%) completed the 30 multiple-choice questions test on active ingredients and excipients. Knowledge on active ingredients was associated with the year of graduation and obtaining a licence to practice pharmacy. Knowledge on excipients was associated with the degree obtained. There was higher risk of error in items on excipients than those on ingredients (P<0.01). The knowledge of community pharmacists in Palestine was insufficient with high risk of errors. Knowledge of community pharmacists on the safety issues of active ingredients and excipients need to be improved.

Glatiramer acetate treatment persistence - but not adherence - in multiple sclerosis patients is predicted by health-related quality of life and self-efficacy: a prospective web-based patient-centred study (CAIR study).

PubMed

Jongen, Peter Joseph; Lemmens, Wim A; Hoogervorst, Erwin L; Donders, Rogier

2017-03-14

In patients with relapsing remitting multiple sclerosis (RRMS) the persistence of and adherence to disease modifying drug (DMD) treatment is inadequate. To take individualised measures there is a need to identify patients with a high risk of non-persistence or non-adherence. As patient-related factors have a major influence on persistence and adherence, we investigated whether health-related quality of life (HRQoL) and self-efficacy could predict persistence or adherence. In a prospective web-based patient-centred study in 203 RRMS patients, starting treatment with glatiramer acatete (GA) 20 mg subcutaneously daily, we measured physical and mental HRQoL (Multiple Sclerosis Quality of Life-54 questionnaire), functional and control self-efficacy (Multiple Sclerosis Self-Efficacy Scale), the 12-month persistence rate and, in persistent patients, the percentage of missed doses. HRQoL and self-efficacy were compared between persistent and non-persistent patients, and between adherent and non-adherent patients. Logistic regression analysis was used to assess whether persistence and adherence were explained by HRQoL and self-efficacy. Persistent patients had higher baseline physical (mean 58.1 [standard deviation, SD] 16.9) and mental HRQoL (63.8 [16.8]) than non-persistent patients (49.5 [17.6]; 55.9 [20.4]) (P = 0.001; P = 0.003) with no differences between adherent and non-adherent patients (P = 0.46; P = 0.54). Likewise, in persistent patients function (752 [156]) and control self-efficacy (568 [178]) were higher than in non-persistent patients (689 [173]; 491 [192]) (P = 0.009; P = 0.004), but not in adherent vs. non-adherent patients (P = 0.26; P = 0.82). Logistic regression modelling identified physical HRQoL and control self-efficacy as factors that explained persistence. Based on predicted scores from the model, patients were classified into quartiles and the percentage of non-persistent patients per quartile was calculated: non-persistence in the highest quartile was 23.4 vs. 53.2% in the lowest quartile. Risk differentiation with respect to adherence was not possible. Based on these findings we propose a practical work-up scheme to identify patients with a high risk of non-persistence and to identify persistence-related factors. Findings suggest that pre-treatment physical HRQoL and control self-efficacy may identify RRMS patients with a high risk of early discontinuation of injectable DMD treatment. Targeting of high-risk patients may enable the efficient use of persistence-promoting measures. Nederlands Trial Register code: NTR2432 .

Management of monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM).

PubMed

Kyle, Robert A; Rajkumar, S Vincent

2011-06-01

Monoclonal gammopathy of undetermined significance (MGUS) is defined as a serum M protein level of less than 3 g/dL, less than 10% clonal plasma cells in the bone marrow, and the absence of end-organ damage. The prevalence of MGUS is 3.2% in the white population but is approximately twice that high in the black population. MGUS may progress to multiple myeloma, AL amyloidosis, Waldenström macroglobulinemia, or lymphoma. The risk of progression is approximately 1% per year, but the risk continues even after more than 25 years of observation. Risk factors for progression include the size of the serum M protein, the type of serum M protein, the number of plasma cells in the bone marrow, and the serum free light chain ratio. Smoldering (asymptomatic) multiple myeloma (SMM) is characterized by the presence of an M protein level of 3 g/dL or higher and/or 10% or more monoclonal plasma cells in the bone marrow but no evidence of end-organ damage. The overall risk of progression to a malignant condition is 10% per year for the first 5 years, approximately 3% per year for the next 5 years, and 1% to 2% per year for the following 10 years. Patients with both MGUS and SMM must be followed up for their lifetime.

Intensive sex partying amongst gay men in Sydney.

PubMed

Hurley, Michael; Prestage, Garrett

2009-08-01

Intensive sex partying is a framework developed to analyse specific frequent behaviours amongst a small minority of gay men in Sydney, Australia. The behaviours included a higher frequency of dance party attendance, more frequent sex, more anal sex, multiple sex partners, more unprotected anal intercourse with casual partners and more frequent drug taking. These occur at a contextual intersection between a sub-group of sexually adventurous gay men and 'party boys'. The men appear to be involved in both high-risk, adventurous sex practices and a specific form of partying distinguishable from dance partying and 'clubbing'. Sex partying occurs on multiple sites (domestic spaces; within dance parties; sex parties; sex-on-premises venues) and appears to be geared to the maximisation of sexual pleasure. Intensive sex partying describes this coincidence of factors and locates them in relation to the multiple pleasures offered by sex partying. It emphasises the importance of 'intensity' in order to understand better the relations between sex, drug use, pleasure, care and risk in some gay men's lives.

Gastrointestinal damage caused by swallowing multiple magnets.

PubMed

Liu, Shiqi; Li, Jianhui; Lv, Yi

2012-09-01

Swallowing multiple magnets is not uncommon worldwide and it frequently leads to serious consequences. However, most patients fail to receive timely and correct diagnosis and treatment. A literature search was performed to establish an algorithm for these accidents by the authors to identify relevant articles published from June 1987 to October 2010 in Google, Medline, ISI Web of Knowledge Ovid, CNKI, Korea Med and library document delivery, using search terms "magnet ingestion, " "fistula," and "perforation." A total of 149 patients with ingestion of magnetic foreign bodies from 20 countries and areas were identified. 22 of them were companioned with neurological and psychiatric disorders. Swallowing magnets occurred throughout childhood and adolescent, mostly ranging 2 to 4 years in age. Various gastrointestinal damages such as necrosis and intestinal perforation or fistula were encountered. Damage from swallowing multiple magnets carries a significant risk of morbidity and even mortality throughout childhood to adolescent worldwide. Older children and adults with neurological and psychiatric problems may be at high risk for such accidents. Early intervention is crucial.

Interleukin-6 Level among Shift and Night Workers in Japan: Cross-Sectional Analysis of the J-HOPE Study.

PubMed

Amano, Hoichi; Fukuda, Yoshiharu; Yokoo, Takashi; Yamaoka, Kazue

2018-03-27

Shift workers have a high risk of cardiovascular disease (CVD). Systemic inflammation measured has been associated with the risk of CVD onset, in addition to classical risk factors. However, the association between work schedule and inflammatory cytokine levels remains unclear. The purpose of this study was to examine the association between work schedule and interleukin-6 (IL-6)/high-sensitivity C-reactive protein (hs-CRP) levels among Japanese workers. The present cross-sectional study was a part of the Japanese Study of Health, Occupation and Psychosocial Factors Related Equity (J-HOPE). A total of 5259 persons who measured inflammatory cytokine were analyzed in this study. One-way analysis of variance was used to test log-transformed IL-6/hs-CRP differences by work schedule. Multiple regression analysis was used to examine the difference adjusted for other possible CVD risk factors. There were 3660 participants who had a regular work schedule; the remaining schedules were shift work without night work for 181 participants, shift work with night work for 1276 participants, and only night work for 142 participants. The unadjusted model showed that only night workers were significantly related to high levels of IL-6 compared with regular workers. Even in the multiple regression analysis, the higher level of IL-6 among only night workers remained significant (β=0.058, P=0.01). On the contrary, hs-CRP was not. The present study revealed that only night shift work is significantly associated with high levels of IL-6 in Japanese workers. These observations help us understand the mechanism for the association between work schedule and CVD onset.

