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

Smoldering multiple myeloma

PubMed Central

Landgren, Ola; Mateos, María-Victoria

2015-01-01

Smoldering multiple myeloma (SMM) is an asymptomatic clonal plasma cell disorder. SMM is distinguished from monoclonal gammopathy of undetermined significance by a much higher risk of progression to multiple myeloma (MM). There have been major advances in the diagnosis, prognosis, and management of SMM in the last few years. These include a revised disease definition, identification of several new prognostic factors, a classification based on underlying cytogenetic changes, and new treatment options. Importantly, a subset of patients previously considered SMM is now reclassified as MM on the basis of biomarkers identifying patients with an ≥80% risk of progression within 2 years. SMM has assumed greater significance on the basis of recent trials showing that early therapy can be potentially beneficial to patients. As a result, there is a need to accurately diagnose and risk-stratify patients with SMM, including routine incorporation of modern imaging and laboratory techniques. In this review, we outline current concepts in diagnosis and risk stratification of SMM, and provide specific recommendations on the management of SMM. PMID:25838344

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 ...

Comparative quantification of health risks: Conceptual framework and methodological issues

PubMed Central

Murray, Christopher JL; Ezzati, Majid; Lopez, Alan D; Rodgers, Anthony; Vander Hoorn, Stephen

2003-01-01

Reliable and comparable analysis of risks to health is key for preventing disease and injury. Causal attribution of morbidity and mortality to risk factors has traditionally been conducted in the context of methodological traditions of individual risk factors, often in a limited number of settings, restricting comparability. In this paper, we discuss the conceptual and methodological issues for quantifying the population health effects of individual or groups of risk factors in various levels of causality using knowledge from different scientific disciplines. The issues include: comparing the burden of disease due to the observed exposure distribution in a population with the burden from a hypothetical distribution or series of distributions, rather than a single reference level such as non-exposed; considering the multiple stages in the causal network of interactions among risk factor(s) and disease outcome to allow making inferences about some combinations of risk factors for which epidemiological studies have not been conducted, including the joint effects of multiple risk factors; calculating the health loss due to risk factor(s) as a time-indexed "stream" of disease burden due to a time-indexed "stream" of exposure, including consideration of discounting; and the sources of uncertainty. PMID:12780936

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

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.

FRAMEWORK FOR CUMULATIVE RISK ASSESSMENT (EXTERNAL REVIEW DRAFT)

EPA Science Inventory

Several reports have highlighted the importance of understanding the accumulation of risks from multiple environmental stressors. These include the National Research Councils 1994 report Science and Judgment in Risk Assessment and the 1997 report by the Presidential/Congressional...

FRAMEWORK FOR CUMULATIVE RISK ASSESSMENT (REVIEW DRAFT)

EPA Science Inventory

Several reports have highlighted the importance of understanding the accumulation of risks from multiple environmental stressors. These include the National Research Council's 1994 report Science and Judgment in Risk Assessment and the 1997 report by the Presidential/Cong...

Anthropometric characteristics and risk of multiple myeloma.

PubMed

Blair, Cindy K; Cerhan, James R; Folsom, Aaron R; Ross, Julie A

2005-09-01

Few studies have examined obesity and risk for multiple myeloma, and the results are inconsistent. Laboratory evidence suggests mechanisms through which obesity could influence carcinogenesis of this hematopoietic malignancy. We examined the association between anthropometric characteristics and incident multiple myeloma in a prospective, population-based sample of 37,083 postmenopausal women. In 1986, the women completed a mailed questionnaire that included self-report of height and weight, and friend measurement of waist and hip circumferences. During 16 years of follow up, 95 cases of multiple myeloma were identified through linkage to the Iowa Cancer Registry. In an age-adjusted model, women in the highest category of several anthropometric measurements compared with the lowest category were at increased risk of developing multiple myeloma. For body mass index (kg/m), the rate ratio (95% confidence interval) was 1.5 (0.92-2.6); for weight, 1.9 (1.1-3.4); for waist circumference, 2.0 (1.1-3.5); and for hip circumference, 1.8 (1.0-3.0). Greater adiposity may increase the risk of multiple myeloma.

Concussions and Risk Within Cultural Contexts of Play.

PubMed

Torres Colón, Gabriel Alejandro; Smith, Sharia; Fucillo, Jenny

2017-06-01

Concussions are a type of traumatic injury caused by a jolting of the brain that disrupts normal brain function, and multiple concussions can lead to serious long-term health consequences. In this article, we examine the relationship between college students' understanding of concussions and their willingness to continue playing despite the possibility of sustaining multiple head injuries. We use a mixed-methods approach that includes participant observation, cultural domain analysis, and structured interviews. Our research finds that students hold a robust cognitive understanding of concussion yet discursively frame concussions as skeletomuscular injuries. More importantly, students affirm the importance of playing sports for themselves and others, so their decisions to risk multiple concussions must be understood within cultural and biocultural contexts of meaningful social play. We suggest that peoples' decision to risk multiple head injuries should be understood as a desire for meaningful social play rather than an uninformed health risk.

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.

The quandaries and promise of risk management: a scientist's perspective on integration of science and management.

Treesearch

B.G. Marcot

2007-01-01

This paper briefly lists constraints and problems of traditional approaches to natural resource risk analysis and risk management. Such problems include disparate definitions of risk, multiple and conflicting objectives and decisions, conflicting interpretations of uncertainty, and failure of articulating decision criteria, risk attitudes, modeling assumptions, and...

Multiple sex partner behavior in female undergraduate students in China: a multi-campus survey.

PubMed

Yan, Hong; Chen, Weiqi; Wu, Haocheng; Bi, Yongyi; Zhang, Miaoxuan; Li, Shiyue; Braun, Kathryn L

2009-08-22

China is realizing increases in women engaged in premarital sex and multiple sex partner behavior. Our aim was to examine prevalence and determinants of multiple sex partner behavior among female undergraduates in China. Anonymously completed questionnaires were received from 4,769 unmarried female undergraduates, recruited using randomized cluster sampling by type of university and students' major and grade. Items captured demographic, family, peer and work influence, and student factors (major, academic performance, and sex-related knowledge and attitudes). To examine risk factors for sexual behaviors, we used multi-level logistic regression, yielding odds ratios (OR) and 95% confidence intervals (95% CI). Of 4,769 female students, 863 (18.10%) reported ever having sexual intercourse, and 5.31% reported having multiple sex partners (29.32% of all women having sexual intercourse). Several demographic, family, peer and work influences, and student factors (including major, performance, knowledge, and attitude toward sex) were risk factors for ever having sex. However, risk factors for multiple sex partners only included working in a place of entertainment, having current close friends that were living with boyfriends, poor academic performance, and positive attitudes toward multiple partners. These women also were more likely to practice masturbation, start having sex at a younger age, have sex with married men and/or men not their "boyfriends" at first coitus, and not use condoms consistently. A small but important subset of Chinese female undergraduates is engaged in unprotected sex with multiple sex partners. Interventions need to target at risk women, stressing the importance of consistent condom use.

Multiple sex partner behavior in female undergraduate students in China: A multi-campus survey

PubMed Central

Yan, Hong; Chen, Weiqi; Wu, Haocheng; Bi, Yongyi; Zhang, Miaoxuan; Li, Shiyue; Braun, Kathryn L

2009-01-01

Background China is realizing increases in women engaged in premarital sex and multiple sex partner behavior. Our aim was to examine prevalence and determinants of multiple sex partner behavior among female undergraduates in China. Methods Anonymously completed questionnaires were received from 4,769 unmarried female undergraduates, recruited using randomized cluster sampling by type of university and students' major and grade. Items captured demographic, family, peer and work influence, and student factors (major, academic performance, and sex-related knowledge and attitudes). To examine risk factors for sexual behaviors, we used multi-level logistic regression, yielding odds ratios (OR) and 95% confidence intervals (95% CI). Results Of 4,769 female students, 863 (18.10%) reported ever having sexual intercourse, and 5.31% reported having multiple sex partners (29.32% of all women having sexual intercourse). Several demographic, family, peer and work influences, and student factors (including major, performance, knowledge, and attitude toward sex) were risk factors for ever having sex. However, risk factors for multiple sex partners only included working in a place of entertainment, having current close friends that were living with boyfriends, poor academic performance, and positive attitudes toward multiple partners. These women also were more likely to practice masturbation, start having sex at a younger age, have sex with married men and/or men not their "boyfriends" at first coitus, and not use condoms consistently. Conclusion A small but important subset of Chinese female undergraduates is engaged in unprotected sex with multiple sex partners. Interventions need to target at risk women, stressing the importance of consistent condom use. PMID:19698132

Identification of appropriate patients for cardiometabolic risk management.

PubMed

Peters, Anne L

2007-01-01

Patients at increased risk for cardiovascular disease have a wide array of clinical features that should alert practitioners to the need for risk reduction. Some, but not all, of these features relate to insulin resistance. Multiple approaches exist for diagnosing and defining this risk, including the traditional Framingham risk assessment, various definitions of the metabolic syndrome, and assessment of risk factors not commonly included in the standard criteria. This article reviews the many clinical findings that should alert healthcare providers to the need for aggressive cardiovascular risk reduction.

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

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.

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.

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

EPA Science Inventory

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

Treatment Results of Postoperative Radiotherapy on Squamous Cell Carcinoma of the Oral Cavity: Coexistence of Multiple Minor Risk Factors Results in Higher Recurrence Rates

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

Fan, Kang-Hsing; Taipei Chang Gung Head and Neck Oncology Group, Chang Gung Memorial Hospital, Taiwan; Graduate Institute of Clinical Medical Sciences, Taiwan

2010-07-15

Purpose: The aim of this study was to investigate the treatment results of postoperative radiotherapy (PORT) on squamous cell carcinoma of the oral cavity (OSCC). Materials and Methods: This study included 302 OSCC patients who were treated by radical surgery and PORT. Indications for PORT include Stage III or IV OSCC according to the 2002 criteria of the American Joint Committee on Cancer, the presence of perineural invasion or lymphatic invasion, the depth of tumor invasion, or a close surgical margin. Patients with major risk factors, such as multiple nodal metastases, a positive surgical margin, or extracapsular spreading, were excluded.more » The prescribed dose of PORT ranged from 59.4 to 66.6Gy (median, 63Gy). Results: The 3-year overall and recurrence-free survival rates were 73% and 70%, respectively. Univariate analysis revealed that differentiation, perineural invasion, lymphatic invasion, bone invasion, location (hard palate and retromolar trigone), invasion depths {>=}10mm, and margin distances {<=}4mm were significant prognostic factors. The presence of multiple significant factors of univariate analysis correlated with disease recurrence. The 3-year recurrence-free survival rates were 82%, 76%, and 45% for patients with no risk factors, one or two risk factors, and three or more risk factors, respectively. After multivariate analysis, the number of risk factors and lymphatic invasion were significant prognostic factors. Conclusion: PORT may be an adequate adjuvant therapy for OSCC patients with one or two risk factors of recurrence. The presence of multiple risk factors and lymphatic invasion correlated with poor prognosis, and more aggressive treatment may need to be considered.« less

A Multiple Deficit Model of Reading Disability and Attention-Deficit/Hyperactivity Disorder: Searching for Shared Cognitive Deficits

ERIC Educational Resources Information Center

McGrath, Lauren M.; Pennington, Bruce F.; Shanahan, Michelle A.; Santerre-Lemmon, Laura E.; Barnard, Holly D.; Willcutt, Erik G.; DeFries, John C.; Olson, Richard K.

2011-01-01

Background: This study tests a multiple cognitive deficit model of reading disability (RD), attention-deficit/hyperactivity disorder (ADHD), and their comorbidity. Methods: A structural equation model (SEM) of multiple cognitive risk factors and symptom outcome variables was constructed. The model included phonological awareness as a unique…

Site-wide seismic risk model for Savannah River Site nuclear facilities

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

Eide, S.A.; Shay, R.S.; Durant, W.S.

1993-09-01

The 200,000 acre Savannah River Site (SRS) has nearly 30 nuclear facilities spread throughout the site. The safety of each facility has been established in facility-specific safety analysis reports (SARs). Each SAR contains an analysis of risk from seismic events to both on-site workers and the off-site population. Both radiological and chemical releases are considered, and air and water pathways are modeled. Risks to the general public are generally characterized by evaluating exposure to the maximally exposed individual located at the SRS boundary and to the off-site population located within 50 miles. Although the SARs are appropriate methods for studyingmore » individual facility risks, there is a class of accident initiators that can simultaneously affect several of all of the facilities, Examples include seismic events, strong winds or tornados, floods, and loss of off-site electrical power. Overall risk to the off-site population from such initiators is not covered by the individual SARs. In such cases multiple facility radionuclide or chemical releases could occur, and off-site exposure would be greater than that indicated in a single facility SAR. As a step towards an overall site-wide risk model that adequately addresses multiple facility releases, a site-wide seismic model for determining off-site risk has been developed for nuclear facilities at the SRS. Risk from seismic events up to the design basis earthquake (DBE) of 0.2 g (frequency of 2.0E-4/yr) is covered by the model. Present plans include expanding the scope of the model to include other types of initiators that can simultaneously affect multiple facilities.« less

Complications in multiple gestation pregnancy: A cross-sectional study of ten maternal-fetal medicine centers in China

PubMed Central

Wei, Jun; Wu, Qi-Jun; Zhang, Tie-Ning; Shen, Zi-Qi; Liu, Hao; Zheng, Dong-Ming; Cui, Hong; Liu, Cai-Xia

2016-01-01

Complications in women with multiple gestation pregnancy have not been studied in China. We aimed to establish a database of women with multiple gestation pregnancy and investigate the complications related to multiple pregnancy. We conducted a cross-sectional study that included 3246 women with multiple gestation pregnancy and who had multiple live-birth deliveries; the women were registered at ten maternal-fetal medicine centers in China in 2013. All participants completed a detailed questionnaire that included basic demographic information, history of gestation and abnormal fetal development, risk factors during pregnancy, and pregnancy outcomes. Overall, 1553 (47.8%) women experienced pregnancy complications; these women were more likely to have lower height and less education than women who did not experience complications. However, women who experienced complications had a higher twin birth rate and were more likely to have received regular antenatal care and assisted reproductive technology than women without complications (P < 0.05). Notably, preterm birth was a primary complication in multiple pregnancy (n = 960). In conclusion, pregnancy complications, especially preterm birth, were relatively common in women with multiple gestation pregnancy. The findings from this cross-sectional study in China may be used as a foundation for investigating risk factors for complications in women with multiple gestation pregnancy in the future. PMID:27127170

Complications in multiple gestation pregnancy: A cross-sectional study of ten maternal-fetal medicine centers in China.

PubMed

Wei, Jun; Wu, Qi-Jun; Zhang, Tie-Ning; Shen, Zi-Qi; Liu, Hao; Zheng, Dong-Ming; Cui, Hong; Liu, Cai-Xia

2016-05-24

Complications in women with multiple gestation pregnancy have not been studied in China. We aimed to establish a database of women with multiple gestation pregnancy and investigate the complications related to multiple pregnancy. We conducted a cross-sectional study that included 3246 women with multiple gestation pregnancy and who had multiple live-birth deliveries; the women were registered at ten maternal-fetal medicine centers in China in 2013. All participants completed a detailed questionnaire that included basic demographic information, history of gestation and abnormal fetal development, risk factors during pregnancy, and pregnancy outcomes. Overall, 1553 (47.8%) women experienced pregnancy complications; these women were more likely to have lower height and less education than women who did not experience complications. However, women who experienced complications had a higher twin birth rate and were more likely to have received regular antenatal care and assisted reproductive technology than women without complications (P < 0.05). Notably, preterm birth was a primary complication in multiple pregnancy (n = 960). In conclusion, pregnancy complications, especially preterm birth, were relatively common in women with multiple gestation pregnancy. The findings from this cross-sectional study in China may be used as a foundation for investigating risk factors for complications in women with multiple gestation pregnancy in the future.

Decrypting Information Sensitivity: Risk, Privacy, and Data Protection Law in the United States and the European Union

ERIC Educational Resources Information Center

Fazlioglu, Muge

2017-01-01

This dissertation examines the risk-based approach to privacy and data protection and the role of information sensitivity within risk management. Determining what information carries the greatest risk is a multi-layered challenge that involves balancing the rights and interests of multiple actors, including data controllers, data processors, and…

The impact of multiple blood donations on the risk of cardiovascular diseases: Insight of lipid profile.

PubMed

Bani-Ahmad, M A; Khabour, O F; Gharibeh, M Y; Alshlool, K N

2017-11-01

The reduction in blood viscosity and iron store were proposed to be connected to the reduction in the risk of cardiovascular disease (CVD) among multiple blood donors. Herein, we evaluated the modulation of serum lipids levels in accordance with donation events. Furthermore, atherogenic impacts on the risk of CVD were investigated. A total of 100 voluntarily male donors were included in the study. Fifty donors were multiple time donors (MTD) and 50 were single time donors (STD). Levels of serum lipids were determined and atherogenic indices including TG/HDL and CHO/HDL ratios were calculated. QRISK2 parameters were determined to evaluate the 10-years risk of developing CVD. Among MTD, there were significantly higher serum levels of triglycerides (TG) and very low-density lipoproteins (VLDL) combined with significantly lower HDL level. These modulations were significantly correlated to the extent of donation. Both CHO/HDL and TG/HDL ratios were also significantly higher among MTD. However, only TG/HDL ratio was strongly correlated to the donation extent even when controlled for age, BMI and smoking status. Despite the significant difference in QRISK2 parameters between study groups, none of these parameters was correlated to the extent of donation when controlling for age, BMI and smoking status. We demonstrate that multiple blood donation is associated with an unfavorable modulation of serum levels of lipids that is influenced by donation extent. This modulation is not associated with an increased risk of CVD but may weakly contribute in a higher risk for coronary heart disease (CHD). Copyright © 2017 Elsevier Masson SAS. All rights reserved.

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.

A review of multi-risk methodologies for natural hazards: Consequences and challenges for a climate change impact assessment.

PubMed

Gallina, Valentina; Torresan, Silvia; Critto, Andrea; Sperotto, Anna; Glade, Thomas; Marcomini, Antonio

2016-03-01

This paper presents a review of existing multi-risk assessment concepts and tools applied by organisations and projects providing the basis for the development of a multi-risk methodology in a climate change perspective. Relevant initiatives were developed for the assessment of multiple natural hazards (e.g. floods, storm surges, droughts) affecting the same area in a defined timeframe (e.g. year, season, decade). Major research efforts were focused on the identification and aggregation of multiple hazard types (e.g. independent, correlated, cascading hazards) by means of quantitative and semi-quantitative approaches. Moreover, several methodologies aim to assess the vulnerability of multiple targets to specific natural hazards by means of vulnerability functions and indicators at the regional and local scale. The overall results of the review show that multi-risk approaches do not consider the effects of climate change and mostly rely on the analysis of static vulnerability (i.e. no time-dependent vulnerabilities, no changes among exposed elements). A relevant challenge is therefore to develop comprehensive formal approaches for the assessment of different climate-induced hazards and risks, including dynamic exposure and vulnerability. This requires the selection and aggregation of suitable hazard and vulnerability metrics to make a synthesis of information about multiple climate impacts, the spatial analysis and ranking of risks, including their visualization and communication to end-users. To face these issues, climate impact assessors should develop cross-sectorial collaborations among different expertise (e.g. modellers, natural scientists, economists) integrating information on climate change scenarios with sectorial climate impact assessment, towards the development of a comprehensive multi-risk assessment process. Copyright © 2015 Elsevier Ltd. All rights reserved.

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.

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.

A new breast cancer risk analysis approach using features extracted from multiple sub-regions on bilateral mammograms

NASA Astrophysics Data System (ADS)

Sun, Wenqing; Tseng, Tzu-Liang B.; Zheng, Bin; Zhang, Jianying; Qian, Wei

2015-03-01

A novel breast cancer risk analysis approach is proposed for enhancing performance of computerized breast cancer risk analysis using bilateral mammograms. Based on the intensity of breast area, five different sub-regions were acquired from one mammogram, and bilateral features were extracted from every sub-region. Our dataset includes 180 bilateral mammograms from 180 women who underwent routine screening examinations, all interpreted as negative and not recalled by the radiologists during the original screening procedures. A computerized breast cancer risk analysis scheme using four image processing modules, including sub-region segmentation, bilateral feature extraction, feature selection, and classification was designed to detect and compute image feature asymmetry between the left and right breasts imaged on the mammograms. The highest computed area under the curve (AUC) is 0.763 ± 0.021 when applying the multiple sub-region features to our testing dataset. The positive predictive value and the negative predictive value were 0.60 and 0.73, respectively. The study demonstrates that (1) features extracted from multiple sub-regions can improve the performance of our scheme compared to using features from whole breast area only; (2) a classifier using asymmetry bilateral features can effectively predict breast cancer risk; (3) incorporating texture and morphological features with density features can boost the classification accuracy.

Data on German farmers risk preference, perception and management strategies.

PubMed

Meraner, Manuela; Finger, Robert

2017-12-01

The extent to which people are willing to take on risk, i.e. their risk preferences as well as subjective risk perception plays a major role in explaining their behavior. This is of particular relevance in agricultural production, which is inherently risky. The data presented here was collected amongst a total of 64 German farmers in 2015. It includes results of three different risk preference elicitation methods (multiple price list, business statements in four relevant domains and general self-assessment) as well as risk perception. Additionally, farm business characteristics (e.g. size, farm-level workforce, succession) and personal farmer characteristics (e.g. age, gender, risk literacy) are included.

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

PubMed

Oldfield, Jeremy; Humphrey, Neil; Hebron, Judith

2015-01-01

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

Infectious Disease risks associated with exposure to stressful environments

NASA Technical Reports Server (NTRS)

Meehan, Ichard T.; Smith, Morey; Sams, Clarence

1993-01-01

Multiple environmental factors asociated with space flight can increase the risk of infectious illness among crewmembers thereby adversely affecting crew health and mission success. Host defences can be impaired by multiple physiological and psychological stressors including: sleep deprivation, disrupted circadian rhythms, separation from family, perceived danger, radiation exposure, and possibly also by the direct and indirect effects of microgravity. Relevant human immunological data from isolated or stressful environments including spaceflight will be reviewed. Long-duration missions should include reliable hardware which supports sophisticated immunodiagnostic capabilities. Future advances in immunology and molecular biology will continue to provide therapeutic agents and biologic response modifiers which should effectively and selectively restore immune function which has been depressed by exposure to environmental stressors.

Multiplicative Effects of Social and Psychological Risk Factors on College Students' Suicidal Behaviors.

PubMed

Assari, Shervin

2018-05-17

Less is known about the multiplicative effects of social and psychological risk and protective factors of suicidality on college campuses. The current study aimed to investigate the multiplicative effects of social (identifying oneself as gay/lesbian, financial difficulty, violence victimization, and religiosity) and psychological (anxiety, depression, problem alcohol use, drug use) and risk/protective factors on suicidal behaviors among college students in the United States. Using a cross-sectional design, the Healthy Mind Study (HMS; 2016⁻2017), is a national online survey of college students in the United States. Social (identifying oneself as gay/lesbian, violence victimization, financial difficulty, and religiosity) and psychological (anxiety, depression, problem alcohol use, and drug use) risk/protective factors were assessed among 27,961 individuals. Three aspects of suicidality, including ideation, plan, and attempt, were also assessed. Logistic regression models were used for data analysis. Financial difficulty, violence victimization, identifying oneself as gay/lesbian, anxiety, depression, and drug use increased, while religiosity reduced the odds of suicidal behaviors. Multiplicative effects were found between the following social and psychological risk factors: (1) financial difficulty and anxiety; (2) financial difficulty and depression; (3) depression and drug use; (4) problem alcohol use and drug use; and (5) depression and problem alcohol use. There is a considerable overlap in the social and psychological processes, such as financial stress, mood disorders, and substance use problems, on risk of suicide in college students. As social and psychological risk factors do not operate independently, comprehensive suicidal risk evaluations that simultaneously address multiple social and psychological risk factors may be superior to programs that only address a single risk factor.

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.

Examining relationships between multiple health risk behaviors, well-being, and productivity.

PubMed

Evers, Kerry E; Castle, Patricia H; Prochaska, James O; Prochaska, Janice M

2014-06-01

Traditionally, the concept of health promotion has emphasized the reduction of health risk behaviors to reduce disease and impairment. Well-being research expands this focus to include positive constructs such as thriving, productivity, life-evaluation, and emotional and physical health. The objective of the present study was to examine the relationships between health risk behaviors and specific measures of individual well-being. Participants (N = 790) from 49 states completed a one-time online assessment that included the Life-Evaluation Index, Emotional and Physical Health Ladders, the Health Risk Intervention Assessment, and the Work Productivity and Activity Improvement Questionnaire for General Health. Life Evaluation and physical and emotional health were all inversely related to the number of health risk behaviors, with higher well-being scores associated with lower number of risk behaviors. Across the three Life Evaluation categories (Suffering, Struggling, and Thriving) the number of health risk behaviors decreased, productivity loss decreased, and emotional and physical health increased. The results add to previous research on how reducing multiple health risk behaviors can be combined with well-being, i.e., an emphasis on increasing life-evaluation, emotional and physical health, better functioning, and productivity.

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.

Uptake, Results, and Outcomes of Germline Multiple-Gene Sequencing After Diagnosis of Breast Cancer.

PubMed

Kurian, Allison W; Ward, Kevin C; Hamilton, Ann S; Deapen, Dennis M; Abrahamse, Paul; Bondarenko, Irina; Li, Yun; Hawley, Sarah T; Morrow, Monica; Jagsi, Reshma; Katz, Steven J

2018-05-10

Low-cost sequencing of multiple genes is increasingly available for cancer risk assessment. Little is known about uptake or outcomes of multiple-gene sequencing after breast cancer diagnosis in community practice. To examine the effect of multiple-gene sequencing on the experience and treatment outcomes for patients with breast cancer. For this population-based retrospective cohort study, patients with breast cancer diagnosed from January 2013 to December 2015 and accrued from SEER registries across Georgia and in Los Angeles, California, were surveyed (n = 5080, response rate = 70%). Responses were merged with SEER data and results of clinical genetic tests, either BRCA1 and BRCA2 (BRCA1/2) sequencing only or including additional other genes (multiple-gene sequencing), provided by 4 laboratories. Type of testing (multiple-gene sequencing vs BRCA1/2-only sequencing), test results (negative, variant of unknown significance, or pathogenic variant), patient experiences with testing (timing of testing, who discussed results), and treatment (strength of patient consideration of, and surgeon recommendation for, prophylactic mastectomy), and prophylactic mastectomy receipt. We defined a patient subgroup with higher pretest risk of carrying a pathogenic variant according to practice guidelines. Among 5026 patients (mean [SD] age, 59.9 [10.7]), 1316 (26.2%) were linked to genetic results from any laboratory. Multiple-gene sequencing increasingly replaced BRCA1/2-only testing over time: in 2013, the rate of multiple-gene sequencing was 25.6% and BRCA1/2-only testing, 74.4%;in 2015 the rate of multiple-gene sequencing was 66.5% and BRCA1/2-only testing, 33.5%. Multiple-gene sequencing was more often ordered by genetic counselors (multiple-gene sequencing, 25.5% and BRCA1/2-only testing, 15.3%) and delayed until after surgery (multiple-gene sequencing, 32.5% and BRCA1/2-only testing, 19.9%). Multiple-gene sequencing substantially increased rate of detection of any pathogenic variant (multiple-gene sequencing: higher-risk patients, 12%; average-risk patients, 4.2% and BRCA1/2-only testing: higher-risk patients, 7.8%; average-risk patients, 2.2%) and variants of uncertain significance, especially in minorities (multiple-gene sequencing: white patients, 23.7%; black patients, 44.5%; and Asian patients, 50.9% and BRCA1/2-only testing: white patients, 2.2%; black patients, 5.6%; and Asian patients, 0%). Multiple-gene sequencing was not associated with an increase in the rate of prophylactic mastectomy use, which was highest with pathogenic variants in BRCA1/2 (BRCA1/2, 79.0%; other pathogenic variant, 37.6%; variant of uncertain significance, 30.2%; negative, 35.3%). Multiple-gene sequencing rapidly replaced BRCA1/2-only testing for patients with breast cancer in the community and enabled 2-fold higher detection of clinically relevant pathogenic variants without an associated increase in prophylactic mastectomy. However, important targets for improvement in the clinical utility of multiple-gene sequencing include postsurgical delay and racial/ethnic disparity in variants of uncertain significance.

Great plains regional climate assessment technical report

USDA-ARS?s Scientific Manuscript database

The Great Plains region (GP) plays important role in providing food and energy to the economy of the United States. Multiple climatic and non-climatic stressors put multiple sectors, livelihoods and communities at risk, including agriculture, water, ecosystems and rural and tribal communities. The G...

Can we prevent or treat multiple sclerosis by individualised vitamin D supply?

PubMed Central

2013-01-01

Apart from its principal role in bone metabolism and calcium homeostasis, vitamin D has been attributed additional effects including an immunomodulatory, anti-inflammatory, and possibly even neuroprotective capacity which implicates a possible role of vitamin D in autoimmune diseases like multiple sclerosis (MS). Indeed, several lines of evidence including epidemiologic, preclinical, and clinical data suggest that reduced vitamin D levels and/or dysregulation of vitamin D homeostasis is a risk factor for the development of multiple sclerosis on the one hand, and that vitamin D serum levels are inversely associated with disease activity and progression on the other hand. However, these data are not undisputable, and many questions regarding the preventive and therapeutic capacity of vitamin D in multiple sclerosis remain to be answered. In particular, available clinical data derived from interventional trials using vitamin D supplementation as a therapeutic approach in MS are inconclusive and partly contradictory. In this review, we summarise and critically evaluate the existing data on the possible link between vitamin D and multiple sclerosis in light of the crucial question whether optimization of vitamin D status may impact the risk and/or the course of multiple sclerosis. PMID:23356351

Modeling month-season of birth as a risk factor in mouse models of chronic disease: from multiple sclerosis to autoimmune encephalomyelitis.

PubMed

Reynolds, Jacob D; Case, Laure K; Krementsov, Dimitry N; Raza, Abbas; Bartiss, Rose; Teuscher, Cory

2017-06-01

Month-season of birth (M-SOB) is a risk factor in multiple chronic diseases, including multiple sclerosis (MS), where the lowest and greatest risk of developing MS coincide with the lowest and highest birth rates, respectively. To determine whether M-SOB effects in such chronic diseases as MS can be experimentally modeled, we examined the effect of M-SOB on susceptibility of C57BL/6J mice to experimental autoimmune encephalomyelitis (EAE). As in MS, mice that were born during the M-SOB with the lowest birth rate were less susceptible to EAE than mice born during the M-SOB with the highest birth rate. We also show that the M-SOB effect on EAE susceptibility is associated with differential production of multiple cytokines/chemokines by neuroantigen-specific T cells that are known to play a role in EAE pathogenesis. Taken together, these results support the existence of an M-SOB effect that may reflect seasonally dependent developmental differences in adaptive immune responses to self-antigens independent of external stimuli, including exposure to sunlight and vitamin D. Moreover, our documentation of an M-SOB effect on EAE susceptibility in mice allows for modeling and detailed analysis of mechanisms that underlie the M-SOB effect in not only MS but in numerous other diseases in which M-SOB impacts susceptibility.-Reynolds, J. D., Case, L. K., Krementsov, D. N., Raza, A., Bartiss, R., Teuscher, C. Modeling month-season of birth as a risk factor in mouse models of chronic disease: from multiple sclerosis to autoimmune encephalomyelitis. © FASEB.

EPA Workshop on Epigenetics and Cumulative Risk ...

EPA Pesticide Factsheets

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

Number of Sexual Partners and Relationship Status Are Associated With Unprotected Sex Across Emerging Adulthood

PubMed Central

Wilhite, Emily R.; Harden, K. Paige; Fromme, Kim

2018-01-01

Sex with multiple partners, consecutively or concurrently, is a risk factor for contracting sexually transmitted infections (STIs) as multiple partner–partner contacts present increased opportunity for transmission. It is unclear, however, if individuals who tend to have more partners also use protection less reliably than those with sexual histories of fewer partners. Longitudinal data can elucidate whether an individual shows a consistent pattern of sex with multiple partners. We used latent class growth analyses to examine emerging adult survey data (N = 2244) spanning 10 waves of assessment across 6 years. We identified three trajectory classes described with respect to number of partners as (a) Multiple, (b) Single, and (c) Rare. Trajectory group, relationship status, and their interactions were tested as predictors of using protection against STIs and pregnancy at each wave. The Multiple Partners class had the greatest odds ratio of reporting sex without protection against STIs and pregnancy, followed by the Single and Rare classes. Exclusive relationship status was a risk factor for unprotected sex at earlier waves, but a protective factor at most later waves. There was no significant interaction between relationship status and trajectory class in predicting use of protection. The Multiple Partners class reported more permissive values on sex and an elevated proportion of homosexual behavior. This group overlaps with an already identified at-risk population, men who have sex with men. Potential mechanisms explaining the increased risk for sex without protection, including communication, risk assessment, and co-occurring risk behaviors are discussed as targets for intervention. PMID:26940966

Number of Sexual Partners and Relationship Status Are Associated With Unprotected Sex Across Emerging Adulthood.

PubMed

Ashenhurst, James R; Wilhite, Emily R; Harden, K Paige; Fromme, Kim

2017-02-01

Sex with multiple partners, consecutively or concurrently, is a risk factor for contracting sexually transmitted infections (STIs) as multiple partner-partner contacts present increased opportunity for transmission. It is unclear, however, if individuals who tend to have more partners also use protection less reliably than those with sexual histories of fewer partners. Longitudinal data can elucidate whether an individual shows a consistent pattern of sex with multiple partners. We used latent class growth analyses to examine emerging adult survey data (N = 2244) spanning 10 waves of assessment across 6 years. We identified three trajectory classes described with respect to number of partners as (a) Multiple, (b) Single, and (c) Rare. Trajectory group, relationship status, and their interactions were tested as predictors of using protection against STIs and pregnancy at each wave. The Multiple Partners class had the greatest odds ratio of reporting sex without protection against STIs and pregnancy, followed by the Single and Rare classes. Exclusive relationship status was a risk factor for unprotected sex at earlier waves, but a protective factor at most later waves. There was no significant interaction between relationship status and trajectory class in predicting use of protection. The Multiple Partners class reported more permissive values on sex and an elevated proportion of homosexual behavior. This group overlaps with an already identified at-risk population, men who have sex with men. Potential mechanisms explaining the increased risk for sex without protection, including communication, risk assessment, and co-occurring risk behaviors are discussed as targets for intervention.

Integrated presentation of ecological risk from multiple stressors

NASA Astrophysics Data System (ADS)

Goussen, Benoit; Price, Oliver R.; Rendal, Cecilie; Ashauer, Roman

2016-10-01

Current environmental risk assessments (ERA) do not account explicitly for ecological factors (e.g. species composition, temperature or food availability) and multiple stressors. Assessing mixtures of chemical and ecological stressors is needed as well as accounting for variability in environmental conditions and uncertainty of data and models. Here we propose a novel probabilistic ERA framework to overcome these limitations, which focusses on visualising assessment outcomes by construct-ing and interpreting prevalence plots as a quantitative prediction of risk. Key components include environmental scenarios that integrate exposure and ecology, and ecological modelling of relevant endpoints to assess the effect of a combination of stressors. Our illustrative results demonstrate the importance of regional differences in environmental conditions and the confounding interactions of stressors. Using this framework and prevalence plots provides a risk-based approach that combines risk assessment and risk management in a meaningful way and presents a truly mechanistic alternative to the threshold approach. Even whilst research continues to improve the underlying models and data, regulators and decision makers can already use the framework and prevalence plots. The integration of multiple stressors, environmental conditions and variability makes ERA more relevant and realistic.

Integrated presentation of ecological risk from multiple stressors.

PubMed

Goussen, Benoit; Price, Oliver R; Rendal, Cecilie; Ashauer, Roman

2016-10-26

Current environmental risk assessments (ERA) do not account explicitly for ecological factors (e.g. species composition, temperature or food availability) and multiple stressors. Assessing mixtures of chemical and ecological stressors is needed as well as accounting for variability in environmental conditions and uncertainty of data and models. Here we propose a novel probabilistic ERA framework to overcome these limitations, which focusses on visualising assessment outcomes by construct-ing and interpreting prevalence plots as a quantitative prediction of risk. Key components include environmental scenarios that integrate exposure and ecology, and ecological modelling of relevant endpoints to assess the effect of a combination of stressors. Our illustrative results demonstrate the importance of regional differences in environmental conditions and the confounding interactions of stressors. Using this framework and prevalence plots provides a risk-based approach that combines risk assessment and risk management in a meaningful way and presents a truly mechanistic alternative to the threshold approach. Even whilst research continues to improve the underlying models and data, regulators and decision makers can already use the framework and prevalence plots. The integration of multiple stressors, environmental conditions and variability makes ERA more relevant and realistic.

Childhood infections and risk of multiple sclerosis.