Comparison of the performance in detection of HPV infections between the high-risk HPV genotyping real time PCR and the PCR-reverse dot blot assays.

PubMed

Zhang, Lahong; Dai, Yibei; Chen, Jiahuan; Hong, Liquan; Liu, Yuhua; Ke, Qiang; Chen, Yiwen; Cai, Chengsong; Liu, Xia; Chen, Zhaojun

2018-01-01

A new multiplex real-time PCR assay, the high-risk HPV genotyping real time PCR assay (HR HPV RT-PCR), has been developed to detect 15 high-risk HPV types with respective viral loads. In this report, a total of 684 cervical specimens from women diagnosed with vaginitis were assessed by the HR HPV RT-PCR and the PCR reaction and reverse dot blot (PCR-RDB) assays, using a PCR-sequencing method as a reference standard. A total coincidence of 97.7% between the HR HPV RT PCR and the PCR-RDB assays was determined with a Kappa value of 0.953. The HR HPV RT PCR assay had sensitivity, specificity, and concordance rates (accuracy) of 99.7%, 99.7%, and 99.7%, respectively, as confirmed by PCR-sequencing, while the PCR-RDB assay had respective rates of 98.8%, 97.1%, and 98.0%. The overall rate of HPV infection, determined by PCR-sequencing, in women diagnosed with vaginitis was 49.85%, including 36.26% of single infection and 13.6% of multiple infections. The most common infections among the 15 high-risk HPV types in women diagnosed with vaginitis were HPV-52, HPV-16, and HPV-58, with a total detection rate of 10.23%, 7.75%, and 5.85%, respectively. We conclude that the HR HPV RT PCR assay exhibits better clinical performance than the PCR-RDB assay, and is an ideal alternative method for HPV genotyping. In addition, the HR HPV RT PCR assay provides HPV DNA viral loads, and could serve as a quantitative marker in the diagnosis and treatment of single and multiple HPV infections. © 2017 Wiley Periodicals, Inc.

High-risk of obstructive sleep apnea and excessive daytime sleepiness among commercial intra-city drivers in Lagos metropolis

PubMed Central

Ozoh, Obianuju B.; Okubadejo, Njideka U.; Akanbi, Maxwell O.; Dania, Michelle G.

2013-01-01

Background: The burden of obstructive sleep apnea among commercial drivers in Nigeria is not known. Aim: To assess the prevalence of high risk of obstructive sleep apnea (OSA) and excessive daytime sleepiness (EDS) among intra-city commercial drivers. Setting and Design: A descriptive cross-sectional study in three major motor parks in Lagos metropolis. Materials and Methods: Demographic, anthropometric and historical data was obtained. The risk of OSA and EDS was assessed using the STOP BANG questionnaire and the Epworth Sleepiness Scale, respectively. Statistical Analysis: The relationship between the OSA risk, EDS risk and past road traffic accident (RTA) was explored using the Pearson's chi square. Independent determinants of OSA risk, EDS risk and past RTA, respectively, were assessed by multiple logistic regression models. Result: Five hundred male commercial drivers (mean age (years) ±SD = 42.36 ± 11.17 and mean BMI (kg/m2) ±SD = 25.68 ± 3.79) were recruited. OSA risk was high in 244 (48.8%) drivers and 72 (14.4%) had EDS. There was a positive relationship between OSA risk and the risk of EDS (Pearson's X2 = 28.2, P < 0.001). Sixty-one (12.2%) drivers had a past history of RTA but there was no significant relationship between a past RTA and either OSA risk (X2 = 2.05, P = 0.15) or EDS risk (X2 = 2.7, P = 0.1), respectively. Abdominal adiposity, regular alcohol use and EDS were independent determinants of OSA risk while the use of cannabis and OSA risk were independent determinants of EDS. No independent risk factor for past RTA was identified. Conclusion: A significant proportion of commercial drivers in Lagos metropolis are at high risk of OSA and EDS. PMID:24249946

Contribution of 20 single nucleotide polymorphisms of 13 genes to dyslipidemia associated with antiretroviral therapy.

PubMed

Arnedo, Mireia; Taffé, Patrick; Sahli, Roland; Furrer, Hansjakob; Hirschel, Bernard; Elzi, Luigia; Weber, Rainer; Vernazza, Pietro; Bernasconi, Enos; Darioli, Roger; Bergmann, Sven; Beckmann, Jacques S; Telenti, Amalio; Tarr, Philip E

2007-09-01

HIV-1 infected individuals have an increased cardiovascular risk which is partially mediated by dyslipidemia. Single nucleotide polymorphisms in multiple genes involved in lipid transport and metabolism are presumed to modulate the risk of dyslipidemia in response to antiretroviral therapy. The contribution to dyslipidemia of 20 selected single nucleotide polymorphisms of 13 genes reported in the literature to be associated with plasma lipid levels (ABCA1, ADRB2, APOA5, APOC3, APOE, CETP, LIPC, LIPG, LPL, MDR1, MTP, SCARB1, and TNF) was assessed by longitudinally modeling more than 4400 plasma lipid determinations in 438 antiretroviral therapy-treated participants during a median period of 4.8 years. An exploratory genetic score was tested that takes into account the cumulative contribution of multiple gene variants to plasma lipids. Variants of ABCA1, APOA5, APOC3, APOE, and CETP contributed to plasma triglyceride levels, particularly in the setting of ritonavir-containing antiretroviral therapy. Variants of APOA5 and CETP contributed to high-density lipoprotein-cholesterol levels. Variants of CETP and LIPG contributed to non-high-density lipoprotein-cholesterol levels, a finding not reported previously. Sustained hypertriglyceridemia and low high-density lipoprotein-cholesterol during the study period was significantly associated with the genetic score. Single nucleotide polymorphisms of ABCA1, APOA5, APOC3, APOE, and CETP contribute to plasma triglyceride and high-density lipoprotein-cholesterol levels during antiretroviral therapy exposure. Genetic profiling may contribute to the identification of patients at risk for antiretroviral therapy-related dyslipidemia.

Adherence to preferable behavior for lipid control by high-risk dyslipidemic Japanese patients under pravastatin treatment: the APPROACH-J study.

PubMed

Kitagawa, Yasuhisa; Teramoto, Tamio; Daida, Hiroyuki

2012-01-01

We evaluated the impact of adherence to preferable behavior on serum lipid control assessed by a self-reported questionnaire in high-risk patients taking pravastatin for primary prevention of coronary artery disease. High-risk patients taking pravastatin were followed for 2 years. Questionnaire surveys comprising 21 questions, including 18 questions concerning awareness of health, and current status of diet, exercise, and drug therapy, were conducted at baseline and after 1 year. Potential domains were established by factor analysis from the results of questionnaires, and adherence scores were calculated in each domain. The relationship between adherence scores and lipid values during the 1-year treatment period was analyzed by each domain using multiple regression analysis. A total of 5,792 patients taking pravastatin were included in the analysis. Multiple regression analysis showed a significant correlation in terms of "Intake of high fat/cholesterol/sugar foods" (regression coefficient -0.58, p=0.0105) and "Adherence to instructions for drug therapy" (regression coefficient -6.61, p<0.0001). Low-density lipoprotein cholesterol (LDL-C) values were significantly lower in patients who had an increase in the adherence score in the "Awareness of health" domain compared with those with a decreased score. There was a significant correlation between high-density lipoprotein (HDL-C) values and "Awareness of health" (regression coefficient 0.26; p= 0.0037), "Preferable dietary behaviors" (regression coefficient 0.75; p<0.0001), and "Exercise" (regression coefficient 0.73; p= 0.0002). Similar relations were seen with triglycerides. In patients who have a high awareness of their health, a positive attitude toward lipid-lowering treatment including diet, exercise, and high adherence to drug therapy, is related with favorable overall lipid control even in patients under treatment with pravastatin.

Tissue Banks and Cell Lines Derived from Patients with a High Risk of Breast Cancer and in situ Disease

DTIC Science & Technology

1998-05-01

multiple molecular abnormalities which progressively accumulate to result in the clinical and morphological phenotypes seen as breast cancer. As the...ill defined and thus all patients with a first or second degree relative affected were recorded. Clinical data, mammograms, and information on risk...This has been done in conjunction with a record of all the clinical data available relating to the macroscopic appearance of the lesions, diagnostic

Legionnaires' disease as an occupational risk related to decontamination work after the Fukushima nuclear disaster: A case report

PubMed Central

Sawano, Toyoaki; Tsubokura, Masaharu; Ozaki, Akihiko; Leppold, Claire; Kato, Shigeaki; Kambe, Toshiyuki

2017-01-01

Objectives: Legionnaires' disease (LD), which is atypical pneumonia with a broad variety of clinical symptoms, can lead to death despite its low incidence. There are multiple risk factors for LD, yet little information is available concerning what kind of environmental factors are linked to higher risk of LD development. We have experienced a fatal case of LD, which occurred in a decontamination worker after the Fukushima nuclear disaster. Case: A 53-year-old Japanese male visited our hospital with symptoms of fever, vomiting, diarrhea, and altered mental status, but not with respiratory manifestations. He was engaged in decontamination work, which generally includes operations such as the removal of topsoil in mountainous areas and cleaning roads and roofs of residential buildings with high-pressure water. He was required to wear specific equipment to prevent radiation exposure, and lived in a workers' dormitory or shared house, thereby sharing spaces with other workers. Normal antibiotic therapy did not improve his symptoms following his diagnosis with pneumonia. A urinary antigen detection test was then conducted, leading to a diagnosis of LD. Despite the change of antibiotic to levofloxacin, multiple organ failure led to his death. Conclusion: Decontamination workers may be at a high risk for developing LD and living and working conditions among them are possible contributors. PMID:29311436

Evaluation of Revised International Staging System (R-ISS) for transplant-eligible multiple myeloma patients.

PubMed

González-Calle, Verónica; Slack, Abigail; Keane, Niamh; Luft, Susan; Pearce, Kathryn E; Ketterling, Rhett P; Jain, Tania; Chirackal, Sintosebastian; Reeder, Craig; Mikhael, Joseph; Noel, Pierre; Mayo, Angela; Adams, Roberta H; Ahmann, Gregory; Braggio, Esteban; Stewart, A Keith; Bergsagel, P Leif; Van Wier, Scott A; Fonseca, Rafael

2018-04-06

The International Myeloma Working Group has proposed the Revised International Staging System (R-ISS) for risk stratification of multiple myeloma (MM) patients. There are a limited number of studies that have validated this risk model in the autologous stem cell transplant (ASCT) setting. In this retrospective study, we evaluated the applicability and value for predicting survival of the R-ISS model in 134 MM patients treated with new agents and ASCT at the Mayo Clinic in Arizona and the University Hospital of Salamanca in Spain. The patients were reclassified at diagnosis according to the R-ISS: 44 patients (33%) had stage I, 75 (56%) had stage II, and 15 (11%) had stage III. After a median follow-up of 60 months, R-ISS assessed at diagnosis was an independent predictor for overall survival (OS) after ASCT, with median OS not reached, 111 and 37 months for R-ISS I, II and III, respectively (P < 0.001). We also found that patients belonging to R-ISS II and having high-risk chromosomal abnormalities (CA) had a significant shorter median OS than those with R-ISS II without CA: 70 vs. 111 months, respectively. Therefore, this study lends further support for the R-ISS as a reliable prognostic tool for estimating survival in transplant myeloma patients and suggests the importance of high-risk CA in the R-ISS II group.

What role does transactional sex play in the HIV/STI and reproductive health risk behaviour among high-tier entertainment centre workers in China?

PubMed

Mantell, Joanne E; LeVasseur, Michael T; Sun, Xiaoming; Zhou, Jiangfang; Mao, Jingshu; Peng, Yanhui; Zhou, Feng; DiCarlo, Abby L; Kelvin, Elizabeth A

2015-01-01

China's rapid economic growth over the last three decades has led to increased population wealth and the proliferation of entertainment centres where people can conduct business, relax and meet new people. Little is known about the sexual risk behaviours of employees at high-tier entertainment centres. This paper addresses this gap in knowledge by comparing HIV risk perception and sexual and reproductive health behaviours among female and male employees at three high-tier entertainment centres in two cities in China, comparing those who report a history of transactional sex to those who do not. In both cities, participants who reported a history of transactional sex were more likely than those without a history of transactional sex to report multiple sexual partnerships, more lifetime sexual partners, a history of sexually transmitted infections (STIs), having anal sex and/or recent abortions, and were more likely to perceive themselves to be at risk for STIs/HIV. However, risk behaviour was also high among those with no history of transactional sex. These findings highlight the need for targeted sexual and reproductive health initiatives for employees in these work settings.

What role does transactional sex play in the HIV/STI and reproductive health risk behaviour among high-tier entertainment centre workers in China?

PubMed Central

Mantell, Joanne E.; LeVasseur, Michael T.; Sun, Xiaoming; Zhou, Jiangfang; Mao, Jingshu; Peng, Yanhui; Zhou, Feng; DiCarlo, Abby L.; Kelvin, Elizabeth A.

2015-01-01

China’s rapid economic growth over the last three decades has led to increased population wealth and the proliferation of entertainment centres where people can conduct business, relax and meet new people. Little is known about the sexual risk behaviours of employees at high-tier entertainment centres. This paper addresses this gap in knowledge by comparing HIV risk perception and sexual and reproductive health behaviours among female and male employees at three high-tier entertainment centres in two cities in China, comparing those who report a history of transactional sex to those who do not. In both cities, participants who reported a history of transactional sex were more likely than those without a history of transactional sex to report multiple sexual partnerships, more lifetime sexual partners, a history of STIs, having anal sex and/or recent abortions, and were more likely to perceive themselves to be at risk for STIs/HIV. However, risk behaviour was also high among those with no history of transactional sex. These findings highlight the need for targeted sexual and reproductive health initiatives for employees in these work settings. PMID:26274897

Application of portfolio theory to risk-based allocation of surveillance resources in animal populations.

PubMed

Prattley, D J; Morris, R S; Stevenson, M A; Thornton, R

2007-09-14

Distribution of finite levels of resources between multiple competing tasks can be a challenging problem. Resources need to be distributed across time periods and geographic locations to increase the probability of detection of a disease incursion or significant change in disease pattern. Efforts should focus primarily on areas and populations where risk factors for a given disease reach relatively high levels. In order to target resources into these areas, the overall risk level can be evaluated periodically across locations to create a dynamic national risk landscape. Methods are described to integrate the levels of various risk factors into an overall risk score for each area, to account for the certainty or variability around those measures and then to allocate surveillance resources across this risk landscape. In addition to targeting resources into high risk areas, surveillance continues in lower risk areas where there is a small yet positive chance of disease occurrence. In this paper we describe the application of portfolio theory concepts, routinely used in finance, to design surveillance portfolios for a series of examples. The appropriate level of resource investment is chosen for each disease or geographical area and time period given the degree of disease risk and uncertainty present.