PubMed

Bager, Peter; Nielsen, Nete Munk; Bihrmann, Kristine; Frisch, Morten; Hjalgrim, Henrik; Wohlfart, Jan; Koch-Henriksen, Nils; Melbye, Mads; Westergaard, Tine

2004-11-01

Multiple sclerosis has been hypothesized to be the result from an aberrant immune response possibly triggered by delayed exposure to a common childhood infection. Because the vast majority of previous studies testing this hypothesis have been based on a history of childhood infections recalled years to decades later in adulthood, we investigated whether age at six common childhood infections was associated with risk of multiple sclerosis, using information recalled in the childhood of a historical cohort of school children in Denmark. Cases included all individuals with multiple sclerosis in the country born between 1940 and 1975, who had attended school in the capital, Copenhagen. Controls were age- and sex-matched peers. School health records were obtained for all subjects. The records contained information on measles, pertussis, scarlet fever, birth order, sibship size, social class of the father, school years, and name of school and attended school classes for children born since 1940 (n(cases) = 455, n(controls) = 1801). For children born since 1950, the records also contained information on rubella, varicella and mumps (n(cases) = 182, n(controls) = 690). Neither age at infection with measles, rubella, varicella, mumps, pertussis and scarlet fever (upper age limit, 14 years) nor the cumulative number of these infections between the ages of 10 and 14 years was associated with the risk of multiple sclerosis. In addition, the risk of multiple sclerosis was not associated with birth order or social class. No clustering of multiple sclerosis in school classes was observed. Our findings suggest that measles, rubella, mumps, varicella, pertussis and scarlet fever, even if acquired late in childhood, are not associated with increased risk of multiple sclerosis later in life.

A Multi-Domain Model of Risk Factors for ODD Symptoms in a Community Sample of 4-Year-Olds

ERIC Educational Resources Information Center

Lavigne, John V.; Gouze, Karen R.; Hopkins, Joyce; Bryant, Fred B.; LeBailly, Susan A.

2012-01-01

Few studies have been designed to assess the pathways by which risk factors are associated with symptoms of psychopathology across multiple domains, including contextual factors, parental depression, parenting, and child characteristics. The present study examines a cross-sectional model of risk factors for symptoms of Oppositional Defiant…

Role of socio-economic and reproductive factors in the risk of multiple sclerosis.

PubMed

Magyari, M

2015-01-01

The incidence of multiple sclerosis is increasing in Danish women. Their risk of developing multiple sclerosis has more than doubled in 25 years while it has remained virtually unchanged for men. The explanation for these epidemiological changes should be sought in the environment as they are too rapid to be explained by gene alterations. We investigated the effect of numerous biological social physical and chemical environmental exposures in different periods of life. These data were available from population-based registries and were used in a case-control approach. This study database included all multiple sclerosis cases (n = 1403) from the Danish MS Registry with clinical onset between 2000 and 2004 as well as 35,045 controls drawn by random from the Danish Civil Registration System and matched by sex year of birth and residential municipality at the reference year. Having newborn children reduced the risk of multiple sclerosis (MS) in women but not in men. Childbirths reduced the risk of MS by about 46% during the following 5 years. Even pregnancies terminated early had a protective effect on the risk of developing MS suggesting a temporary immunosuppression during pregnancy. Our data on social behaviour regarding educational level income and relationship stability did not indicate reverse causality. A greater likelihood to be exposed to common infections did not show any effect on the risk of MS neither in puberty nor in adulthood. Socio-economic status and lifestyle expressed in educational level and sanitary conditions in youth were not associated with the risk of MS. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Multiple pregnancies achieved with IVF/ICSI and risk of specific congenital malformations: a meta-analysis of cohort studies.

PubMed

Zheng, Zan; Chen, Letao; Yang, Tubao; Yu, Hong; Wang, Hua; Qin, Jiabi

2018-04-01

Studies comparing risk of specific congenital malformations (CM) between multiple pregnancies resulting from IVF/intracytoplasmic sperm injection (ICSI) and those conceived naturally report conflicting results; furthermore, there is a lack of a complete overview. This meta-analysis aimed to address which types of CM are increased in IVF/ICSI multiple pregnancies compared with those conceived naturally. All studies testing the association between IVF/ICSI multiple pregnancies and specific CM identified in various databases were considered. The literature search yielded 856 records, of which 21 cohort studies were included for analysis. Overall, multiple pregnancies achieved with IVF/ICSI experienced a significantly higher risk of chromosomal defects (relative risk [RR] = 1.36; 95% confidence interval [CI]: 1.04-1.77), urogenital (RR = 1.18; 95% CI: 1.03-1.36) and circulatory (RR = 1.22; 95% CI: 1.01-1.47) system malformations. However, the remaining specific CM, such as cleft lip and/or palate, eye, ear, face and neck, respiratory, musculoskeletal, nervous and digestive system malformations, were similar in the two groups. No substantial heterogeneity was observed for most outcomes except for digestive (P = 0.094; I 2 = 38.3%) and circulatory (P = 0.070; I 2 = 35.2%) system malformations. These findings provide additional information on risks of IVF/ICSI for use when counselling patients. Copyright © 2018 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

Twelve Month Prevalence of and Risk Factors for Suicide Attempts in the WHO World Mental Health Surveys

PubMed Central

Borges, Guilherme; Nock, Matthew K.; Haro Abad, Josep M.; Hwang, Irving; Sampson, Nancy A.; Alonso, Jordi; Andrade, Laura Helena; Angermeyer, Matthias C.; Beautrais, Annette; Bromet, Evelyn; Bruffaerts, Ronny; de Girolamo, Giovanni; Florescu, Silvia; Gureje, Oye; Hu, Chiyi; Karam, Elie G; Kovess-Masfety, Viviane; Lee, Sing; Levinson, Daphna; Medina-Mora, Maria Elena; Ormel, Johan; Posada-Villa, Jose; Sagar, Rajesh; Tomov, Toma; Uda, Hidenori; Williams, David R.; Kessler, Ronald C.

2009-01-01

Objective Although suicide is a leading cause of death worldwide, clinicians and researchers lack a data-driven method to assess the risk of suicide attempts. This study reports the results of an analysis of a large cross-national epidemiological survey database that estimates the 12-month prevalence of suicidal behaviors, identifies risk factors for suicide attempts, and combines these factors to create a risk index for 12-month suicide attempts separately for developed and developing countries. Method Data come from the WHO World Mental Health (WMH) Surveys (conducted 2001–2007) in which 108,705 adults from 21 countries were interviewed using the WHO Composite International Diagnostic Interview (CIDI). The survey assessed suicidal behaviors and potential risk factors across multiple domains including: socio-demographics, parent psychopathology, childhood adversities, DSM-IV disorders, and history of suicidal behavior. Results Twelve-month prevalence estimates of suicide ideation, plans and attempts are 2.0%, 0.6% and 0.3% respectively for developed countries and 2.1%, 0.7% and 0.4% for developing countries. Risk factors for suicidal behaviors in both developed and developing countries include: female sex, younger age, lower education and income, unmarried status, unemployment, parent psychopathology, childhood adversities, and presence of diverse 12-month DSM-IV mental disorders. Combining risk factors from multiple domains produced risk indices that accurately predicted 12-month suicide attempts in both developed and developing countries (AUC=.74–.80). Conclusion Suicidal behaviors occur at similar rates in both developed and developing countries. Risk indices assessing multiple domains can predict suicide attempts with fairly good accuracy and may be useful in aiding clinicians in the prediction of these behaviors. PMID:20816034

Arcjet Testing of Micro-Meteoroid Impacted Thermal Protection Materials

NASA Technical Reports Server (NTRS)

Agrawal, Parul; Munk, Michelle M.; Glaab, Louis J.

2013-01-01

There are several harsh space environments that could affect thermal protection systems and in turn pose risks to the atmospheric entry vehicles. These environments include micrometeoroid impact, extreme cold temperatures, and ionizing radiation during deep space cruise, all followed by atmospheric entry heating. To mitigate these risks, different thermal protection material samples were subjected to multiple tests, including hyper velocity impact, cold soak, irradiation, and arcjet testing, at various NASA facilities that simulated these environments. The materials included a variety of honeycomb packed ablative materials as well as carbon-based non-ablative thermal protection systems. The present paper describes the results of the multiple test campaign with a focus on arcjet testing of thermal protection materials. The tests showed promising results for ablative materials. However, the carbon-based non-ablative system presented some concerns regarding the potential risks to an entry vehicle. This study provides valuable information regarding the capability of various thermal protection materials to withstand harsh space environments, which is critical to sample return and planetary entry missions.

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.

The Changing Landscape of Genetic Testing for Inherited Breast Cancer Predisposition.

PubMed

Afghahi, Anosheh; Kurian, Allison W

2017-05-01

The advent of multiple-gene germline panel testing has led to significant advances in hereditary breast and ovarian cancer risk assessment. These include guideline-specific cancer risk management recommendations for patients and their families, such as screening with breast magnetic resonance imaging and risk-reducing surgeries, which have the potential to reduce substantially the morbidity and mortality associated with a hereditary cancer predisposition. However, controversy remains about the clinical validity and actionability of genetic testing in a broader patient population. We discuss events leading to the wider availability of commercialized multiple-gene germline panel testing, the recent data that support using this powerful tool to improve cancer risk assessment and reduction strategies, and remaining challenges to clinical optimization of this new genetic technology.

Quantitative meta-analytic approaches for the analysis of animal toxicology and epidemiologic data in human health risk assessments

EPA Science Inventory

Often, human health risk assessments have relied on qualitative approaches for hazard identification to integrate evidence across multiple studies to conclude whether particular hazards exist. However, quantitative approaches for evidence integration, including the application o...

Distinct encoding of risk and value in economic choice between multiple risky options☆

PubMed Central

Wright, Nicholas D.; Symmonds, Mkael; Dolan, Raymond J.

2013-01-01

Neural encoding of value-based stimuli is suggested to involve representations of summary statistics, including risk and expected value (EV). A more complex, but ecologically more common, context is when multiple risky options are evaluated together. However, it is unknown whether encoding related to option evaluation in these situations involves similar principles. Here we employed fMRI during a task that parametrically manipulated EV and risk in two simultaneously presented lotteries, both of which contained either gains or losses. We found representations of EV in medial prefrontal cortex and anterior insula, an encoding that was dependent on which option was chosen (i.e. chosen and unchosen EV) and whether the choice was over gains or losses. Parietal activity reflected whether the riskier or surer option was selected, whilst activity in a network of regions that also included parietal cortex reflected both combined risk and difference in risk for the two options. Our findings provide support for the idea that summary statistics underpin a representation of value-based stimuli, and further that these summary statistics undergo distinct forms of encoding. PMID:23684860

Young People’s Sexual Partnerships in KwaZulu/Natal, South Africa: Patterns, Contextual Influences, and HIV Risk

PubMed Central

Harrison, Abigail; Cleland, John; Frohlich, Janet

2013-01-01

Certain sexual partnering practices, such as multiple, concurrent or age-discrepant partnerships, are known to increase HIV risk. Yet the underlying dynamics of young people’s relationships are less understood. Using household survey and qualitative data, this study examines the partnership context of HIV risk, including partner types, their characteristics, and key aspects of partnership dynamics, including partner numbers and age differences, duration, concurrency, and frequency of contact among youth aged 15–24 in rural KwaZulu/Natal, South Africa. One-third of men reported multiple and/or concurrent partnering, while one-quarter of women had partners > 5 years older. Non-participation in civic organizations or schooling was correlated with higher risk partnerships for women, but not men. On average, relationships lasted >1 year for women and men, and were frequently characterized as ‘serious’. However, qualitative findings pointed to the sequential and overlapping nature of relationships, with distance and mobility as important influences. These fluid partnership patterns are an important feature of young people’s sexual risk in the context of South Africa’s severe HIV epidemic. PMID:19248716

Risk factors for epistaxis in jump racing in Great Britain (2001-2009).

PubMed

Reardon, Richard J M; Boden, Lisa A; Mellor, Dominic J; Love, Sandy; Newton, Richard J; Stirk, Anthony J; Parkin, Timothy D

2015-07-01

The aim of this study was to evaluate risk factors associated with developing epistaxis in jump racing in Great Britain (GB). A retrospective analysis of records from horses running in all hurdle and steeplechase races in GB between 2001 and 2009 identified diagnoses of epistaxis whilst still at the racecourse. Data were used from 603 starts resulting in epistaxis (event) and 169,065 starts resulting in no epistaxis (non-event) in hurdle racing, and from 550 event starts and 102,344 non-event starts in steeplechase racing. Two multivariable logistic regression models to evaluate risk factors associated with epistaxis were produced. The potential effect of clustering of data (within horse, horse dam, horse sire, trainer, jockey, course, race and race meet) on the associations between risk factors and epistaxis was examined using mixed-effects models. Multiple factors associated with increased risk of epistaxis were identified. Those identified in both types of jump racing included running on firmer ground; horses with >75% of career starts in flat racing and a previous episode of epistaxis recorded during racing. Risk factors identified only in hurdle racing included racing in the spring and increased age at first race; and those identified only in steeplechase racing included running in a claiming race and more starts in the previous 3-6 months. The risk factors identified provide important information about the risk of developing epistaxis. Multiple avenues for further investigation are highlighted, including unmeasured variables at the level of the racecourse. The results of this study can be used to guide the development of interventions to minimise the risk of epistaxis in jump racing. Copyright © 2015. Published by Elsevier Ltd.

Complex interventions can increase osteoporosis investigations and treatment: a systematic review and meta-analysis.

PubMed

Kastner, M; Perrier, L; Munce, S E P; Adhihetty, C C; Lau, A; Hamid, J; Treister, V; Chan, J; Lai, Y; Straus, S E

2018-01-01

Osteoporosis is affecting over 200 million people worldwide. Despite available guidelines, care for these patients remains sub-optimal. We developed an osteoporosis tool to address the multiple dimensions of chronic disease management. Findings from its evaluation showed a significant increase from baseline in osteoporosis investigations and treatment, so we are revising this tool to include multiple chronic conditions including an update of evidence about osteoporosis. Our objectives were to conduct a systematic review of osteoporosis interventions in adults at risk for osteoporosis. We searched bibliometric databases for randomized controlled trials (RCTs) in any language evaluating osteoporosis disease management interventions in adults at risk for osteoporosis. Reviewer pairs independently screened citations and full-text articles, extracted data, and assessed risk of bias. Analysis included random effects meta-analysis. Primary outcomes were osteoporosis investigations and treatment, and fragility fractures. Fifty-five RCTs and one companion report were included in the analysis representing 165,703 patients. Our findings from 55 RCTs and 18 sub-group meta-analyses showed that complex implementation interventions with multiple components consisting of at least education + feedback + follow-up significantly increased the initiation of osteoporosis medications, and interventions with at least education + follow-up significantly increased the initiation of osteoporosis investigations. No significant impact was found for any type of intervention to reduce fracture. Complex interventions that include at least education + follow-up or feedback have the most potential for increasing osteoporosis investigations and treatment. Patient education appears to be an important component in osteoporosis disease management.

Multiple Interacting Risk Factors: On Methods for Allocating Risk Factor Interactions.

PubMed

Price, Bertram; MacNicoll, Michael

2015-05-01

A persistent problem in health risk analysis where it is known that a disease may occur as a consequence of multiple risk factors with interactions is allocating the total risk of the disease among the individual risk factors. This problem, referred to here as risk apportionment, arises in various venues, including: (i) public health management, (ii) government programs for compensating injured individuals, and (iii) litigation. Two methods have been described in the risk analysis and epidemiology literature for allocating total risk among individual risk factors. One method uses weights to allocate interactions among the individual risk factors. The other method is based on risk accounting axioms and finding an optimal and unique allocation that satisfies the axioms using a procedure borrowed from game theory. Where relative risk or attributable risk is the risk measure, we find that the game-theory-determined allocation is the same as the allocation where risk factor interactions are apportioned to individual risk factors using equal weights. Therefore, the apportionment problem becomes one of selecting a meaningful set of weights for allocating interactions among the individual risk factors. Equal weights and weights proportional to the risks of the individual risk factors are discussed. © 2015 Society for Risk Analysis.

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.

Multiple Intravenous Infusions Phase 2b: Laboratory Study

PubMed Central

Pinkney, Sonia; Fan, Mark; Chan, Katherine; Koczmara, Christine; Colvin, Christopher; Sasangohar, Farzan; Masino, Caterina; Easty, Anthony; Trbovich, Patricia

2014-01-01

Background Administering multiple intravenous (IV) infusions to a single patient via infusion pump occurs routinely in health care, but there has been little empirical research examining the risks associated with this practice or ways to mitigate those risks. Objectives To identify the risks associated with multiple IV infusions and assess the impact of interventions on nurses’ ability to safely administer them. Data Sources and Review Methods Forty nurses completed infusion-related tasks in a simulated adult intensive care unit, with and without interventions (i.e., repeated-measures design). Results Errors were observed in completing common tasks associated with the administration of multiple IV infusions, including the following (all values from baseline, which was current practice): setting up and programming multiple primary continuous IV infusions (e.g., 11.7% programming errors) identifying IV infusions (e.g., 7.7% line-tracing errors) managing dead volume (e.g., 96.0% flush rate errors following IV syringe dose administration) setting up a secondary intermittent IV infusion (e.g., 11.3% secondary clamp errors) administering an IV pump bolus (e.g., 11.5% programming errors) Of 10 interventions tested, 6 (1 practice, 3 technology, and 2 educational) significantly decreased or even eliminated errors compared to baseline. Limitations The simulation of an adult intensive care unit at 1 hospital limited the ability to generalize results. The study results were representative of nurses who received training in the interventions but had little experience using them. The longitudinal effects of the interventions were not studied. Conclusions Administering and managing multiple IV infusions is a complex and risk-prone activity. However, when a patient requires multiple IV infusions, targeted interventions can reduce identified risks. A combination of standardized practice, technology improvements, and targeted education is required. PMID:26316919

Battered Women's Perceptions of Risk Versus Risk Factors and Instruments in Predicting Repeat Reassault

ERIC Educational Resources Information Center

Heckert, D. Alex; Gondolf, Edward W.

2004-01-01

This study partially replicates and expands on a previous study that showed women's perceptions of risk to be a strong predictor of reassault among batterers. The current study employed a larger and multisite sample, a longer follow-up period of 15 months, and multiple outcomes including "repeated reassault" (n = 499). According to the multinomial…

Recovery in Young Children with Weight Faltering: Child and Household Risk Factors

PubMed Central

Black, Maureen M.; Tilton, Nicholas; Bento, Samantha; Cureton, Pamela; Feigelman, Susan

2015-01-01

Objective To examine whether weight recovery among children with weight faltering varied by enrollment age and child and household risk factors. Study design Observational, conducted in an interdisciplinary specialty practice with a skill-building mealtime behavior intervention, including coaching with video-recorded interactions. Eligibility included age 6–36 months with weight/age <5th percentile or crossing of two major percentiles. Children were categorized as <24 months vs ≥24 months. Child and household risk factors were summed into risk indices (top quartile, elevated risks, vs. reference). Outcome was weight/age z-score change over 6 months. Analyses were conducted with longitudinal linear mixed-effects models, including age by risk index interaction terms. Results Enrolled 286 children (mean age 18.8 months, SD 6.8). Significant weight/age recovery occurred regardless of risk index or age. Mean weight/age z-score change was significantly greater among younger, compared with older age (0.29 vs. 0.17, p=0.03); top household risk quartile, compared with reference (0.34 vs. 0.22, p=0.046); and marginally greater among top child risk quartile, compared with reference (0.37 vs. 0.25, p=0.058). Mean weight/age z-score change was not associated with single risk factors, or interactions; greatest weight gain occurred in most underweight children. Conclusions Weight recovery over 6 months was statistically significant, although modest, and greater among younger children and among children with multiple child and household risk factors. Findings support Differential Susceptibility Theory, whereby some children with multiple risk factors are differentially responsive to intervention. Future investigations should evaluate components of the mealtime behavior intervention. PMID:26687578

Human and bovine viruses and bacteria at three Great Lakes beaches: Environmental variable associations and health risk

USGS Publications Warehouse

Corsi, Steven R.; Borchardt, Mark A.; Carvin, Rebecca B.; Burch, Tucker R; Spencer, Susan K.; Lutz, Michelle A.; McDermott, Colleen M.; Busse, Kimberly M.; Kleinheinz, Gregory; Feng, Xiaoping; Zhu, Jun

2016-01-01

Waterborne pathogens were measured at three beaches in Lake Michigan, environmental factors for predicting pathogen concentrations were identified, and the risk of swimmer infection and illness was estimated. Waterborne pathogens were detected in 96% of samples collected at three Lake Michigan beaches in summer, 2010. Samples were quantified for 22 pathogens in four microbial categories (human viruses, bovine viruses, protozoa, and pathogenic bacteria). All beaches had detections of human and bovine viruses and pathogenic bacteria indicating influence of multiple contamination sources at these beaches. Occurrence ranged from 40 to 87% for human viruses, 65–87% for pathogenic bacteria, and 13–35% for bovine viruses. Enterovirus, adenovirus A, Salmonella spp., Campylobacter jejuni, bovine polyomavirus, and bovine rotavirus A were present most frequently. Variables selected in multiple regression models used to explore environmental factors that influence pathogens included wave direction, cloud cover, currents, and water temperature. Quantitative Microbial Risk Assessment was done for C. jejuni, Salmonella spp., and enteroviruses to estimate risk of infection and illness. Median infection risks for one-time swimming events were approximately 3 × 10–5, 7 × 10–9, and 3 × 10–7 for C. jejuni, Salmonella spp., and enteroviruses, respectively. Results highlight the importance of investigating multiple pathogens within multiple categories to avoid underestimating the prevalence and risk of waterborne pathogens.

Chronic periodontitis with multiple risk factor syndrome: a case report.

PubMed

Shimoe, Masayuki; Yamamoto, Tadashi; Iwamoto, Yoshihiro; Shiomi, Nobuyuki; Maeda, Hiroshi; Nishimura, Fusanori; Takashiba, Shogo

2011-07-01

Multiple risk factor syndrome is a clustering of cardiovascular risk factors, such as diabetes, dyslipidemia, hypertension, and obesity associated epidemiologically with insulin resistance. This report describes the clinical course of a patient suffering from severe periodontitis with multiple risk factor syndrome, and discusses the association between periodontal infection and systemic health. The patient had a history of type 2 diabetes, dyslipidemia, and hypertension for over 10 years. At baseline, her hemoglobin A1 c was 8.1%. However, she had no diabetic complications except periodontitis. The IgG antibody titers against Porphyromonas gingivalis FDC 381 and SU63 were elevated above the mean of healthy subjects +2 standard deviations. Intensive periodontal treatment, including periodontal surgery, was performed to reduce periodontal infection and bacteremia. Her systemic and periodontal conditions were evaluated longitudinally for 10 years. Following periodontal treatment, antibody titers against Porphyromonas gingivalis and hemoglobin A1c values were significantly improved. The other clinical data and medication for her systemic condition also remained stable during supportive periodontal therapy. However, she developed myocardial infarction, and showed continuous deterioration of hemoglobin A1 c level and periodontitis. The long-term clustering of risk factors, such as diabetes, dyslipidemia, hypertension, and periodontitis, are associated with the development of myocardial infarction. Treatment of systemic conditions in combination with comprehensive periodontal treatment is important in management of patients with multiple risk factor syndrome.

Risk of multiple myeloma following medication use and medical conditions: a case-control study in Connecticut women.

PubMed

Landgren, Ola; Zhang, Yawei; Zahm, Sheila Hoar; Inskip, Peter; Zheng, Tongzhang; Baris, Dalsu

2006-12-01

Certain commonly used drugs and medical conditions characterized by chronic immune dysfunction and/or antigen stimulation have been suggested to affect important pathways in multiple myeloma tumor cell growth and survival. We conducted a population-based case-control study to investigate the role of medical history in the etiology of multiple myeloma among Connecticut women. A total of 179 incident multiple myeloma cases (21-84 years, diagnosed 1996-2002) and 691 population-based controls was included in this study. Information on medical conditions, medications, and medical radiation was obtained by in-person interviews. We calculated odds ratios (OR) as measures of relative risks using logistic regression models. A reduced multiple myeloma risk was found among women who had used antilipid statin therapy [OR, 0.4; 95% confidence interval (95% CI), 0.2-0.8] or estrogen replacement therapy (OR, 0.6; 95% CI, 0.4-0.99) or who had a medical history of allergy (OR, 0.4; 95% CI, 0.3-0.7), scarlet fever (OR, 0.5; 95% CI, 0.2-0.9), or bursitis (OR, 0.4; 95% CI, 0.2-0.7). An increased risk of multiple myeloma was found among women who used prednisone (OR, 5.1; 95% CI, 1.8-14.4), insulin (OR, 3.1; 95% CI, 1.1-9.0), or gout medication (OR, 6.7; 95% CI, 1.2-38.0). If our results are confirmed, mechanistic studies examining how prior use of insulin, prednisone, and, perhaps, gout medication might promote increased occurrence of multiple myeloma and how antilipid statins, estrogen replacement therapy, and certain medical conditions might protect against multiple myeloma may provide insights to the as yet unknown etiology of multiple myeloma.

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.

Integrated presentation of ecological risk from multiple stressors

PubMed Central

Goussen, Benoit; Price, Oliver R.; Rendal, Cecilie; Ashauer, Roman

2016-01-01

Current environmental risk assessments (ERA) do not account explicitly for ecological factors (e.g. species composition, temperature or food availability) and multiple stressors. Assessing mixtures of chemical and ecological stressors is needed as well as accounting for variability in environmental conditions and uncertainty of data and models. Here we propose a novel probabilistic ERA framework to overcome these limitations, which focusses on visualising assessment outcomes by construct-ing and interpreting prevalence plots as a quantitative prediction of risk. Key components include environmental scenarios that integrate exposure and ecology, and ecological modelling of relevant endpoints to assess the effect of a combination of stressors. Our illustrative results demonstrate the importance of regional differences in environmental conditions and the confounding interactions of stressors. Using this framework and prevalence plots provides a risk-based approach that combines risk assessment and risk management in a meaningful way and presents a truly mechanistic alternative to the threshold approach. Even whilst research continues to improve the underlying models and data, regulators and decision makers can already use the framework and prevalence plots. The integration of multiple stressors, environmental conditions and variability makes ERA more relevant and realistic. PMID:27782171

Genomic variability of Helicobacter pylori isolates of gastric regions from two Colombian populations

PubMed Central

Matta, Andrés Jenuer; Pazos, Alvaro Jairo; Bustamante-Rengifo, Javier Andrés; Bravo, Luis Eduardo

2017-01-01

AIM To compare the genomic variability and the multiple colonization of Helicobacter pylori (H. pylori) in patients with chronic gastritis from two Colombian populations with contrast in the risk of developing gastric cancer (GC): Túquerres-Nariño (High risk) and Tumaco-Nariño (Low risk). METHODS Four hundred and nine patients from both genders with dyspeptic symptoms were studied. Seventy-two patients were included in whom H. pylori was isolated from three anatomic regions of the gastric mucosa, (31/206) of the high risk population of GC (Túquerres) and (41/203) of the low risk population of GC (Tumaco). The isolates were genotyped by PCR-RAPD. Genetic diversity between the isolates was evaluated by conglomerates analysis and multiple correspondence analyses. RESULTS The proportion of virulent genotypes of H. pylori was 99% in Túquerres and 94% in Tumaco. The coefficient of similarity of Nei-Li showed greater genetic diversity among isolates of Túquerres (0.13) than those of Tumaco (0.07). After adjusting by age, gender and type of gastritis, the multiple colonization was 1.7 times more frequent in Túquerres than in Tumaco (P = 0.05). CONCLUSION In Túquerres, high risk of GC there was a greater probability of multiple colonization by H. pylori. From the analysis of the results of the PCR-RAPD, it was found higher genetic variability in the isolates of H. pylori in the population of high risk for the development of GC. PMID:28223724

How does the use of multiple needles/syringes per injecting episode impact on the measurement of individual level needle and syringe program coverage?

PubMed

O'Keefe, Daniel; McCormack, Angus; Cogger, Shelley; Aitken, Campbell; Burns, Lucinda; Bruno, Raimondo; Stafford, Jenny; Butler, Kerryn; Breen, Courtney; Dietze, Paul

2017-08-01

Recent work by McCormack et al. (2016) showed that the inclusion of syringe stockpiling improves the measurement of individual-level syringe coverage. We explored whether including the use of a new parameter, multiple sterile syringes per injecting episode, further improves coverage measures. Data comes from 838 people who inject drugs, interviewed as part of the 2015 Illicit Drug Reporting System. Along with syringe coverage questions, the survey recorded the number of sterile syringes used on average per injecting episode. We constructed three measures of coverage: one adapted from Bluthenthal et al. (2007), the McCormack et al. measure, and a new coverage measure that included use of multiple syringes. Predictors of multiple syringe use and insufficient coverage (<100% of injecting episodes using a sterile syringe) using the new measure, were tested in logistic regression and the ability of the measures to discriminate key risk behaviours was compared using ROC curve analysis. 134 (16%) participants reported needing multiple syringes per injecting episode. Women showed significantly increased odds of multiple syringe use, as did those reporting injection related injuries/diseases and injecting of opioid substitution drugs or pharmaceutical opioids. Levels of insufficient coverage across the three measures were substantial (20%-28%). ROC curve analysis suggested that our new measure was no better at discriminating injecting risk behaviours than the existing measures. Based on our findings, there appears to be little need for adding a multiple syringe use parameter to existing coverage formulae. Hence, we recommend that multiple syringe use is not included in the measurement of individual-level syringe coverage. Copyright © 2017 Elsevier B.V. All rights reserved.

Non-Hodgkin Lymphoma risk and insecticide, fungicide and fumigant use in the Agricultural Health Study

EPA Science Inventory

Farming and pesticide use have previously been linked to non-Hodgkin lymphoma (NHL), chronic lymphocytic leukemia (CLL) and multiple myeloma (MM). We evaluated agricultural use of specific insecticides, fungicides, and fumigants and risk of NHL and NHL-subtypes (including CLL an...

Understanding the positive benefit:risk profile of alemtuzumab in relapsing multiple sclerosis: perspectives from the Alemtuzumab Clinical Development Program.

PubMed

Havrdova, Eva; Cohen, Jeffrey A; Horakova, Dana; Kovarova, Ivana; Meluzinova, Eva

2017-01-01

The introduction of high-efficacy therapies for relapsing-remitting multiple sclerosis has driven re-evaluation of treatment goals and benefit:risk considerations in treatment choice. In the alemtuzumab Phase II and III clinical trials, patients treated with alemtuzumab 12 mg versus subcutaneous interferon beta-1a demonstrated significantly reduced annualized relapse rates and improved magnetic resonance imaging outcomes, and were significantly more likely to achieve no evidence of disease activity and reduction in brain volume loss. In two of the studies, alemtuzumab-treated patients had a significantly reduced risk of 6-month confirmed disease worsening, compared with subcutaneous interferon beta-1a. Benefits were maintained throughout 5 years, with a majority of patients receiving no alemtuzumab retreatment or other disease-modifying therapy. Trial results support alemtuzumab's manageable, consistent safety profile in relapsing-remitting multiple sclerosis. Infusion-associated reactions, the most frequent adverse events (AEs), can be minimized by corticosteroid pretreatment, monitoring, and symptomatic management. Other AEs include infections and autoimmune events. Oral anti-herpes prophylaxis should be initiated on the first day of each alemtuzumab treatment course and continued according to local guidelines. Overall cancer risk was lower in the alemtuzumab clinical trials than in a reference population; however, continuing surveillance will determine if alemtuzumab may be associated with certain malignancies such as thyroid papillary carcinoma and melanoma, which are currently identified as potential risks. The post-approval risk management strategy includes a safety monitoring program. Autoimmune AEs (thyroid events, immune thrombocytopenia, nephropathies) can be detected in a timely manner with the monitoring program, which includes physician and patient education about the signs and symptoms, monthly renal and hematologic monitoring, and quarterly thyroid function monitoring for 48 months after the last alemtuzumab course. Education, vigilance by physicians and patients, and monthly laboratory monitoring are recommended to maintain alemtuzumab's positive benefit:risk profile.

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.

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

PubMed

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

2011-05-01

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

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

STD and HIV risk factors among U.S. young adults: variations by gender, race, ethnicity and sexual orientation.

PubMed

Mojola, Sanyu A; Everett, Bethany

2012-06-01

STDs, including HIV, disproportionately affect individuals who have multiple minority identities. Understanding differences in STD risk factors across racial, ethnic and sexual minority groups, as well as genders, is important for tailoring public health interventions. Data from Waves 3 (2001-2002) and 4 (2007-2008) of the National Longitudinal Study of Adolescent Health were used to develop population-based estimates of STD and HIV risk factors among 11,045 young adults (mean age, 29 at Wave 4), by gender, race and ethnicity, and sexual orientation (heterosexual, mixed-oriented, gay). Regression analyses were conducted to examine associations between risk factors and young adults' characteristics. Overall, sexual-minority women in each racial or ethnic group had a higher prevalence of sexual risk behaviors-including a history of multiple partners, forced sex and incarceration-than their heterosexual counterparts. Mixed-oriented women in each racial or ethnic group were more likely than heterosexual white women to have received an STD diagnosis (odds ratios, 1.8-6.4). Black men and sexual-minority men also appeared to be at heightened risk. Gay men in all racial and ethnic groups were significantly more likely than heterosexual white men to report having received an STD diagnosis (2.3-8.3); compared with heterosexual white men, mixed-oriented black men had the highest odds of having received such a diagnosis (15.2). Taking account of multiple minority identities should be an important part of future research and intervention efforts for STD and HIV prevention. Copyright © 2012 by the Guttmacher Institute.

Lymphohaematopoietic malignancy around all industrial complexes that include major oil refineries in Great Britain.

PubMed

Wilkinson, P; Thakrar, B; Walls, P; Landon, M; Falconer, S; Grundy, C; Elliott, P

1999-09-01

To examine the incidence of lymphohaematopoietic malignancy around industrial complexes that include major oil refineries in Great Britain after recent public and scientific concern of possible carcinogenic hazards of emissions from the petrochemical industry. Small area study of the incidence of lymphohaematopoietic malignancies, 1974-91, within 7.5 km of all 11 oil refineries (grouped into seven sites) in Great Britain that were operational by the early 1970s and processed more than two million tonnes of crude oil in 1993. Combined analysis of data from all seven sites showed no significant (p < 0.05) increase in risk of these malignancies within 2 km or 7.5 km. Hodgkin's lymphoma, but no other malignancy, showed evidence (p = 0.02) of a decline in risk with distance from refineries, but there was an apparent deficit of cases of multiple myeloma near the refineries (p = 0.04). There was no evidence of association between residence near oil refineries and leukaemias, or non-Hodgkin's lymphoma. A weak positive association was found between risk of Hodgkin's disease and proximity to major petrochemical industry, and a negative association with multiple myeloma, which may be chance findings within the context of multiple statistical testing.

Relationships between childhood sexual abuse and substance use and sexual risk behaviors during adolescence: An integrative review.

PubMed

Draucker, Claire Burke; Mazurczyk, Jill

2013-01-01

Childhood sexual abuse (CSA) is thought to be a precursor to substance use and sexual risk behaviors during adolescence. To inform adolescent prevention efforts, information is needed to explicate the nature of the relationships between CSA and these health risks. The aim of this study was to summarize the current literature on the associations between a history of CSA and substance use and sexual risk behaviors during adolescence. We conducted a systematic literature search and an integrative review. Current evidence implicates CSA as a robust precursor to the use of a wide variety of substances and multiple sexual risk behaviors during adolescence. Screening for CSA in adolescents at risk and incorporating strategies that enhance CSA recovery in adolescent prevention programs are warranted. Future research that includes longitudinal designs, uses multiple methods of assessment, and identifies pathways between CSA and adolescent health risks is recommended. Copyright © 2013 Elsevier Inc. All rights reserved.

SOCIAL STABILITY AND HIV RISK BEHAVIOR: EVALUATING THE ROLE OF ACCUMULATED VULNERABILITY

PubMed Central

German, Danielle; Latkin, Carl A.

2011-01-01

This study evaluated a cumulative and syndromic relationship among commonly co-occurring vulnerabilites (homelessness, incarceration, low-income, residential transition) in association with HIV-related risk behaviors among 635 low-income women in Baltimore. Analysis included descriptive statistics, logistic regression, latent class analysis and latent class regression. Both methods of assessing multidimensional instability showed significant associations with risk indicators. Risk of multiple partners, sex exchange, and drug use decreased significantly with each additional domain. Higher stability class membership (77%) was associated with decreased likelihood of multiple partners, exchange partners, recent drug use, and recent STI. Multidimensional social vulnerabilities were cumulatively and synergistically linked to HIV risk behavior. Independent instability measures may miss important contextual determinants of risk. Social stability offers a useful framework to understand the synergy of social vulnerabilities that shape sexual risk behavior. Social policies and programs aiming to enhance housing and overall social stability are likely to be beneficial for HIV prevention. PMID:21259043

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

Adolescent Victimization and Early-Adult Psychopathology: Approaching Causal Inference Using a Longitudinal Twin Study to Rule Out Noncausal Explanations

PubMed Central

Schaefer, Jonathan D.; Moffitt, Terrie E.; Arseneault, Louise; Danese, Andrea; Fisher, Helen L.; Houts, Renate; Sheridan, Margaret A.; Wertz, Jasmin; Caspi, Avshalom

2017-01-01

Adolescence is the peak age for both victimization and mental disorder onset. Previous research has reported associations between victimization exposure and many psychiatric conditions. However, causality remains controversial. Within the Environmental Risk Longitudinal Twin Study, we tested whether seven types of adolescent victimization increased risk of multiple psychiatric conditions and approached causal inference by systematically ruling out noncausal explanations. Longitudinal within-individual analyses showed that victimization was followed by increased mental health problems over a childhood baseline of emotional/behavioral problems. Discordant-twin analyses showed that victimization increased risk of mental health problems independent of family background and genetic risk. Both childhood and adolescent victimization made unique contributions to risk. Victimization predicted heightened generalized liability (the “p factor”) to multiple psychiatric spectra, including internalizing, externalizing, and thought disorders. Results recommend violence reduction and identification and treatment of adolescent victims to reduce psychiatric burden. PMID:29805917

Plasma Cell Neoplasms (Including Multiple Myeloma) Treatment (PDQ®)—Patient Version

Cancer.gov

Plasma cell neoplasms occur when abnormal plasma cells or myeloma cells form tumors in the bones or soft tissues of the body. Multiple myeloma, plasmacytoma, lymphoplasmacytic lymphoma, and monoclonal gammopathy of undetermined significance (MGUS) are different types of plasma cell neoplasms. Find out about risk factors, symptoms, diagnostic tests, prognosis, and treatment for these diseases.

PTSD and Comorbid Disorders in a Representative Sample of Adolescents: The Risk Associated with Multiple Exposures to Potentially Traumatic Events

ERIC Educational Resources Information Center

Macdonald, Alexandra; Danielson, Carla Kmett; Resnick, Heidi S.; Saunders, Benjamin E.; Kilpatrick, Dean G.

2010-01-01

Objective: This study compared the impact of multiple exposures to potentially traumatic events (PTEs), including sexual victimization, physical victimization, and witnessed violence, on posttraumatic stress disorder (PTSD) and comorbid conditions (i.e., major depressive episode [MDE], and substance use [SUD]). Methods: Participants were a…

Obesity, Inflammation, and Cancer.

PubMed

Deng, Tuo; Lyon, Christopher J; Bergin, Stephen; Caligiuri, Michael A; Hsueh, Willa A

2016-05-23

Obesity, a worldwide epidemic, confers increased risk for multiple serious conditions, including cancer, and is increasingly recognized as a growing cause of preventable cancer risk. Chronic inflammation, a well-known mediator of cancer, is a central characteristic of obesity, leading to many of its complications, and obesity-induced inflammation confers additional cancer risk beyond obesity itself. Multiple mechanisms facilitate this strong association between cancer and obesity. Adipose tissue is an important endocrine organ, secreting several hormones, including leptin and adiponectin, and chemokines that can regulate tumor behavior, inflammation, and the tumor microenvironment. Excessive adipose expansion during obesity causes adipose dysfunction and inflammation to increase systemic levels of proinflammatory factors. Cells from adipose tissue, such as cancer-associated adipocytes and adipose-derived stem cells, enter the cancer microenvironment to enhance protumoral effects. Dysregulated metabolism that stems from obesity, including insulin resistance, hyperglycemia, and dyslipidemia, can further impact tumor growth and development. This review describes how adipose tissue becomes inflamed in obesity, summarizes ways these mechanisms impact cancer development, and discusses their role in four adipose-associated cancers that demonstrate elevated incidence or mortality in obesity.

Action control and situational risks in the prevention of HIV and STIs: individual, dyadic, and social influences on consistent condom use in a university population.

PubMed

Svenson, Gary R; Ostergren, Per-Olof; Merlo, Juan; Råstam, Lennart

2002-12-01

The aim of this study was to gain an understanding of consistent condom use. We took the perspective that condom use involves the ability to handle situational risks influenced at multiple levels, including the individual, dyadic, and social. The hypothesis was that action control, as measured by self-regulation, implementation intentions, and self-efficacy, was the primary determinant. The study was conducted at part of a community-based intervention at a major university (36,000 students). Data was collected using a validated questionnaire mailed to a random sample of students (n = 493, response rate = 71.5%). Statistical analysis included logistic regression models that successively included background, individual, dyadic, and social variables. In the final model, consistent condom use was higher among students with strong implementation intentions, high self-regulation and positive peer norms. The results contribute new knowledge on action control in predicting sexual risk behaviors and lends support to the conceptualization and analysis of HIV/sexually transmitted infection prevention at multiple levels of influence.

Raising multiples: mental health of mothers and fathers in early parenthood

PubMed Central

Battle, Cynthia L.; Tezanos, Katherine M.

2015-01-01

The rate of twin and higher-order gestation births has risen dramatically in recent decades in the United States as well as other Western countries. Although the obstetrical and neonatal risks of multiple gestation pregnancies are well-documented, much less is known regarding the mental health impact on parents of multiples during the perinatal and early parenthood period. Given that parents of multiples face greater functional demands, as well as other pressures (financial, medical) this population may be at risk for heightened distress. We conducted a systematic review of quantitative, English language studies that assessed mental health outcomes of parents of multiples during pregnancy, in the first postpartum year, and in the period of early parenthood, including depression, anxiety, stress, and related constructs. Twenty-seven articles published between 1989 and 2014 met selection criteria and were included in the review. Studies utilized a wide range of methods and outcome constructs, often making comparisons difficult. Although some studies found no differences, most investigations that compared mental health outcomes in parents of multiples versus parents of singletons found that parents of multiples experience heightened symptoms of depression, anxiety, and parenting stress. We discuss gaps in the existing body of literature on parental mental health related to multiple gestation birth and conclude by discussing the need for novel intervention strategies to meet the needs of this growing population. Parents of multiples may experience worse mental health outcomes than parents of singletons. More research is needed, and future work should explore potential treatment and support options. PMID:25515039

Exposure to Different Types of Violence and Subsequent Sexual Risk Behavior among Female STD Clinic Patients: A Latent Class Analysis

PubMed Central

Walsh, Jennifer L.; Senn, Theresa E.; Carey, Michael P.

2013-01-01

Objective Diverse forms of violence, including childhood maltreatment (CM), intimate partner violence (IPV), and exposure to community violence (ECV), have been linked separately with sexual risk behaviors. However, few studies have explored multiple experiences of violence simultaneously in relation to sexual risk-taking, especially in women who are most vulnerable to violent experiences. Methods Participants were 481 women (66% African American, Mage = 27 years) attending a publicly-funded STD clinic who reported on their past and current experiences with violence and their current sexual risk behavior. We identified patterns of experience with violence using latent class analysis (LCA) and investigated which combinations of experiences were associated with the riskiest sexual outcomes. Results Four classes of women with different experiences of violence were identified: Low Violence (39%), Predominantly ECV (20%), Predominantly CM (23%), and Multiply Victimized (18%). Women in the Multiply Victimized and Predominantly ECV classes reported the highest levels of sexual risk behavior, including more lifetime sexual partners and a greater likelihood of receiving STD treatment and using substances before sex. Conclusions Women with different patterns of violent experiences differed in their sexual risk behavior. Interventions to reduce sexual risk should address violence against women, focusing on experiences with multiple types of violence and experiences specifically with ECV. Additional research is needed to determine the best ways to address violence in sexual risk reduction interventions. PMID:23626921

Stress in multiple sclerosis: review of new developments and future directions.

PubMed

Lovera, Jesus; Reza, Tara

2013-11-01

In the experimental autoimmune encephalitis model of multiple sclerosis, the effects of stress on disease severity depend on multiple factors, including the animal's genetics and the type of stressor. The studies in humans relating stress to the risk of developing multiple sclerosis have found discordant results. The studies looking at the association of stress with relapses show a fairly consistent association, where higher stress is associated with a higher risk of relapse. Higher stress levels also appear to increase the risk of development of gadolinium-enhancing lesions. A recent randomized trial shows that reducing stress using stress management therapy (SMT), a cognitive-behavioral therapy approach, results in a statistically significant reduction in new magnetic resonance imaging lesions. The magnitude of this effect is large and comparable to the effects of existent disease-modifying therapies, but no data exist yet proving that SMT reduces relapses or clinical progression; the effect of SMT appears to be short-lived. Additional work is needed to improve the duration of this effect and make this therapy more widely accessible.

How Does Sexual Minority Stigma "Get under the Skin"? A Psychological Mediation Framework

ERIC Educational Resources Information Center

Hatzenbuehler, Mark L.

2009-01-01

Sexual minorities are at increased risk for multiple mental health burdens compared with heterosexuals. The field has identified 2 distinct determinants of this risk, including group-specific minority stressors and general psychological processes that are common across sexual orientations. The goal of the present article is to develop a…

Marching to a Different Beat: A Bibliography of Materials about Children at Risk because of Disabilities and/or Abilities.

ERIC Educational Resources Information Center

Buckingham, Betty Jo

This annotated bibliography covers materials about children at risk because of disabilities and/or abilities. The bibliography includes approximately 560 entries. The following categories are addressed: autism; gifted; handicapped--general and multiple; hearing impaired/deaf; learning disabilities; mental illness; mentally handicapped/brain…

A Study on the Perceived Risk of Surface Sample Collection Systems in Proposal Formulation

NASA Technical Reports Server (NTRS)

Sunday, Cecily M.

2012-01-01

This project compares design and proposal elements from multiple proposals and presents conclusions and recommendations for sampling systems. Contributions from this project include a list of common evaluation themes, concept and proposal-related strengths and weaknesses and ways in which self-identified risks relate the evaluation of the mission.

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,…

New opportunities of real-world data from clinical routine settings in life-cycle management of drugs: example of an integrative approach in multiple sclerosis.

PubMed

Rothenbacher, Dietrich; Capkun, Gorana; Uenal, Hatice; Tumani, Hayrettin; Geissbühler, Yvonne; Tilson, Hugh

2015-05-01

The assessment and demonstration of a positive benefit-risk balance of a drug is a life-long process and includes specific data from preclinical, clinical development and post-launch experience. However, new integrative approaches are needed to enrich evidence from clinical trials and sponsor-initiated observational studies with information from multiple additional sources, including registry information and other existing observational data and, more recently, health-related administrative claims and medical records databases. To illustrate the value of this approach, this paper exemplifies such a cross-package approach to the area of multiple sclerosis, exploring also possible analytic strategies when using these multiple sources of information.

Pre- and Perinatal Risk for Attention-Deficit Hyperactivity Disorder: Does Neuropsychological Weakness Explain the Link?

PubMed

Wiggs, Kelsey; Elmore, Alexis L; Nigg, Joel T; Nikolas, Molly A

2016-11-01

Etiological investigations of attention-deficit hyperactivity disorder (ADHD) and disruptive behavior problems support multiple causal pathways, including involvement of pre- and perinatal risk factors. Because these risks occur early in life, well before observable ADHD and externalizing symptoms emerge, the relation between risk and symptoms may be mediated by neurodevelopmental effects that manifest later in neuropsychological functioning. However, potential dissociable effects of pre/perinatal risk elements on ADHD and familial confounds must also be considered to test alternative hypotheses. 498 youth aged 6-17 years (55.0 % male) completed a multi-stage, multi-informant assessment including parent and teacher symptom reports of symptoms and parent ratings of pre/perinatal health risk indicators. Youth completed a neuropsychological testing battery. Multiple mediation models examined direct effects of pre- and perinatal health risk on ADHD and other disruptive behavior disorder symptoms and indirect effects via neuropsychological functioning. Parental ADHD symptoms and externalizing status was covaried to control for potential familial effects. Effects of prenatal substance exposure on inattention were mediated by memory span and temporal processing deficits. Further, effects of perinatal health risk on inattention, hyperactivity-impulsivity, and ODD were mediated by deficits in response variability and temporal processing. Further, maternal health risks during pregnancy appeared to exert direct rather than indirect effects on outcomes. Results suggest that after controlling for familial relatedness of ADHD between parent and child, early developmental health risks may influence ADHD via effects on neuropsychological processes underpinning the disorder.

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

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.

Characteristics of Interventions Targeting Multiple Lifestyle Risk Behaviours in Adult Populations: A Systematic Scoping Review

PubMed Central

King, Kristel; Meader, Nick; Wright, Kath; Graham, Hilary; Power, Christine; Petticrew, Mark; White, Martin; Sowden, Amanda J.

2015-01-01

Background Modifiable lifestyle risk behaviours such as smoking, unhealthy diet, physical inactivity and alcohol misuse are the leading causes of major, non-communicable diseases worldwide. It is increasingly being recognised that interventions which target more than one risk behaviour may be an effective and efficient way of improving people’s lifestyles. To date, there has been no attempt to summarise the global evidence base for interventions targeting multiple risk behaviours. Objective To identify and map the characteristics of studies evaluating multiple risk behaviour change interventions targeted at adult populations in any country. Methods Seven bibliographic databases were searched between January, 1990, and January/ May, 2013. Authors of protocols, conference abstracts, and other relevant articles were contacted. Study characteristics were extracted and inputted into Eppi-Reviewer 4. Results In total, 220 studies were included in the scoping review. Most were randomised controlled trials (62%) conducted in the United States (49%), and targeted diet and physical activity (56%) in people from general populations (14%) or subgroups of general populations (45%). Very few studies had been conducted in the Middle East (2%), Africa (0.5%), or South America (0.5%). There was also a scarcity of studies conducted among young adults (1%), or racial and minority ethnic populations (4%) worldwide. Conclusions Research is required to investigate the interrelationships of lifestyle risk behaviours in varying cultural contexts around the world. Cross-cultural development and evaluation of multiple risk behaviour change interventions is also needed, particularly in populations of young adults and racial and minority ethnic populations. PMID:25617783

Risk of falls in older people during fast-walking--the TASCOG study.

PubMed

Callisaya, M L; Blizzard, L; McGinley, J L; Srikanth, V K

2012-07-01

To investigate the relationship between fast-walking and falls in older people. Individuals aged 60-86 years were randomly selected from the electoral roll (n=176). Gait speed, step length, cadence and a walk ratio were recorded during preferred- and fast-walking using an instrumented walkway. Falls were recorded prospectively over 12 months. Log multinomial regression was used to estimate the relative risk of single and multiple falls associated with gait variables during fast-walking and change between preferred- and fast-walking. Covariates included age, sex, mood, physical activity, sensorimotor and cognitive measures. The risk of multiple falls was increased for those with a smaller walk ratio (shorter steps, faster cadence) during fast-walking (RR 0.92, CI 0.87, 0.97) and greater reduction in the walk ratio (smaller increase in step length, larger increase in cadence) when changing to fast-walking (RR 0.73, CI 0.63, 0.85). These gait patterns were associated with poorer physiological and cognitive function (p<0.05). A higher risk of multiple falls was also seen for those in the fastest quarter of gait speed (p=0.01) at fast-walking. A trend for better reaction time, balance, memory and physical activity for higher categories of gait speed was stronger for fallers than non-fallers (p<0.05). Tests of fast-walking may be useful in identifying older individuals at risk of multiple falls. There may be two distinct groups at risk--the frail person with short shuffling steps, and the healthy person exposed to greater risk. Copyright © 2012 Elsevier B.V. All rights reserved.

Streets, drugs, and the economy of sex in the age of AIDS.

PubMed

Weeks, M R; Grier, M; Romero-Daza, N; Puglisi-Vasquez, M J; Singer, M

1998-01-01

Drug addicted women whose economic and social base is urban streets face limited options for income generation and multiple dangers of predation, assault, arrest, and illness. Exchanging sex for money or drugs offers one important source of income in this context. Yet the legal, social, and safety risks associated with these exchanges reduce the likelihood of regular safer sex practices during these encounters, thereby increasing the risk of HIV infection. Such conditions lead women engaged in sexual exchanges for money to varied and complex responses influenced by multiple and often contradictory pressures, both personal and contextual. Street-recruited women drug users in an AIDS prevention program in Hart-ford, Connecticut reported a range of condom use when engaging in sex for money exchanges. This paper explores their differences by ethnicity, economic resources, and drug use, and analyzes these and other factors that impact on street risks through sexual income generation. Surveys and in-depth interviews with drug-addicted women sex workers describe their various approaches to addressing multiple risks on the streets and suggest significant effort by women in these contexts to avoid the many risks, including HIV infection.

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.

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.

What Is the Prevalence of Symptomatic Obstructive Sleep Apnea Syndrome in Chronic Spinal Pain Patients? An Assessment of the Correlation of OSAS with Chronic Opioid Therapy, Obesity, and Smoking.

PubMed

Pampati, Sanjana; Manchikanti, Laxmaiah

2016-05-01

In modern medicine, obstructive sleep apnea syndrome (OSAS) is a commonly described sleep disorder with airway obstruction, disrupted sleep, and excessive daytime sleepiness. Since its description in 1976 by Guilleminault et al, numerous epidemiologic studies and systematic reviews, with multiple comorbidities related to cardiovascular sequelae, altered cognitive function, and multiple other potential complications have been described. Multiple risk factors have been identified included obesity, smoking, alcohol consumption, and other factors. Chronic pain and chronic opioid therapy also have been described to contribute to a large proportion of patients with OSAS. Chronic pain, obesity, smoking, and chronic opioid therapy are often found together, yet there is a paucity of literature describing OSAS in chronic pain patients. To assess the prevalence of symptomatic OSAS in chronic spinal pain patients receiving chronic opioid therapy and determine the association of OSAS with multiple risk factors and comorbidities. A retrospective assessment of patients who attend a single interventional pain management practice from January 1, 2010to December 31, 2014. A private interventional pain management practice in the United States. The data were collected from 4,036 consecutive patients presenting for assessment to a pain management center from January 1, 2010 to December 31, 2014. All assessments were comprehensive and performed by 2 physicians. The comprehensive assessment included a complete history, a physical examination, and a review of records. The prevalence of OSAS in patients with chronic spinal pain was 13.8%. The results showed a higher prevalence in males compared to females (15.1% versus 12.8%), a higher prevalence in those aged 45 or older compared to those 25-45 years and those 18-25 years (16.3% versus 10.7% or 2.5%), higher prevalence in Hispanics and Asians compared to African Americans and whites (23.7% versus 16.2% versus 13.4%), higher prevalence in patients with combined back and neck pain compared to patients with thoracic pain only or back pain only (16.3% versus 8.2% to 11%). Prevalence also varied by body mass index (BMI): 32.4% in morbidly obese patients, 20.3% in severely obese patients, 15.7% in obese patients, 9.2% in those who were overweight, and only 5.7% in those with normal weight. A significant correlation with OSAS was also observed in patients smoking more than 40 pack years and multiple respiratory symptoms except for chronic bronchitis and multiple cardiovascular ailments. The retrospective nature of the assessment. This retrospective assessment of over 4,000 patients suffering from chronic pain and receiving chronic opioid therapy indicated a prevalence of sleep apnea syndrome as 13.8%. Multiple risk factors including obesity, chronic obstructive pulmonary disease (COPD), chronic sinus and nasal discharge, and multiple comorbidities including cardiovascular and related ailments have been identified. Obstructive sleep apnea syndrome, chronic pain, chronic spinal pain, chronic opioid therapy, obesity, smoking, cardiovascular risk factors, pulmonary risk factors.

Review: The size of the risk: Histories of multiple use in the Great Basin by Leisl Carr Childers

USGS Publications Warehouse

Johnson, Craig A.

2017-01-01

In The Size of the Risk, Leisl Carr Childers chronicles the changing ways in which public lands of the Great Basin have been managed from the latter half of the nineteenth century through the late 1970s. The main focus is the State of Nevada, which constitutes the core of the Great Basin. Rather than proceeding chronologically, the book is organized by the uses to which lands were put, including grazing of cattle and sheep, weapons testing by the military, parks and recreation, and grazing of wild mustangs.Review info: The size of the risk: Histories of multiple use in the Great Basin. By Leisl Carr Childers, 2015. ISBN: 9780806152530, 320pp.

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.

The Best Anticoagulation Therapy in Multiple-Trauma Patients with Mechanical Heart Valves: Evaluation of Latest Guidelines and Studies.

PubMed

Moeinipour, Aliasghar; Zarifian, Ahmadreza; Sheikh Andalibi, Mohammad Sobhan; Shamloo, Alireza Sepehri; Ahmadabadi, Ali; Amouzeshi, Ahmad; Hoseinikhah, Hamid

2015-12-22

It is common practice for patients with prosthetic cardiac devices, especially heart valve prosthesis, arterial stents, defibrillators, and pacemaker devices, to use anticoagulation treatment. When these patients suffer from multiple trauma after motor vehicle accidents, the best medical management for this challenging position is mandatory. This strategy should include a rapid diagnosis of all possible multiple organ injuries, with special attention to anticoagulation therapy so as to minimize the risk of thromboembolism complication in prosthetic devices. In this review, we describe the best medical management for patients with multiple trauma who use anticoagulants after heart valve replacement. We searched electronic databases PubMed/Medline, Scopus, Embase, and Google Scholar using the following terms: anticoagulant, warfarin, heparin, and multiple trauma. Also, similar studies suggested by the databases were included. Non-English articles were excluded from the review. For patients who use anticoagulation therapy, teamwork between cardiac surgeons, general surgeons, anesthesiologists, and cardiologists is essential. For optimal medical management, multiple consults between members of this team is mandatory for rapid diagnosis of all possible damaged organs, with special attention to the central nervous system, chest, and abdominal traumas. With this strategy, it is important to take note of anticoagulation drugs to minimize the risk of thromboembolism complications in cardiac devices. The best anticoagulant agents for emergency operations in patients with multiple trauma who are using an anticoagulant after heart valve replacement are fresh frozen plasma (FFP) and prothrombin complex concentrates (PCC).

Psychosocial Predictors and Correlates of Suicidality in Teenage Latino Males

ERIC Educational Resources Information Center

Locke, Thomas F.; Newcomb, Michael D.

2005-01-01

Multiple ecodevelopmental factors were tested as they influence suicidality in a community sample of Latino adolescent males. Risk factors tested included childhood maltreatment, parental alcohol-related problems, and polysubstance problems. Protective factors included general self-efficacy, social conformity, and family bonding. Male participants…

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

Low cigarette consumption and risk of coronary heart disease and stroke: meta-analysis of 141 cohort studies in 55 study reports.

PubMed

Hackshaw, Allan; Morris, Joan K; Boniface, Sadie; Tang, Jin-Ling; Milenković, Dušan

2018-01-24

To use the relation between cigarette consumption and cardiovascular disease to quantify the risk of coronary heart disease and stroke for light smoking (one to five cigarettes/day). Systematic review and meta-analysis. Medline 1946 to May 2015, with manual searches of references. Prospective cohort studies with at least 50 events, reporting hazard ratios or relative risks (both hereafter referred to as relative risk) compared with never smokers or age specific incidence in relation to risk of coronary heart disease or stroke. MOOSE guidelines were followed. For each study, the relative risk was estimated for smoking one, five, or 20 cigarettes per day by using regression modelling between risk and cigarette consumption. Relative risks were adjusted for at least age and often additional confounders. The main measure was the excess relative risk for smoking one cigarette per day (RR 1_per_day -1) expressed as a proportion of that for smoking 20 cigarettes per day (RR 20_per_day -1), expected to be about 5% assuming a linear relation between risk and consumption (as seen with lung cancer). The relative risks for one, five, and 20 cigarettes per day were also pooled across all studies in a random effects meta-analysis. Separate analyses were done for each combination of sex and disorder. The meta-analysis included 55 publications containing 141 cohort studies. Among men, the pooled relative risk for coronary heart disease was 1.48 for smoking one cigarette per day and 2.04 for 20 cigarettes per day, using all studies, but 1.74 and 2.27 among studies in which the relative risk had been adjusted for multiple confounders. Among women, the pooled relative risks were 1.57 and 2.84 for one and 20 cigarettes per day (or 2.19 and 3.95 using relative risks adjusted for multiple factors). Men who smoked one cigarette per day had 46% of the excess relative risk for smoking 20 cigarettes per day (53% using relative risks adjusted for multiple factors), and women had 31% of the excess risk (38% using relative risks adjusted for multiple factors). For stroke, the pooled relative risks for men were 1.25 and 1.64 for smoking one or 20 cigarettes per day (1.30 and 1.56 using relative risks adjusted for multiple factors). In women, the pooled relative risks were 1.31 and 2.16 for smoking one or 20 cigarettes per day (1.46 and 2.42 using relative risks adjusted for multiple factors). The excess risk for stroke associated with one cigarette per day (in relation to 20 cigarettes per day) was 41% for men and 34% for women (or 64% and 36% using relative risks adjusted for multiple factors). Relative risks were generally higher among women than men. Smoking only about one cigarette per day carries a risk of developing coronary heart disease and stroke much greater than expected: around half that for people who smoke 20 per day. No safe level of smoking exists for cardiovascular disease. Smokers should aim to quit instead of cutting down to significantly reduce their risk of these two common major disorders. 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.

Low cigarette consumption and risk of coronary heart disease and stroke: meta-analysis of 141 cohort studies in 55 study reports

PubMed Central

Morris, Joan K; Boniface, Sadie; Tang, Jin-Ling; Milenković, Dušan

2018-01-01

Abstract Objective To use the relation between cigarette consumption and cardiovascular disease to quantify the risk of coronary heart disease and stroke for light smoking (one to five cigarettes/day). Design Systematic review and meta-analysis. Data sources Medline 1946 to May 2015, with manual searches of references. Eligibility criteria for selecting studies Prospective cohort studies with at least 50 events, reporting hazard ratios or relative risks (both hereafter referred to as relative risk) compared with never smokers or age specific incidence in relation to risk of coronary heart disease or stroke. Data extraction/synthesis MOOSE guidelines were followed. For each study, the relative risk was estimated for smoking one, five, or 20 cigarettes per day by using regression modelling between risk and cigarette consumption. Relative risks were adjusted for at least age and often additional confounders. The main measure was the excess relative risk for smoking one cigarette per day (RR1_per_day−1) expressed as a proportion of that for smoking 20 cigarettes per day (RR20_per_day−1), expected to be about 5% assuming a linear relation between risk and consumption (as seen with lung cancer). The relative risks for one, five, and 20 cigarettes per day were also pooled across all studies in a random effects meta-analysis. Separate analyses were done for each combination of sex and disorder. Results The meta-analysis included 55 publications containing 141 cohort studies. Among men, the pooled relative risk for coronary heart disease was 1.48 for smoking one cigarette per day and 2.04 for 20 cigarettes per day, using all studies, but 1.74 and 2.27 among studies in which the relative risk had been adjusted for multiple confounders. Among women, the pooled relative risks were 1.57 and 2.84 for one and 20 cigarettes per day (or 2.19 and 3.95 using relative risks adjusted for multiple factors). Men who smoked one cigarette per day had 46% of the excess relative risk for smoking 20 cigarettes per day (53% using relative risks adjusted for multiple factors), and women had 31% of the excess risk (38% using relative risks adjusted for multiple factors). For stroke, the pooled relative risks for men were 1.25 and 1.64 for smoking one or 20 cigarettes per day (1.30 and 1.56 using relative risks adjusted for multiple factors). In women, the pooled relative risks were 1.31 and 2.16 for smoking one or 20 cigarettes per day (1.46 and 2.42 using relative risks adjusted for multiple factors). The excess risk for stroke associated with one cigarette per day (in relation to 20 cigarettes per day) was 41% for men and 34% for women (or 64% and 36% using relative risks adjusted for multiple factors). Relative risks were generally higher among women than men. Conclusions Smoking only about one cigarette per day carries a risk of developing coronary heart disease and stroke much greater than expected: around half that for people who smoke 20 per day. No safe level of smoking exists for cardiovascular disease. Smokers should aim to quit instead of cutting down to significantly reduce their risk of these two common major disorders. PMID:29367388

Prevalence of multiple health-related behaviors in adolescents with cancer.

PubMed

Carpentier, Melissa Y; Mullins, Larry L; Elkin, T David; Wolfe-Christensen, Cortney

2008-12-01

This preliminary study investigated prevalence rates of multiple health-related behaviors (ie, tobacco, alcohol, and other drug use; sexual risk-taking; nutrition/physical activity; overweight and dietary behaviors; sun safety) among 42 adolescents on active treatment for cancer, as compared with healthy adolescent norms. Health-related behaviors were assessed using the 2005 National Youth Risk Behavior Survey, for which healthy adolescent norms were publicly available. Adolescents with cancer reported significantly lower current and lifetime rates of tobacco, alcohol, and other drug use; fruit/vegetable consumption; physical activity; and dietary behavior, in addition to lower rates of lifetime sexual intercourse, early-onset sexual intercourse, and alcohol/drug use before last sexual intercourse, compared with healthy peers. Among those who have previously engaged in sexual intercourse, there appeared to be a trend toward increased partners, current sexual activity, and lack of protection at last episode of sexual intercourse. Adolescents with cancer also reported significantly higher rates of television watching compared with healthy peers. Adolescents on active treatment for cancer are engaging in multiple health-risk behaviors, including sedentary behavior, poor nutrition, lack of sun safety, and sexual risk-taking (eg, multiple partners, lack of protection at last sexual intercourse). Health promotion interventions are needed during active treatment to facilitate the acquisition of good health practices as adolescents transition into survivorship.

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 road to treating smoldering multiple myeloma.

PubMed

Korde, Neha; Mailankody, Sham; Landgren, Ola

2014-09-01

The management of smoldering multiple myeloma (SMM) has been a challenge to clinicians, ever since the condition was first characterized in 1980. While the risk of progression to symptomatic myeloma is greater for SMM (10% per year) compared to MGUS (1% per year), several SMM patients remain asymptomatic for years without evidence of disease progression. Early clinical trials focusing on early treatment of SMM have been equivocal with no clear benefit. However, the last decade has seen a greater understanding of the pathogenesis of plasma cell disorders, including SMM, and development of better therapeutics. A recent randomized trial has provided evidence of clinical benefit with early treatment of high-risk SMM. In this review, we summarize issues related to the early treatment of SMM including risk stratification and possible outcomes with therapy initiation. In the context of reviewing recent clinical trial data supporting early treatment, we define challenges faced by clinicians and provide future directions to the road to treating SMM. Published by Elsevier Inc.

Lowering risk score profile during PCI in multiple vessel disease is associated with low adverse events: The ERACI risk score.

PubMed

Rodriguez, Alfredo E; Fernandez-Pereira, Carlos; Mieres, Juan; Pavlovsky, Hernan; Del Pozo, Juan; Rodriguez-Granillo, Alfredo M; Antoniucci, David

2018-02-13

In recent years angiographic risk scores have been introduced in clinical practice to stratify different levels of risk after percutaneous coronary interventions (PCI). The SYNTAX score included all intermediate lesions in vessels ≥1.5 mm, consequently, multiple stent implantation was required. Four years ago, we built a new angiographic score in order to guide PCI strategy avoiding stent deployment both in intermediate stenosis as in small vessels, therefore these were not scored (ERACI risk score). The purpose of this mini review is to validate the strategy of PCI guided by this scoring, taking into account long term follow up outcomes of two observational and prospective registries where this policy was used. With this new risk score we have modified risk profile of our patient's candidates for PCI or coronary artery bypass surgery lowering the risk and <20% of them are now included anatomically as high risk for PCI. The simple exclusion of small vessels and intermediate stenosis from the revascularization approach resulted in clinical outcome comparable with the one of fractional flow reserve guided revascularization. Low events rate at late follow up observed in both studies was also in agreement with guided PCI by functional lesion assessment observed by Syntax II registry, where investigators found lower events rate in spite of a few number of stents implanted per patient. use of ERACI risk scores may significantly reclassify patients into a lower risk category and be associated with low adverse events rate. Copyright © 2018. Published by Elsevier Inc.

Using digital notifications to improve attendance in clinic: systematic review and meta-analysis.

PubMed

Robotham, Dan; Satkunanathan, Safarina; Reynolds, John; Stahl, Daniel; Wykes, Til

2016-10-24

Assess the impact of text-based electronic notifications on improving clinic attendance, in relation to study quality (according to risk of bias), and to assess simple ways in which notifications can be optimised (ie, impact of multiple notifications). Systematic review, study quality appraisal assessing risk of bias, data synthesised in meta-analyses. MEDLINE, EMBASE, PsycINFO, Web of Science and Cochrane Database of Systematic Reviews (01.01.05 until 25.4.15). A systematic search to discover all studies containing quantitative data for synthesis into meta-analyses. Studies examining the effect of text-based electronic notifications on prescheduled appointment attendance in healthcare settings. Primary analysis included experimental studies where randomisation was used to define allocation to intervention and where a control group consisting of 'no reminders' was used. Secondary meta-analysis included studies comparing text reminders with voice reminders. Studies lacking sufficient information for inclusion (after attempting to contact study authors) were excluded. Primary outcomes were rate of attendance/non-attendance at healthcare appointments. Secondary outcome was rate of rescheduled and cancelled appointments. 26 articles were included. 21 included in the primary meta-analysis (8345 patients receiving electronic text notifications, 7731 patients receiving no notifications). Studies were included from Europe (9), Asia (7), Africa (2), Australia (2) and America (1). Patients who received notifications were 23% more likely to attend clinic than those who received no notification (risk ratio=1.23, 67% vs 54%). Those receiving notifications were 25% less likely to 'no show' for appointments (risk ratio=.75, 15% vs 21%). Results were similar when accounting for risk of bias, region and publication year. Multiple notifications were significantly more effective at improving attendance than single notifications. Voice notifications appeared more effective than text notifications at improving attendance. Electronic text notifications improve attendance and reduce no shows across healthcare settings. Sending multiple notifications could improve attendance further. 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/.

Lack of findings for the association between obesity risk and usual sugar-sweetened beverage consumption in adults--a primary analysis of databases of CSFII-1989-1991, CSFII-1994-1998, NHANES III, and combined NHANES 1999-2002.

PubMed

Sun, Sam Z; Empie, Mark W

2007-08-01

The relationship between obesity risk and sugar-sweetened beverage (SSB) consumption was examined together with multiple lifestyle factors. Statistical analysis was performed using population dietary survey databases of USDA CSFII 1989-1991, CSFII 1994-1996, CDC NHANES III, and combined NHANES 1999-2002. Totally, 38,409 individuals, ages 20-74 years, with accompanying data of dietary intake, lifestyle factors, and anthropometrics were included in the descriptive statistics and risk analysis. Analytical results indicate that obesity risk was significantly and positively associated with gender, age, daily TV/screen watching hours and dietary fat content, and negatively associated with smoking habit, education and physical activity; obesity risk was not significantly associated with SSB consumption pattern, dietary saturated fat content and total calorie intake. No elevated BMI values or increased obesity rates were observed in populations frequently consuming SSB compared to populations infrequently consuming SSB. Additionally, one-day food consumption data was found to overestimate SSB usual intake by up to 38.9% compared to the data of multiple survey days. multiple lifestyle factors and higher dietary fat intake were significantly associated with obesity risk. Populations who frequently consumed SSB, primarily HFCS sweetened beverages, did not have a higher obesity rate or increased obesity risk than that of populations which consumed SSB infrequently.

Occupational use of insecticides, fungicides ~and fumigants and risk of non-Hodgkin lymphoma and nultiplc myeloma in the Agricultural Health Study

EPA Science Inventory

Farming and exposure to pesticides have been linked to non-Hodgkin lymphoma (NHL), and multiple myeloma (MM) in previous studies. We evaluated use of insecticides, fungicides and fumigants and risk of NHL, including MM and other NHL sub-types in the Agricultural Health Study, a ...

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…

In Vitro Fertilization (IVF)

MedlinePlus

... or eggs are implanted in your uterus. One cycle of IVF takes about two weeks. IVF is ... Specific steps of an in vitro fertilization (IVF) cycle carry risks, including: Multiple births. IVF increases the ...

The multiple stressor ecological risk assessment for the mercury-contaminated South River and upper Shenandoah River using the Bayesian network-relative risk model.

PubMed

Landis, Wayne G; Ayre, Kimberley K; Johns, Annie F; Summers, Heather M; Stinson, Jonah; Harris, Meagan J; Herring, Carlie E; Markiewicz, April J

2017-01-01

We have conducted a regional scale risk assessment using the Bayesian Network Relative Risk Model (BN-RRM) to calculate the ecological risks to the South River and upper Shenandoah River study area. Four biological endpoints (smallmouth bass, white sucker, Belted Kingfisher, and Carolina Wren) and 4 abiotic endpoints (Fishing River Use, Swimming River Use, Boating River Use, and Water Quality Standards) were included in this risk assessment, based on stakeholder input. Although mercury (Hg) contamination was the original impetus for the site being remediated, other chemical and physical stressors were evaluated. There were 3 primary conclusions from the BN-RRM results. First, risk varies according to location, type and quality of habitat, and exposure to stressors within the landscape. The patterns of risk can be evaluated with reasonable certitude. Second, overall risk to abiotic endpoints was greater than overall risk to biotic endpoints. By including both biotic and abiotic endpoints, we are able to compare risk to endpoints that represent a wide range of stakeholder values. Third, whereas Hg reduction is the regulatory priority for the South River, Hg is not the only stressor driving risk to the endpoints. Ecological and habitat stressors contribute risk to the endpoints and should be considered when managing this site. This research provides the foundation for evaluating the risks of multiple stressors of the South River to a variety of endpoints. From this foundation, tools for the evaluation of management options and an adaptive management tools have been forged. Integr Environ Assess Manag 2017;13:85-99. © 2016 SETAC. © 2016 SETAC.