Suicide attempters examined in a Parisian Emergency Department: Contrasting characteristics associated with multiple suicide attempts or with the motive to die.

PubMed

Perquier, Florence; Duroy, David; Oudinet, Camille; Maamar, Alya; Choquet, Christophe; Casalino, Enrique; Lejoyeux, Michel

2017-07-01

Among patients examined after a suicide attempt in a Parisian emergency department, we aimed to compare individual characteristics of i) first time and multiple suicide attempters, ii) attempters whose principal motive was "to die" and attempters who had any other motive. Information regarding sociodemographics, clinical characteristics, prior mental health care and outgoing referral was collected in 168 suicide attempters using a standardized form. Associations of these variables with suicide attempt repetition (yes or no) and with the motive underlying the attempt (to die or not) were examined using descriptive statistics and multivariable logistic regression models. Multiple attempters were more likely to have no occupation and to report previous mental health care: mental health follow-up, psychiatric medication or psychiatric hospitalization. The motive to die was not associated with the risk of multiple suicide attempts but related to past suicidal ideation and to some specific precipitating factors, including psychiatric disorder. Patients who intended to die were also more likely to be referred to inpatient than to outpatient psychiatric care. Multiple attempters and attempters who desire to die might represent two distinct high-risk groups regarding clinical characteristics and care pathways. They would probably not benefit from the same intervention strategies. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

Epidemiology of multiple childhood traumatic events: child abuse, parental psychopathology, and other family-level stressors.

PubMed

Menard, C B; Bandeen-Roche, K J; Chilcoat, H D

2004-11-01

Multiple family-level childhood stressors are common and are correlated. It is unknown if clusters of commonly co-occurring stressors are identifiable. The study was designed to explore family-level stressor clustering in the general population, to estimate the prevalence of exposure classes, and to examine the correlation of sociodemographic characteristics with class prevalence. Data were collected from an epidemiological sample and analyzed using latent class regression. A six-class solution was identified. Classes were characterized by low risk (prevalence=23%), universal high risk (7 %), family conflict (11 %), household substance problems (22 %), non-nuclear family structure (24 %), parent's mental illness (13 %). Class prevalence varied with race and welfare status, not gender. Interventions for childhood stressors are person-focused; the analytic approach may uniquely inform resource allocation.

Left Thoracotomy HeartWare Implantation With Outflow Graft Anastomosis to the Descending Aorta: A Simplified Bridge for Patients With Multiple Previous Sternotomies

PubMed Central

Umakanthan, Ramanan; Haglund, Nicholas A.; Stulak, John M.; Joyce, Lyle D.; Ahmad, Rashid; Keebler, Mary E.; Maltais, Simon

2014-01-01

Advances in mechanical circulatory support have been critical in bridging patients awaiting heart transplantation. In addition, improvement in device durability has enabled left ventricular assist device therapy to be applied as destination therapy in those not felt to be transplant candidate. Because of the increasing complexity of patients, there continues to be a need for alternative strategies for device implantation to bridge high-risk patients awaiting heart transplantation, wherein the risks of numerous previous sternotomies may be prohibitive. We present a unique technique for placement of the HeartWare ventricular assist device via left anterior thoracotomy to the descending aorta in a patient awaiting heart transplantation with a history of multiple previous sternotomies. PMID:24172273

Comprehensive approach to the management of the patient with multiple rib fractures: a review and introduction of a bundled rib fracture management protocol.

PubMed

Witt, Cordelie E; Bulger, Eileen M

2017-01-01

Rib fractures are common among patients sustaining blunt trauma, and are markers of severe bodily and solid organ injury. They are associated with high morbidity and mortality, including multiple pulmonary complications, and can lead to chronic pain and disability. Clinical and radiographic scoring systems have been developed at several institutions to predict risk of complications. Clinical strategies to reduce morbidity have been studied, including multimodal pain management, catheter-based analgesia, pulmonary hygiene, and operative stabilization. In this article, we review risk factors for morbidity and complications, intervention strategies, and discuss experience with bundled clinical pathways for rib fractures. In addition, we introduce the multidisciplinary rib fracture management protocol used at our level I trauma center.

Critical pathogenic steps to high risk Helicobacter pylori gastritis and gastric carcinogenesis

PubMed Central

Lee, Inchul

2014-01-01

Helicobacter pylori (H. pylori) gastritis may progress to high risk gastropathy and cancer. However, the pathological progression has not been characterized in detail. H. pylori induce persistent inflammatory infiltration. Neutrophils are unique in that they directly infiltrate into foveolar epithelium aiming the proliferative zone specifically. Neutrophilic proliferative zone foveolitis is a critical pathogenic step in H. pylori gastritis inducing intensive epithelial damage. Epithelial cells carrying accumulated genomic damage and mutations show the Malgun (clear) cell change, characterized by large clear nucleus and prominent nucleolus. Malgun cells further undergo atypical changes, showing nuclear folding, coarse chromatin, and multiple nucleoli. The atypical Malgun cell (AMC) change is a novel premalignant condition in high risk gastropathy, which may progress and undergo malignant transformation directly. The pathobiological significance of AMC in gastric carcinogenesis is reviewed. A new diagnosis system of gastritis is proposed based on the critical pathologic steps classifying low and high risk gastritis for separate treatment modality. It is suggested that the regulation of H. pylori-induced neutrophilic foveolitis might be a future therapeutic goal replacing bactericidal antibiotics approach. PMID:24914362

Critical pathogenic steps to high risk Helicobacter pylori gastritis and gastric carcinogenesis.

PubMed

Lee, Inchul

2014-06-07

Helicobacter pylori (H. pylori) gastritis may progress to high risk gastropathy and cancer. However, the pathological progression has not been characterized in detail. H. pylori induce persistent inflammatory infiltration. Neutrophils are unique in that they directly infiltrate into foveolar epithelium aiming the proliferative zone specifically. Neutrophilic proliferative zone foveolitis is a critical pathogenic step in H. pylori gastritis inducing intensive epithelial damage. Epithelial cells carrying accumulated genomic damage and mutations show the Malgun (clear) cell change, characterized by large clear nucleus and prominent nucleolus. Malgun cells further undergo atypical changes, showing nuclear folding, coarse chromatin, and multiple nucleoli. The atypical Malgun cell (AMC) change is a novel premalignant condition in high risk gastropathy, which may progress and undergo malignant transformation directly. The pathobiological significance of AMC in gastric carcinogenesis is reviewed. A new diagnosis system of gastritis is proposed based on the critical pathologic steps classifying low and high risk gastritis for separate treatment modality. It is suggested that the regulation of H. pylori-induced neutrophilic foveolitis might be a future therapeutic goal replacing bactericidal antibiotics approach.

HIV Risk Perception and Risky Behavior Among People Who Inject Drugs in Kermanshah, Western Iran.