Risk Factors for Lung Cancer in Iowa Women: Implications for Prevention

PubMed Central

Neuberger, John S.; Mahnken, Jonathan D.; Mayo, Matthew S.; Field, R. William

2007-01-01

Background Multiple risk factors possibly associated with lung cancer were examined as part of a large-scale residential radon case-control study conducted in Iowa between 1994 and 1997. We were particularly interested in stratifying risk factors by smoking status. Relatively little risk factor information is available for Midwestern rural women. Methods Four hundred thirteen female lung cancer cases and 614 controls aged 40-84, who were residents of their current home for at least 20 years, were included. Risk factors examined included cigarette smoking, passive smoking, occupation, chemical exposure, previous lung disease, family history of cancer, and urban residence. Multiple logistic regression analysis was conducted after adjusting for age, education, and cumulative radon exposure. Results As expected, active cigarette smoking was the major risk factor for lung cancer. While cessation of smoking was significantly associated with a reduced risk for lung cancer, the risk remained significantly elevated for 25 years. Among all cases, asbestos exposure was a significant risk. Among ex-smokers, pack-year history predominated as the major risk. Among never smokers, a family history of kidney or bladder cancer were significant risk factors (OR= 7.34, 95% CI = 1.91 - 28.18; and 5.02, 95% CI = 1.64-15.39, respectively), as was a history of previous lung disease (OR=2.28, 95% CI=1.24-4.18) and asbestos exposure. No statistically significant increase in lung cancer risk was found for occupation or urban residence. Conclusions Smoking prevention activities are urgently needed in rural areas of the United States. Relatives of individuals with smoking-related cancers are potentially at increased risk. Genetic risk factors should be more fully investigated in never smokers. PMID:16581199

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.

Control of aliphatic halogenated DBP precursors with multiple drinking water treatment processes: Formation potential and integrated toxicity.

PubMed

Zhang, Yimeng; Chu, Wenhai; Yao, Dechang; Yin, Daqiang

2017-08-01

The comprehensive control efficiency for the formation potentials (FPs) of a range of regulated and unregulated halogenated disinfection by-products (DBPs) (including carbonaceous DBPs (C-DBPs), nitrogenous DBPs (N-DBPs), and iodinated DBPs (I-DBPs)) with the multiple drinking water treatment processes, including pre-ozonation, conventional treatment (coagulation-sedimentation, pre-sand filtration), ozone-biological activated carbon (O 3 -BAC) advanced treatment, and post-sand filtration, was investigated. The potential toxic risks of DBPs by combing their FPs and toxicity values were also evaluated. The results showed that the multiple drinking water treatment processes had superior performance in removing organic/inorganic precursors and reducing the formation of a range of halogenated DBPs. Therein, ozonation significantly removed bromide and iodide, and thus reduced the formation of brominated and iodinated DBPs. The removal of organic carbon and nitrogen precursors by the conventional treatment processes was substantially improved by O 3 -BAC advanced treatment, and thus prevented the formation of chlorinated C-DBPs and N-DBPs. However, BAC filtration leads to the increased formation of brominated C-DBPs and N-DBPs due to the increase of bromide/DOC and bromide/DON. After the whole multiple treatment processes, the rank order for integrated toxic risk values caused by these halogenated DBPs was haloacetonitriles (HANs)≫haloacetamides (HAMs)>haloacetic acids (HAAs)>trihalomethanes (THMs)>halonitromethanes (HNMs)≫I-DBPs (I-HAMs and I-THMs). I-DBPs failed to cause high integrated toxic risk because of their very low FPs. The significant higher integrated toxic risk value caused by HANs than other halogenated DBPs cannot be ignored. Copyright © 2017. Published by Elsevier B.V.

Dose-response relationships between internally-deposited uranium and select health outcomes in gaseous diffusion plant workers, 1948-2011.

PubMed

Yiin, James H; Anderson, Jeri L; Bertke, Stephen J; Tollerud, David J

2018-05-09

To examine dose-response relationships between internal uranium exposures and select outcomes among a cohort of uranium enrichment workers. Cox regression was conducted to examine associations between selected health outcomes and cumulative internal uranium with consideration for external ionizing radiation, work-related medical X-rays and contaminant radionuclides technetium ( 99 Tc) and plutonium ( 239 Pu) as potential confounders. Elevated and monotonically increasing mortality risks were observed for kidney cancer, chronic renal diseases, and multiple myeloma, and the association with internal uranium absorbed organ dose was statistically significant for multiple myeloma. Adjustment for potential confounders had minimal impact on the risk estimates. Kidney cancer, chronic renal disease, and multiple myeloma mortality risks were elevated with increasing internal uranium absorbed organ dose. The findings add to evidence of an association between internal exposure to uranium and cancer. Future investigation includes a study of cancer incidence in this cohort. © 2018 Wiley Periodicals, Inc.

Individual risk factors for deep infection and compromised fracture healing after intramedullary nailing of tibial shaft fractures: a single centre experience of 480 patients.

PubMed

Metsemakers, W-J; Handojo, K; Reynders, P; Sermon, A; Vanderschot, P; Nijs, S

2015-04-01

Despite modern advances in the treatment of tibial shaft fractures, complications including nonunion, malunion, and infection remain relatively frequent. A better understanding of these injuries and its complications could lead to prevention rather than treatment strategies. A retrospective study was performed to identify risk factors for deep infection and compromised fracture healing after intramedullary nailing (IMN) of tibial shaft fractures. Between January 2000 and January 2012, 480 consecutive patients with 486 tibial shaft fractures were enrolled in the study. Statistical analysis was performed to determine predictors of deep infection and compromised fracture healing. Compromised fracture healing was subdivided in delayed union and nonunion. The following independent variables were selected for analysis: age, sex, smoking, obesity, diabetes, American Society of Anaesthesiologists (ASA) classification, polytrauma, fracture type, open fractures, Gustilo type, primary external fixation (EF), time to nailing (TTN) and reaming. As primary statistical evaluation we performed a univariate analysis, followed by a multiple logistic regression model. Univariate regression analysis revealed similar risk factors for delayed union and nonunion, including fracture type, open fractures and Gustilo type. Factors affecting the occurrence of deep infection in this model were primary EF, a prolonged TTN, open fractures and Gustilo type. Multiple logistic regression analysis revealed polytrauma as the single risk factor for nonunion. With respect to delayed union, no risk factors could be identified. In the same statistical model, deep infection was correlated with primary EF. The purpose of this study was to evaluate risk factors of poor outcome after IMN of tibial shaft fractures. The univariate regression analysis showed that the nature of complications after tibial shaft nailing could be multifactorial. This was not confirmed in a multiple logistic regression model, which only revealed polytrauma and primary EF as risk factors for nonunion and deep infection, respectively. Future strategies should focus on prevention in high-risk populations such as polytrauma patients treated with EF. Copyright © 2014 Elsevier Ltd. All rights reserved.

The sequence of disease-modifying therapies in relapsing multiple sclerosis: safety and immunologic considerations.

PubMed

Pardo, Gabriel; Jones, David E

2017-12-01

The treatment landscape for relapsing forms of multiple sclerosis (RMS) has expanded considerably over the last 10 years with the approval of multiple new disease-modifying therapies (DMTs), and others in late-stage clinical development. All DMTs for RMS are believed to reduce central nervous system immune-mediated inflammatory processes, which translate into demonstrable improvement in clinical and radiologic outcomes. However, some DMTs are associated with long-lasting effects on the immune system and/or serious adverse events, both of which may complicate the use of subsequent therapies. When customizing a treatment program, a benefit-risk assessment must consider multiple factors, including the efficacy of the DMT to reduce disease activity, the short- and long-term safety and immunologic profiles of each DMT, the criteria used to define switching treatment, and the risk tolerance of each patient. A comprehensive benefit-risk assessment can only be achieved by evaluating the immunologic, safety, and efficacy data for DMTs in the controlled clinical trial environment and the postmarketing clinical practice setting. This review is intended to help neurologists make informed decisions when treating RMS by summarizing the known data for each DMT and raising awareness of the multiple considerations involved in treating people with RMS throughout the entire course of their disease.

A retrospective likelihood approach for efficient integration of multiple omics factors in case-control association studies.

PubMed

Balliu, Brunilda; Tsonaka, Roula; Boehringer, Stefan; Houwing-Duistermaat, Jeanine

2015-03-01

Integrative omics, the joint analysis of outcome and multiple types of omics data, such as genomics, epigenomics, and transcriptomics data, constitute a promising approach for powerful and biologically relevant association studies. These studies often employ a case-control design, and often include nonomics covariates, such as age and gender, that may modify the underlying omics risk factors. An open question is how to best integrate multiple omics and nonomics information to maximize statistical power in case-control studies that ascertain individuals based on the phenotype. Recent work on integrative omics have used prospective approaches, modeling case-control status conditional on omics, and nonomics risk factors. Compared to univariate approaches, jointly analyzing multiple risk factors with a prospective approach increases power in nonascertained cohorts. However, these prospective approaches often lose power in case-control studies. In this article, we propose a novel statistical method for integrating multiple omics and nonomics factors in case-control association studies. Our method is based on a retrospective likelihood function that models the joint distribution of omics and nonomics factors conditional on case-control status. The new method provides accurate control of Type I error rate and has increased efficiency over prospective approaches in both simulated and real data. © 2015 Wiley Periodicals, Inc.

Prevention of triplets and higher order multiples: trends in reproductive medicine.

PubMed

Armour, Kim L; Callister, Lynn Clark

2005-01-01

In the United States and throughout the world, today's healthcare providers are challenged by the risks of multiple gestation pregnancy. Assisted reproductive technologies (ARTs) often used to treat infertility raise ethical issues including informed consent, veracity, and nonmalificence. In the United States, there is the need to improve maternal and fetal/neonatal mortality and morbidity by proposing legislation regulating ART and supporting single embryo transfers with no more than 2 such transfers. Beginning with the diagnosis of infertility, providers have a responsibility to educate, inform, and treat infertile couples. From the moment pregnancy with multiples is confirmed, these families are faced with incredible stressors including decision making on multifetal or selective reduction. Full disclosure of risks involved throughout the course of care should be discussed and documented in the record and plan of care. Currently in the United States, legislation does not regulate ART, including ovulation induction/enhancement and in vitro fertilization. Although the United States does have self-regulation via limited reporting through their professional organization and the Centers for Disease Control and Prevention, an unlimited number of embryos may be transferred. Unfortunately, many healthcare providers have not recognized the responsibility and burden placed on families and society as a whole. Lack of regulation means women may become pregnant with high order multiples, which raises serious moral and ethical issues.

Tissue-Specific Enrichment of Lymphoma Risk Loci in Regulatory Elements

PubMed Central

Hayes, James E.; Trynka, Gosia; Vijai, Joseph; Offit, Kenneth; Raychaudhuri, Soumya; Klein, Robert J.

2015-01-01

Though numerous polymorphisms have been associated with risk of developing lymphoma, how these variants function to promote tumorigenesis is poorly understood. Here, we report that lymphoma risk SNPs, especially in the non-Hodgkin’s lymphoma subtype chronic lymphocytic leukemia, are significantly enriched for co-localization with epigenetic marks of active gene regulation. These enrichments were seen in a lymphoid-specific manner for numerous ENCODE datasets, including DNase-hypersensitivity as well as multiple segmentation-defined enhancer regions. Furthermore, we identify putatively functional SNPs that are both in regulatory elements in lymphocytes and are associated with gene expression changes in blood. We developed an algorithm, UES, that uses a Monte Carlo simulation approach to calculate the enrichment of previously identified risk SNPs in various functional elements. This multiscale approach integrating multiple datasets helps disentangle the underlying biology of lymphoma, and more broadly, is generally applicable to GWAS results from other diseases as well. PMID:26422229

The Relationship Between Pregnancy Prevention and STI/HIV Prevention and Sexual Risk Behavior Among American Indian Men.

PubMed

Rink, Elizabeth; FourStar, Kristofer; Anastario, Michael P

2017-01-01

We examined the relationship between American Indian men's attitudes toward pregnancy prevention, STI/HIV prevention, and sexual risk behavior. Attention was given to: (1) attitudes and intentions to use condoms and sexual risk behavior; (2) STI/HIV prevention characteristics and sexual risk behavior; (3) attitudes toward abstinence and monogamy and sexual risk behavior; and (4) decision-making in relationships and sexual risk behavior. Our sample included 120 heterosexual American Indian men aged 18 to 24 living on a reservation. Data were collected during in-depth interviews. A community-based participatory research framework was used to ensure the relevancy and acceptability of the study given the sensitivity of the topic. Results demonstrated that attitudinal factors were associated with sexual risk behavior, particularly inconsistent condom use. Attitudes associated with consistent condom use suggested greater levels of positive dispositions toward prevention and intention to use condoms. Consistent condom use was associated with more cautious attitudes toward sex with multiple sex partners. Study results suggested that American Indian men who reported sex with multiple partners exhibited a set of attitudes and beliefs toward pregnancy prevention and STI/HIV prevention that corresponded with a disposition resulting from their behaviors, in that engaging in sexual risk behavior elevated their levels of risk perception. Our findings suggest that heterosexual American Indian men living in rural environments need sexual and reproductive health programs and clinical services that address differing attitudes toward condom use within the context of multiple sex partners and sexual risk behavior. © 2015 National Rural Health Association.

Problem formulation for risk assessment of combined exposures to chemicals and other stressors in humans.

PubMed

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

2016-11-01

When the human health risk assessment/risk management paradigm was developed, it did not explicitly include a "problem formulation" phase. The concept of problem formulation was first introduced in the context of ecological risk assessment (ERA) for the pragmatic reason to constrain and focus ERAs on the key questions. However, this need also exists for human health risk assessment, particularly for cumulative risk assessment (CRA), because of its complexity. CRA encompasses the combined threats to health from exposure via all relevant routes to multiple stressors, including biological, chemical, physical and psychosocial stressors. As part of the HESI Risk Assessment in the 21st Century (RISK21) Project, a framework for CRA was developed in which problem formulation plays a critical role. The focus of this effort is primarily on a chemical CRA (i.e., two or more chemicals) with subsequent consideration of non-chemical stressors, defined as "modulating factors" (ModFs). Problem formulation is a systematic approach that identifies all factors critical to a specific risk assessment and considers the purpose of the assessment, scope and depth of the necessary analysis, analytical approach, available resources and outcomes, and overall risk management goal. There are numerous considerations that are specific to multiple stressors, and proper problem formulation can help to focus a CRA to the key factors in order to optimize resources. As part of the problem formulation, conceptual models for exposures and responses can be developed that address these factors, such as temporal relationships between stressors and consideration of the appropriate ModFs.

Multiple Myeloma Index for Risk of Infection.

PubMed

T, Valkovic; V, Gacic; A, Nacinovic-Duletic

2018-01-01

Based on our earlier research into the main characteristics and risk factors for infections in hospitalized patients with multiple myeloma, we created the numerical Multiple Myeloma Index for Risk of Infection (MMIRI) to predict infection in myeloma patients. The included factors that could influence the pathogenesis and incidence of infections were sex, performance status, Durie Salmon stage of disease, International Staging System, serum creatinine level, immune paresis, neutropenia, serum ferritin level, the presence of any catheters, disease duration, stable/progressive disease, and type of therapy. For each of these parameters, the strength of association with infection was statistically estimated and specific number of points was assigned to each of these parameters, proportional to the strength of the association. When designing the MMIRI, we included only those parameters that we determined were pathophysiologically associated with the infection. After further statistical analysis, we identified an optimal cutoff score of 6 or above as indicating a significant risk for infection, with a sensitivity of 93.2% and specificity of 80.2%. The scoring system in the retrospective receiver operating characteristic analysis showed an area under the curve of 0.918. The potential value of the MMIRI is the possibility of identifying those patients who would benefit from the prophylactic administration of antibiotics and other anti-infective measures while minimizing the contribution to antibiotic resistance related to the overuse of these drugs. As far as we know, this index represents the first attempt to create such an instrument for predicting the occurrence of infections in myeloma patients.

Upper extremity fractures among hospitalized road traffic accident adults.

PubMed

Rubin, Guy; Peleg, Kobi; Givon, Adi; Rozen, Nimrod

2015-02-01

Upper extremity fractures (UEFs) associated with road traffic accidents (RTAs) may result in long-term disability. Previous studies have examined UEF profiles with small patient populations. The objective of this study was to examine the injury profiles of UEFs in all mechanisms of injury related to RTAs. Data on 71,231 RTA adult patients between 1997 and 2012 whose records were entered in a centralized country trauma database were reviewed. Data on UEFs related to mechanism of injury (car, motorcycle, bicycle, and pedestrian) including associated injuries, multiple UEFs, and frequency of UEF were analyzed. Of 71,231 adult RTA cases recorded in 1997-2012, 12,754 (17.9%) included UEFs. Motorcycle (27%) and bicycle riders (25%) had the greater risk for UEF (P<.0001). Of 12,754 patients with UEFs, 9701 (76%) had other injuries. Pedestrians (86%) and car occupants (81%) had the greater risk for associated injuries (P<.0001). Most of the injuries were head/face/neck (52%), lower extremities (49%), and chest (46%) injuries (P<.0001). Twenty-two percent of all cases had multiple UEFs. The motorcycle riders (27%) had the greater risk for multiple UEFs (P<.0001). Of 12,754 patients with UEFs we found 16,371 UEFs. Most of the fractures were in the radius (22%), humerus (19%), and clavicle (17%) (P<.0001). This study contributes the largest database on reported adult UEFs related to all mechanisms of injury in RTAs and finds the comparative epidemiology of associated injuries, multiple UEFs, and frequency of UEFs. It is important that the treating surgeon is aware of the complexity of the UEF patient, the strong possibility for associated injury, the possibility for multiple fractures in the upper limbs, and the most common fractures associated with each mechanism of accident. Copyright © 2014 Elsevier Inc. All rights reserved.

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.

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.

Society of Thoracic Surgeons 2008 cardiac risk models predict in-hospital mortality of heart valve surgery in a Chinese population: a multicenter study.

PubMed

Wang, Lv; Lu, Fang-Lin; Wang, Chong; Tan, Meng-Wei; Xu, Zhi-yun

2014-12-01

The Society of Thoracic Surgeons 2008 cardiac surgery risk models have been developed for heart valve surgery with and without coronary artery bypass grafting. The aim of our study was to evaluate the performance of Society of Thoracic Surgeons 2008 cardiac risk models in Chinese patients undergoing single valve surgery and the predicted mortality rates of those undergoing multiple valve surgery derived from the Society of Thoracic Surgeons 2008 risk models. A total of 12,170 patients underwent heart valve surgery from January 2008 to December 2011. Combined congenital heart surgery and aortal surgery cases were excluded. A relatively small number of valve surgery combinations were excluded. The final research population included the following isolated heart valve surgery types: aortic valve replacement, mitral valve replacement, and mitral valve repair. The following combined valve surgery types were included: mitral valve replacement plus tricuspid valve repair, mitral valve replacement plus aortic valve replacement, and mitral valve replacement plus aortic valve replacement and tricuspid valve repair. Evaluation was performed by using the Hosmer-Lemeshow test and C-statistics. Data from 9846 patients were analyzed. The Society of Thoracic Surgeons 2008 cardiac risk models showed reasonable discrimination and poor calibration (C-statistic, 0.712; P = .00006 in Hosmer-Lemeshow test). Society of Thoracic Surgeons 2008 models had better discrimination (C-statistic, 0.734) and calibration (P = .5805) in patients undergoing isolated valve surgery than in patients undergoing multiple valve surgery (C-statistic, 0.694; P = .00002 in Hosmer-Lemeshow test). Estimates derived from the Society of Thoracic Surgeons 2008 models exceeded the mortality rates of multiple valve surgery (observed/expected ratios of 1.44 for multiple valve surgery and 1.17 for single valve surgery). The Society of Thoracic Surgeons 2008 cardiac surgery risk models performed well when predicting the mortality for Chinese patients undergoing valve surgery. The Society of Thoracic Surgeons 2008 models were suitable for single valve surgery in a Chinese population; estimates of mortality for multiple valve surgery derived from the Society of Thoracic Surgeons 2008 models were less accurate. Copyright © 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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.

Level of education and multiple sclerosis risk over a 50-year period: Registry-based sibling study.

PubMed

Bjørnevik, Kjetil; Riise, Trond; Benjaminsen, Espen; Celius, Elisabeth G; Dahl, Ole P; Kampman, Margitta T; Løken-Amsrud, Kristin I; Midgard, Rune; Myhr, Kjell-Morten; Torkildsen, Øivind; Vatne, Anita; Grytten, Nina

2017-02-01

The conflicting results from studies on socioeconomic status (SES) and multiple sclerosis (MS) risk might be due to a change in the distribution of environmental exposures over time or to methodological limitations in previous research. To examine the association between SES and MS risk during 50 years. We included patients registered in Norwegian MS registries and prevalence studies born between 1930 and 1979, and identified their siblings and parents using the Norwegian Population Registry. Information on education was retrieved from the National Education Registry, categorized into four levels (primary, secondary, undergraduate and graduate) and compared in patients and siblings using conditional logistic regression. A total of 4494 MS patients and 9193 of their siblings were included in the analyses. Level of education was inversely associated with MS risk ( p trend < 0.001) with an odds ratio (OR) of 0.73 (95% confidence interval (CI): 0.59-0.90) when comparing the highest and lowest levels. The effect estimates did not vary markedly between participants born before or after the median year of birth (1958), but we observed a significant effect modification by parental education ( p = 0.047). Level of education was inversely associated with MS risk, and the estimates were similar in the earliest and latest birth cohorts.

Trade-space Analysis for Constellations

NASA Astrophysics Data System (ADS)

Le Moigne, J.; Dabney, P.; de Weck, O. L.; Foreman, V.; Grogan, P.; Holland, M. P.; Hughes, S. P.; Nag, S.

2016-12-01

Traditionally, space missions have relied on relatively large and monolithic satellites, but in the past few years, under a changing technological and economic environment, including instrument and spacecraft miniaturization, scalable launchers, secondary launches as well as hosted payloads, there is growing interest in implementing future NASA missions as Distributed Spacecraft Missions (DSM). The objective of our project is to provide a framework that facilitates DSM Pre-Phase A investigations and optimizes DSM designs with respect to a-priori Science goals. In this first version of our Trade-space Analysis Tool for Constellations (TAT-C), we are investigating questions such as: "How many spacecraft should be included in the constellation? Which design has the best cost/risk value?" The main goals of TAT-C are to: Handle multiple spacecraft sharing a mission objective, from SmallSats up through flagships, Explore the variables trade space for pre-defined science, cost and risk goals, and pre-defined metrics Optimize cost and performance across multiple instruments and platforms vs. one at a time. This paper describes the overall architecture of TAT-C including: a User Interface (UI) interacting with multiple users - scientists, missions designers or program managers; an Executive Driver gathering requirements from UI, then formulating Trade-space Search Requests for the Trade-space Search Iterator first with inputs from the Knowledge Base, then, in collaboration with the Orbit & Coverage, Reduction & Metrics, and Cost& Risk modules, generating multiple potential architectures and their associated characteristics. TAT-C leverages the use of the Goddard Mission Analysis Tool (GMAT) to compute coverage and ancillary data, streamlining the computations by modeling orbits in a way that balances accuracy and performance. TAT-C current version includes uniform Walker constellations as well as Ad-Hoc constellations, and its cost model represents an aggregate model consisting of Cost Estimating Relationships (CERs) from widely accepted models. The Knowledge Base supports both analysis and exploration, and the current GUI prototype automatically generates graphics representing metrics such as average revisit time or coverage as a function of cost.

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.

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.

Allergen source materials: state-of-the-art.

PubMed

Esch, Robert E

2009-01-01

A variety of positive outcomes can be realized from validation and risk management activities (see Table 4). They are dependent on the participation of multiple functional groups including the quality unit, regulatory and legal affairs, engineering and production operations, research and development, and sales and marketing. Quality risk management is receiving increased attention in the area of public health, pharmacovigilance, and pharmaceutical manufacturing. Recent examples of its regulatory use in our industry include the assessment of the potential risks of transmissible spongiform encephalopathies (TSE) agents through contaminated products], the risks of precipitates in allergenic extracts, and the revision of the potency limits for standardized dust mite and grass allergen vaccines. Its application to allergen source material process validation activities allowed for a practical strategy, especially in a complex manufacturing environment involving hundreds of products with multiple intended uses. In addition, the use of tools such as FMEA was useful in evaluating proposed changes made to manufacturing procedures and product specifications, new regulatory actions, and customer feedback or complaints. The success of such a quality assurance programs will ultimately be reflected in the elimination or reduction of product failures, improvement in the detection and prediction of potential product failures, and increased confidence in product quality.

A systematic review of risk and protective factors associated with family related violence in refugee families.

PubMed

Timshel, Isabelle; Montgomery, Edith; Dalgaard, Nina Thorup

2017-08-01

The current systematic review summarizes the evidence from studies examining the risk and protective factors associated with family related violence in refugee families. Data included 15 peer-reviewed qualitative and quantitative studies. In order to gain an overview of the identified risk and protective factors an ecological model was used to structure the findings. At the individual level, parental trauma experiences/mental illness, substance abuse and history of child abuse were found to be risk factors. Family level risk factors included parent-child interaction, family structure and family acculturation stress. At the societal level low socioeconomic status was identified as a risk factor. Cultural level risk factors included patriarchal beliefs. Positive parental coping strategies were a protective factor. An ecological analysis of the results suggests that family related violence in refugee families is a result of accumulating, multiple risk factors on the individual, familial, societal and cultural level. The findings suggest that individual trauma and exile related stress do not only affect the individual but have consequences at a family level. Thus, interventions targeting family related violence should not only include the individual, but the family. Copyright © 2017 Elsevier Ltd. All rights reserved.

Habitat risk assessment for regional ocean planning in the U.S. Northeast and Mid-Atlantic.

PubMed

Wyatt, Katherine H; Griffin, Robert; Guerry, Anne D; Ruckelshaus, Mary; Fogarty, Michael; Arkema, Katie K

2017-01-01

Coastal habitats provide important benefits to people, including habitat for species targeted by fisheries and opportunities for tourism and recreation. Yet, such human activities also can imperil these habitats and undermine the ecosystem services they provide to people. Cumulative risk assessment provides an analytical framework for synthesizing the influence of multiple stressors across habitats and decision-support for balancing human uses and ecosystem health. To explore cumulative risk to habitats in the U.S. Northeast and Mid-Atlantic Ocean Planning regions, we apply the open-source InVEST Habitat Risk Assessment model to 13 habitats and 31 stressors in an exposure-consequence framework. In doing so, we advance the science priorities of EBM and both regional planning bodies by synthesizing the wealth of available data to improve our understanding of human uses and how they affect marine resources. We find that risk to ecosystems is greatest first, along the coast, where a large number of stressors occur in close proximity and secondly, along the continental shelf, where fewer, higher consequence activities occur. Habitats at greatest risk include soft and hard-bottom nearshore areas, tidal flats, soft-bottom shelf habitat, and rocky intertidal zones-with the degree of risk varying spatially. Across all habitats, our results indicate that rising sea surface temperatures, commercial fishing, and shipping consistently and disproportionally contribute to risk. Further, our findings suggest that management in the nearshore will require simultaneously addressing the temporal and spatial overlap as well as intensity of multiple human activities and that management in the offshore requires more targeted efforts to reduce exposure from specific threats. We offer a transparent, generalizable approach to evaluating cumulative risk to multiple habitats and illustrate the spatially heterogeneous nature of impacts along the eastern Atlantic coast and the importance of spatial scale in estimating such impacts. These results offer a valuable decision-support tool by helping to constrain the decision space, focus attention on habitats and locations at the greatest risk, and highlight effect management strategies.

Habitat risk assessment for regional ocean planning in the U.S. Northeast and Mid-Atlantic

PubMed Central

Guerry, Anne D.; Ruckelshaus, Mary; Fogarty, Michael; Arkema, Katie K.

2017-01-01

Coastal habitats provide important benefits to people, including habitat for species targeted by fisheries and opportunities for tourism and recreation. Yet, such human activities also can imperil these habitats and undermine the ecosystem services they provide to people. Cumulative risk assessment provides an analytical framework for synthesizing the influence of multiple stressors across habitats and decision-support for balancing human uses and ecosystem health. To explore cumulative risk to habitats in the U.S. Northeast and Mid-Atlantic Ocean Planning regions, we apply the open-source InVEST Habitat Risk Assessment model to 13 habitats and 31 stressors in an exposure-consequence framework. In doing so, we advance the science priorities of EBM and both regional planning bodies by synthesizing the wealth of available data to improve our understanding of human uses and how they affect marine resources. We find that risk to ecosystems is greatest first, along the coast, where a large number of stressors occur in close proximity and secondly, along the continental shelf, where fewer, higher consequence activities occur. Habitats at greatest risk include soft and hard-bottom nearshore areas, tidal flats, soft-bottom shelf habitat, and rocky intertidal zones—with the degree of risk varying spatially. Across all habitats, our results indicate that rising sea surface temperatures, commercial fishing, and shipping consistently and disproportionally contribute to risk. Further, our findings suggest that management in the nearshore will require simultaneously addressing the temporal and spatial overlap as well as intensity of multiple human activities and that management in the offshore requires more targeted efforts to reduce exposure from specific threats. We offer a transparent, generalizable approach to evaluating cumulative risk to multiple habitats and illustrate the spatially heterogeneous nature of impacts along the eastern Atlantic coast and the importance of spatial scale in estimating such impacts. These results offer a valuable decision-support tool by helping to constrain the decision space, focus attention on habitats and locations at the greatest risk, and highlight effect management strategies. PMID:29261672

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.

The 2006 William Feinberg lecture: shifting the paradigm from stroke to global vascular risk estimation.

PubMed

Sacco, Ralph L

2007-06-01

By the year 2010, it is estimated that 18.1 million people worldwide will die annually because of cardiovascular diseases and stroke. "Global vascular risk" more broadly includes the multiple overlapping disease silos of stroke, myocardial infarction, peripheral arterial disease, and vascular death. Estimation of global vascular risk requires consideration of a variety of variables including demographics, environmental behaviors, and risk factors. Data from multiple studies suggest continuous linear relationships between the physiological vascular risk modulators of blood pressure, lipids, and blood glucose rather than treating these conditions as categorical risk factors. Constellations of risk factors may be more relevant than individual categorical components. Exciting work with novel risk factors may also have predictive value in estimates of global vascular risk. Advances in imaging have led to the measurement of subclinical conditions such as carotid intima-media thickness and subclinical brain conditions such as white matter hyperintensities and silent infarcts. These subclinical measurements may be intermediate stages in the transition from asymptomatic to symptomatic vascular events, appear to be associated with the fundamental vascular risk factors, and represent opportunities to more precisely quantitate disease progression. The expansion of studies in molecular epidemiology and detection of genetic markers underlying vascular risks also promises to extend our precision of global vascular risk estimation. Global vascular risk estimation will require quantitative methods that bundle these multi-dimensional data into more precise estimates of future risk. The power of genetic information coupled with data on demographics, risk-inducing behaviors, vascular risk modulators, biomarkers, and measures of subclinical conditions should provide the most realistic approximation of an individual's future global vascular risk. The ultimate public health benefit, however, will depend on not only identification of global vascular risk but also the realization that we can modify this risk and prove the prediction models wrong.

Update on Multiple Ovulations in Dairy Cattle.

PubMed

Macmillan, Kira; Kastelic, John P; Colazo, Marcos G

2018-04-24

This review updates the causal mechanisms and risk factors for multiple ovulations (MOV) in cattle. Clearly, MOV can lead to twin pregnancies, which negatively affects the health, production, and reproduction of cows. Therefore, a better understanding of the factors causing MOV may help to reduce twinning. Multiple ovulations occur after two or more follicles deviate and achieve codominance. The MOV rate is influenced by a complex network of hormones. For example, MOV is more common during periods of low progesterone (P4), that is, in anovulatory cattle or when luteolysis coincides with the selection of the future ovulatory follicle. There is also strong evidence for the luteinizing hormone (LH) being the primary factor leading to codominance, as high P4 concentrations suppress the transient LH surges and can reduce the ovulation rate in cattle or even inhibit deviation. Rates of MOV are increased in older and higher-producing dairy cows. Increased milk production and dry matter intake (DMI) increases hormone clearance, including P4; however, the association between milk yield and MOV has not been consistent. Additional risk factors for MOV include ovarian cysts, diet, season, and genetics.

Sexual Orientation Disparities in Sexually Transmitted Infection Risk Behaviors and Risk Determinants Among Sexually Active Adolescent Males: Results From a School-Based Sample

PubMed Central

Schnarrs, Phillip W.; Rosario, Margaret; Garofalo, Robert; Mustanski, Brian

2014-01-01

Objectives. We examined disparities in risk determinants and risk behaviors for sexually transmitted infections (STIs) between gay-identified, bisexual-identified, and heterosexual-identified young men who have sex with men (YMSM) and heterosexual-identified young men who have sex with women (YMSW) using a school-based sample of US sexually active adolescent males. Methods. We analyzed a pooled data set of Youth Risk Behavior Surveys from 2005 and 2007 that included information on sexual orientation identity, sexual behaviors, and multiple STI risk factors. Results. Bisexual-identified adolescents were more likely to report multiple STI risk behaviors (number of sex partners, concurrent sex partners, and age of sexual debut) compared with heterosexual YMSW as well as heterosexual YMSM and gay-identified respondents. Gay, bisexual, and heterosexual YMSM were significantly more likely to report forced sex compared with heterosexual YMSW. Conclusions. Our results provide evidence that sexual health disparities emerge early in the life course and vary by both sexual orientation identity and sexual behaviors. In particular, they show that bisexual-identified adolescent males exhibit a unique risk profile that warrants targeted sexual health interventions. PMID:24825214

Forced bachelors, migration and HIV transmission risk in the context of China's gender imbalance: a meta-analysis.

PubMed

Liu, Huijun; Li, Shuzhuo; Feldman, M W

2012-01-01

China has experienced continual increase in the sex ratio at birth (SRB) since the 1980s, which has led to a serious gender imbalance. To identify whether the future forced bachelors, especially those who migrate to cities, will increase the risk of HIV spread, a systematic review was carried out of studies published since 2000 that include the sexual risks of male migrants of China. Five studies comparing risk differences between migrants and non-migrants showed male migrants had greater risk of having multiple sexual partners and engaging in commercial sex. Ten studies concerning the relationship between sexual risks and socio-demographic characteristics showed that unmarried male migrants were more likely to engage in commercial sex and be infected with STDs than married migrants, while male migrants with higher income were more likely to have multiple sexual partners and be infected with STDs. In an analysis stratified by sample characteristics, the association between marriage and sexual risk was greater among samples with lower mean age, higher average income and education. In addition, the risk selection on education and income disappeared in the samples of migrants of whom more than half were unmarried.

Natural history of age-related lobular involution and impact on breast cancer risk.

PubMed

Radisky, Derek C; Visscher, Daniel W; Frank, Ryan D; Vierkant, Robert A; Winham, Stacey; Stallings-Mann, Melody; Hoskin, Tanya L; Nassar, Aziza; Vachon, Celine M; Denison, Lori A; Hartmann, Lynn C; Frost, Marlene H; Degnim, Amy C

2016-02-01

Age-related lobular involution (LI) is a physiological process in which the terminal duct lobular units of the breast regress as a woman ages. Analyses of breast biopsies from women with benign breast disease (BBD) have found that extent of LI is negatively associated with subsequent breast cancer development. Here we assess the natural course of LI within individual women, and the impact of progressive LI on breast cancer risk. The Mayo Clinic BBD cohort consists of 13,455 women with BBD from 1967 to 2001. The BBD cohort includes 1115 women who had multiple benign biopsies, 106 of whom had developed breast cancer. Within this multiple biopsy cohort, the progression of the LI process was examined by age at initial biopsy and time between biopsies. The relationship between LI progression and breast cancer risk was assessed using standardized incidence ratios and by Cox proportional hazards analysis. Women who had multiple biopsies were younger age and had a slightly higher family history of breast cancer as compared with the overall BBD cohort. Extent of LI at subsequent biopsy was greater with increasing time between biopsies and for women age 55 + at initial biopsy. Among women with multiple biopsies, there was a significant association of higher breast cancer risk among those with involution stasis (lack of progression, HR 1.63) as compared with those with involution progression, p = 0.036. The multiple biopsy BBD cohort allows for a longitudinal study of the natural progression of LI. The majority of women in the multiple biopsy cohort showed progression of LI status between benign biopsies, and extent of progression was highest for women who were in the perimenopausal age range at initial biopsy. Progression of LI status between initial and subsequent biopsy was associated with decreased breast cancer risk.

Prediction of individual probabilities of livebirth and multiple birth events following in vitro fertilization (IVF): a new outcomes counselling tool for IVF providers and patients using HFEA metrics

PubMed Central

Jones, Christopher A.; Christensen, Anna L.; Salihu, Hamisu; Carpenter, William; Petrozzino, Jeffrey; Abrams, Elizabeth; Sills, Eric Scott; Keith, Louis G.

2011-01-01

In vitro fertilization (IVF) has become a standard treatment for subfertility after it was demonstrated to be of value to humans in 1978. However, the introduction of IVF into mainstream clinical practice has been accompanied by concerns regarding the number of multiple gestations that it can produce, as multiple births present significant medical consequences to mothers and offspring. When considering IVF as a treatment modality, a balance must be set between the chance of having a live birth and the risk of having a multiple birth. As IVF is often a costly decision for patients—financially, medically, and emotionally—there is benefit from estimating a patient’s specific chance that IVF could result in a birth as fertility treatment options are contemplated. Historically, a patient’s “chance of success” with IVF has been approximated from institution-based statistics, rather than on the basis of any particular clinical parameter (except age). Furthermore, the likelihood of IVF resulting in a twin or triplet outcome must be acknowledged for each patient, given the known increased complications of multiple gestation and consequent increased risk of poor birth outcomes. In this research, we describe a multivariate risk assessment model that incorporates metrics adapted from a national 7.5-year sampling of the Human Fertilisation & Embryology Authority (HFEA) dataset (1991–1998) to predict reproductive outcome (including estimation of multiple birth) after IVF. To our knowledge, http://www.formyodds.com is the first Software-as-a-Service (SaaS) application to predict IVF outcome. The approach also includes a confirmation functionality, where clinicians can agree or disagree with the computer-generated outcome predictions. It is anticipated that the emergence of predictive tools will augment the reproductive endocrinology consultation, improve the medical informed consent process by tailoring the outcome assessment to each patient, and reduce the potential for adverse outcomes with IVF. PMID:21991292

Communicative participation restrictions in multiple sclerosis: associated variables and correlation with social functioning.

PubMed

Yorkston, Kathryn M; Baylor, Carolyn; Amtmann, Dagmar

2014-01-01

Individuals with multiple sclerosis (MS) are at risk for communication problems that may restrict their ability to take participation in important life roles such as maintenance of relationships, work, or household management. The aim of this project is to examine selected demographic and symptom-related variables that may contribute to participation restrictions. This examination is intended to aid clinicians in predicting who might be at risk for such restrictions and what variables may be targeted in interventions. Community-dwelling adults with MS (n=216) completed a survey either online or using paper forms. The survey included the 46-item version of the Communicative Participation Item Bank, demographics (age, sex, living situation, employment status, education, and time since onset of diagnosis of MS), and self-reported symptom-related variables (physical activity, emotional problems, fatigue, pain, speech severity, and cognitive/communication skills). In order to identify predictors of restrictions in communicative participation, these variables were entered into a backwards stepwise multiple linear regression analysis. Five variables (cognitive/communication skills, speech severity, speech usage, physical activity, and education) were statistically significant predictors of communication participation. In order to examine the relationship of communicative participation and social role variables, bivariate Spearman correlations were conducted. Results suggest only a fair to moderate relationship between communicative participation and measures of social roles. Communicative participation is a complex construct associated with a number of self-reported variables. Clinicians should be alert to risk factors for reduced communicative participation including reduced cognitive and speech skills, lower levels of speech usage, limitations in physical activities and higher levels of education. The reader will be able to: (a) describe the factors that may restrict participation in individuals with multiple sclerosis; (b) list measures of social functioning that may be pertinent in adults with multiple sclerosis; (c) discuss factors that can be used to predict communicative participation in multiple sclerosis. Copyright © 2014 Elsevier Inc. All rights reserved.

Prediction of individual probabilities of livebirth and multiple birth events following in vitro fertilization (IVF): a new outcomes counselling tool for IVF providers and patients using HFEA metrics.

PubMed

Jones, Christopher A; Christensen, Anna L; Salihu, Hamisu; Carpenter, William; Petrozzino, Jeffrey; Abrams, Elizabeth; Sills, Eric Scott; Keith, Louis G

2011-01-01

In vitro fertilization (IVF) has become a standard treatment for subfertility after it was demonstrated to be of value to humans in 1978. However, the introduction of IVF into mainstream clinical practice has been accompanied by concerns regarding the number of multiple gestations that it can produce, as multiple births present significant medical consequences to mothers and offspring. When considering IVF as a treatment modality, a balance must be set between the chance of having a live birth and the risk of having a multiple birth. As IVF is often a costly decision for patients-financially, medically, and emotionally-there is benefit from estimating a patient's specific chance that IVF could result in a birth as fertility treatment options are contemplated. Historically, a patient's "chance of success" with IVF has been approximated from institution-based statistics, rather than on the basis of any particular clinical parameter (except age). Furthermore, the likelihood of IVF resulting in a twin or triplet outcome must be acknowledged for each patient, given the known increased complications of multiple gestation and consequent increased risk of poor birth outcomes. In this research, we describe a multivariate risk assessment model that incorporates metrics adapted from a national 7.5-year sampling of the Human Fertilisation & Embryology Authority (HFEA) dataset (1991-1998) to predict reproductive outcome (including estimation of multiple birth) after IVF. To our knowledge, http://www.formyodds.com is the first Software-as-a-Service (SaaS) application to predict IVF outcome. The approach also includes a confirmation functionality, where clinicians can agree or disagree with the computer-generated outcome predictions. It is anticipated that the emergence of predictive tools will augment the reproductive endocrinology consultation, improve the medical informed consent process by tailoring the outcome assessment to each patient, and reduce the potential for adverse outcomes with IVF.

Iodine-based contrast media, multiple myeloma and monoclonal gammopathies: literature review and ESUR Contrast Media Safety Committee guidelines.

PubMed

Stacul, Fulvio; Bertolotto, Michele; Thomsen, Henrik S; Pozzato, Gabriele; Ugolini, Donatella; Bellin, Marie-France; Bongartz, Georg; Clement, Olivier; Heinz-Peer, Gertraud; van der Molen, Aart; Reimer, Peter; Webb, Judith A W

2018-02-01

Many radiologists and clinicians still consider multiple myeloma (MM) and monoclonal gammopathies (MG) a contraindication for using iodine-based contrast media. The ESUR Contrast Media Safety Committee performed a systematic review of the incidence of post-contrast acute kidney injury (PC-AKI) in these patients. A systematic search in Medline and Scopus databases was performed for renal function deterioration studies in patients with MM or MG following administration of iodine-based contrast media. Data collection and analysis were performed according to the PRISMA statement 2009. Eligibility criteria and methods of analysis were specified in advance. Cohort and case-control studies reporting changes in renal function were included. Thirteen studies were selected that reported 824 iodine-based contrast medium administrations in 642 patients with MM or MG, in which 12 unconfounded cases of PC-AKI were found (1.6 %). The majority of patients had intravenous urography with high osmolality ionic contrast media after preparatory dehydration and purgation. MM and MG alone are not risk factors for PC-AKI. However, the risk of PC-AKI may become significant in dehydrated patients with impaired renal function. Hypercalcaemia may increase the risk of kidney damage, and should be corrected before contrast medium administration. Assessment for Bence-Jones proteinuria is not necessary. • Monoclonal gammopathies including multiple myeloma are a large spectrum of disorders. • In monoclonal gammopathy with normal renal function, PC-AKI risk is not increased. • Renal function is often reduced in myeloma, increasing the risk of PC-AKI. • Correction of hypercalcaemia is necessary in myeloma before iodine-based contrast medium administration. • Bence-Jones proteinuria assessment in myeloma is unnecessary before iodine-based contrast medium administration.

Can Non-HLA Single Nucleotide Polymorphisms Help Stratify Risk in TrialNet Relatives at Risk for Type 1 Diabetes?

PubMed

Steck, Andrea K; Xu, Ping; Geyer, Susan; Redondo, Maria J; Antinozzi, Peter; Wentworth, John M; Sosenko, Jay; Onengut-Gumuscu, Suna; Chen, Wei-Min; Rich, Stephen S; Pugliese, Alberto

2017-08-01

Genome-wide association studies identified >50 type 1 diabetes (T1D) associated non-human leukocyte antigens (non-HLA) loci. The purpose of this study was to assess the contribution of non-HLA single nucleotide polymorphisms (SNPs) to risk of disease progression. The TrialNet Pathway to Prevention Study follows relatives of T1D patients for development of autoantibodies (Abs) and T1D. Using the Immunochip, we analyzed 53 diabetes-associated, non-HLA SNPs in 1016 Ab-positive, at-risk non-Hispanic white relatives. Effect of SNPs on the development of multiple Abs and T1D. Cox proportional analyses included all substantial non-HLA SNPs, HLA genotypes, relationship to proband, sex, age at initial screening, initial Ab type, and number. Factors involved in progression from single to multiple Abs included age at screening, relationship to proband, HLA genotypes, and rs3087243 (cytotoxic T lymphocyte antigen-4). Significant factors for diabetes progression included age at screening, Ab number, HLA genotypes, rs6476839 [GLIS family zinc finger 3 (GLIS3)], and rs3184504 [SH2B adaptor protein 3 (SH2B3)]. When glucose area under the curve (AUC) was included, factors involved in disease progression included glucose AUC, age at screening, Ab number, relationship to proband, HLA genotypes, rs6476839 (GLIS3), and rs7221109 (CCR7). In stratified analyses by age, glucose AUC, age at screening, sibling, HLA genotypes, rs6476839 (GLIS3), and rs4900384 (C14orf64) were significantly associated with progression to diabetes in participants <12 years old, whereas glucose AUC, sibling, rs3184504 (SH2B3), and rs4900384 (C14orf64) were significant in those ≥12. In conclusion, we identified five non-HLA SNPs associated with increased risk of progression from Ab positivity to disease that may improve risk stratification for prevention trials. Copyright © 2017 by the Endocrine Society

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

DTIC Science & Technology

2015-02-01

distribution unlimited 13. SUPPLEMENTARY NOTES 14. ABSTRACT Athletes in contact sports who have sustained multiple concussive traumatic brain...who have sustained multiple concussive traumatic brain injuries 15-17 may also be at risk for this condition. Currently, there are no methods to...repetitive concussive TBI in mice has been optimal. Ongoing efforts include development of more sensitive methods to detect tau, and combinations of

Synergistic and Non-synergistic Associations for Cigarette Smoking and Non-tobacco Risk Factors for Cardiovascular Disease Incidence in the Atherosclerosis Risk In Communities (ARIC) Study.

PubMed

Lubin, Jay H; Couper, David; Lutsey, Pamela L; Yatsuya, Hiroshi

2017-07-01

Cigarette smoking, various metabolic and lipid-related factors and hypertension are well-recognized cardiovascular disease (CVD) risk factors. Since smoking affects many of these factors, use of a single imprecise smoking metric, for example, ever or never smoked, may allow residual confounding and explain inconsistencies in current assessments of interactions. Using a comprehensive model in pack-years and cigarettes/day for the complex smoking-related relative risk (RR) of CVD to reduce residual confounding, we evaluated interactions with non-tobacco risk factors, including additive (non-synergistic) and multiplicative (synergistic) forms. Data were from the prospective Atherosclerosis Risk in Communities (ARIC) Study from four areas of the United States recruited in 1987-1989 with follow-up through 2008. Analyses included 14 127 participants, 207 693 person-years and 2857 CVD events. Analyses revealed distinct interactions with smoking: including statistical consistency with additive (body mass index [BMI], waist to hip ratio [WHR], diabetes mellitus [DM], glucose, insulin, high density lipoproteins [HDL] and HDL(2)); and multiplicative (hypertension, total cholesterol [TC], low density lipoproteins [LDLs], apolipoprotein B [apoB], TC to HDL ratio and HDL(3)) associations, as well as indeterminate (apolipoprotein A-I [apoA-I] and triglycerides) associations. The forms of the interactions were revealing but require confirmation. Improved understanding of joint associations may help clarify the public health burden of smoking for CVD, links between etiologic factors and biological mechanisms, and the consequences of joint exposures, whereby synergistic associations highlight joint effects and non-synergistic associations suggest distinct contributions. Joint associations for cigarette smoking and non-tobacco risk factors were distinct, revealing synergistic/multiplicative (hypertension, TC, LDL, apoB, TC/HDL, HDL(3)), non-synergistic/additive (BMI, WHR, DM, glucose, insulin, HDL, HDL(2)) and indeterminate (apoA-I and TRIG) associations. If confirmed, these results may help better define the public health burden of smoking on CVD risk and identify links between etiologic factors and biologic mechanisms, where synergistic associations highlight joint impacts and non-synergistic associations suggest distinct contributions from each factor. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco 2016. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Key Steps in the Special Review Process

EPA Pesticide Factsheets

EPA uses this process when it has reason to believe that the use of a pesticide may result in unreasonable adverse effects on people or the environment. Steps include comprehensive risk and benefit analyses and multiple Position Documents.

The World Hypertension League: where now and where to in salt reduction

PubMed Central

Lackland, Daniel T.; Lisheng, Liu; Zhang, Xin-Hua; Nilsson, Peter M.; Niebylski, Mark L.

2015-01-01

High dietary salt is a leading risk for death and disability largely by causing increased blood pressure. Other associated health risks include gastric and renal cell cancers, osteoporosis, renal stones, and increased disease activity in multiple sclerosis, headache, increased body fat and Meniere’s disease. The World Hypertension League (WHL) has prioritized advocacy for salt reduction. WHL resources and actions include a non-governmental organization policy statement, dietary salt fact sheet, development of standardized nomenclature, call for quality research, collaboration in a weekly salt science update, development of a process to set recommended dietary salt research standards and regular literature reviews, development of adoptable power point slide sets to support WHL positions and resources, and critic of weak research studies on dietary salt. The WHL plans to continue to work with multiple governmental and non-governmental organizations to promote dietary salt reduction towards the World Health Organization (WHO) recommendations. PMID:26090335

Evaluation of Risk Factors for Severe Pneumonia in Children: The Pneumonia Etiology Research for Child Health Study

PubMed Central

Deloria-Knoll, Maria; Feikin, Daniel R.; DeLuca, Andrea N.; Driscoll, Amanda J.; Moïsi, Jennifer C.; Johnson, Hope L.; Murdoch, David R.; O’Brien, Katherine L.; Levine, Orin S.; Scott, J. Anthony G.

2012-01-01

As a case-control study of etiology, the Pneumonia Etiology Research for Child Health (PERCH) project also provides an opportunity to assess the risk factors for severe pneumonia in hospitalized children at 7 sites. We identified relevant risk factors by literature review and iterative expert consultation. Decisions for inclusion in PERCH were based on comparability to published data, analytic plans, data collection costs and logistic feasibility, including interviewer time and subject fatigue. We aimed to standardize questions at all sites, but significant variation in the economic, cultural, and geographic characteristics of sites made it difficult to obtain this objective. Despite these challenges, the depth of the evaluation of multiple risk factors across the breadth of the PERCH sites should furnish new and valuable information about the major risk factors for childhood severe and very severe pneumonia, including risk factors for pneumonia caused by specific etiologies, in developing countries. PMID:22403226

Evaluation of risk factors for severe pneumonia in children: the Pneumonia Etiology Research for Child Health study.

PubMed

Wonodi, Chizoba B; Deloria-Knoll, Maria; Feikin, Daniel R; DeLuca, Andrea N; Driscoll, Amanda J; Moïsi, Jennifer C; Johnson, Hope L; Murdoch, David R; O'Brien, Katherine L; Levine, Orin S; Scott, J Anthony G

2012-04-01

As a case-control study of etiology, the Pneumonia Etiology Research for Child Health (PERCH) project also provides an opportunity to assess the risk factors for severe pneumonia in hospitalized children at 7 sites. We identified relevant risk factors by literature review and iterative expert consultation. Decisions for inclusion in PERCH were based on comparability to published data, analytic plans, data collection costs and logistic feasibility, including interviewer time and subject fatigue. We aimed to standardize questions at all sites, but significant variation in the economic, cultural, and geographic characteristics of sites made it difficult to obtain this objective. Despite these challenges, the depth of the evaluation of multiple risk factors across the breadth of the PERCH sites should furnish new and valuable information about the major risk factors for childhood severe and very severe pneumonia, including risk factors for pneumonia caused by specific etiologies, in developing countries.

An ImmunoChip study of multiple sclerosis risk in African Americans

PubMed Central

Isobe, Noriko; Madireddy, Lohith; Khankhanian, Pouya; Matsushita, Takuya; Caillier, Stacy J.; Moré, Jayaji M.; Gourraud, Pierre-Antoine; McCauley, Jacob L.; Beecham, Ashley H.; Piccio, Laura; Herbert, Joseph; Khan, Omar; Cohen, Jeffrey; Stone, Lael; Santaniello, Adam; Cree, Bruce A. C.; Onengut-Gumuscu, Suna; Rich, Stephen S.; Hauser, Stephen L.; Sawcer, Stephen

2015-01-01

The aims of this study were: (i) to determine to what degree multiple sclerosis-associated loci discovered in European populations also influence susceptibility in African Americans; (ii) to assess the extent to which the unique linkage disequilibrium patterns in African Americans can contribute to localizing the functionally relevant regions or genes; and (iii) to search for novel African American multiple sclerosis-associated loci. Using the ImmunoChip custom array we genotyped 803 African American cases with multiple sclerosis and 1516 African American control subjects at 130 135 autosomal single nucleotide polymorphisms. We conducted association analysis with rigorous adjustments for population stratification and admixture. Of the 110 non-major histocompatibility complex multiple sclerosis-associated variants identified in Europeans, 96 passed stringent quality control in our African American data set and of these, >70% (69) showed over-representation of the same allele amongst cases, including 21 with nominally significant evidence for association (one-tailed test P < 0.05). At a further eight loci we found nominally significant association with an alternate correlated risk-tagging single nucleotide polymorphism from the same region. Outside the regions known to be associated in Europeans, we found seven potentially associated novel candidate multiple sclerosis variants (P < 10−4), one of which (rs2702180) also showed nominally significant evidence for association (one-tailed test P = 0.034) in an independent second cohort of 620 African American cases and 1565 control subjects. However, none of these novel associations reached genome-wide significance (combined P = 6.3 × 10−5). Our data demonstrate substantial overlap between African American and European multiple sclerosis variants, indicating common genetic contributions to multiple sclerosis risk. PMID:25818868

An ImmunoChip study of multiple sclerosis risk in African Americans.

PubMed

Isobe, Noriko; Madireddy, Lohith; Khankhanian, Pouya; Matsushita, Takuya; Caillier, Stacy J; Moré, Jayaji M; Gourraud, Pierre-Antoine; McCauley, Jacob L; Beecham, Ashley H; Piccio, Laura; Herbert, Joseph; Khan, Omar; Cohen, Jeffrey; Stone, Lael; Santaniello, Adam; Cree, Bruce A C; Onengut-Gumuscu, Suna; Rich, Stephen S; Hauser, Stephen L; Sawcer, Stephen; Oksenberg, Jorge R

2015-06-01

The aims of this study were: (i) to determine to what degree multiple sclerosis-associated loci discovered in European populations also influence susceptibility in African Americans; (ii) to assess the extent to which the unique linkage disequilibrium patterns in African Americans can contribute to localizing the functionally relevant regions or genes; and (iii) to search for novel African American multiple sclerosis-associated loci. Using the ImmunoChip custom array we genotyped 803 African American cases with multiple sclerosis and 1516 African American control subjects at 130 135 autosomal single nucleotide polymorphisms. We conducted association analysis with rigorous adjustments for population stratification and admixture. Of the 110 non-major histocompatibility complex multiple sclerosis-associated variants identified in Europeans, 96 passed stringent quality control in our African American data set and of these, >70% (69) showed over-representation of the same allele amongst cases, including 21 with nominally significant evidence for association (one-tailed test P < 0.05). At a further eight loci we found nominally significant association with an alternate correlated risk-tagging single nucleotide polymorphism from the same region. Outside the regions known to be associated in Europeans, we found seven potentially associated novel candidate multiple sclerosis variants (P < 10(-4)), one of which (rs2702180) also showed nominally significant evidence for association (one-tailed test P = 0.034) in an independent second cohort of 620 African American cases and 1565 control subjects. However, none of these novel associations reached genome-wide significance (combined P = 6.3 × 10(-5)). Our data demonstrate substantial overlap between African American and European multiple sclerosis variants, indicating common genetic contributions to multiple sclerosis risk. © The Author (2015). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

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,…

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.

Modified social ecological model: a tool to guide the assessment of the risks and risk contexts of HIV epidemics.

PubMed

Baral, Stefan; Logie, Carmen H; Grosso, Ashley; Wirtz, Andrea L; Beyrer, Chris

2013-05-17

Social and structural factors are now well accepted as determinants of HIV vulnerabilities. These factors are representative of social, economic, organizational and political inequities. Associated with an improved understanding of multiple levels of HIV risk has been the recognition of the need to implement multi-level HIV prevention strategies. Prevention sciences research and programming aiming to decrease HIV incidence requires epidemiologic studies to collect data on multiple levels of risk to inform combination HIV prevention packages. Proximal individual-level risks, such as sharing injection devices and unprotected penile-vaginal or penile-anal sex, are necessary in mediating HIV acquisition and transmission. However, higher order social and structural-level risks can facilitate or reduce HIV transmission on population levels. Data characterizing these risks is often far more actionable than characterizing individual-level risks. We propose a modified social ecological model (MSEM) to help visualize multi-level domains of HIV infection risks and guide the development of epidemiologic HIV studies. Such a model may inform research in epidemiology and prevention sciences, particularly for key populations including men who have sex with men (MSM), people who inject drugs (PID), and sex workers. The MSEM builds on existing frameworks by examining multi-level risk contexts for HIV infection and situating individual HIV infection risks within wider network, community, and public policy contexts as well as epidemic stage. The utility of the MSEM is demonstrated with case studies of HIV risk among PID and MSM. The MSEM is a flexible model for guiding epidemiologic studies among key populations at risk for HIV in diverse sociocultural contexts. Successful HIV prevention strategies for key populations require effective integration of evidence-based biomedical, behavioral, and structural interventions. While the focus of epidemiologic studies has traditionally been on describing individual-level risk factors, the future necessitates comprehensive epidemiologic data characterizing multiple levels of HIV risk.

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.

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.

Managing comorbidities in COPD

PubMed Central

Hillas, Georgios; Perlikos, Fotis; Tsiligianni, Ioanna; Tzanakis, Nikolaos

2015-01-01

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Age and smoking are common risk factors for COPD and other illnesses, often leading COPD patients to demonstrate multiple coexisting comorbidities. COPD exacerbations and comorbidities contribute to the overall severity in individual patients. Clinical trials investigating the treatment of COPD routinely exclude patients with multiple comorbidities or advanced age. Clinical practice guidelines for a specific disease do not usually address comorbidities in their recommendations. However, the management and the medical intervention in COPD patients with comorbidities need a holistic approach that is not clearly established worldwide. This holistic approach should include the specific burden of each comorbidity in the COPD severity classification scale. Further, the pharmacological and nonpharmacological management should also include optimal interventions and risk factor modifications simultaneously for all diseases. All health care specialists in COPD management need to work together with professionals specialized in the management of the other major chronic diseases in order to provide a multidisciplinary approach to COPD patients with multiple diseases. In this review, we focus on the major comorbidities that affect COPD patients. We present an overview of the problems faced, the reasons and risk factors for the most commonly encountered comorbidities, and the burden on health care costs. We also provide a rationale for approaching the therapeutic options of the COPD patient afflicted by comorbidity. PMID:25609943

Trade Study of Multiple Thruster Options for the Mars Airplane Concept

NASA Technical Reports Server (NTRS)

Kuhl, Christopher A.; Gayle, Steven W.; Hunter, Craig A.; Kenney, Patrick S.; Scola, Salvatore; Paddock, David A.; Wright, Henry S.; Gasbarre, Joseph F.

2009-01-01

A trade study was performed at NASA Langley Research Center under the Planetary Airplane Risk Reduction (PARR) project (2004-2005) to examine the option of using multiple, smaller thrusters in place of a single large thruster on the Mars airplane concept with the goal to reduce overall cost, schedule, and technical risk. The 5-lbf (22N) thruster is a common reaction control thruster on many satellites. Thousands of these types of thrusters have been built and flown on numerous programs, including MILSTAR and Intelsat VI. This study has examined the use of three 22N thrusters for the Mars airplane propulsion system and compared the results to those of the baseline single thruster system.

The impact of attachment and depression symptoms on multiple risk behaviors in post-war adolescents in northern Uganda.

PubMed

Okello, J; Nakimuli-Mpungu, E; Klasen, F; Voss, C; Musisi, S; Broekaert, E; Derluyn, I

2015-07-15

We have previously shown that depression symptoms are associated with multiple risk behaviors and that parental attachments are protective against depression symptoms in post-war adolescents. Accumulating literature indicates that low levels of attachment may sensitize individuals to increased multiple risk behaviors when depression symptoms exist. This investigation examined the interactive effects of attachment and depression symptoms on multiple risk behavior. We conducted hierarchical logistic regression analyses to examine the impact of attachment and depression symptoms on multiple risk behavior in our post-war sample of 551 adolescents in Gulu district. Analyses revealed interactive effects for only maternal attachment-by-depression interaction. Interestingly, high levels of maternal attachment exacerbated the relationship between depression symptoms and multiple risk behaviors while low levels of maternal attachment attenuated this relationship. It is possible that this analysis could be biased by a common underlying factor that influences self-reporting and therefore is correlated with each of self-reported attachment security, depressive symptoms, and multiple risk behaviors. These findings suggest that maternal attachment serves as a protective factor at low levels while serving as an additional risk factor at high levels. Findings support and expand current knowledge about the roles that attachment and depression symptoms play in the development of multiple risk behaviors and suggest a more complex etiology for post-war adolescents. Copyright © 2015 Elsevier B.V. All rights reserved.

A Population-Based Study on Alcohol and High-Risk Sexual Behaviors in Botswana

PubMed Central

Weiser, Sheri D; Leiter, Karen; Heisler, Michele; McFarland, Willi; Korte, Fiona Percy-de; DeMonner, Sonya M; Tlou, Sheila; Phaladze, Nthabiseng; Iacopino, Vincent; Bangsberg, David R

2006-01-01

Background In Botswana, an estimated 24% of adults ages 15–49 years are infected with HIV. While alcohol use is strongly associated with HIV infection in Africa, few population-based studies have characterized the association of alcohol use with specific high-risk sexual behaviors. Methods and Findings We conducted a cross-sectional, population-based study of 1,268 adults from five districts in Botswana using a stratified two-stage probability sample design. Multivariate logistic regression was used to assess correlates of heavy alcohol consumption (>14 drinks/week for women, and >21 drinks/week for men) as a dependent variable. We also assessed gender-specific associations between alcohol use as a primary independent variable (categorized as none, moderate, problem and heavy drinking) and several risky sex outcomes including: (a) having unprotected sex with a nonmonogamous partner; (b) having multiple sexual partners; and (c) paying for or selling sex in exchange for money or other resources. Criteria for heavy drinking were met by 31% of men and 17% of women. Adjusted correlates of heavy alcohol use included male gender, intergenerational relationships (age gap ≥10 y), higher education, and living with a sexual partner. Among men, heavy alcohol use was associated with higher odds of all risky sex outcomes examined, including unprotected sex (AOR = 3.48; 95% confidence interval [CI], 1.65 to 7.32), multiple partners (AOR = 3.08; 95% CI, 1.95 to 4.87), and paying for sex (AOR = 3.65; 95% CI, 2.58 to 12.37). Similarly, among women, heavy alcohol consumption was associated with higher odds of unprotected sex (AOR = 3.28; 95% CI, 1.71 to 6.28), multiple partners (AOR = 3.05; 95% CI, 1.83 to 5.07), and selling sex (AOR = 8.50; 95% CI, 3.41 to 21.18). A dose-response relationship was seen between alcohol use and risky sexual behaviors, with moderate drinkers at lower risk than both problem and heavy drinkers. Conclusions Alcohol use is associated with multiple risks for HIV transmission among both men and women. The findings of this study underscore the need to integrate alcohol abuse and HIV prevention efforts in Botswana and elsewhere. PMID:17032060

Can Parenting Intervention Prevent Cascading Effects From Placement Instability to Insecure Attachment to Externalizing Problems in Maltreated Toddlers?

PubMed

Pasalich, Dave S; Fleming, Charles B; Oxford, Monica L; Zheng, Yao; Spieker, Susan J

2016-08-01

Multiple placement changes disrupt continuity in caregiving and undermine well-being in children in child welfare. This study conducted secondary data analysis of a randomized controlled trial to examine whether a relationship-based intervention, Promoting First Relationships(©) (PFR), reduced risk for a maladaptive cascade from placement instability to less secure attachment to elevated externalizing problems. Participants included caregivers (birth or foster/kin) of toddlers (10-24 months) recently transitioned to their care because of child welfare placement decisions. Although main effects of PFR on security and externalizing problems were not previously observed, this study's results revealed that PFR attenuated the association between multiple placement changes (baseline) and less security (postintervention) and that the indirect effect of placement instability on greater externalizing problems (6-month follow-up) via less security was evident only in toddlers in the comparison condition. These findings shed light on how a history of multiple caregiver changes may influence toddlers' risk for poor adjustment in subsequent placements, and the promise of supporting caregivers through a parenting intervention to prevent such risk. © The Author(s) 2016.

Can parenting intervention prevent cascading effects from placement instability to insecure attachment to externalizing problems in maltreated toddlers?

PubMed Central

Pasalich, Dave S.; Fleming, Charles B.; Oxford, Monica L.; Zheng, Yao; Spieker, Susan J.

2016-01-01

Multiple placement changes disrupt continuity in caregiving and undermine well-being in children in child welfare. This study conducted secondary data analysis of a randomized controlled trial to examine whether a relationship-based intervention, Promoting First Relationships© (PFR), reduced risk for a maladaptive cascade from placement instability to less secure attachment to elevated externalizing problems. Participants included caregivers (birth or foster/kin) of toddlers (10–24 months) recently transitioned to their care because of child welfare placement decisions. Although main effects of PFR on security and externalizing problems were not previously observed, this study’s results revealed that PFR attenuated the association between multiple placement changes (baseline) and less security (postintervention), and that the indirect effect of placement instability on greater externalizing problems (6-month follow-up) via less security was evident only in toddlers in the comparison condition. These findings shed light on how a history of multiple caregiver changes may influence toddlers’ risk for poor adjustment in subsequent placements, and the promise of supporting caregivers through a parenting intervention to prevent such risk. PMID:27381935

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

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.

Meeting the challenge of interacting threats in freshwater ecosystems: A call to scientists and managers

USGS Publications Warehouse

Craig, Laura S.; Olden, Julian D.; Arthington, Angela; Entrekin, Sally; Hawkins, Charles P.; Kelly, John J.; Kennedy, Theodore A.; Maitland, Bryan M.; Rosi, Emma J.; Roy, Allison; Strayer, David L.; Tank, Jennifer L.; West, Amie O.; Wooten, Matthew S.

2017-01-01

Human activities create threats that have consequences for freshwater ecosystems and, in most watersheds, observed ecological responses are the result of complex interactions among multiple threats and their associated ecological alterations. Here we discuss the value of considering multiple threats in research and management, offer suggestions for filling knowledge gaps, and provide guidance for addressing the urgent management challenges posed by multiple threats in freshwater ecosystems. There is a growing literature assessing responses to multiple alterations, and we build off this background to identify three areas that require greater attention: linking observed alterations to threats, understanding when and where threats overlap, and choosing metrics that best quantify the effects of multiple threats. Advancing science in these areas will help us understand existing ecosystem conditions and predict future risk from multiple threats. Because addressing the complex issues and novel ecosystems that arise from the interaction of multiple threats in freshwater ecosystems represents a significant management challenge, and the risks of management failure include loss of biodiversity, ecological goods, and ecosystem services, we also identify actions that could improve decision-making and management outcomes. These actions include drawing insights from management of individual threats, using threat attributes (e.g., causes and spatio-temporal dynamics) to identify suitable management approaches, testing management strategies that are likely to be successful despite uncertainties about the nature of interactions among threats, avoiding unintended consequences, and maximizing conservation benefits. We also acknowledge the broadly applicable challenges of decision-making within a socio-political and economic framework, and suggest that multidisciplinary teams will be needed to innovate solutions to meet the current and future challenge of interacting threats in freshwater ecosystems. 

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

PubMed

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

2015-07-14

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

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.

Polygenic Risk, Personality Dimensions, and Adolescent Alcohol Use Problems: A Longitudinal Study

PubMed Central

Li, James J.; Savage, Jeanne E.; Kendler, Kenneth S.; Hickman, Matthew; Mahedy, Liam; Macleod, John; Kaprio, Jaakko; Rose, Richard J.; Dick, Danielle M.

2017-01-01

Objective: Alcohol use problems are common during adolescence and can predict serious negative outcomes in adulthood, including substance dependence and psychopathology. The current study examines the notion that alcohol use problems are driven by polygenic influences and that genetic influences may indirectly affect alcohol use problems through multiple pathways of risk, including variations in personality. Method: We used a genome-wide approach to examine associations between genetic risk for alcohol use problems, personality dimensions, and adolescent alcohol use problems in two separate longitudinal population-based samples, the Finnish Twin Cohort (FinnTwin12) and the Avon Longitudinal Study of Parents and Children (ALSPAC). Participants were 1,035 young adults from FinnTwin12 and 3,160 adolescents from ALSPAC. Polygenic risk scores (PRS) were calculated for ALSPAC using genome-wide association results (on alcohol dependence symptoms as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) from FinnTwin12. A parallel multiple mediator model was tested to examine whether the association between PRS and alcohol use problems assessed at age 16 could be explained by variations in personality dimensions assessed at age 13, including sensation seeking and negative emotionality. Results: PRS were marginally predictive of age 16 alcohol use problems; this association was partially mediated by sensation seeking. Polygenic variation underlying risk for alcohol use problems may directly influence the effects of sensation seeking, which in turn influence the development of alcohol use problems in later adolescence. Conclusions: These findings contribute to the increasing evidence regarding the salience of sensation seeking during early adolescence as a potential constituent in the risk pathway underlying the development of alcohol use problems. PMID:28499112

Neonatal Risk Factors for Treatment-Demanding Retinopathy of Prematurity: A Danish National Study.

PubMed

Slidsborg, Carina; Jensen, Aksel; Forman, Julie Lyng; Rasmussen, Steen; Bangsgaard, Regitze; Fledelius, Hans Callø; Greisen, Gorm; la Cour, Morten

2016-04-01

One goal of the study was to identify "new" statistically independent risk factors for treatment-demanding retinopathy of prematurity (ROP). Another goal was to evaluate whether any new risk factors could explain the increase in the incidence of treatment-demanding ROP over time in Denmark. A retrospective, register-based cohort study. The study included premature infants (n = 6490) born in Denmark from 1997 to 2008. The study sample and the 31 candidate risk factors were identified in 3 national registers. Data were linked through a unique civil registration number. Each of the 31 candidate risk factors were evaluated in univariate analyses, while adjusted for known risk factors (i.e., gestational age [GA] at delivery, small for gestational age [SGA], multiple births, and male sex). Significant outcomes were analyzed thereafter in a backward selection multiple logistic regression model. Treatment-demanding ROP and its associations to candidate risk factors. Mechanical ventilation (odds ratio [OR], 2.84; 95% confidence interval [CI], 1.99-4.08; P < 0.01) and blood transfusion (OR, 1.97; 95% CI, 1.20-3.14; P = 0.01) were the only new statistically independent risk factors, in addition to GA at delivery, SGA, multiple births, and male sex. Modification in these prognostic factors for ROP did not cause an increase in treatment-demanding ROP. In a large study population, blood transfusion and mechanical ventilation were the only new statistically independent risk factors to predict the development of treatment-demanding ROP. Modification in the neonatal treatment with mechanical ventilation or blood transfusion did not cause the observed increase in the incidence of preterm infants with treatment-demanding ROP during a recent birth period (2003-2008). Copyright © 2016 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

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.

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.

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

A Technical Approach to Expedited Processing of NTPR Radiation Dose Assessments

DTIC Science & Technology

2011-10-01

Pharynx ET Region+ Surrogate Oral Cavity and Pharynx (140-149) None PNLGL Pineal Gland Brain Surrogate Other Endocrine Glands (194) PITTGL PITTGL...including brain); endocrine glands other than thyroid; other and ill-defined sites; lymphoma and multiple myeloma Risk depends on age at exposure...endocrine glands 14 45 Cancers of other and ill-defined sites 16 50 Lymphoma and multiple myeloma 22 61 Leukemia, excluding CLL 1.9 (5 years) 41

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.

Whole-genome sequencing of monozygotic twins discordant for schizophrenia indicates multiple genetic risk factors for schizophrenia.

PubMed

Tang, Jinsong; Fan, Yu; Li, Hong; Xiang, Qun; Zhang, Deng-Feng; Li, Zongchang; He, Ying; Liao, Yanhui; Wang, Ya; He, Fan; Zhang, Fengyu; Shugart, Yin Yao; Liu, Chunyu; Tang, Yanqing; Chan, Raymond C K; Wang, Chuan-Yue; Yao, Yong-Gang; Chen, Xiaogang

2017-06-20

Schizophrenia is a common disorder with a high heritability, but its genetic architecture is still elusive. We implemented whole-genome sequencing (WGS) analysis of 8 families with monozygotic (MZ) twin pairs discordant for schizophrenia to assess potential association of de novo mutations (DNMs) or inherited variants with susceptibility to schizophrenia. Eight non-synonymous DNMs (including one splicing site) were identified and shared by twins, which were either located in previously reported schizophrenia risk genes (p.V24689I mutation in TTN, p.S2506T mutation in GCN1L1, IVS3+1G > T in DOCK1) or had a benign to damaging effect according to in silico prediction analysis. By searching the inherited rare damaging or loss-of-function (LOF) variants and common susceptible alleles from three classes of schizophrenia candidate genes, we were able to distill genetic alterations in several schizophrenia risk genes, including GAD1, PLXNA2, RELN and FEZ1. Four inherited copy number variations (CNVs; including a large deletion at 16p13.11) implicated for schizophrenia were identified in four families, respectively. Most of families carried both missense DNMs and inherited risk variants, which might suggest that DNMs, inherited rare damaging variants and common risk alleles together conferred to schizophrenia susceptibility. Our results support that schizophrenia is caused by a combination of multiple genetic factors, with each DNM/variant showing a relatively small effect size. Copyright © 2017 Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, and Genetics Society of China. All rights reserved.