PubMed

Noroozi, Mehdi; Ahounbar, Elahe; Karimi, Salah Eddin; Ahmadi, Sina; Najafi, Mohammad; Bazrafshan, Ali; Shushtari, Zahra Jorjoran; Farhadi, Mohammad Hassan; Higgs, Peter; Rezaei, Fatemeh; Ghiasvand, Hesam; Sharhani, Asaad; Armoon, Bahram; Waye, Katherine

2017-08-01

Understanding and increasing awareness on individual risk for HIV infection as well as HIV risk perception's effects on different behavioral outcomes for people who inject drugs (PWID) is important for policymaking and planning purposes. The objectives of the present study were to determine whether HIV risk perception was associated with greater injection and sexual risk-taking behaviors among PWIDs. We surveyed 460 PWID in Kermanshah regarding their demographic characteristics, sexual risk behaviors, HIV risk perception, and drug-related risk behaviors in the month prior to the study. Three classes of HIV risk perception were identified using ordinal regression to determine factors associated with HIV risk perception. Study participants were categorized as follows: "low" (n = 100, 22%), "moderate" (n = 150, 32%), and "high" (n = 210, 46%) risk perception for becoming infected with HIV. The odds of categorizing as "high" risk for HIV was significantly greater in PWID that reported unprotected sex (adjusted odds ratio (AOR) 2.4, p value 0.02), receptive syringe sharing (AOR 1.8, p value 0.01), and multiple sex partners (AOR 1.4, p value 0.03). PWID who reported unprotected sex had 2.7 times the odds of "high" risk perception when compared to PWID with "low" risk perception. Findings show that PWID could rate their HIV risk with acceptable accuracy. Additionally, perceived HIV risk was associated with many risk factors for transmission of HIV, emphasizing the importance of developing targeted prevention and harm reduction programs for all domains of risk behaviors, both sexual and drug-related use.

Factors predicting high estimated 10-year stroke risk: thai epidemiologic stroke study.

PubMed

Hanchaiphiboolkul, Suchat; Puthkhao, Pimchanok; Towanabut, Somchai; Tantirittisak, Tasanee; Wangphonphatthanasiri, Khwanrat; Termglinchan, Thanes; Nidhinandana, Samart; Suwanwela, Nijasri Charnnarong; Poungvarin, Niphon

2014-08-01

The purpose of the study was to determine the factors predicting high estimated 10-year stroke risk based on a risk score, and among the risk factors comprising the risk score, which factors had a greater impact on the estimated risk. Thai Epidemiologic Stroke study was a community-based cohort study, which recruited participants from the general population from 5 regions of Thailand. Cross-sectional baseline data of 16,611 participants aged 45-69 years who had no history of stroke were included in this analysis. Multiple logistic regression analysis was used to identify the predictors of high estimated 10-year stroke risk based on the risk score of the Japan Public Health Center Study, which estimated the projected 10-year risk of incident stroke. Educational level, low personal income, occupation, geographic area, alcohol consumption, and hypercholesterolemia were significantly associated with high estimated 10-year stroke risk. Among these factors, unemployed/house work class had the highest odds ratio (OR, 3.75; 95% confidence interval [CI], 2.47-5.69) followed by illiterate class (OR, 2.30; 95% CI, 1.44-3.66). Among risk factors comprising the risk score, the greatest impact as a stroke risk factor corresponded to age, followed by male sex, diabetes mellitus, systolic blood pressure, and current smoking. Socioeconomic status, in particular, unemployed/house work and illiterate class, might be good proxy to identify the individuals at higher risk of stroke. The most powerful risk factors were older age, male sex, diabetes mellitus, systolic blood pressure, and current smoking. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Patterns of Gender-Based Violence and Associations with Mental Health and HIV Risk Behavior Among Female Sex Workers in Mombasa, Kenya: A Latent Class Analysis.

PubMed

Roberts, Sarah T; Flaherty, Brian P; Deya, Ruth; Masese, Linnet; Ngina, Jacqueline; McClelland, R Scott; Simoni, Jane; Graham, Susan M

2018-03-30

Gender-based violence (GBV) is common among female sex workers (FSWs) and is associated with multiple HIV risk factors, including poor mental health, high-risk sexual behavior, and sexually transmitted infections (STIs). Prior studies have focused on GBV of one type (e.g. physical or sexual) or from one kind of perpetrator (e.g., clients or regular partners), but many FSWs experience overlapping types of violence from multiple perpetrators, with varying frequency and severity. We examined the association between lifetime patterns of GBV and HIV risk factors in 283 FSWs in Mombasa, Kenya. Patterns of GBV were identified with latent class analysis based on physical, sexual, or emotional violence from multiple perpetrators. Cross-sectional outcomes included depressive symptoms, post-traumatic stress disorder (PTSD) symptoms, disordered alcohol and other drug use, number of sex partners, self-reported unprotected sex, prostate-specific antigen (PSA) in vaginal secretions, and a combined unprotected sex indicator based on self-report or PSA detection. We also measured HIV/STI incidence over 12 months following GBV assessment. Associations between GBV patterns and each outcome were modeled separately using linear regression for mental health outcomes and Poisson regression for sexual risk outcomes. Lifetime prevalence of GBV was 87%. We identified 4 GBV patterns, labeled Low (21% prevalence), Sexual (23%), Physical/Moderate Emotional (18%), and Severe (39%). Compared to women with Low GBV, those with Severe GBV had higher scores for depressive symptoms, PTSD symptoms, and disordered alcohol use, and had more sex partners. Women with Sexual GBV had higher scores for disordered alcohol use than women with Low GBV, but similar sexual risk behavior. Women with Physical/Moderate Emotional GBV had more sex partners and a higher prevalence of unprotected sex than women with Low GBV, but no differences in mental health. HIV/STI incidence did not differ significantly by GBV pattern. The prevalence of GBV was extremely high in this sample of Kenyan FSWs, and different GBV patterns were associated with distinct mental health and sexual risk outcomes. Increased understanding of how health consequences vary by GBV type and severity could lead to more effective programs to reduce HIV risk in this vulnerable population.

Intervening with High Risk Youth: A Program Model.

ERIC Educational Resources Information Center

Davis, Ruth B.; And Others

1994-01-01

Describes a program for older adolescents exhibiting substance use problems. After initial assessment and referral, most patients enter outpatient treatment groups. Groups fulfill three purposes: (1) Staff monitors clients; (2) Help clients recognize the promise of recovery; and (3) Change behavior. Difficulties of working with multiple community…

Mitigating Risks to Pregnant Teens from Zika Virus.

PubMed

Maynard, Andrew D; Bowman, Diana M; Hodge, James G

2016-12-01

Zika infection in pregnant women is associated with an elevated probability of giving birth to a child with microcephaly and multiple other disabilities. Public health messaging on Zika prevention has predominantly targeted women who know they are pregnant or intend to become pregnant, but not teenage females for whom unintended pregnancy is more likely. Vulnerabilities among this population to reproductive risks associated with Zika are further amplified by restrictive abortion laws in several Zika-impacted states. Key to prevention is enhanced, targeted public health messaging centered on teens nationally and particularly in certain high-risk regions.

The Effect of Childhood Supervisory Neglect on Emerging Adults’ Drinking

PubMed Central

Snyder, Susan M.; Merritt, Darcey H.

2016-01-01

This study investigated the effect of childhood supervisory neglect on emerging adults’ drinking. Child supervisory neglect is the most common form of child maltreatment in the United States, but few studies explore supervisory neglect separate from other forms of maltreatment among emerging adults, 18–25 years old. The study sample included (n = 11,117) emerging adults, 18–25 years old who participated in Waves I and III of the National Longitudinal Study of Adolescent Health (Add Health). We conducted separate analyses for male and female emerging adults, because they have different rates of alcohol consumption and alcohol risk behaviors. Our study used latent class analysis to understand how patterns of alcohol risk behaviors clustered together. For males, we found the following four classes: (1) multiple-risk drinkers, (2) moderate-risk drinkers, (3) binge-drinkers, and (4) low-risk drinkers or abstainers. For females, we found the following three classes: (1) multiple-risk drinkers, (2) moderate-risk drinkers, and (3) low-risk drinkers or abstainers. For both males and females, supervisory neglect increased the odds of membership in the multiple-risk drinkers’ class compared to the low-risk drinkers or abstainers’ class. Single males who did not live with their parents, and who were white had increased odds of being in the multiple-risk drinkers. For females, being more educated, or in a serious romantic relationship increased the odds of membership in the multiple-risk drinkers’ class. Practitioners should ask about histories of supervisory neglect among emerging adults who engage in alcohol risk behaviors. PMID:26771736

Trends in high-risk sexual behaviors among general population groups in China: a systematic review.