Serious suicide attempts in outpatients with multiple substance use disorders.

PubMed

Icick, R; Karsinti, E; Lépine, J-P; Bloch, V; Brousse, G; Bellivier, F; Vorspan, F

2017-12-01

Suicide is a major public health concern and suicide attempts (SA) are frequent and burdensome in people suffering from substance use disorders (SUDs). In particular, serious SAs are a preoccupying form of attempt, which remain largely overlooked in these populations, especially regarding basic risk factors such as gender, addictive comorbidity and substance use patterns. Thus, we undertook a gender-specific approach to identify the risk factors for serious SAs in outpatients with multiple SUDs. 433 Treatment-seeking outpatients were consecutively recruited in specialized care centers and reliably classified as serious, non-serious and non-suicide attempters. We also characterized lifetime exposure to SUDs, including tobacco smoking, with standardized instruments. Current medication, including psychotropic treatments were collected, which informed psychiatric diagnoses. Multinomial regression identified independent factors specifically associated with serious SAs in each gender, separately. 32% Participants (N=139, 47% Women and 27% Men) reported lifetime SA. There were 82 serious attempters (59% of attempters), without significant gender difference. Sedative dependence was an independent risk factor for serious SA compared to non-SA in Women and compared to non-serious SA in Men, respectively. Other risk factors included later onset of daily tobacco smoking in Men and history of psychiatric hospitalizations in Women, whose serious SA risk was conversely lower when reporting opiate use disorder or mood disorder, probably because of treatment issues. Despite several study limitations, we identified subgroups for a better-tailored prevention of serious SAs among individuals with SUDs, notably highlighting the need to better prevent and treat sedative dependence. Copyright © 2017 Elsevier B.V. All rights reserved.

Unknown risk: co-exposure to lead and other heavy metals among children living in small-scale mining communities in Zamfara State, Nigeria.

PubMed

Bartrem, Casey; Tirima, Simba; von Lindern, Ian; von Braun, Margrit; Worrell, Mary Claire; Mohammad Anka, Shehu; Abdullahi, Aishat; Moller, Gregory

2014-08-01

The lead poisoning crisis in Zamfara State, Northern Nigeria has been called the worst such case in modern history and it presents unique challenges for risk assessment and management of co-exposure to multiple heavy metals. More than 400 children have died in Zamfara as a result of ongoing lead intoxication since early in 2010. A review of the common toxic endpoints of the major heavy metals advances analysis of co-exposures and their common pathologies. Environmental contamination in Bagega village, examined by X-ray fluorescence of soils, includes lead, mercury, cadmium, arsenic and manganese. Co-exposure risk is explored by scoring common toxic endpoints and hazard indices to calculate a common pathology hazard risk ranking of Pb > As > Hg > Cd > Mn. Zamfara presents an extreme picture of both lead and multiple heavy metal mortality and morbidity, but similar situations have become increasingly prevalent worldwide.

Adolescent Maltreatment in the Child Welfare System and Developmental Patterns of Sexual Risk Behaviors

PubMed Central

Fowler, Patrick J.; Motley, Darnell; Zhang, Jinjin; Rolls-Reutz, Jennifer; Landsverk, John

2018-01-01

In this longitudinal study, we tested whether adolescent maltreatment and out-of-home placement as a response to maltreatment altered developmental patterns of sexual risk behaviors in a nationally representative sample of youth involved in the child welfare system. Participants included adolescents aged 13 to 17 (M=15.5, SD=1.49) at baseline (n=714), followed over 18 months. Computer-assisted interviews were used to collect self-reported sexual practices and experiences of physical and psychological abuse at both time points. Latent transition analyses were used to identify three patterns of sexual risk behaviors: abstainers, safe sex with multiple partners, and unsafe sex with multiple partners. Most adolescents transitioned to safer sexual behavior patterns over time. Adolescents exhibiting the riskiest sexual practices at baseline were most likely to report subsequent abuse and less likely to be placed into out-of-home care. Findings provide a more nuanced understanding of sexual risk among child welfare–involved adolescents and inform practices to promote positive transitions within the system. PMID:25155702

Advancing Risk Assessment through the Application of Systems Toxicology

PubMed Central

Sauer, John Michael; Kleensang, André; Peitsch, Manuel C.; Hayes, A. Wallace

2016-01-01

Risk assessment is the process of quantifying the probability of a harmful effect to individuals or populations from human activities. Mechanistic approaches to risk assessment have been generally referred to as systems toxicology. Systems toxicology makes use of advanced analytical and computational tools to integrate classical toxicology and quantitative analysis of large networks of molecular and functional changes occurring across multiple levels of biological organization. Three presentations including two case studies involving both in vitro and in vivo approaches described the current state of systems toxicology and the potential for its future application in chemical risk assessment. PMID:26977253

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

PubMed

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

2017-08-01

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

A comparison of imputation techniques for handling missing predictor values in a risk model with a binary outcome.

PubMed

Ambler, Gareth; Omar, Rumana Z; Royston, Patrick

2007-06-01

Risk models that aim to predict the future course and outcome of disease processes are increasingly used in health research, and it is important that they are accurate and reliable. Most of these risk models are fitted using routinely collected data in hospitals or general practices. Clinical outcomes such as short-term mortality will be near-complete, but many of the predictors may have missing values. A common approach to dealing with this is to perform a complete-case analysis. However, this may lead to overfitted models and biased estimates if entire patient subgroups are excluded. The aim of this paper is to investigate a number of methods for imputing missing data to evaluate their effect on risk model estimation and the reliability of the predictions. Multiple imputation methods, including hotdecking and multiple imputation by chained equations (MICE), were investigated along with several single imputation methods. A large national cardiac surgery database was used to create simulated yet realistic datasets. The results suggest that complete case analysis may produce unreliable risk predictions and should be avoided. Conditional mean imputation performed well in our scenario, but may not be appropriate if using variable selection methods. MICE was amongst the best performing multiple imputation methods with regards to the quality of the predictions. Additionally, it produced the least biased estimates, with good coverage, and hence is recommended for use in practice.

Exposures Resulting in Safety and Health Concerns for Child Laborers in Less Developed Countries

PubMed Central

Shendell, Derek G.; Noomnual, Saisattha; Chishti, Shumaila; Sorensen Allacci, MaryAnn; Madrigano, Jaime

2016-01-01

Objectives. Worldwide, over 200 million children are involved in child labor, with another 20 million children subjected to forced labor, leading to acute and chronic exposures resulting in safety and health (S&H) risks, plus removal from formal education and play. This review summarized S&H issues in child labor, including forced or indentured domestic labor as other sectors of child labor. Specifically, we focused on exposures leading to S&H risks. Methods. We used PubMed, Scopus, Science Direct, and Google Scholar. References were in English, published in 1990–2015, and included data focused on exposures and S&H concerns of child labor. Results. Seventy-six journal articles were identified, 67 met criteria, 57 focused on individual countries, and 10 focused on data from multiple countries (comparing 3–83 countries). Major themes of concern were physical exposures including ergonomic hazards, chemical exposure hazards, and missed education. Childhood labor, especially forced, exploitative labor, created a significant burden on child development, welfare, and S&H. Conclusions. More field researche data emphasizing longitudinal quantitative effects of exposures and S&H risks are needed. Findings warranted developing policies and educational interventions with proper monitoring and evaluation data collection, plus multiple governmental, international organization and global economic reform efforts, particularly in lower-income, less developed countries. PMID:27382374

Risk factors and mediating pathways of loneliness and social support in community-dwelling older adults.

PubMed

Schnittger, Rebecca I B; Wherton, Joseph; Prendergast, David; Lawlor, Brian A

2012-01-01

To develop biopsychosocial models of loneliness and social support thereby identifying their key risk factors in an Irish sample of community-dwelling older adults. Additionally, to investigate indirect effects of social support on loneliness through mediating risk factors. A total of 579 participants (400 females; 179 males) were given a battery of biopsychosocial assessments with the primary measures being the De Jong Gierveld Loneliness Scale and the Lubben Social Network Scale along with a broad range of secondary measures. Bivariate correlation analyses identified items to be included in separate psychosocial, cognitive, biological and demographic multiple regression analyses. The resulting model items were then entered into further multiple regression analyses to obtain overall models. Following this, bootstrapping mediation analyses was conducted to examine indirect effects of social support on the subtypes (emotional and social) of loneliness. The overall model for (1) emotional loneliness included depression, neuroticism, perceived stress, living alone and accommodation type, (2) social loneliness included neuroticism, perceived stress, animal naming and number of grandchildren and (3) social support included extraversion, executive functioning (Trail Making Test B-time), history of falls, age and whether the participant drives or not. Social support influenced emotional loneliness predominantly through indirect means, while its effect on social loneliness was more direct. These results characterise the biopsychosocial risk factors of emotional loneliness, social loneliness and social support and identify key pathways by which social support influences emotional and social loneliness. These findings highlight issues with the potential for consideration in the development of targeted interventions.

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

PubMed

Ostaszewski, Krzysztof; Zimmerman, Marc A

2006-12-01

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

Family Relationships, Parenting Practices, the Availability of Male Family Members, and the Behavior of Inner-City Boys in Single-Mother and Two-Parent Families.

ERIC Educational Resources Information Center

Florsheim, Paul; Tolan, Patrick; Gorman-Smith, Deborah

1998-01-01

Examined if and how differences in functioning of single-mother and two-parent families relate to occurrence of behavioral problems among inner-city boys ages 10-15. Findings included (1) multiple family risk factors contribute to occurrence of behavior problems; (2) most family risk factors were generalizable to both single-mother and two-parent…

Identification and Quantification of Cumulative Factors that ...

EPA Pesticide Factsheets

Evaluating the combined adverse effects of multiple stressors upon human health is an imperative component of cumulative risk assessment (CRA)1. In addition to chemical stressors, other non-chemical factors are also considered. For examples, smoking will elevate the risks of having lung cancer associated with radon exposure2; toluene and noise together will induce higher levels of hearing loss3; children exposed to violence will have higher risks of developing asthma in the presence of air pollution4. Environmental Justice (EJ) indicators, used as a tool to assess and quantify some of these non-chemical factors, include health, economic, and social indicators such as vulnerability and susceptibility5. Vulnerability factors encompass race, ethnicity, behavior, geographic location, etc., while susceptibility factors include life stage, genetic predisposition, pre-existing health condition and others6, although these two categories are not always mutually exclusive. Numerous findings regarding combined effects of EJ indicators and chemical stressors have been identified7-11. However, fewer studies have analyzed the interrelation between multiple stressors that exert combined harmful effects upon individual or population health in the context of exposure assessment within the risk assessment framework12. In this study, we connected EJ indicators to variables in the exposure assessment model, especially the Average Daily Dose (ADD) model13, in order to better underst

Implementation of Systematic Review Tools in IRIS | Science ...

EPA Pesticide Factsheets

Currently, the number of chemicals present in the environment exceeds the ability of public health scientists to efficiently screen the available data in order to produce well-informed human health risk assessments in a timely manner. For this reason, the US EPA’s Integrated Risk Information System (IRIS) program has started implementing new software tools into the hazard characterization workflow. These automated tools aid in multiple phases of the systematic review process including scoping and problem formulation, literature search, and identification and screening of available published studies. The increased availability of these tools lays the foundation for automating or semi-automating multiple phases of the systematic review process. Some of these software tools include modules to facilitate a structured approach to study quality evaluation of human and animal data, although approaches are generally lacking for assessing complex mechanistic information, in particular “omics”-based evidence tools are starting to become available to evaluate these types of studies. We will highlight how new software programs, online tools, and approaches for assessing study quality can be better integrated to allow for a more efficient and transparent workflow of the risk assessment process as well as identify tool gaps that would benefit future risk assessments. Disclaimer: The views expressed here are those of the authors and do not necessarily represent the view

Trial of Minocycline in a Clinically Isolated Syndrome of Multiple Sclerosis.

PubMed

Metz, Luanne M; Li, David K B; Traboulsee, Anthony L; Duquette, Pierre; Eliasziw, Misha; Cerchiaro, Graziela; Greenfield, Jamie; Riddehough, Andrew; Yeung, Michael; Kremenchutzky, Marcelo; Vorobeychik, Galina; Freedman, Mark S; Bhan, Virender; Blevins, Gregg; Marriott, James J; Grand'Maison, Francois; Lee, Liesly; Thibault, Manon; Hill, Michael D; Yong, V Wee

2017-06-01

On the basis of encouraging preliminary results, we conducted a randomized, controlled trial to determine whether minocycline reduces the risk of conversion from a first demyelinating event (also known as a clinically isolated syndrome) to multiple sclerosis. During the period from January 2009 through July 2013, we randomly assigned participants who had had their first demyelinating symptoms within the previous 180 days to receive either 100 mg of minocycline, administered orally twice daily, or placebo. Administration of minocycline or placebo was continued until a diagnosis of multiple sclerosis was established or until 24 months after randomization, whichever came first. The primary outcome was conversion to multiple sclerosis (diagnosed on the basis of the 2005 McDonald criteria) within 6 months after randomization. Secondary outcomes included conversion to multiple sclerosis within 24 months after randomization and changes on magnetic resonance imaging (MRI) at 6 months and 24 months (change in lesion volume on T 2 -weighted MRI, cumulative number of new lesions enhanced on T 1 -weighted MRI ["enhancing lesions"], and cumulative combined number of unique lesions [new enhancing lesions on T 1 -weighted MRI plus new and newly enlarged lesions on T 2 -weighted MRI]). A total of 142 eligible participants underwent randomization at 12 Canadian multiple sclerosis clinics; 72 participants were assigned to the minocycline group and 70 to the placebo group. The mean age of the participants was 35.8 years, and 68.3% were women. The unadjusted risk of conversion to multiple sclerosis within 6 months after randomization was 61.0% in the placebo group and 33.4% in the minocycline group, a difference of 27.6 percentage points (95% confidence interval [CI], 11.4 to 43.9; P=0.001). After adjustment for the number of enhancing lesions at baseline, the difference in the risk of conversion to multiple sclerosis within 6 months after randomization was 18.5 percentage points (95% CI, 3.7 to 33.3; P=0.01); the unadjusted risk difference was not significant at the 24-month secondary outcome time point (P=0.06). All secondary MRI outcomes favored minocycline over placebo at 6 months but not at 24 months. Trial withdrawals and adverse events of rash, dizziness, and dental discoloration were more frequent among participants who received minocycline than among those who received placebo. The risk of conversion from a clinically isolated syndrome to multiple sclerosis was significantly lower with minocycline than with placebo over 6 months but not over 24 months. (Funded by the Multiple Sclerosis Society of Canada; ClinicalTrials.gov number, NCT00666887 .).

Individual and Neighborhood Stressors, Air Pollution and Cardiovascular Disease.

PubMed

Hazlehurst, Marnie F; Nurius, Paula S; Hajat, Anjum

2018-03-08

Psychosocial and environmental stress exposures across the life course have been shown to be relevant in the development of cardiovascular disease (CVD). Assessing more than one stressor from different domains (e.g., individual and neighborhood) and across the life course moves us towards a more integrated picture of how stress affects health and well-being. Furthermore, these individual and neighborhood psychosocial stressors act on biologic pathways, including immune function and inflammatory response, which are also impacted by ubiquitous environmental exposures such as air pollution. The objective of this study is to evaluate the interaction between psychosocial stressors, at both the individual and neighborhood level, and air pollution on CVD. This study used data from the 2009-2011 Behavioral Risk Factor Surveillance System (BRFSS) from Washington State. Adverse childhood experiences (ACEs) measured at the individual level, and neighborhood deprivation index (NDI) measured at the zip code level, were the psychosocial stressors of interest. Exposures to three air pollutants-particulate matter (both PM 2.5 and PM 10 ) and nitrogen dioxide (NO₂)-were also calculated at the zip code level. Outcome measures included several self-reported CVD-related health conditions. Both multiplicative and additive interaction quantified using the relative excess risk due to interaction (RERI), were evaluated. This study included 32,151 participants in 502 unique zip codes. Multiplicative and positive additive interactions were observed between ACEs and PM 10 for diabetes, in models adjusted for NDI. The prevalence of diabetes was 1.58 (95% CI: 1.40, 1.79) times higher among those with both high ACEs and high PM 10 compared to those with low ACEs and low PM 10 ( p -value = 0.04 for interaction on the multiplicative scale). Interaction was also observed between neighborhood-level stressors (NDI) and air pollution (NO₂) for the stroke and diabetes outcomes on both multiplicative and additive scales. Modest interaction was observed between NDI and air pollution, supporting prior literature on the importance of neighborhood-level stressors in cardiovascular health and reinforcing the importance of NDI on air pollution health effects. ACEs may exert health effects through selection into disadvantaged neighborhoods and more work is needed to understand the accumulation of risk in multiple domains across the life course.

Bayesian dose-response analysis for epidemiological studies with complex uncertainty in dose estimation.

PubMed

Kwon, Deukwoo; Hoffman, F Owen; Moroz, Brian E; Simon, Steven L

2016-02-10

Most conventional risk analysis methods rely on a single best estimate of exposure per person, which does not allow for adjustment for exposure-related uncertainty. Here, we propose a Bayesian model averaging method to properly quantify the relationship between radiation dose and disease outcomes by accounting for shared and unshared uncertainty in estimated dose. Our Bayesian risk analysis method utilizes multiple realizations of sets (vectors) of doses generated by a two-dimensional Monte Carlo simulation method that properly separates shared and unshared errors in dose estimation. The exposure model used in this work is taken from a study of the risk of thyroid nodules among a cohort of 2376 subjects who were exposed to fallout from nuclear testing in Kazakhstan. We assessed the performance of our method through an extensive series of simulations and comparisons against conventional regression risk analysis methods. When the estimated doses contain relatively small amounts of uncertainty, the Bayesian method using multiple a priori plausible draws of dose vectors gave similar results to the conventional regression-based methods of dose-response analysis. However, when large and complex mixtures of shared and unshared uncertainties are present, the Bayesian method using multiple dose vectors had significantly lower relative bias than conventional regression-based risk analysis methods and better coverage, that is, a markedly increased capability to include the true risk coefficient within the 95% credible interval of the Bayesian-based risk estimate. An evaluation of the dose-response using our method is presented for an epidemiological study of thyroid disease following radiation exposure. Copyright © 2015 John Wiley & Sons, Ltd.

Assessing the Climate Resilience of Transport Infrastructure Investments in Tanzania

NASA Astrophysics Data System (ADS)

Hall, J. W.; Pant, R.; Koks, E.; Thacker, S.; Russell, T.

2017-12-01

Whilst there is an urgent need for infrastructure investment in developing countries, there is a risk that poorly planned and built infrastructure will introduce new vulnerabilities. As climate change increases the magnitudes and frequency of natural hazard events, incidence of disruptive infrastructure failures are likely to become more frequent. Therefore, it is important that infrastructure planning and investment is underpinned by climate risk assessment that can inform adaptation planning. Tanzania's rapid economic growth is placing considerable strain on the country's transportation infrastructure (roads, railways, shipping and aviation); especially at the port of Dar es Salaam and its linking transport corridors. A growing number of natural hazard events, in particular flooding, are impacting the reliability of this already over-used network. Here we report on new methodology to analyse vulnerabilities and risks due to failures of key locations in the intermodal transport network of Tanzania, including strategic connectivity to neighboring countries. To perform the national-scale risk analysis we will utilize a system-of-systems methodology. The main components of this general risk assessment, when applied to transportation systems, include: (1) Assembling data on: spatially coherent extreme hazards and intermodal transportation networks; (2) Intersecting hazards with transport network models to initiate failure conditions that trigger failure propagation across interdependent networks; (3) Quantifying failure outcomes in terms of social impacts (customers/passengers disrupted) and/or macroeconomic consequences (across multiple sectors); and (4) Simulating, testing and collecting multiple failure scenarios to perform an exhaustive risk assessment in terms of probabilities and consequences. The methodology is being used to pinpoint vulnerability and reduce climate risks to transport infrastructure investments.

Syndromes, disorders and maternal risk factors associated with neural tube defects (VII).

PubMed

Chen, Chih-Ping

2008-09-01

Neural tube defects (NTDs) may be associated with syndromes, disorders and maternal risk factors. This article provides a comprehensive review of the syndromes, disorders and maternal risk factors associated with NTDs, including DK phocomelia syndrome (von Voss-Cherstvoy syndrome), Siegel-Bartlet syndrome, fetal warfarin syndrome, craniotelencephalic dysplasia, Czeizel-Losonci syndrome, maternal cocaine abuse, Weissenbacher- Zweymller syndrome, parietal foramina (cranium bifidum), Apert syndrome, craniomicromelic syndrome, XXagonadism with multiple dysraphic lesions including omphalocele and NTDs, Fryns microphthalmia syndrome, Gershoni-Baruch syndrome, PHAVER syndrome, periconceptional vitamin B6 deficiency, and autosomal dominant Dandy-Walker malformation with occipital cephalocele. NTDs associated with these syndromes, disorders and maternal risk factors are a rare but important cause of NTDs. The recurrence risk and the preventive effect of maternal folic acid intake in NTDs associated with syndromes, disorders and maternal risk factors may be different from those of nonsyndromic multifactorial NTDs. Perinatal diagnosis of NTDs should alert doctors to the syndromes, disorders and maternal risk factors associated with NTDs, and prompt thorough etiologic investigation and genetic counseling.

Assessing and managing breast cancer risk: clinicians' current practice and future needs.

PubMed

Collins, Ian M; Steel, Emma; Mann, G Bruce; Emery, Jon D; Bickerstaffe, Adrian; Trainer, Alison; Butow, Phyllis; Pirotta, Marie; Antoniou, Antonis C; Cuzick, Jack; Hopper, John; Phillips, Kelly-Anne; Keogh, Louise A

2014-10-01

Decision support tools for the assessment and management of breast cancer risk may improve uptake of prevention strategies. End-user input in the design of such tools is critical to increase clinical use. Before developing such a computerized tool, we examined clinicians' practice and future needs. Twelve breast surgeons, 12 primary care physicians and 5 practice nurses participated in 4 focus groups. These were recorded, coded, and analyzed to identify key themes. Participants identified difficulties assessing risk, including a lack of available tools to standardize practice. Most expressed confidence identifying women at potentially high risk, but not moderate risk. Participants felt a tool could especially reassure young women at average risk. Desirable features included: evidence-based, accessible (e.g. web-based), and displaying absolute (not relative) risks in multiple formats. The potential to create anxiety was a concern. Development of future tools should address these issues to optimize translation of knowledge into clinical practice. Copyright © 2014 Elsevier Ltd. All rights reserved.

Multiple, but not traditional risk factors predict mortality in older people: the Concord Health and Ageing in Men Project.

PubMed

Hirani, Vasant; Naganathan, Vasi; Blyth, Fiona; Le Couteur, David G; Gnjidic, Danijela; Stanaway, Fiona F; Seibel, Markus J; Waite, Louise M; Handelsman, David J; Cumming, Robert G

2014-01-01

This study aims to identify the common risk factors for mortality in community-dwelling older men. A prospective population-based study was conducted with a median of 6.7 years of follow-up. Participants included 1705 men aged ≥70 years at baseline (2005-2007) living in the community in Sydney, Australia. Demographic information, lifestyle factors, health status, self-reported history of diseases, physical performance measures, blood pressure, height and weight, disability (activities of daily living (ADL) and instrumental ADLs, instrumental ADLs (IADLs)), cognitive status, depressive symptoms and blood analyte measures were considered. Cox regression analyses were conducted to model predictors delete time until of mortality. During follow-up, 461 men (27 %) died. Using Cox proportional hazards model, significant predictors of delete time to time to mortality included in the final model (p < 0.05) were older age, body mass index < 20 kg m(2), high white cell count, anaemia, low albumin, current smoking, history of cancer, history of myocardial infarction, history of congestive heart failure, depressive symptoms and ADL and IADL disability and impaired chair stands. We found that overweight and obesity and/or being a lifelong non-drinker of alcohol were protective against mortality. Compared to men with less than or equal to one risk factor, the hazard ratio in men with three risk factors was 2.5; with four risk factors, it was 4.0; with five risk factors, it was 4.9; and for six or more risk factors, it was 11.4, respectively. We have identified common risk factors that predict mortality that may be useful in making clinical decisions among older people living in the community. Our findings suggest that, in primary care, screening and management of multiple risk factors are important to consider for extending survival, rather than simply considering individual risk factors in isolation. Some of the "traditional" risk factors for mortality in a younger population, including high blood pressure, hypercholesterolaemia, overweight and obesity and diabetes, were not independent predictors of mortality in this population of older men.

Risk Prediction Score for HIV Infection: Development and Internal Validation with Cross-Sectional Data from Men Who Have Sex with Men in China.

PubMed

Yin, Lu; Zhao, Yuejuan; Peratikos, Meridith Blevins; Song, Liang; Zhang, Xiangjun; Xin, Ruolei; Sun, Zheya; Xu, Yunan; Zhang, Li; Hu, Yifei; Hao, Chun; Ruan, Yuhua; Shao, Yiming; Vermund, Sten H; Qian, Han-Zhu

2018-05-21

Receptive anal intercourse, multiple partners, condomless sex, sexually transmitted infections (STIs), and drug/alcohol addiction are familiar factors that correlate with increased human immunodeficiency virus (HIV) risk among men who have sex with men (MSM). To improve estimation to HIV acquisition, we created a composite score using questions from routine survey of 3588 MSM in Beijing, China. The HIV prevalence was 13.4%. A risk scoring tool using penalized maximum likelihood multivariable logistic regression modeling was developed, deploying backward step-down variable selection to obtain a reduced-form model. The full penalized model included 19 sexual predictors, while the reduced-form model had 12 predictors. Both models calibrated well; bootstrap-corrected c-indices were 0.70 (full model) and 0.71 (reduced-form model). Non-Beijing residence, short-term living in Beijing, illegal drug use, multiple male sexual partners, receptive anal sex, inconsistent condom use, alcohol consumption before sex, and syphilis infection were the strongest predictors of HIV infection. Discriminating higher-risk MSM for targeted HIV prevention programming using a validated risk score could improve the efficiency of resource deployment for educational and risk reduction programs. A valid risk score can also identify higher risk persons into prevention and vaccine clinical trials, which would improve trial cost-efficiency.

Return to the Primary Acute Care Service Among Patients With Multiple Myeloma on an Acute Inpatient Rehabilitation Unit.

PubMed

Fu, Jack B; Lee, Jay; Shin, Ben C; Silver, Julie K; Smith, Dennis W; Shah, Jatin J; Bruera, Eduardo

2017-06-01

Pancytopenia, immunosuppression, and other factors may place patients with multiple myeloma at risk for medical complications. These patients often require inpatient rehabilitation. No previous studies have looked at risk factors for return to the primary acute care service of this patient population. To determine the percentage of and factors associated with return to the primary acute care service of multiple myeloma rehabilitation inpatients. Retrospective review. Acute inpatient rehabilitation unit within a National Cancer Institute Comprehensive Cancer Center. All patients with multiple myeloma admitted to the inpatient rehabilitation unit between March 1, 2004, and February 28, 2015. Return to the primary acute care service was analyzed with demographic information, multiple myeloma characteristics, medications, laboratory values, and hospital admission characteristics. One hundred forty-three inpatient rehabilitation admissions were found during the study period. After we removed multiple admissions of the same patients and planned transfers to the primary acute care service, 122 admissions were analyzed. Thirty-two (26%) patients transferred back to the primary acute care service for unplanned reasons. Multivariate analysis revealed male gender and thrombocytopenia as significantly associated with return to the primary acute care service. The median survival of patients who transferred back to the inpatient primary acute care service was 180 days versus 550 days for those who did not (P < .001). Because of their medical fragility, clinicians caring for rehabilitation inpatients with multiple myeloma should maintain close contact with the primary oncology service. Factors associated with an increased risk of transfer back to the primary acute care service include male gender and thrombocytopenia. IV. Copyright © 2017 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Integrative assessment of multiple pesticides as risk factors for non-Hodgkin's lymphoma among men

PubMed Central

De Roos, A J; Zahm, S; Cantor, K; Weisenburger, D; Holmes, F; Burmeister, L; Blair, A

2003-01-01

Methods: During the 1980s, the National Cancer Institute conducted three case-control studies of NHL in the midwestern United States. These pooled data were used to examine pesticide exposures in farming as risk factors for NHL in men. The large sample size (n = 3417) allowed analysis of 47 pesticides simultaneously, controlling for potential confounding by other pesticides in the model, and adjusting the estimates based on a prespecified variance to make them more stable. Results: Reported use of several individual pesticides was associated with increased NHL incidence, including organophosphate insecticides coumaphos, diazinon, and fonofos, insecticides chlordane, dieldrin, and copper acetoarsenite, and herbicides atrazine, glyphosate, and sodium chlorate. A subanalysis of these "potentially carcinogenic" pesticides suggested a positive trend of risk with exposure to increasing numbers. Conclusion: Consideration of multiple exposures is important in accurately estimating specific effects and in evaluating realistic exposure scenarios. PMID:12937207

Single, double or multiple-injection techniques for non-ultrasound guided axillary brachial plexus block in adults undergoing surgery of the lower arm.

PubMed

Chin, Ki Jinn; Alakkad, Husni; Cubillos, Javier E

2013-08-08

Regional anaesthesia comprising axillary block of the brachial plexus is a common anaesthetic technique for distal upper limb surgery. This is an update of a review first published in 2006 and updated in 2011. To compare the relative effects (benefits and harms) of three injection techniques (single, double and multiple) of axillary block of the brachial plexus for distal upper extremity surgery. We considered these effects primarily in terms of anaesthetic effectiveness; the complication rate (neurological and vascular); and pain and discomfort caused by performance of the block. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE, EMBASE and reference lists of trials. We contacted trial authors. The date of the last search was March 2013 (updated from March 2011). We included randomized controlled trials that compared double with single-injection techniques, multiple with single-injection techniques, or multiple with double-injection techniques for axillary block in adults undergoing surgery of the distal upper limb. We excluded trials using ultrasound-guided techniques. Independent study selection, risk of bias assessment and data extraction were performed by at least two investigators. We undertook meta-analysis. The 21 included trials involved a total of 2148 participants who received regional anaesthesia for hand, wrist, forearm or elbow surgery. Risk of bias assessment indicated that trial design and conduct were generally adequate; the most common areas of weakness were in blinding and allocation concealment.Eight trials comparing double versus single injections showed a statistically significant decrease in primary anaesthesia failure (risk ratio (RR 0.51), 95% confidence interval (CI) 0.30 to 0.85). Subgroup analysis by method of nerve location showed that the effect size was greater when neurostimulation was used rather than the transarterial technique.Eight trials comparing multiple with single injections showed a statistically significant decrease in primary anaesthesia failure (RR 0.25, 95% CI 0.14 to 0.44) and of incomplete motor block (RR 0.61, 95% CI 0.39 to 0.96) in the multiple injection group.Eleven trials comparing multiple with double injections showed a statistically significant decrease in primary anaesthesia failure (RR 0.28, 95% CI 0.20 to 0.40) and of incomplete motor block (RR 0.55, 95% CI 0.36 to 0.85) in the multiple injection group.Tourniquet pain was significantly reduced with multiple injections compared with double injections (RR 0.53, 95% CI 0.33 to 0.84). Otherwise there were no statistically significant differences between groups in any of the three comparisons on secondary analgesia failure, complications and patient discomfort. The time for block performance was significantly shorter for single and double injections compared with multiple injections. This review provides evidence that multiple-injection techniques using nerve stimulation for axillary plexus block produce more effective anaesthesia than either double or single-injection techniques. However, there was insufficient evidence for a significant difference in other outcomes, including safety.

Cervical human papillomavirus infection among young women engaged in sex work in Phnom Penh, Cambodia: prevalence, genotypes, risk factors and association with HIV infection.

PubMed

Couture, Marie-Claude; Page, Kimberly; Stein, Ellen S; Sansothy, Neth; Sichan, Keo; Kaldor, John; Evans, Jennifer L; Maher, Lisa; Palefsky, Joel

2012-07-28

Although cervical cancer is the leading cancer in Cambodia, most women receive no routine screening for cervical cancer and few treatment options exist. Moreover, nothing is known regarding the prevalence of cervical HPV or the genotypes present among women in the country. Young sexually active women, especially those with multiple sex partners are at highest risk of HPV infection. We examine the prevalence and genotypes of cervical HPV, as well as the associated risk factors among young women engaged in sex work in Phnom Penh, Cambodia. We conducted a cross-sectional study among 220 young women (15-29 years) engaged in sex work in different venues including brothels or entertainment establishments, and on a freelance basis in streets, parks and private apartments. Cervical specimens were collected using standard cytobrush technique. HPV DNA was tested for by polymerase chain reaction (PCR) and genotyping using type-specific probes for 29 individual HPV types, as well as for a mixture of 10 less common HPV types. All participants were also screened for HIV status using blood samples. Multivariate logistic regression analyses were conducted to assess risk factors for any or multiple HPV infection. The prevalence of cervical HPV 41.1%. HPV 51 and 70 were the most common (5.0%), followed by 16 (4.6%), 71 (4.1%) and 81 (3.7%). Thirty-six women (16.4%) were infected with multiple genotypes and 23.3% were infected with at least one oncogenic HPV type. In multivariate analyses, having HIV infection and a higher number of sexual partners were associated with cervical HPV infection. Risk factors for infection with multiple genotypes included working as freelance female sex workers (FSW) or in brothels, recent binge use of drugs, high number of sexual partners, and HIV infection. This is the first Cambodian study on cervical HPV prevalence and genotypes. We found that HPV infection was common among young FSW, especially among women infected with HIV. These results underscore the urgent need for accessible cervical cancer screening and treatment, as well as for a prophylactic vaccine that covers the HPV subtypes present in Cambodia.

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

[Premature rupture of membranes one fetus from a multiple pregnancy].

PubMed

Malinowski, Witold

2011-10-01

In multiple gestation, premature rupture of fetal membranes (PROM) is an important risk factor for premature delivery and intrauterine infection. The incidence of PROM in twin gestations is threefold of that in singleton pregnancies. The incidence in triplets occurs even more frequently underlining the role of PROM as a leading cause of infant mortality and morbidity. Besides prematurity the complications of PROM include umbilical cord compression due to oligohydramnios, cord prolapse, placental abruption, and chorioamnionitis. Together with PROM, chorioamnionitis is held responsible for significant maternal and neonatal morbidity including endometritis and sepsis in the mother and early-onset sepsis, respiratory distress syndrome, inborn pneumonia, bronchopulmonary dysplasia, intraventricular hemorrhage, and periventricular white matter injury in the neonate. Furthermore, in twin gestations, PROM remains an independent risk factor for long-term neonatal care. An uncommon situation develops when in multiple gestation PROM affects only one of the fetuses. In such cases, the co-existence in the uterine cavity of the properly developing fetus(es) can be a challenge for the process of medical decision-making. In the present work, limited world literature on the topic was critically reviewed in search of the best possible recommendations for clinical management.

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…

Neurofibromatosis.

PubMed

Korf, Bruce R

2013-01-01

The "neurofibromatoses" are a set of distinct genetic disorders that have in common the occurrence of tumors of the nerve sheath. They include NF1, NF2, and schwannomatosis. All are dominantly inherited with a high rate of new mutation and variable expression. NF1 includes effects on multiple systems of the body. The major NF1-associated tumor is the neurofibroma. In addition, clinical manifestations include bone dysplasia, learning disabilities, and an increased risk of malignancy. NF2 includes schwannomas of multiple cranial and spinal nerves, especially the vestibular nerve, as well as other tumors such as meningiomas and ependymomas. The schwannomatosis phenotype is limited to multiple schwannomas, and usually presents with pain. The genes that underlie each of the disorders are known: NF1 for neurofibromatosis type 1, NF2 for neurofibromatosis type 2, and INI1/SMARCB1 for schwannomatosis. Genetic testing is possible to identify mutations. Insights into pathogenesis are beginning to suggest new treatment strategies, and therapeutic trials with several new forms of treatment are underway. Copyright © 2013 Elsevier B.V. All rights reserved.

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

PubMed

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

2014-03-01

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

Analysis of correlation between pediatric asthma exacerbation and exposure to pollutant mixtures with association rule mining.

PubMed

Toti, Giulia; Vilalta, Ricardo; Lindner, Peggy; Lefer, Barry; Macias, Charles; Price, Daniel

2016-11-01

Traditional studies on effects of outdoor pollution on asthma have been criticized for questionable statistical validity and inefficacy in exploring the effects of multiple air pollutants, alone and in combination. Association rule mining (ARM), a method easily interpretable and suitable for the analysis of the effects of multiple exposures, could be of use, but the traditional interest metrics of support and confidence need to be substituted with metrics that focus on risk variations caused by different exposures. We present an ARM-based methodology that produces rules associated with relevant odds ratios and limits the number of final rules even at very low support levels (0.5%), thanks to post-pruning criteria that limit rule redundancy and control for statistical significance. The methodology has been applied to a case-crossover study to explore the effects of multiple air pollutants on risk of asthma in pediatric subjects. We identified 27 rules with interesting odds ratio among more than 10,000 having the required support. The only rule including only one chemical is exposure to ozone on the previous day of the reported asthma attack (OR=1.14). 26 combinatory rules highlight the limitations of air quality policies based on single pollutant thresholds and suggest that exposure to mixtures of chemicals is more harmful, with odds ratio as high as 1.54 (associated with the combination day0 SO 2 , day0 NO, day0 NO 2 , day1 PM). The proposed method can be used to analyze risk variations caused by single and multiple exposures. The method is reliable and requires fewer assumptions on the data than parametric approaches. Rules including more than one pollutant highlight interactions that deserve further investigation, while helping to limit the search field. Copyright © 2016 Elsevier B.V. All rights reserved.

Fingolimod hydrochloride for the treatment of relapsing remitting multiple sclerosis.

PubMed

Thomas, Katja; Proschmann, Undine; Ziemssen, Tjalf

2017-10-01

Fingolimod was the first oral and the first in class disease modifying treatment in multiple sclerosis that acts as sphingosine-1-phospathe receptor agonist. Since approval in 2010 there is a growing experience with fingolimod use in clinical practice, but also next-generation sphingosin-1-receptor agonists in ongoing clinical trials. Growing evidence demonstrates additional effects beyond impact on lymphocyte circulation, highlighting further promising targets in multiple sclerosis therapy. Areas covered: Here we present a systematic review using PubMed database searching and expert opinion on fingolimod use in clinical practice. Long-term data of initial clinical trials and post-marketing evaluations including long-term efficacy, safety, tolerability and management especially within growing disease modifying treatment options and pre-treatment constellation in multiple sclerosis patients are critically discussed. Furthermore novel findings in mechanism of actions and prospective on additional use in progressive forms in multiple sclerosis are presented. Expert opinion: There is an extensive long-term experience on fingolimod use in clinical practice demonstrating the favorable benefit-risk of this drug. Using a defined risk management approach experienced MS clinicians should apply fingolimod after critical choice of patients and review of clinical aspects. Further studies are essential to discuss additional benefit in progressive forms in multiple sclerosis.

Geographic risk modeling of childhood cancer relative to county-level crops, hazardous air pollutants and population density characteristics in Texas.

PubMed

Thompson, James A; Carozza, Susan E; Zhu, Li

2008-09-25

Childhood cancer has been linked to a variety of environmental factors, including agricultural activities, industrial pollutants and population mixing, but etiologic studies have often been inconclusive or inconsistent when considering specific cancer types. More specific exposure assessments are needed. It would be helpful to optimize future studies to incorporate knowledge of high-risk locations or geographic risk patterns. The objective of this study was to evaluate potential geographic risk patterns in Texas accounting for the possibility that multiple cancers may have similar geographic risks patterns. A spatio-temporal risk modeling approach was used, whereby 19 childhood cancer types were modeled as potentially correlated within county-years. The standard morbidity ratios were modeled as functions of intensive crop production, intensive release of hazardous air pollutants, population density, and rapid population growth. There was supportive evidence for elevated risks for germ cell tumors and "other" gliomas in areas of intense cropping and for hepatic tumors in areas of intense release of hazardous air pollutants. The risk for Hodgkin lymphoma appeared to be reduced in areas of rapidly growing population. Elevated spatial risks included four cancer histotypes, "other" leukemias, Central Nervous System (CNS) embryonal tumors, CNS other gliomas and hepatic tumors with greater than 95% likelihood of elevated risks in at least one county. The Bayesian implementation of the Multivariate Conditional Autoregressive model provided a flexible approach to the spatial modeling of multiple childhood cancer histotypes. The current study identified geographic factors supporting more focused studies of germ cell tumors and "other" gliomas in areas of intense cropping, hepatic cancer near Hazardous Air Pollutant (HAP) release facilities and specific locations with increased risks for CNS embryonal tumors and for "other" leukemias. Further study should be performed to evaluate potentially lower risk for Hodgkin lymphoma and malignant bone tumors in counties with rapidly growing population.

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

PubMed

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

2014-01-01

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

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

PubMed Central

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

2014-01-01

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

Hierarchical clustering of HPV genotype patterns in the ASCUS-LSIL triage study

PubMed Central

Wentzensen, Nicolas; Wilson, Lauren E.; Wheeler, Cosette M.; Carreon, Joseph D.; Gravitt, Patti E.; Schiffman, Mark; Castle, Philip E.

2010-01-01

Anogenital cancers are associated with about 13 carcinogenic HPV types in a broader group that cause cervical intraepithelial neoplasia (CIN). Multiple concurrent cervical HPV infections are common which complicate the attribution of HPV types to different grades of CIN. Here we report the analysis of HPV genotype patterns in the ASCUS-LSIL triage study using unsupervised hierarchical clustering. Women who underwent colposcopy at baseline (n = 2780) were grouped into 20 disease categories based on histology and cytology. Disease groups and HPV genotypes were clustered using complete linkage. Risk of 2-year cumulative CIN3+, viral load, colposcopic impression, and age were compared between disease groups and major clusters. Hierarchical clustering yielded four major disease clusters: Cluster 1 included all CIN3 histology with abnormal cytology; Cluster 2 included CIN3 histology with normal cytology and combinations with either CIN2 or high-grade squamous intraepithelial lesion (HSIL) cytology; Cluster 3 included older women with normal or low grade histology/cytology and low viral load; Cluster 4 included younger women with low grade histology/cytology, multiple infections, and the highest viral load. Three major groups of HPV genotypes were identified: Group 1 included only HPV16; Group 2 included nine carcinogenic types plus non-carcinogenic HPV53 and HPV66; and Group 3 included non-carcinogenic types plus carcinogenic HPV33 and HPV45. Clustering results suggested that colposcopy missed a prevalent precancer in many women with no biopsy/normal histology and HSIL. This result was confirmed by an elevated 2-year risk of CIN3+ in these groups. Our novel approach to study multiple genotype infections in cervical disease using unsupervised hierarchical clustering can address complex genotype distributions on a population level. PMID:20959485

Greater involvement and diversity of Internet gambling as a risk factor for problem gambling

PubMed Central

Russell, Alex; Blaszczynski, Alex; Hing, Nerilee

2015-01-01

Background: Concerns that Internet gambling has elevated the prevalence of problem gambling have not been substantiated; however, evidence suggests a subgroup of Internet gamblers do experience higher rates of gambling harms. Greater overall involvement in gambling appears to be predictive of harms. The purpose of this study was to examine differences between Internet gamblers with a single or multiple online gambling accounts, including their gambling behaviours, factors influencing their online gambling and risk of experiencing gambling problems. Methods: Internet gamblers (3178) responding to an online survey that assessed their gambling behaviour, and use of single or multiple online gambling accounts. Results: Results revealed that multiple account holders were more involved gamblers, gambling on more activities and more frequently, and had higher rates of gambling problems than single account holders. Multiple account holders selected gambling sites based on price, betting options, payout rates and game experience, whereas single account holders prioritized legality and consumer protection features. Conclusion: Results suggest two different types of Internet gamblers: one motivated to move between sites to optimize preferred experiences with a tendency to gamble in a more volatile manner; and a smaller, but more stable group less influenced by promotions and experiences, and seeking a reputable and safe gambling experience. As the majority of Internet gamblers use multiple accounts, more universal responsible gambling strategies are needed to assist gamblers to track and control their expenditure to reduce risks of harm. PMID:25745873

Multiple-Strain Approach and Probabilistic Modeling of Consumer Habits in Quantitative Microbial Risk Assessment: A Quantitative Assessment of Exposure to Staphylococcal Enterotoxin A in Raw Milk.

PubMed

Crotta, Matteo; Rizzi, Rita; Varisco, Giorgio; Daminelli, Paolo; Cunico, Elena Cosciani; Luini, Mario; Graber, Hans Ulrich; Paterlini, Franco; Guitian, Javier

2016-03-01

Quantitative microbial risk assessment (QMRA) models are extensively applied to inform management of a broad range of food safety risks. Inevitably, QMRA modeling involves an element of simplification of the biological process of interest. Two features that are frequently simplified or disregarded are the pathogenicity of multiple strains of a single pathogen and consumer behavior at the household level. In this study, we developed a QMRA model with a multiple-strain approach and a consumer phase module (CPM) based on uncertainty distributions fitted from field data. We modeled exposure to staphylococcal enterotoxin A in raw milk in Lombardy; a specific enterotoxin production module was thus included. The model is adaptable and could be used to assess the risk related to other pathogens in raw milk as well as other staphylococcal enterotoxins. The multiplestrain approach, implemented as a multinomial process, allowed the inclusion of variability and uncertainty with regard to pathogenicity at the bacterial level. Data from 301 questionnaires submitted to raw milk consumers were used to obtain uncertainty distributions for the CPM. The distributions were modeled to be easily updatable with further data or evidence. The sources of uncertainty due to the multiple-strain approach and the CPM were identified, and their impact on the output was assessed by comparing specific scenarios to the baseline. When the distributions reflecting the uncertainty in consumer behavior were fixed to the 95th percentile, the risk of exposure increased up to 160 times. This reflects the importance of taking into consideration the diversity of consumers' habits at the household level and the impact that the lack of knowledge about variables in the CPM can have on the final QMRA estimates. The multiple-strain approach lends itself to use in other food matrices besides raw milk and allows the model to better capture the complexity of the real world and to be capable of geographical specificity.

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

The Iodine Satellite (iSAT) Hall Thruster Demonstration Mission Concept and Development

NASA Technical Reports Server (NTRS)

Dankanich, John W.; Polzin, Kurt A.; Calvert, Derek; Kamhawi, Hani

2014-01-01

The use of iodine propellant for Hall thrusters has been studied and proposed by multiple organizations due to the potential mission benefits over xenon. In 2013, NASA Marshall Space Flight Center competitively selected a project for the maturation of an iodine flight operational feed system through the Technology Investment Program. Multiple partnerships and collaborations have allowed the team to expand the scope to include additional mission concept development and risk reduction to support a flight system demonstration, the iodine Satellite (iSAT). The iSAT project was initiated and is progressing towards a technology demonstration mission preliminary design review. The current status of the mission concept development and risk reduction efforts in support of this project is presented.

Violence and school shootings.

PubMed

Flannery, Daniel J; Modzeleski, William; Kretschmar, Jeff M

2013-01-01

Multiple-homicide school shootings are rare events, but when they happen they significantly impact individuals, the school and the community. We focus on multiple-homicide incidents and identified mental health issues of shooters. To date, studies of school shootings have concluded that no reliable profile of a shooter exists, so risk should be assessed using comprehensive threat assessment protocols. Existing studies primarily utilize retrospective case histories or media accounts. The field requires more empirical and systematic research on all types of school shootings including single victim incidents, those that result in injury but not death and those that are successfully averted. We discuss current policies and practices related to school shootings and the role of mental health professionals in assessing risk and supporting surviving victims.

Preschool-Based Programs for Externalizing Problems

ERIC Educational Resources Information Center

Arnold, David H.; Brown, Sharice A.; Meagher, Susan; Baker, Courtney N.; Dobbs, Jennifer; Doctoroff, Greta L.

2006-01-01

Few mental health initiatives for young children have used classroom programs. Preschool-based efforts targeting externalizing behavior could help prevent conduct disorders. Additional benefits may include improved academic achievement and reduced risk for other mental health difficulties. Pro-grams that target multiple developmental domains are…

ASSESSING RISKS TO WILDLIFE POPULATIONS FROM MULTIPLE STRESSORS: OVERVIEW OF PROBLEM AND RESEARCH NEEDS

EPA Science Inventory

Wildlife populations are experiencing increasing pressure from human-induced changes in the landscape. Stressors including agricultural and urban land use, introduced invasive and exotic species, nutrient enrichment, direct human disturbance, and toxic chemicals directly or indi...

Adjuvant radiotherapy for stage I endometrial cancer.

PubMed

Kong, A; Johnson, N; Cornes, P; Simera, I; Collingwood, M; Williams, C; Kitchener, H

2007-04-18

The role of adjuvant radiotherapy (both pelvic external beam radiotherapy and vaginal intracavity brachytherapy) in stage I endometrial cancer following total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH and BSO) remains unclear. To assess the efficacy of adjuvant radiotherapy following surgery for stage I endometrial cancer. The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CancerLit, Physician Data Query (PDQ) of National Cancer Institute. Handsearching was also carried out where appropriate. Randomised controlled trials (RCTs) which compared adjuvant radiotherapy versus no radiotherapy following surgery for patients with stage I endometrial cancer were included. Quality of the studies was assessed and data collected using a predefined data collection form. The primary endpoint was overall survival. Secondary endpoints were locoregional recurrence, distant recurrence and endometrial cancer death. Data on quality of life (QOL) and morbidity were also collected. A meta-analysis on included trials was performed using the Cochrane Collaboration Review Manager Software 4.2. The meta-analysis was performed on four trials (1770 patients). The addition of pelvic external beam radiotherapy to surgery reduced locoregional recurrence, a relative risk (RR) of 0.28 (95% confidence interval (CI) 0.17 to 0.44, p < 0.00001), which is a 72% reduction in the risk of pelvic relapse (95% CI 56% to 83%) and an absolute risk reduction of 6% (95% CI of 4 to 8%). The number needed to treat (NNT) to prevent one locoregional recurrence is 16.7 patients (95% CI 12.5 to 25). The reduction in the risk of locoregional recurrence did not translate into either a reduction in the risk of distant recurrence or death from all causes or endometrial cancer death. A subgroup analysis of women with multiple high risk factors (including stage 1c and grade 3) showed a trend toward the reduction in the risk of death from all causes and endometrial cancer death in patients who underwent adjuvant external beam radiotherapy. Patients with stage I endometrial carcinoma have different risks of local and distant recurrence depending on the presence of risk factors including stage 1c, grade 3, lymphovascular space invasion and age. Though external beam pelvic radiotherapy reduced locoregional recurrence by 72%, there is no evidence to suggest that it reduced the risk of death. In patients with multiple high risk factors, including stage 1c and grade 3, there was a trend towards a survival benefit and adjuvant external beam radiotherapy may be justified. For patients with only one risk factor, grade 3 or stage 1c, no definite conclusion can be made and data from ongoing studies ( ASTEC; Lukka) are awaited. External beam radiotherapy carries a risk of toxicity and should be avoided in stage 1 endometrial cancer patients with no high risk factors.

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

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

Communicating Genetic Risk Information for Common Disorders in the Era of Genomic Medicine

PubMed Central

Lautenbach, Denise M.; Christensen, Kurt D.; Sparks, Jeffrey A.; Green, Robert C.

2013-01-01

Communicating genetic risk information in ways that maximize understanding and promote health is increasingly important given the rapidly expanding availability and capabilities of genomic technologies. A well-developed literature on risk communication in general provides guidance for best practices, including presentation of information in multiple formats, attention to framing effects, use of graphics, sensitivity to the way numbers are presented, parsimony of information, attentiveness to emotions, and interactivity as part of the communication process. Challenges to communicating genetic risk information include deciding how best to tailor it, streamlining the process, deciding what information to disclose, accepting that communications may have limited influence, and understanding the impact of context. Meeting these challenges has great potential for empowering individuals to adopt healthier lifestyles and improve public health, but will require multidisciplinary approaches and collaboration. PMID:24003856

Exogenous and endogenous hormones and breast cancer

PubMed Central

ChenMD, Wendy Y.

2008-01-01

Exposure to higher levels of both exogenous and endogenous hormone is associated with breast cancer risk. Because of the association between breast cancer and HRT, only the minimal duration of HRT use is recommended for symptom control, and it is not recommended for chronic disease management. Current research issues include the role of progestins, other types of HRT, duration of unopposed estrogen use, and characteristics of cancers that develop on HRT. Circulating sex steroid levels are associated with breast cancer risk, but multiple issues need to be addressed before they are used routinely in clinical practice. Current research issues include measurement of levels for routine clinical practice, integration with standard breast cancer risk models and genetic polymorphism data, and applicability to estrogen-receptor-negative cancers. PMID:18971119

The role of exercise in fall prevention for older adults.

PubMed

Rose, Debra J; Hernandez, Danielle

2010-11-01

This article reviews the evidence for the effectiveness of stand-alone exercise interventions and multifactorial intervention strategies that include exercise in lowering fall incidence rates and/or fall risk among older adults residing in the community, acute, subacute, and long-term care settings. Stand-alone exercise programs that emphasize multiple exercise categories are effective in reducing fall rates and fall risk in community-residing older adults, and may also be effective when conducted for a sufficient duration with older adult patients in subacute settings. In contrast, multifactorial fall risk reduction programs that include exercise as a component and are delivered by a multidisciplinary team are more effective in lowering fall rates in long-term care settings. Copyright © 2010 Elsevier Inc. All rights reserved.

Three methods for integration of environmental risk into the benefit-risk assessment of veterinary medicinal products.

PubMed

Chapman, Jennifer L; Porsch, Lucas; Vidaurre, Rodrigo; Backhaus, Thomas; Sinclair, Chris; Jones, Glyn; Boxall, Alistair B A

2017-12-15

Veterinary medicinal products (VMPs) require, as part of the European Union (EU) authorization process, consideration of both risks and benefits. Uses of VMPs have multiple risks (e.g., risks to the animal being treated, to the person administering the VMP) including risks to the environment. Environmental risks are not directly comparable to therapeutic benefits; there is no standardized approach to compare both environmental risks and therapeutic benefits. We have developed three methods for communicating and comparing therapeutic benefits and environmental risks for the benefit-risk assessment that supports the EU authorization process. Two of these methods support independent product evaluation (i.e., a summative classification and a visual scoring matrix classification); the other supports a comparative evaluation between alternative products (i.e., a comparative classification). The methods and the challenges to implementing a benefit-risk assessment including environmental risk are presented herein; how these concepts would work in current policy is discussed. Adaptability to scientific and policy development is considered. This work is an initial step in the development of a standardized methodology for integrated decision-making for VMPs. Copyright © 2017 Elsevier B.V. All rights reserved.

Prospective study of blood metabolites associated with colorectal cancer risk.

PubMed

Shu, Xiang; Xiang, Yong-Bing; Rothman, Nathaniel; Yu, Danxia; Li, Hong-Lan; Yang, Gong; Cai, Hui; Ma, Xiao; Lan, Qing; Gao, Yu-Tang; Jia, Wei; Shu, Xiao-Ou; Zheng, Wei

2018-02-26

Few prospective studies, and none in Asians, have systematically evaluated the relationship between blood metabolites and colorectal cancer risk. We conducted a nested case-control study to search for risk-associated metabolite biomarkers for colorectal cancer in an Asian population using blood samples collected prior to cancer diagnosis. Conditional logistic regression was performed to assess associations of metabolites with cancer risk. In this study, we included 250 incident cases with colorectal cancer and individually matched controls nested within two prospective Shanghai cohorts. We found 35 metabolites associated with risk of colorectal cancer after adjusting for multiple comparisons. Among them, 12 metabolites were glycerophospholipids including nine associated with reduced risk of colorectal cancer and three with increased risk [odds ratios per standard deviation increase of transformed metabolites: 0.31-1.98; p values: 0.002-1.25 × 10 -10 ]. The other 23 metabolites associated with colorectal cancer risk included nine lipids other than glycerophospholipid, seven aromatic compounds, five organic acids and four other organic compounds. After mutual adjustment, nine metabolites remained statistically significant for colorectal cancer. Together, these independently associated metabolites can separate cancer cases from controls with an area under the curve of 0.76 for colorectal cancer. We have identified that dysregulation of glycerophospholipids may contribute to risk of colorectal cancer. © 2018 UICC.

Association of Antenatal Corticosteroids with Mortality, Morbidity, and Neurodevelopmental Outcomes in Extremely Preterm Multiple Gestation Infants

PubMed Central

Boghossian, Nansi S.; McDonald, Scott A.; Bell, Edward F.; Carlo, Waldemar A.; Brumbaugh, Jane E.; Stoll, Barbara J.; Laptook, Abbot R.; Shankaran, Seetha; Walsh, Michele C.; Das, Abhik; Higgins, Rosemary D.

2017-01-01

Importance Little is known about the benefits of antenatal corticosteroids on extremely preterm multiples. Objective To examine in extremely preterm multiples if use of antenatal corticosteroids is associated with improvement in major outcomes. Design, Setting, and Participants Infants with gestational age 22–28 weeks born at an NICHD Neonatal Research Network center (1998–2013) were studied. Generalized estimating equation models were used to generate adjusted relative risks (aRR) controlling for important maternal and neonatal variables. Main Outcome Measures In-hospital mortality, the composite outcome of neurodevelopmental impairment at 18–22 months’ corrected age or death before assessment. Results Of 6925 multiple-birth infants, 6094 (88%) were born to women who received antenatal corticosteroids. In-hospital mortality was lower among infants with exposure to antenatal corticosteroids vs no exposure (aRR=0.87, 95% CI 0.78–0.96). Neurodevelopmental impairment or death was not significantly lower among those exposed to antenatal corticosteroids vs no exposure (aRR=0.93, 95% CI 0.84–1.03). Other adverse outcomes that occurred less frequently among infants of women receiving antenatal corticosteroids included severe intraventricular hemorrhage (aRR=0.68, 95% CI 0.58–0.78) and the combined outcomes of necrotizing enterocolitis or death and severe intraventricular hemorrhage or death. Subgroup analyses indicated that exposure to antenatal corticosteroids was associated with a lower risk of mortality and the composite of neurodevelopmental impairment or mortality among non-small for gestational age multiples (aRR=0.82, 95% CI 0.74–0.92 and aRR=0.89, 95% CI 0.80–0.98, respectively) and a higher risk among small for gestational age multiples (aRR=1.40, 95% CI 1.02–1.93 and aRR=1.62, 95% CI 1.22–2.16, respectively). Antenatal corticosteroids were associated with higher neurodevelopmental impairment or mortality among multiple-birth infants of mothers with diabetes (aRR=1.55, 95% CI 1.00–2.38) but not among infants of mothers without diabetes (aRR=0.91, 95% CI 0.83–1.01). Conclusion In extremely preterm multiples, exposure to antenatal corticosteroids compared with no exposure was associated with a lower risk of mortality with no significant differences for the composite of neurodevelopmental impairment or death. Future research should investigate the increased risks of mortality and the composite of neurodevelopmental impairment or death associated with exposure to corticosteroids among small for gestational age multiples. PMID:27088897

Association of multiple infarctions and ICAS with outcomes of minor stroke and TIA.

PubMed

Pan, Yuesong; Meng, Xia; Jing, Jing; Li, Hao; Zhao, Xingquan; Liu, Liping; Wang, David; Johnston, S Claiborne; Wang, Yilong; Wang, Yongjun

2017-03-14

To estimate the association of different patterns of infarction and intracranial arterial stenosis (ICAS) with the prognosis of acute minor ischemic stroke and TIA. We derived data from the Clopidogrel in High-risk Patients with Acute Nondisabling Cerebrovascular Events (CHANCE) trial. A total of 1,089 patients from 45 of 114 participating sites of the trial undergoing baseline MRI/angiography were included in this subgroup analysis. Patterns of infarction and ICAS were recorded for each individual. The primary efficacy outcome was an ischemic stroke at the 90-day follow-up. We assessed the associations between imaging patterns and prognosis of patients using multivariable Cox regression models. Among the 1,089 patients included in this subgroup analysis, 93 (8.5%) patients had a recurrent ischemic stroke at 90 days. Compared with those without infarction or ICAS, patients with single infarction with ICAS (11.9% vs 1.3%, hazard ratio [HR] 6.25, 95% confidence intervals [CIs] 1.40-27.86, p = 0.02) and single infarction without ICAS (6.8% vs 1.3%, HR 4.65, 95% CI 1.05-20.64, p = 0.04) were all associated with an increased risk of ischemic stroke at 90 days. Patients with both multiple infarctions and ICAS were associated with approximately 13-fold risk of ischemic stroke at 90 days (18.0% vs 1.3%, HR 13.14, 95% CI 2.96-58.36, p < 0.001). The presence of multiple infarctions and ICAS were both associated with an increased risk of 90-day ischemic stroke in patients with minor stroke or TIA, while the presence of both imaging features had a combined effect. NCT00979589. © 2017 American Academy of Neurology.

Incremental Benefit of a Home Visit Following Discharge for Patients with Multiple Chronic Conditions Receiving Transitional Care

PubMed Central

Jackson, Carlos; Kasper, Elizabeth W.; Williams, Christianna

2016-01-01

Abstract Transitional care management is effective at reducing hospital readmissions among patients with multiple chronic conditions, but evidence is lacking on the relative benefit of the home visit as a component of transitional care. The sample included non-dual Medicaid recipients with multiple chronic conditions enrolled in Community Care of North Carolina (CCNC), with a hospital discharge between July 2010 and December 2012. Using claims data and care management records, this study retrospectively examined whether home visits reduced the odds of 30-day readmission compared to less intensive transitional care support, using multivariate logistic regression to control for demographic and clinical characteristics. Additionally, the researchers examined group differences within clinical risk strata on inpatient admissions and total cost of care in the 6 months following hospital discharge. Of 35,174 discharges receiving transitional care from a CCNC care manager, 21% (N = 7468) included a home visit. In multivariate analysis, home visits significantly reduced the odds of readmission within 30 days (odds ratio = 0.52, 95% confidence interval 0.48–0.57). At the 6-month follow-up, home visits were associated with fewer inpatient admissions within 4 of 6 clinical risk strata, and lower total costs of care for highest risk patients (average per member per month cost difference $970; P < 0.01). For complex chronic patients, home visits reduced the likelihood of a 30-day readmission by almost half compared to less intensive forms of nurse-led transitional care support. Higher risk patients experienced the greatest benefit in terms of number of inpatient admissions and total cost of care in the 6 months following discharge. (Population Health Management 2016;19:163–170) PMID:26431255

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.

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 effectiveness of behaviour change interventions to increase physical activity participation in people with multiple sclerosis: a systematic review and meta-analysis.

PubMed

Sangelaji, Bahram; Smith, Catherin M; Paul, Lorna; Sampath, Kesava Kovanur; Treharne, Gareth J; Hale, Leigh Anne

2016-06-01

A systematic review and meta-analysis was conducted to illustrate whether people with multiple sclerosis engage in more physical activity following behaviour change interventions. MEDLINE, CINAHL, PubMed, Web of Sciences, Cochrane Library, SCOPUS, EMBASE and PEDro were searched from their inception till 30 April 2015. Randomized and clinical controlled trials that used behaviour change interventions to increase physical activity in people with multiple sclerosis were selected, regardless of type or duration of multiple sclerosis or disability severity. Data extraction was conducted by two independent reviewers and the Cochrane Collaboration's recommended method was used to assess the risk of bias of each included study. A total of 19 out of 573 studies were included. Focusing on trials without risk of bias, meta-analysis showed that behaviour change interventions can significantly increase physical activity participation (z = 2.20, p = 0.03, standardised main difference 0.65, 95% confidence interval 0.07 to 1.22, 3 trials, I(2) = 68%) (eight to 12 weeks' duration). Behaviour change interventions did not significantly impact on the physical components of quality of life or fatigue. Behaviour change interventions provided for relatively short duration (eight to 12 weeks) may increase the amount of physical activity people with multiple sclerosis engage in, but appear to have no effect on the physical components of quality of life and fatigue. Further high quality investigations of the efficacy of behaviour change interventions to increase physical activity participation that focus on dose, long-term impact and method of delivery are warranted for people with multiple sclerosis. © The Author(s) 2015.

Novel biomarkers for cardiovascular risk assessment: current status and future directions.

PubMed

MacNamara, James; Eapen, Danny J; Quyyumi, Arshed; Sperling, Laurence

2015-09-01

Cardiovascular disease (CVD) is the leading cause of mortality in the modern world. Traditional risk algorithms may miss up to 20% of CVD events. Therefore, there is a need for new cardiac biomarkers. Many fields of research are dedicated to improving cardiac risk prediction, including genomics, transcriptomics and proteomics. To date, even the most promising biomarkers have only demonstrated modest associations and predictive ability. Few have undergone randomized control trials. A number of biomarkers are targets to new therapies aimed to reduce cardiovascular risk. Currently, some of the most promising risk prediction has been demonstrated with panels of multiple biomarkers. This article reviews the current state and future of proteomic biomarkers and aggregate biomarker panels.

[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.

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.

Drug use disorders in the polydrug context: new epidemiological evidence from a foodborne outbreak approach

PubMed Central

Lopez-Quintero, Catalina; Anthony, James C.

2016-01-01

As epidemiologists studying foodborne illness outbreaks, we do not ask luncheon attendees to say which food caused their illnesses. Instead, we use measurement and analysis methods to estimate food-specific risk variations. Here, we adapt the foodborne outbreak approach to develop new estimates of drug use disorder risk for single-drug and polydrug users, without attributing the syndrome to a specific drug when multiple drugs have been used. We estimate drug use disorder risk for cannabis-only users as a reference value. We then derive comparative relative risk estimates for users of other drug subtypes, including polydrug combinations. Data are from the 2002 to 2003 U.S. National Comorbidity Survey Replication, a nationally representative sample of household residents (18+ years), with standardized drug use and drug dependence assessments. Multiple logistic regression provides odds ratio estimates of relative risk. With this approach, for every 1000 cannabis-only users, an estimated 17 had become cases (1.7%). By comparison, polydrug users and cocaine-only users had much greater cumulative incidence (>10%), even with adjustment for covariates and local area matching (P < 0.001). Using this approach, we find exceptionally low risk for cannabis-only users and greater risk for polydrug and cocaine-only users. PMID:26348487

Quantitative Risk Analysis

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

Helms, J.

2017-02-10

The US energy sector is vulnerable to multiple hazards including both natural disasters and malicious attacks from an intelligent adversary. The question that utility owners, operators and regulators face is how to prioritize their investments to mitigate the risks from a hazard that can have the most impact on the asset of interest. In order to be able to understand their risk landscape and develop a prioritized mitigation strategy, they must quantify risk in a consistent way across all hazards their asset is facing. Without being able to quantitatively measure risk, it is not possible to defensibly prioritize security investmentsmore » or evaluate trade-offs between security and functionality. Development of a methodology that will consistently measure and quantify risk across different hazards is needed.« less

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.

YOUNG ADULT DATING RELATIONSHIPS AND THE MANAGEMENT OF SEXUAL RISK

PubMed Central

Manning, Wendy D.; Giordano, Peggy C.; Longmore, Monica A.; Flanigan, Christine M.

2012-01-01

Young adult involvement in sexual behavior typically occurs within a relationship context, but we know little about the ways in which specific features of romantic relationships influence sexual decision-making. Prior work on sexual risk taking focuses attention on health issues rather than relationship dynamics. We draw on data from the Toledo Adolescent Relationships Study (TARS) (n = 475) to examine the association between qualities and dynamics of current/most recent romantic relationships such as communication and emotional processes, conflict, demographic asymmetries, and duration and the management of sexual risk. We conceptualize ‘risk management’ as encompassing multiple domains, including (1) questioning the partner about previous sexual behaviors/risks, (2) using condoms consistently, and (3) maintaining sexual exclusivity within the relationship. We identify distinct patterns of risk management among dating young adults and find that specific qualities and dynamics of these relationships are linked to variations in risk management. Results from this paper suggest the need to consider relational dynamics in efforts to target and influence young adult sexual risk-taking and reduce STIs, including HIV. PMID:23805015

YOUNG ADULT DATING RELATIONSHIPS AND THE MANAGEMENT OF SEXUAL RISK.

PubMed

Manning, Wendy D; Giordano, Peggy C; Longmore, Monica A; Flanigan, Christine M

2012-04-01

Young adult involvement in sexual behavior typically occurs within a relationship context, but we know little about the ways in which specific features of romantic relationships influence sexual decision-making. Prior work on sexual risk taking focuses attention on health issues rather than relationship dynamics. We draw on data from the Toledo Adolescent Relationships Study (TARS) (n = 475) to examine the association between qualities and dynamics of current/most recent romantic relationships such as communication and emotional processes, conflict, demographic asymmetries, and duration and the management of sexual risk. We conceptualize 'risk management' as encompassing multiple domains, including (1) questioning the partner about previous sexual behaviors/risks, (2) using condoms consistently, and (3) maintaining sexual exclusivity within the relationship. We identify distinct patterns of risk management among dating young adults and find that specific qualities and dynamics of these relationships are linked to variations in risk management. Results from this paper suggest the need to consider relational dynamics in efforts to target and influence young adult sexual risk-taking and reduce STIs, including HIV.

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.

Perceived cancer risk: why is it lower among nonwhites than whites?

PubMed

Orom, Heather; Kiviniemi, Marc T; Underwood, Willie; Ross, Levi; Shavers, Vickie L

2010-03-01

We explored racial/ethnic differences in perceived cancer risk and determinants of these differences in a nationally representative sample of whites, blacks, Hispanics, and Asians. Multiple regression techniques, including mediational analyses, were used to identify determinants and quantify racial/ethnic differences in the perception of the risk of developing cancer among 5,581 adult respondents to the 2007 Health Information Trends Survey (HINTS). Blacks, Hispanics, and Asians reported lower perceived cancer risk than whites [Bs = -0.40, -0.34, and -0.69, respectively; (Ps < 0.001)]. Contributing factors included relatively lower likelihood of reporting a family history of cancer, lower likelihood of having smoked, and a less strong belief that everything causes cancer among nonwhites than among whites. Racial/ethnic differences in perceived risk were attenuated in older respondents because perceived cancer risk was negatively associated with age for whites but not for nonwhites. Nonwhites had lower perceptions of cancer risk than whites. Some of the racial/ethnic variability in perceived risk may be due to racial and ethnic differences in awareness of one's family history of cancer and its relevance for cancer risk, experiences with behavioral risk factors, and salience of cancer risk information.

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.

Risk Factors for 30-Day Complications After Thumb CMC Joint Arthroplasty: An American College of Surgeons National Surgery Quality Improvement Program Study.

PubMed

Shah, Kalpit N; Defroda, Steven F; Wang, Bo; Weiss, Arnold-Peter C

2017-12-01

The first carpometacarpal (CMC) joint is a common site of osteoarthritis, with arthroplasty being a common procedure to provide pain relief and improve function with low complications. However, little is known about risk factors that may predispose a patient for postoperative complications. All CMC joint arthroplasty from 2005 to 2015 in the prospectively collected American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database were identified. Bivariate testing and multiple logistic regressions were performed to determine which patient demographics, surgical variables and medical comorbidities were significant predictors for complications. These included wound related, cardiopulmonary, neurological and renal complications, return to the operating room (OR) and readmission. A total of 3344 patients were identified from the database. Of those, 45 patients (1.3%) experienced a complication including wound issues (0.66%), return to the OR (0.15%) and readmission (0.27%) amongst others. When performing bivariate analysis, age over 65, American Society of Anesthesiologists (ASA) Class, diabetes and renal dialysis were significant risk factors. Multiple logistic regression after adjusting for confounding factors demonstrated that insulin-dependent diabetes and ASA Class 4 had a strong trend while renal dialysis was a significant risk factor. CMC arthroplasty has a very low overall complication rate of 1.3% and wound complication rate of 0.66%. Diabetes requiring insulin and ASA Class 4 trended towards significance while renal dialysis was found to be a significant risk factors in logistic regression. This information may be useful for preoperative counseling and discussion with patients who have these risk factors.

Genetics and the environment converge to dysregulate N-glycosylation in multiple sclerosis

PubMed Central

Mkhikian, Haik; Grigorian, Ani; Li, Carey F.; Chen, Hung-Lin; Newton, Barbara; Zhou, Raymond W.; Beeton, Christine; Torossian, Sevan; Tatarian, Gevork Grikor; Lee, Sung-Uk; Lau, Ken; Walker, Erin; Siminovitch, Katherine A.; Chandy, K. George; Yu, Zhaoxia; Dennis, James W.; Demetriou, Michael

2011-01-01

How environmental factors combine with genetic risk at the molecular level to promote complex trait diseases such as multiple sclerosis (MS) is largely unknown. In mice, N-glycan branching by the Golgi enzymes Mgat1 and/or Mgat5 prevents T cell hyperactivity, cytotoxic T-lymphocyte antigen 4 (CTLA-4) endocytosis, spontaneous inflammatory demyelination and neurodegeneration, the latter pathologies characteristic of MS. Here we show that MS risk modulators converge to alter N-glycosylation and/or CTLA-4 surface retention conditional on metabolism and vitamin D3, including genetic variants in interleukin-7 receptor-α (IL7RA*C), interleukin-2 receptor-α (IL2RA*T), MGAT1 (IVAVT−T) and CTLA-4 (Thr17Ala). Downregulation of Mgat1 by IL7RA*C and IL2RA*T is opposed by MGAT1 (IVAVT−T) and vitamin D3, optimizing branching and mitigating MS risk when combined with enhanced CTLA-4 N-glycosylation by CTLA-4 Thr17. Our data suggest a molecular mechanism in MS whereby multiple environmental and genetic inputs lead to dysregulation of a final common pathway, namely N-glycosylation. PMID:21629267

Bayesian networks improve causal environmental ...

EPA Pesticide Factsheets

Rule-based weight of evidence approaches to ecological risk assessment may not account for uncertainties and generally lack probabilistic integration of lines of evidence. Bayesian networks allow causal inferences to be made from evidence by including causal knowledge about the problem, using this knowledge with probabilistic calculus to combine multiple lines of evidence, and minimizing biases in predicting or diagnosing causal relationships. Too often, sources of uncertainty in conventional weight of evidence approaches are ignored that can be accounted for with Bayesian networks. Specifying and propagating uncertainties improve the ability of models to incorporate strength of the evidence in the risk management phase of an assessment. Probabilistic inference from a Bayesian network allows evaluation of changes in uncertainty for variables from the evidence. The network structure and probabilistic framework of a Bayesian approach provide advantages over qualitative approaches in weight of evidence for capturing the impacts of multiple sources of quantifiable uncertainty on predictions of ecological risk. Bayesian networks can facilitate the development of evidence-based policy under conditions of uncertainty by incorporating analytical inaccuracies or the implications of imperfect information, structuring and communicating causal issues through qualitative directed graph formulations, and quantitatively comparing the causal power of multiple stressors on value

A MULTIPLE-PURPOSE DESIGN APPROACH TO THE EVALUATION OF RISKS FROM COMPLEX MIXTURES OF DISINFECTION BY-PRODUCTS

EPA Science Inventory

Drinking water disinfection has effectively eliminated much of the morbidity and mortality associated with waterborne infectious diseases in the United States. Various disinfection processes, however, produce certain types and amounts of disinfection by-products (DBPs), including...