PubMed

Cai, Rui; Richardus, Jan Hendrik; Looman, Caspar W N; de Vlas, Sake J

2013-01-01

The objective of this review was to investigate whether Chinese population groups that do not belong to classical high risk groups show an increasing trend of engaging in high-risk sexual behaviors. We systematically searched the English and Chinese literature on sexual risk behaviors published between January 1980 and March 2012 in PubMed and the China National Knowledge Infrastructure (CNKI). We included observational studies that focused on population groups other than commercial sex workers (CSWs) and their clients, and men who have sex with men (MSM) and quantitatively reported one of the following indicators of recent high-risk sexual behavior: premarital sex, commercial sex, multiple sex partners, condom use or sexually transmitted infections (STIs). We used generalized linear mixed model to examine the time trend in engaging in high-risk sexual behaviors. We included 174 observational studies involving 932,931 participants: 55 studies reported on floating populations, 73 on college students and 46 on other groups (i.e. out-of-school youth, rural residents, and subjects from gynecological or obstetric clinics and premarital check-up centers). From the generalized linear mixed model, no significant trends in engaging in high-risk sexual behaviors were identified in the three population groups. Sexual risk behaviors among certain general population groups have not increased substantially. These groups are therefore unlikely to incite a STI/HIV epidemic among the general Chinese population. Because the studied population groups are not necessarily representative of the general population, the outcomes found may not reflect those of the general population.

Trends in High-Risk Sexual Behaviors among General Population Groups in China: A Systematic Review

PubMed Central

Cai, Rui; Richardus, Jan Hendrik; Looman, Caspar W. N.; de Vlas, Sake J.

2013-01-01

Background The objective of this review was to investigate whether Chinese population groups that do not belong to classical high risk groups show an increasing trend of engaging in high-risk sexual behaviors. Methods We systematically searched the English and Chinese literature on sexual risk behaviors published between January 1980 and March 2012 in PubMed and the China National Knowledge Infrastructure (CNKI). We included observational studies that focused on population groups other than commercial sex workers (CSWs) and their clients, and men who have sex with men (MSM) and quantitatively reported one of the following indicators of recent high-risk sexual behavior: premarital sex, commercial sex, multiple sex partners, condom use or sexually transmitted infections (STIs). We used generalized linear mixed model to examine the time trend in engaging in high-risk sexual behaviors. Results We included 174 observational studies involving 932,931 participants: 55 studies reported on floating populations, 73 on college students and 46 on other groups (i.e. out-of-school youth, rural residents, and subjects from gynecological or obstetric clinics and premarital check-up centers). From the generalized linear mixed model, no significant trends in engaging in high-risk sexual behaviors were identified in the three population groups. Discussion Sexual risk behaviors among certain general population groups have not increased substantially. These groups are therefore unlikely to incite a STI/HIV epidemic among the general Chinese population. Because the studied population groups are not necessarily representative of the general population, the outcomes found may not reflect those of the general population. PMID:24236121

MULTIPLE NONSPECIFIC SITES OF JOINT PAIN OUTSIDE THE KNEES DEVELOP IN PERSONS WITH KNEE PAIN

PubMed Central

Felson, David T.; Niu, Jingbo; Quinn, Emily K; Neogi, Tuhina; Lewis, Cara; Lewis, Cora E.; Law, Laura Frey; McCulloch, Chuck; Nevitt, Michael; LaValley, Michael

2017-01-01

Objective Many persons with knee pain have joint pain outside the knee but despite the impact and high frequency of this pain, its distribution and causes have not been studied. Those studying gait abnormalities have suggested that knee pain causes pain in adjacent joints but pain adaptation strategies are highly individualized. Methods We studied persons age 50-79 years with or at high risk of knee osteoarthritis drawn from two community-based cohorts, the Multicenter Osteoarthritis Study and the Osteoarthritis Initiative and followed for 5-7 years. We excluded those with knee pain at baseline and compared those who developed and did not develop knee pain at the first follow-up examination (the index visit). We examined pain on most days at joint regions outside the knee in examinations after the index visit. Logistic regression analyses examined the risk of joint specific pain adjusted for age, sex, BMI, depression with sensitivity analyses excluding those with widespread pain. Results In the combined cohorts, there were 693 persons with index visit knee pain vs. 2793 without it. 79.6% of those with bilateral and 63.8% of those with unilateral knee pain had pain during follow-up in a joint region outside the knee vs. 49.9% of those without knee pain. An increased risk of pain was present in most extremity joint sites without a predilection for specific sites. Results were unchanged when those with widespread pain were excluded. Conclusions Persons with chronic knee pain are at increased risk of pain in multiple joints in no specific pattern. PMID:27589036

Prediction of Falls in Subjects Suffering From Parkinson Disease, Multiple Sclerosis, and Stroke.

PubMed

Beghi, Ettore; Gervasoni, Elisa; Pupillo, Elisabetta; Bianchi, Elisa; Montesano, Angelo; Aprile, Irene; Agostini, Michela; Rovaris, Marco; Cattaneo, Davide

2018-04-01

To compare the risk of falls and fall predictors in patients with Parkinson disease (PD), multiple sclerosis (MS), and stroke using the same study design. Multicenter prospective cohort study. Institutions for physical therapy and rehabilitation. Patients (N=299) with PD (n=94), MS (n=111), and stroke (n=94) seen for rehabilitation. Not applicable. Functional scales were applied to investigate balance, disability, daily performance, self-confidence with balance, and social integration. Patients were followed for 6 months. Telephone interviews were organized at 2, 4, and 6 months to record falls and fall-related injuries. Incidence ratios, Kaplan-Meier survival curves, and Cox proportional hazards models were used. Of the 299 patients enrolled, 259 had complete follow-up. One hundred and twenty-two patients (47.1%) fell at least once; 82 (31.7%) were recurrent fallers and 44 (17.0%) suffered injuries; and 16%, 32%, and 40% fell at 2, 4, and 6 months. Risk of falls was associated with disease type (PD, MS, and stroke in decreasing order) and confidence with balance (Activities-specific Balance Confidence [ABC] scale). Recurrent fallers were 7%, 15%, and 24% at 2, 4, and 6 months. The risk of recurrent falls was associated with disease type, high educational level, and ABC score. Injured fallers were 3%, 8%, and 12% at 2, 4, and 6 months. The only predictor of falls with injuries was disease type (PD). PD, MS, and stroke carry a high risk of falls. Other predictors include perceived balance confidence and high educational level. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Breastfeeding education and support for women with twins or higher order multiples.

PubMed

Whitford, Heather M; Wallis, Selina K; Dowswell, Therese; West, Helen M; Renfrew, Mary J

2017-02-28

There are rising rates of multiple births worldwide with associated higher rates of complications and more hospital care, often due to prematurity. While there is strong evidence about the risks of not breastfeeding, rates of breastfeeding in women who have given birth to more than one infant are lower than with singleton births. Breastfeeding more than one infant can be more challenging because of difficulties associated with the birth or prematurity. The extra demands on the mother of frequent suckling, coordinating the needs of more than one infant or admission to the neonatal intensive care unit can lead to delayed initiation or early cessation. Additional options such as breast milk expression, the use of donor milk or different methods of supplementary feeding may be considered. Support and education about breastfeeding has been found to improve the duration of any breastfeeding for healthy term infants and their mothers, however evidence is lacking about interventions that are effective to support women with twins or higher order multiples. To assess effectiveness of breastfeeding education and support for women with twins or higher order multiples. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 June 2016), ClinicalTrials.gov (30 June 2016), the WHO International Clinical Trials Registry Platform (ICTRP) (1 July 2016), the excluded studies list from the equivalent Cochrane review of singletons, and reference lists of retrieved studies. Randomised or quasi-randomised trials comparing extra education or support for women with twins or higher order multiples were included. Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We planned to assess the quality of evidence using the GRADE approach, but were unable to analyse any data. We found 10 trials (23 reports) of education and support for breastfeeding that included women with twins or higher order multiples. The quality of evidence was mixed, and the risk of bias was mostly high or unclear. It is difficult to blind women or staff to group allocation for this intervention, so in all studies there was high risk of performance and high or unclear risk of detection bias. Trials recruited 5787 women (this included 512 women interviewed as part of a cluster randomised trial); of these, data were available from two studies for 42 women with twins or higher order multiples. None of the interventions were specifically designed for women with more than one infant, and the outcomes for multiples were not reported separately for each infant. Due to the scarcity of evidence and the format in which data were reported, a narrative description of the data is presented, no analyses are presented in this review, and we were unable to GRADE the evidence.The two trials with data for women with multiple births compared home nurse visits versus usual care (15 women), and telephone peer counselling versus usual care (27 women). The number of women who initiated breastfeeding was reported (all 15 women in one study, 25 out of 27 women in one study). Stopping any breastfeeding before four to six weeks postpartum, stopping exclusive breastfeeding before four to six weeks postpartum, stopping any breastfeeding before six months postpartum andstopping exclusive breastfeeding before six months postpartum were not explicitly reported, and there were insufficient data to draw any meaningful conclusions from survival data. Stopping breast milk expression before four to six weeks postpartum, andstopping breast milk expression before six months postpartum were not reported. Measures ofmaternal satisfaction were reported in one study of 15 women, but there were insufficient data to draw any conclusions; no other secondary outcomes were reported for women with multiple births in either study. No adverse events were reported. We found no evidence from randomised controlled trials about the effectiveness of breastfeeding education and support for women with twins or higher order multiples, or the most effective way to provide education and support . There was no evidence about the best way to deliver the intervention, the timing of care, or the best person to deliver the care. There is a need for well-designed, adequately powered studies of interventions designed for women with twins or higher order multiples to find out what types of education and support are effective in helping these mothers to breastfeed their babies.

Current and future role of genetic screening in gynecologic malignancies.

PubMed

Ring, Kari L; Garcia, Christine; Thomas, Martha H; Modesitt, Susan C

2017-11-01

The world of hereditary cancers has seen exponential growth in recent years. While hereditary breast and ovarian cancer and Lynch syndrome account for the majority of mutations encountered by gynecologists, newly identified deleterious genetic mutations continue to be unearthed with their associated risks of malignancies. However, these advances in genetic cancer predispositions then force practitioners and their patients to confront the uncertainties of these less commonly identified mutations and the fact that there is limited evidence to guide them in expected cancer risk and appropriate risk-reduction strategies. Given the speed of information, it is imperative to involve cancer genetics experts when counseling these patients. In addition, coordination of screening and care in conjunction with specialty high-risk clinics, if available, allows for patients to have centralized management for multiple cancer risks under the guidance of physicians with experience counseling these patients. The objective of this review is to present the current literature regarding genetic mutations associated with gynecologic malignancies as well to propose screening and risk-reduction options for these high-risk patients. Copyright © 2017 Elsevier Inc. All rights reserved.

Stigma and suicidal ideation among young people at risk of psychosis after one year.

PubMed

Xu, Ziyan; Mayer, Benjamin; Müller, Mario; Heekeren, Karsten; Theodoridou, Anastasia; Dvorsky, Diane; Metzler, Sibylle; Oexle, Nathalie; Walitza, Susanne; Rössler, Wulf; Rüsch, Nicolas

2016-09-30

Suicidality is common among individuals at risk of psychosis. Emerging findings suggest that mental illness stigma contributes to suicidality. However, it is unclear whether stigma variables are associated with suicidality among young people at risk of psychosis. This longitudinal study assessed perceived public stigma and the cognitive appraisal of stigma as a stressor (stigma stress) as predictors of suicidal ideation among individuals at risk of psychosis over the period of one year. One hundred and seventy-two participants between 13 and 35 years of age were included who were at high or ultra-high risk of psychosis or at risk of bipolar disorder. At one-year follow-up, data were available from 73 completers. In multiple logistic regressions an increase of stigma stress (but not of perceived stigma) over one year was significantly associated with suicidal ideation at one-year follow-up, controlling for age, gender, symptoms, comorbid depression and suicidal ideation at baseline. Interventions to reduce public stigma and stigma stress could therefore improve suicide prevention among young people at risk of psychosis. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Ecological School Counseling in High-Poverty Elementary Schools: Counselors' Backgrounds and Perceptions Regarding the Effects of Poverty, Importance of Advocacy and School-Based Mental Health Programs

ERIC Educational Resources Information Center

Brown, La Vera C.

2016-01-01

Elementary school counselors working in high-poverty schools experience several challenges due to the multiple barriers associated with serving children from low-SES families. Research shows that children from low-SES families are at risk of adverse consequences to their developmental and psychological progress due to negative environmental…

Female methamphetamine users: social characteristics and sexual risk behavior.

PubMed

Semple, Shirley J; Grant, Igor; Patterson, Thomas L

2004-01-01

The primary objective of this research was to expand our knowledge regarding the personal and social characteristics of female methamphetamine (meth) users, their motivations for using meth, patterns of meth use, medical and social problems associated with meth use, and the relationship between meth use and sexual risk behaviors. The sample consisted of 98 HIV-negative, heterosexually-identified, meth-using females residing in San Diego, California. Female meth users were characterized by personal and social disadvantage, high rates of psychiatric symptomatology, and high levels of sexual risk behavior, including multiple partners, risky partner types (e.g., anonymous sex partners), and high rates of unprotected vaginal and oral sex. Meth use was also associated with the subjective positive experience of sex. These finding suggest that behavioral interventions should be tailored to the social characteristics of female meth users, and program content should reflect the intertwining of women's sexual experience and meth use.

Progressing Insights into the Role of Dietary Fats in the Prevention of Cardiovascular Disease.

PubMed

Zock, Peter L; Blom, Wendy A M; Nettleton, Joyce A; Hornstra, Gerard

2016-11-01

Dietary fats have important effects on the risk of cardiovascular disease (CVD). Abundant evidence shows that partial replacement of saturated fatty acids (SAFA) with unsaturated fatty acids improves the blood lipid and lipoprotein profile and reduces the risk of coronary heart disease (CHD). Low-fat diets high in refined carbohydrates and sugar are not effective. Very long-chain polyunsaturated n-3 or omega-3 fatty acids (n-3 VLCPUFA) present in fish have multiple beneficial metabolic effects, and regular intake of fatty fish is associated with lower risks of fatal CHD and stroke. Food-based guidelines on dietary fats recommend limiting the consumption of animal fats high in SAFA, using vegetable oils high in monounsaturated (MUFA) and polyunsaturated fatty acids (PUFA), and eating fatty fish. These recommendations are part of a healthy eating pattern that also includes ample intake of plant-based foods rich in fiber and limited sugar and salt.

Genetic testing for hereditary cancer predisposition: BRCA1/2, Lynch syndrome, and beyond.

PubMed

Hall, M J; Obeid, E I; Schwartz, S C; Mantia-Smaldone, G; Forman, A D; Daly, M B

2016-03-01

Obstetrician/gynecologists and gynecologic oncologists serve an integral role in the care of women at increased hereditary risk of cancer. Their contribution includes initial identification of high risk patients, screening procedures like bimanual exam, trans-vaginal ultrasound and endometrial biopsy, prophylaxis via TAH and/or BSO, and chemoprevention. Further, gynecologists also serve a central role in the management of the secondary repercussions of efforts to mitigate increased cancer risks, including vasomotor symptoms, sexual function, bone health, cardiovascular disease, and mental health. The past several years has seen multiple new high and moderate penetrance genes introduced into the clinical care of women at increased risk of gynecologic malignancy. Awareness of these new genes and the availability of new multi-gene panel tests is critical for providers on the front-line of women's health. Copyright © 2016 Elsevier Inc. All rights reserved.

Psychosexual and social-cognitive correlates of sexual risk behavior among male clients of female sex workers in Tijuana, Mexico

PubMed Central

Semple, Shirley J.; Strathdee, Steffanie A.; Gallardo Cruz, Manuel; Robertson, Angela; Goldenberg, Shira; Patterson, Thomas L.

2011-01-01

Male clients of female sex workers (FSWs) may act as a bridge to the general population contributing to the spread of HIV and other sexually transmitted infections in the United States and Mexico. This study used cross-sectional data to identify psychosexual and social cognitive factors associated with sexual risk behavior in a bi-national sample of 300 male clients of FSWs recruited in Tijuana, Mexico from June to October, 2008. In a multiple regression analysis, the number of unprotected vaginal sex acts with FSWs was associated with higher sexual compulsivity scores, lower self-efficacy for condom use, greater use of illicit drugs, and more financial need. Behavioral interventions are urgently needed to assist clients of FSWs in reducing high-risk behaviors in an effort to prevent the spread of HIV/STIs in this high-risk population and their sexual partners. PMID:21154035

Multiple risk-behavior profiles of smokers with serious mental illness and motivation for change.

PubMed

Prochaska, Judith J; Fromont, Sebastien C; Delucchi, Kevin; Young-Wolff, Kelly C; Benowitz, Neal L; Hall, Stephen; Bonas, Thomas; Hall, Sharon M

2014-12-01

Individuals with serious mental illness (SMI) are dying on average 25 years prematurely. The leading causes are chronic preventable diseases. In the context of a tobacco-treatment trial, this exploratory study examined the behavioral risk profiles of adults with SMI to identify broader interventional needs. Recruited from five acute inpatient psychiatry units, participants were 693 adult smokers (recruitment rate = 76%, 50% male, 45% Caucasian, age M = 39, 49% had income < $10,000) diagnosed with mood disorders (71%), substance-use disorders (63%), posttraumatic stress disorder (39%), psychotic disorders (25%), and attention deficit-hyperactivity disorder (25%). The Staging Health Risk Assessment, the primary measure used in this study, screened for risk status and readiness to change 11 health behaviors, referencing the period prior to acute hospitalization. Participants averaged 5.2 (SD = 2.1) risk behaviors, including smoking (100%), high-fat diet (68%), inadequate fruits/vegetables (67%), poor sleep (53%), physical inactivity (52%), and marijuana use (46%). The percent prepared to change ranged from 23% for tobacco and marijuana to 76% for depression management. Latent class analysis differentiated three risk groups: the global higher risk group included patients elevated on all risk behaviors; the global lower risk group was low on all risks; and a mood and metabolic risk group, characterized by inactivity, unhealthy diet, sleep problems, and poor stress and depression management. The global higher risk group (11% of sample) was younger, largely male, and had the greatest number of risk behaviors and mental health diagnoses; had the most severe psychopathologies, addiction-treatment histories, and nicotine dependence; and the lowest confidence for quitting smoking and commitment to abstinence. Most smokers with SMI engaged in multiple risks. Expanding targets to treat co-occurring risks and personalizing treatment to individuals' multibehavioral profiles may increase intervention relevance, interest, and impact on health.

The additive effects of depressive symptoms and polysubstance use on HIV risk among gay, bisexual, and other men who have sex with men.

PubMed

Card, Kiffer G; Lachowsky, Nathan J; Armstrong, Heather L; Cui, Zishan; Wang, Lu; Sereda, Paul; Jollimore, Jody; Patterson, Thomas L; Corneil, Trevor; Hogg, Robert S; Roth, Eric A; Moore, David M

2018-07-01

Among gay, bisexual, and other men who have sex with men (GBM), collinearity between polysubstance use and mental health concerns has obscured their combined effects on HIV risk with multivariable results often highlighting only one or the other. We used mediation and moderation analyses to examine the effects of polysubstance use and depressive symptoms on high-risk sex (i.e., condomless anal sex with serodiscordant/unknown status partner) in a sample of sexually-active GBM, aged ≥16 years, recruited in Metro Vancouver using respondent driven sampling. Hospital Anxiety and Depression Scale scores assessed mental health. Alcohol Use Disorder Identification Test scores assessed alcohol disorders. Poly-use of multiple drug types (e.g., stimulants, sedatives, opiates, hallucinogens) was assessed over the previous six months. Among 719 predominantly white (68.0%), gay-identified (80.7%) GBM, alcohol use was not associated with increased prevalence of high-risk sex. Controlling for demographic factors and partner number, an interaction between polysubstance use and depressive symptoms revealed that the combined effects were additively associated with increased odds for high-risk sex. Mediation models showed that polysubstance use partially mediated the relationship between depressive symptoms and high-risk sex. An interaction effect between polysubstance use (defined by using 3 or more substances in the past six months) and depressive symptoms (defined by HADS scores) revealed that the combination of these factors was associated with increased risk for high-risk sex - supporting a syndemic understanding of the production of HIV risk. Copyright © 2018 Elsevier Ltd. All rights reserved.

Nonsuicidal Self-Injury and Suicidal Behavior: A Latent Class Analysis among Young Adults

PubMed Central

Hamza, Chloe A.; Willoughby, Teena

2013-01-01

Although there is a general consensus among researchers that engagement in nonsuicidal self-injury (NSSI) is associated with increased risk for suicidal behavior, little attention has been given to whether suicidal risk varies among individuals engaging in NSSI. To identify individuals with a history of NSSI who are most at risk for suicidal behavior, we examined individual variability in both NSSI and suicidal behavior among a sample of young adults with a history of NSSI (N = 439, Mage = 19.1). Participants completed self-report measures assessing NSSI, suicidal behavior, and psychosocial adjustment (e.g., depressive symptoms, daily hassles). We conducted a latent class analysis using several characteristics of NSSI and suicidal behaviors as class indicators. Three subgroups of individuals were identified: 1) an infrequent NSSI/not high risk for suicidal behavior group, 2) a frequent NSSI/not high risk for suicidal behavior group, and 3) a frequent NSSI/high risk for suicidal behavior group. Follow-up analyses indicated that individuals in the ‘frequent NSSI/high risk for suicidal behavior’ group met the clinical-cut off score for high suicidal risk and reported significantly greater levels of suicidal ideation, attempts, and risk for future suicidal behavior as compared to the other two classes. Thus, this study is the first to identity variability in suicidal risk among individuals engaging in frequent and multiple methods of NSSI. Class 3 was also differentiated by higher levels of psychosocial impairment relative to the other two classes, as well as a comparison group of non-injuring young adults. Results underscore the importance of assessing individual differences in NSSI characteristics, as well as psychosocial impairment, when assessing risk for suicidal behavior. PMID:23544113