Managing Stress for At-Risk Students

ERIC Educational Resources Information Center

Spiegel, Ellen J.

2017-01-01

The BRIDGE Alternative Middle School in Lowell, Massachusetts, serves students ages 12-16 who have exhibited behavioral problems in traditional school settings, including problems such as truancy, multiple suspensions, mental health issues, peer conflicts, family dysfunction, academic problems, and gang involvement. Students referred to BRIDGE are…

Atraumatic Spinal Cord Injury in the Novice Surfer: A Comprehensive Review and Update

PubMed Central

Flick, David; Cheng, Moses

2017-01-01

Novice surfers are at risk for a rare but potentially devastating form of atraumatic myelopathy. There are 16 published studies on this condition, including 66 cases. The most common suggested mechanism of injury is static hyperextension. However, active mechanisms, in contrast to static, have also been proposed and may be contributory. First time surfers, defined as those who have never been on a surfboard prior to the day of injury, are at particular risk. These individuals make up 89.5%–100% of the reported novice surfers found in the various reports. Multiple neurologic deficits occur and often include paraparesis, paraplegia, urinary retention, and hyperesthesia. While these deficits resolve in some cases, there are reports of multiple instances of permanent injury. Increased awareness of this condition is arguably the most effective preventative measure, as it may lead to avoidance of the predisposing postures. It may also lead to earlier diagnosis in the acute setting, which will become relevant as treatment modalities continue to be refined. PMID:28210528

Unprotected sex of homeless youth: results from a multilevel dyadic analysis of individual, social network, and relationship factors.

PubMed

Kennedy, David P; Tucker, Joan S; Green, Harold D; Golinelli, Daniela; Ewing, Brett

2012-10-01

Homeless youth have elevated risk of HIV through sexual behavior. This project investigates the multiple levels of influence on unprotected sex among homeless youth, including social network, individual, and partner level influences. Findings are based on analyses of an exploratory, semi-structured interview (n = 40) and a structured personal network interview (n = 240) with randomly selected homeless youth in Los Angeles. Previous social network studies of risky sex by homeless youth have collected limited social network data from non-random samples and have not distinguished sex partner influences from other network influences. The present analyses have identified significant associations with unprotected sex at multiple levels, including individual, partner, and, to a lesser extent, the social network. Analyses also distinguished between youth who did or did not want to use condoms when they had unprotected sex. Implications for social network based HIV risk interventions with homeless youth are discussed.

Unprotected Sex of Homeless Youth: Results from a Multilevel Analysis of Individual, Social Network, and Relationship Factors

PubMed Central

Kennedy, David P.; Tucker, Joan S.; Green, Harold D.; Golinelli, Daniela; Ewing, Brett

2012-01-01

Homeless youth have elevated risk of HIV through sexual behavior. This project investigates the multiple levels of influence on unprotected sex among homeless youth, including social network, individual, and partner level influences. Findings are based on analyses of an exploratory, semi-structured interview (n=40) and a structured personal network interview (n=240) with randomly selected homeless youth in Los Angeles. Previous social network studies of risky sex by homeless youth have collected limited social network data from non-random samples and have not distinguished sex partner influences from other network influences. The present analyses have identified significant associations with unprotected sex at multiple levels, including individual, partner, and, to a lesser extent, the social network. Analyses also distinguished between youth who wished they used condoms after having unprotected sex and youth who did not regret having unprotected sex. Implications for social network based HIV risk interventions with homeless youth are discussed. PMID:22610421

Quantifying and Reducing Uncertainty in Correlated Multi-Area Short-Term Load Forecasting

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

Sun, Yannan; Hou, Zhangshuan; Meng, Da

2016-07-17

In this study, we represent and reduce the uncertainties in short-term electric load forecasting by integrating time series analysis tools including ARIMA modeling, sequential Gaussian simulation, and principal component analysis. The approaches are mainly focusing on maintaining the inter-dependency between multiple geographically related areas. These approaches are applied onto cross-correlated load time series as well as their forecast errors. Multiple short-term prediction realizations are then generated from the reduced uncertainty ranges, which are useful for power system risk analyses.

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.

Future directions of multiple behavior change research.

PubMed

Geller, Karly; Lippke, Sonia; Nigg, Claudio R

2017-02-01

Non-communicable diseases (i.e., chronic diseases including cardiovascular disease, cancer, chronic respiratory disease, diabetes and obesity) result in 36 million deaths each year. Individuals' habitual participation in a single health-risk behaviors substantially contribute to morbidity and mortality (e.g., tobacco use, daily fast food intake, etc.); however, more concerning is the impact of typically co-occurring or clustering of multiple health-risk behaviors. This burden can be minimized through successful cessation of health-risk behaviors and adoption of healthy behaviors; namely healthy lifestyle adoption or multiple health behavior change (MHBC). MHBC is a developing field and future research recommendations are provided to advance MHBC research. A valid measure of MHBC (i.e., lifestyle) is warranted to provide the needed basis for MHBC investigations and evaluations. MHBC is thought to occur through shared co-variation of underlying motivating mechanisms, but how these relationships influence behavior remains unclear. A better understanding of the relationship between behaviors and the related motivating mechanisms (and potential cross-relationship of influences) is needed. Future research should also aim to improve lifestyles through understanding how to change multiple health behaviors. Finally, MHBC research should target the development of sustainable interventions which result in lasting effects (e.g., capacity, systems, policy and environmental changes), with dissemination considered during development. Focusing MHBC research in these areas will increase our understanding and maximize the impact on the health of populations.

Rationale of technical requirements for NRG-BR001: The first NCI-sponsored trial of SBRT for the treatment of multiple metastases.

PubMed

Al-Hallaq, Hania A; Chmura, Steven; Salama, Joseph K; Winter, Kathryn A; Robinson, Clifford G; Pisansky, Thomas M; Borges, Virginia; Lowenstein, Jessica R; McNulty, Susan; Galvin, James M; Followill, David S; Timmerman, Robert D; White, Julia R; Xiao, Ying; Matuszak, Martha M

In 2014, the NRG Oncology Group initiated the first National Cancer Institute-sponsored, phase 1 clinical trial of stereotactic body radiation therapy (SBRT) for the treatment of multiple metastases in multiple organ sites (BR001; NCT02206334). The primary endpoint is to test the safety of SBRT for the treatment of 2 to 4 multiple lesions in several anatomic sites in a multi-institutional setting. Because of the technical challenges inherent to treating multiple lesions as their spatial separation decreases, we present the technical requirements for NRG-BR001 and the rationale for their selection. Patients with controlled primary tumors of breast, non-small cell lung, or prostate are eligible if they have 2 to 4 metastases distributed among 7 extracranial anatomic locations throughout the body. Prescription and organ-at-risk doses were determined by expert consensus. Credentialing requirements include (1) irradiation of the Imaging and Radiation Oncology Core phantom with SBRT, (2) submitting image guided radiation therapy case studies, and (3) planning the benchmark. Guidelines for navigating challenging planning cases including assessing composite dose are discussed. Dosimetric planning to multiple lesions receiving differing doses (45-50 Gy) and fractionation (3-5) while irradiating the same organs at risk is discussed, particularly for metastases in close proximity (≤5 cm). The benchmark case was selected to demonstrate the planning tradeoffs required to satisfy protocol requirements for 2 nearby lesions. Examples of passing benchmark plans exhibited a large variability in plan conformity. NRG-BR001 was developed using expert consensus on multiple issues from the dose fractionation regimen to the minimum image guided radiation therapy guidelines. Credentialing was tied to the task rather than the anatomic site to reduce its burden. Every effort was made to include a variety of delivery methods to reflect current SBRT technology. Although some simplifications were adopted, the successful completion of this trial will inform future designs of both national and institutional trials and would allow immediate clinical adoption of SBRT trials for oligometastases. Copyright © 2016 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

[Influence of neonatal diseases and treatments on the development of cerebral palsy in preterm infant].

PubMed

Yu, Tao; Rong, Luo; Wang, Qiu; You, Yi; Fu, Jun-Xian; Kang, Lin-Min; Wu, Yan-Qiao

2013-03-01

To investigated the risk factors of cerebral palsy development in preterm infants. This study included 203 preterm infants (gestation age < 37 weeks) diagnosed with cerebral palsy (CP) and 220 preterm infants without cerebral palsy or any other severe neurological disorders during April 2005 to August 2011. The risk factors in the development of cerebral palsy, including the diseases of premature infants and the treatments in neonatal period, were analyzed by multiple logistic regression analysis. Multivariate logistic analysis for the risk factors associated with cerebral palsy in neonatal period found significant differences in the occurrence of periventricular leukomalacia (PVL, OR = 39.87, P < 0.05), hypoxia-ischemic encephalopathy (HIE, OR = 4.24, P < 0.05), hypoglycemia of neonatal (OR = 2.18, P < 0.05), neonatal hyperbilirubinemia (OR = 1.72, P < 0.05), continuous positive airway pressure (CPAP, OR = 0.21, P < 0.05). The factors including PLV, HIE, hypoglycemia, and neonatal jaundice may increase the risk in the development of CP in preterm infant, while CPAP may decrease the risk of cerebral palsy.

Multiple myeloma and family history of lymphohaematopoietic cancers: Results from the International Multiple Myeloma Consortium.

PubMed

Schinasi, Leah H; Brown, Elizabeth E; Camp, Nicola J; Wang, Sophia S; Hofmann, Jonathan N; Chiu, Brian C; Miligi, Lucia; Beane Freeman, Laura E; de Sanjose, Silvia; Bernstein, Leslie; Monnereau, Alain; Clavel, Jacqueline; Tricot, Guido J; Atanackovic, Djordje; Cocco, Pierluigi; Orsi, Laurent; Dosman, James A; McLaughlin, John R; Purdue, Mark P; Cozen, Wendy; Spinelli, John J; de Roos, Anneclaire J

2016-10-01

Family clusters of multiple myeloma (MM) suggest disease heritability. Nevertheless, patterns of inheritance and the importance of genetic versus environmental risk factors in MM aetiology remain unclear. We pooled data from eleven case-control studies from the International Multiple Myeloma Consortium to characterize the association of MM risk with having a first-degree relative with a history of a lympho-haematapoietic cancer. Unconditional logistic regression models, adjusted for study, sex, age and education level, were used to estimate associations between MM risk and having a first-degree relative with a history of non-Hodgkin lymphoma, Hodgkin lymphoma, leukaemia or MM. Sex, African American race/ethnicity and age were explored as effect modifiers. A total of 2843 cases and 11 470 controls were included. MM risk was elevated in association with having a first-degree relative with any lympho-haematapoietic cancer (Odds Ratio (OR) = 1·29, 95% Confidence Interval (CI): 1·08-1·55). The association was particularly strong for having a first-degree relative with MM (OR = 1·90, 95% CI: 1·26-2·87), especially among men (OR = 4·13, 95% CI: 2·17-7·85) and African Americans (OR = 5·52, 95% CI: 1·87-16·27).These results support the hypothesis that genetic inheritance plays a role in MM aetiology. Future studies are warranted to characterize interactions of genetic markers with environmental exposures. © 2016 John Wiley & Sons Ltd.

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.

Contributions of vitamin D response elements and HLA promoters to multiple sclerosis risk.

PubMed

Nolan, David; Castley, Alison; Tschochner, Monika; James, Ian; Qiu, Wei; Sayer, David; Christiansen, Frank T; Witt, Campbell; Mastaglia, Frank; Carroll, William; Kermode, Allan

2012-08-07

The identification of a vitamin D-responsive (VDRE) motif within the HLA-DRB1*15:01 promoter region provides an attractive explanation for the combined effects of HLA-DR inheritance and vitamin D exposure on multiple sclerosis (MS) risk. We therefore sought to incorporate HLA-DRB1 promoter variation, including the VDRE motif, in an assessment of HLA-DRB1-associated MS risk. We utilized 32 homozygous HLA cell lines (covering 17 DRB1 alleles) and 53 heterozygote MS samples (20 DRB1 alleles) for HLA-DRB1 promoter sequencing. The influence of HLA-DRB1 variation on MS risk was then assessed among 466 MS cases and 498 controls. The majority of HLA*DRB1 alleles (including HLA-DRB1*15:01) express the functional VDRE motif, apart from HLA-DRB1*04, *07, and *09 alleles that comprise the HLA-DR53 serologic group. Allele-specific variation within functional X-box and Y-box motifs was also associated with serologically defined HLA-DR haplotypes. Incorporating these results in an analysis of MS risk, we identified a strong protective effect of HLA-DRB1*04, *07, and *09 (DR53) alleles (p = 10(-12)) and elevated risk associated with DRB1*15 and *16 (DR51) and *08 (DR8) alleles (p < 10(-18)). HLA-DRB1 groups corresponding to serologic HLA-DR profiles as well as promoter polymorphism haplotypes effectively stratified MS risk over an 11-fold range, suggesting functional relationships between risk-modifying HLA-DRB1 alleles. An independent contribution of VDRE motif variation to increase MS risk was not discernible, although vitamin D-dependent regulation of HLA-DR expression may still play an important role given that HLA-DRB1*04/*07/*09 (DR53) alleles that express the "nonresponsive" VDRE motif were associated with significantly reduced risk of MS.

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.

[Bone structure in rheumatoid arthritis].

PubMed

Ono, Kumiko; Ohashi, Satoru; Tanaka, Sakae; Matsumoto, Takuya

2013-07-01

In rheumatoid arthritis (RA) , the osteoclast pathway is activated by abnormal immune conditions accompanied by chronic inflammation, resulting in periarticular osteoporosis and local bone destruction around joints. In addition, multiple factors, including reduced physical activity and pharmacotherapies such as steroids, lead to systemic osteoporosis. These conditions cause decreasing bone mineral density and deterioration of bone quality, and expose patients to increased risk of fracture. Understanding the bone structures of RA and evaluating fracture risk are central to the treatment of RA.

Infection risk in patients on multiple sclerosis therapeutics.

PubMed

Williamson, Eric M; Berger, Joseph R

2015-03-01

The interface of multiple sclerosis (MS) and infection occurs on several levels. First, infectious disease has been postulated as a potential trigger, if not cause, of MS. Second, exacerbation of MS has been well-documented as a consequence of infection, and, lastly, infectious diseases have been recognized as a complication of the therapies currently employed in the treatment of MS. MS is a disease in which immune dysregulation is a key component. Examination of central nervous system (CNS) tissue of people affected by MS demonstrates immune cell infiltration, activation and inflammation. Therapies that alter the immune response have demonstrated efficacy in reducing relapse rates and evidence of brain inflammation on magnetic resonance imaging (MRI). Despite the altered immune response in MS, there is a lack of evidence that these patients are at increased risk of infectious disease in the absence of treatment or debility. Links between infections and disease-modifying therapies (DMTs) used in MS will be discussed in this review, as well as estimates of occurrence and ways to potentially minimize these risks. We address infection in MS in a comprehensive fashion, including (1) the impact of infections on relapse rates in patients with MS; (2) a review of available infection data from pivotal trials and postmarketing studies for the approved and experimental DMTs, including frequency, types and severity of infections; and (3) relevant risk minimization strategies, particularly as they pertain to progressive multifocal leukoencephalopathy (PML).

Perception and risk factors for cervical cancer among women in northern Ghana.

PubMed

Opoku, Constance A; Browne, Edmund Nii Laryea; Spangenberg, Kathryn; Moyer, Cheryl; Kolbilla, David; Gold, Katherine J

2016-06-01

This study assessed the perception of risk of cervical cancer and existence of risk factors for cervical cancer based on five known risk factors among women attending the Tamale Teaching Hospital in Tamale, Ghana. A consecutive sample of 300 women was interviewed using a semi-structured questionnaire to inquire about risk factors and perception of risk of cervical cancer. Specific risk factors that were explored included early coitarche, multiple sexual partners, polygamous relationships, history of smoking, and having a current partner who had multiple sexual partners. Sixty-one per cent of women reported that they had no personal risk for cervical cancer. 27% of respondents were in polygamous relationships, and of those, more than half didn't think they were at an increased risk of cervical cancer. 2 women had a total of ≥ 5 sexual partners in their lifetime and neither believed they were at any risk for cervical cancer. 23% said their current partner had had at least 2 sexual partners in his lifetime, and of those, (61%) thought they were at no risk for cervical cancer. 46% of respondents reported not having any of the risk factors listed in the study. 23% of respondents reported having one risk factor while 21% had two risk factors and 11% had three or more risk factors. Women's perception of personal risk for cervical cancer is lower than their actual risk based on the five behavioural risk factors assessed and a lack of knowledge of the personal factors for the disease. This project was supported by NIH Research Training Grant #R25 TW009345 funded by the Fogarty International Centre, in partnership with several NIH Institutes (NIMH, NIGMS, NHLBI, OAR and OWH).

A review of vulnerability and risks for schizophrenia: Beyond the two hit hypothesis

PubMed Central

Davis, Justin; Eyre, Harris; Jacka, Felice N; Dodd, Seetal; Dean, Olivia; McEwen, Sarah; Debnath, Monojit; McGrath, John; Maes, Michael; Amminger, Paul; McGorry, Patrick D; Pantelis, Christos; Berk, Michael

2016-01-01

Schizophrenia risk has often been conceptualized using a model which requires two hits in order to generate the clinical phenotype—the first as an early priming in a genetically predisposed individual and the second a likely environmental insult. The aim of this paper was to review the literature and reformulate this binary risk-vulnerability model. We sourced the data for this narrative review from the electronic database PUBMED. Our search terms were not limited by language or date of publication. The development of schizophrenia may be driven by genetic vulnerability interacting with multiple vulnerability factors including lowered prenatal vitamin D exposure, viral infections, smoking intelligence quotient, social cognition cannabis use, social defeat, nutrition and childhood trauma. It is likely that these genetic risks, environmental risks and vulnerability factors are cumulative and interactive with each other and with critical periods of neurodevelopmental vulnerability. The development of schizophrenia is likely to be more complex and nuanced than the binary two hit model originally proposed nearly thirty years ago. Risk appears influenced by a more complex process involving genetic risk interfacing with multiple potentially interacting hits and vulnerability factors occurring at key periods of neurodevelopmental activity, which culminate in the expression of disease state. These risks are common across a number of neuropsychiatric and medical disorders, which might inform common preventive and intervention strategies across non-communicable disorders. PMID:27073049

Positive Fungal Cultures in Burn Patients: A Multicenter Review

DTIC Science & Technology

2008-02-01

These factors include neutropenia, systemic ste- roids, central venous access,39 TPN, hemodialysis, diabetes mellitus, and urinary catheterization .40...burn treatment exposes patients to multiple other risks for fungal infection, including central venous lines, uri- nary catheters, prolonged...patients with central venous *See appendix for complete list of participants and institutions. This work was supported in part by a grant from Merck & Co

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.

A meta-analysis of observational studies of the association between chronic occupational exposure to lead and amyotrophic lateral sclerosis.

PubMed

Wang, Ming-Dong; Gomes, James; Cashman, Neil R; Little, Julian; Krewski, Daniel

2014-12-01

The association between occupational exposure to lead and amyotrophic lateral sclerosis (ALS) was examined through systematic review and meta-analyses of relevant epidemiological studies and reported according to PRISMA guidelines. Relevant studies were searched in multiple bibliographic databases through September 2013; additional articles were tracked through PubMed until submission. All records were screened in DistillerSR, and the data extracted from included articles were synthesized with meta-analysis. The risk of developing ALS among individuals with a history of exposure to lead was almost doubled (odds ratio, 1.81; 95% confidence interval, 1.39 to 2.36) on the basis of nine included case-control studies with specific lead exposure information, with no apparent heterogeneity across included studies (I = 14%). The attributable risk of ALS because of exposure to lead was estimated to be 5%. Previous exposure to lead may be a risk factor for ALS.

The Role of C-Peptide as Marker of Cardiometabolic Risk in Women With Polycystic Ovary Syndrome: A Controlled Study

PubMed Central

de Medeiros, Sebastiao Freitas; Angelo, Laura Camila Antunes; de Medeiros, Matheus Antonio Souto; Banhara, Camila Regis; Barbosa, Bruna Barcelo; Yamamoto, Marcia Marly Winck

2018-01-01

Background The aim of this study was to examine the role of C-peptide as a biological marker of cardiometabolic risk in polycystic ovary syndrome (PCOS). Methods This case-control study enrolled 385 PCOS patients and 240 normal cycling women. Anthropometric and clinical variables were taken at first visit. Fasting C-peptide, glucose, lipids, and hormone measurements were performed. Simple and multiple correlations between C-peptide and other variables associated with dysmetabolism and cardiovascular disease were examined. Results C-peptide was well correlated with several anthropometric, metabolic, and endocrine parameters. In PCOS patients, stepwise multiple regression including C-peptide as the criterion variable and other predictors of cardiovascular disease risk provided a significant model in which the fasting C-peptide/glucose ratio, glucose, body weight, and free estrogen index (FEI) were retained (adjusted R2 = 0.988, F = 7.161, P = 0.008). Conclusion C-peptide levels alone or combined with C-peptide/glucose ratio, glucose, body weight, and FEI provided a significant model to identify PCOS patients with higher risk of future cardiometabolic diseases. PMID:29416587

Managing the side effects of multiple sclerosis therapy: pharmacotherapy options for patients.

PubMed

Rommer, Paulus S; Zettl, Uwe K

2018-04-01

Multiple sclerosis (MS) is an immune-mediated and neurodegenerative disease with an unpredictable outcome. Immune-modulatory treatment aims at decreasing long-term disability. With the increasing number of treatment options, it is essential to fully digest the possible side effects of the available therapeutics and to monitor patients is essential. Areas covered: All approved disease-modifying drugs (DMD) for MS are discussed in this review. Mode of action, adverse effects, reported risks for infections and malignancies, and pregnancy related issues are discussed in the review. The authors also provide suggestions for monitoring therapy. For all approved DMDs the pivotal studies have been included for possible side effects, as well as reports by health authorities. For this manuscript, PubMed was checked for reports on side effects for various drugs. Expert opinion: Treatment options in MS are manifold, each carrying different risks. The safety-risk profile for approved agents is favorable. Knowing and monitoring these possible side effects is essential to minimize risks associated with treatment. Presently, the long-term experience for some of these therapies is missing and this must be addressed.

Home Parenteral Nutrition: Fat Emulsions and Potential Complications.

PubMed

Mundi, Manpreet S; Salonen, Bradley R; Bonnes, Sara

2016-10-01

Since the first intravenous nutrition support attempt with olive oil in the 17th century, intravenous fat emulsions (IVFEs) have evolved to become an integral component in the management of patients receiving home parenteral nutrition (HPN). IVFEs serve as a calorie source and provide essential fatty acids (linoleic acid and α-linolenic acid) in patients unable to achieve adequate intake of these fatty acids through alternative means. However, IVFE use is also associated with multiple complications, including increased infection risk, liver disease, and systemic proinflammatory states. In the United States, most IVFEs are composed of 100% soybean oil; internationally multiple alternative IVFEs (using fish oil, olive oil, and long- and medium-chain triglycerides) are available or being developed. The hope is that these IVFEs will prevent, or decrease the risk of, some of the HPN-associated complications. The goal of this article is to review how IVFEs came into use, their composition and metabolism, options for IVFE delivery in HPN, benefits and risks of IVFE use, and strategies to minimize the risks associated with IVFE use in HPN patients. © 2016 American Society for Parenteral and Enteral Nutrition.

The health outcomes of human offspring conceived by assisted reproductive technologies (ART).

PubMed

Chen, M; Heilbronn, L K

2017-08-01

Concerns have been raised about the health and development of children conceived by assisted reproductive technologies (ART) since 1978. Controversially, ART has been linked with adverse obstetric and perinatal outcomes, an increased risk of birth defects, cancers, and growth and development disorders. Emerging evidence suggests that ART treatment may also predispose individuals to an increased risk of chronic ageing related diseases such as obesity, type 2 diabetes and cardiovascular disease. This review will summarize the available evidence on the short-term and long-term health outcomes of ART singletons, as multiple pregnancies after multiple embryos transfer, are associated with low birth weight and preterm delivery, which can separately increase risk of adverse postnatal outcomes, and impact long-term health. We will also examine the potential factors that may contribute to these health risks, and discuss underlying mechanisms, including epigenetic changes that may occur during the preimplantation period and reprogram development in utero, and adult health, later in life. Lastly, this review will consider the future directions with the view to optimize the long-term health of ART children.

Adolescent maltreatment in the child welfare system and developmental patterns of sexual risk behaviors.

PubMed

Fowler, Patrick J; Motley, Darnell; Zhang, Jinjin; Rolls-Reutz, Jennifer; Landsverk, John

2015-02-01

In this longitudinal study, we tested whether adolescent maltreatment and out-of-home placement as a response to maltreatment altered developmental patterns of sexual risk behaviors in a nationally representative sample of youth involved in the child welfare system. Participants included adolescents aged 13 to 17 (M = 15.5, SD = 1.49) at baseline (n = 714), followed over 18 months. Computer-assisted interviews were used to collect self-reported sexual practices and experiences of physical and psychological abuse at both time points. Latent transition analyses were used to identify three patterns of sexual risk behaviors: abstainers, safe sex with multiple partners, and unsafe sex with multiple partners. Most adolescents transitioned to safer sexual behavior patterns over time. Adolescents exhibiting the riskiest sexual practices at baseline were most likely to report subsequent abuse and less likely to be placed into out-of-home care. Findings provide a more nuanced understanding of sexual risk among child welfare-involved adolescents and inform practices to promote positive transitions within the system. © The Author(s) 2014.

A Qualitative Study of Migrant-related Stressors, Psychosocial Outcomes and HIV Risk Behavior among Truck Drivers in Zambia

PubMed Central

Ncube, Nomagugu; Simona, Simona J.; Kansankala, Brian; Sinkala, Emmanuel; Raidoo, Jasmin

2017-01-01

Truck drivers are part of mobile populations which have been noted as a key population at risk of HIV in Zambia. This study was aimed at 1) determining Potentially Traumatic Events (PTEs), labor migrant-related stressors, psychosocial problems and HIV risk behaviors among truck drivers in Zambia and 2) examining the relationship between PTEs, migrant-related stressors, psychosocial outcomes and HIV sexual risk behavior among truck drivers in Zambia. We conducted fifteen semi-structured interviews with purposively sampled male truck drivers at trucking companies in Lusaka, Zambia. Findings indicate that truck drivers experience multiple stressors and potentially traumatic incidences, including delays and long waiting hours at borders, exposure to crime and violence, poverty, stress related to resisting temptation of sexual interactions with sex workers or migrant women, and job-related safety concerns. Multiple psychosocial problems such as intimate partner violence, loneliness, anxiety and depression-like symptoms were noted. Transactional sex, coupled with inconsistent condom use were identified as HIV sexual risk behaviors. Findings suggest the critical need to develop HIV prevention interventions which account for mobility, potentially traumatic events, psychosocial problems, and the extreme fear of HIV testing among this key population. PMID:27681145

Monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM): novel biological insights and development of early treatment strategies

PubMed Central

Kristinsson, Sigurdur Y.

2011-01-01

Monoclonal gammopathy of unknown significance (MGUS) and smoldering multiple myeloma (SMM) are asymptomatic plasma cell dyscrasias, with a propensity to progress to symptomatic MM. In recent years there have been improvements in risk stratification models (involving molecular markers) of both disorders, which have led to better understanding of the biology and probability of progression of MGUS and SMM. In the context of numerous molecular events and heterogeneous risk of progression, developing individualized risk profiles for patients with MGUS and SMM represents an ongoing challenge that has to be addressed by prospective clinical monitoring and extensive correlative science. In this review we discuss the current standard of care of patients with MGUS and SMM, the use of risk models, including flow cytometry and free-light chain analyses, for predicting risk of progression. Emerging evidence from molecular studies on MGUS and SMM, involving cytogenetics, gene-expression profiling, and microRNA as well as molecular imaging is described. Finally, future directions for improving individualized management of MGUS and SMM patients, as well as the potential for developing early treatment strategies designed to delay and prevent development of MM are discussed. PMID:21441462

Monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM): novel biological insights and development of early treatment strategies.

PubMed

Korde, Neha; Kristinsson, Sigurdur Y; Landgren, Ola

2011-05-26

Monoclonal gammopathy of unknown significance (MGUS) and smoldering multiple myeloma (SMM) are asymptomatic plasma cell dyscrasias, with a propensity to progress to symptomatic MM. In recent years there have been improvements in risk stratification models (involving molecular markers) of both disorders, which have led to better understanding of the biology and probability of progression of MGUS and SMM. In the context of numerous molecular events and heterogeneous risk of progression, developing individualized risk profiles for patients with MGUS and SMM represents an ongoing challenge that has to be addressed by prospective clinical monitoring and extensive correlative science. In this review we discuss the current standard of care of patients with MGUS and SMM, the use of risk models, including flow cytometry and free-light chain analyses, for predicting risk of progression. Emerging evidence from molecular studies on MGUS and SMM, involving cytogenetics, gene-expression profiling, and microRNA as well as molecular imaging is described. Finally, future directions for improving individualized management of MGUS and SMM patients, as well as the potential for developing early treatment strategies designed to delay and prevent development of MM are discussed.

High- and low-risk profiles for the development of multiple sclerosis within 10 years after optic neuritis: experience of the optic neuritis treatment trial.

PubMed

Beck, Roy W; Trobe, Jonathan D; Moke, Pamela S; Gal, Robin L; Xing, Dongyuan; Bhatti, M Tariq; Brodsky, Michael C; Buckley, Edward G; Chrousos, Georgia A; Corbett, James; Eggenberger, Eric; Goodwin, James A; Katz, Barrett; Kaufman, David I; Keltner, John L; Kupersmith, Mark J; Miller, Neil R; Nazarian, Sarkis; Orengo-Nania, Silvia; Savino, Peter J; Shults, William T; Smith, Craig H; Wall, Michael

2003-07-01

To identify factors associated with a high and low risk of developing multiple sclerosis after an initial episode of optic neuritis. Three hundred eighty-eight patients who experienced acute optic neuritis between July 1, 1988, and June 30, 1991, were followed up prospectively for the development of multiple sclerosis. Consenting patients were reassessed after 10 to 13 years. The 10-year risk of multiple sclerosis was 38% (95% confidence interval, 33%-43%). Patients (160) who had 1 or more typical lesions on the baseline magnetic resonance imaging (MRI) scan of the brain had a 56% risk; those with no lesions (191) had a 22% risk (P<.001, log rank test). Among the patients who had no lesions on MRI, male gender and optic disc swelling were associated with a lower risk of multiple sclerosis, as was the presence of the following atypical features for optic neuritis: no light perception vision; absence of pain; and ophthalmoscopic findings of severe optic disc edema, peripapillary hemorrhages, or retinal exudates. The 10-year risk of multiple sclerosis following an initial episode of acute optic neuritis is significantly higher if there is a single brain MRI lesion; higher numbers of lesions do not appreciably increase that risk. However, even when brain lesions are seen on MRI, more than 40% of the patients will not develop clinical multiple sclerosis after 10 years. In the absence of MRI lesions, certain demographic and clinical features seem to predict a very low likelihood of developing multiple sclerosis. This natural history information is a critical input for estimating a patient's 10-year multiple sclerosis risk and for weighing the benefit of initiating prophylactic treatment at the time of optic neuritis or other initial demyelinating events in the central nervous system.

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.

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.

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

It is complicated: sexual partner characteristic profiles and sexually transmitted infection rates within a predominantly African American population in Mississippi.

PubMed

Alexander, Jalen; Rose, Jennifer; Dierker, Lisa; Chan, Philip A; MacCarthy, Sarah; Simmons, Dantrell; Mena, Leandro; Nunn, Amy

2015-05-01

Mississippi has among the highest prevalence of sexually transmitted infections (STIs) in the United States. Understanding sexual networks can provide insight into risk factors for transmission and guide prevention interventions. Participants included 1437 primarily African American (95%) adults presenting for care at an STI clinic in Jackson, Mississippi. Latent class analysis identified underlying population subgroups with unique patterns of response on a comprehensive set of 14 sexual partner variables, such as living with or having a child with a partner, partner dependence and trust, 1-time sexual encounters, multiple main partners, substance use, sexual concurrency, and incarceration. Classes were compared on participant age, sex, sexual orientation, public assistance, lifetime partners, relationship status, and self-reported past-year STI. Three classes emerged. Class 1 (n = 746) participants were less dependent on partners and less likely to live with or have a child with a partner. Class 2 participants (n = 427) endorsed multiple STI risk factors, including partner incarceration, 6 or more lifetime partners, sexual concurrency, 1-time sexual encounters, and substance use at last sex. Class 3 participants (n = 226) were more likely to be in dependent, committed relationships with children. Class 2 had a higher proportion of self-report past-year STIs (36.7%) compared with classes 1 (26.6%) and 3 (26.1%). Certain partner factors such as incarceration, substance use, and concurrency may contribute to increased STI risk. Partner factors may be useful proxies for STI risks and could be useful questions to include in screening questionnaires in clinical settings.

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

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.

Medicines can affect thermoregulation and accentuate the risk of dehydration and heat-related illness during hot weather.

PubMed

Westaway, K; Frank, O; Husband, A; McClure, A; Shute, R; Edwards, S; Curtis, J; Rowett, D

2015-08-01

Hot days are increasingly common and are often associated with increased morbidity and mortality, especially in the elderly. Most heat-related illness and heat-related deaths are preventable. Medicines may accentuate the risk of dehydration and heat-related illness, especially in elderly people taking multiple medicines, through the following mechanisms: diuresis and electrolyte imbalance, sedation and cognitive impairment, changed thermoregulation, reduced thirst recognition, reduced sweat production, and hypotension and reduced cardiac output. Commonly used medicines that may significantly increase the risk include diuretics, especially when combined with an angiotensin converting enzyme (ACE) inhibitor or an angiotensin II receptor blocker (ARB), anticholinergics and psychotropics. Initiation of individualized preventive measures prior to the start of the hot weather season, which includes a review of the patient and their medicines to identify thermoregulatory issues, may reduce the risk of heat-related illness or death. © 2015 John Wiley & Sons Ltd.

Degrees of difference among minority female juvenile offenders' psychological functioning, risk behavior engagement, and health status: a latent profile investigation.

PubMed

Guthrie, Barbara J; Cooper, Shauna M; Brown, Charity; Metzger, Isha

2012-02-01

Given the increase in the number of female youth who come in contact with the juvenile justice system, particularly those from ethnic minority backgrounds, concerns have been raised about the health status of this population. Using a latent profile analysis, we identified health profiles using indicators of psychological well-being, health risk behaviors, and health status. Participants included 153 minority adolescent females (M=15.13, SD=1.70) who were currently in a juvenile diversion program. Results indicated that a three-class solution fit the data optimally. Profiles included girls with low to moderate health risks (n=35; 22.9%), higher mental health symptoms (n=68; 44.4%), and a combination of multiple health risks (n=50; 32.7%). Additionally, demographic, contextual and offense-related variation existed across health profiles. Treatment and policy implications are discussed.

Risk assessment and management to prevent preterm birth.

PubMed

Koullali, B; Oudijk, M A; Nijman, T A J; Mol, B W J; Pajkrt, E

2016-04-01

Preterm birth is the most important cause of neonatal mortality and morbidity worldwide. In this review, we review potential risk factors associated with preterm birth and the subsequent management to prevent preterm birth in low and high risk women with a singleton or multiple pregnancy. A history of preterm birth is considered the most important risk factor for preterm birth in subsequent pregnancy. General risk factors with a much lower impact include ethnicity, low socio-economic status, maternal weight, smoking, and periodontal status. Pregnancy-related characteristics, including bacterial vaginosis and asymptomatic bacteriuria, appear to be of limited value in the prediction of preterm birth. By contrast, a mid-pregnancy cervical length measurement is independently associated with preterm birth and could be used to identify women at risk of a premature delivery. A fetal fibronectin test may be of additional value in the prediction of preterm birth. The most effective methods to prevent preterm birth depend on the obstetric history, which makes the identification of women at risk of preterm birth an important task for clinical care providers. Copyright © 2016 Elsevier Ltd. All rights reserved.

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

PubMed Central

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

2012-01-01

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

NASA Human Research Program Space Radiation Program Element

NASA Technical Reports Server (NTRS)

Chappell, Lori; Huff, Janice; Patel, Janapriya; Wang, Minli; Hu, Shaowwen; Kidane, Yared; Myung-Hee, Kim; Li, Yongfeng; Nounu, Hatem; Plante, Ianik;

Greater involvement and diversity of Internet gambling as a risk factor for problem gambling.

PubMed

Gainsbury, Sally M; Russell, Alex; Blaszczynski, Alex; Hing, Nerilee

2015-08-01

Concerns that Internet gambling has elevated the prevalence of problem gambling have not been substantiated; however, evidence suggests a subgroup of Internet gamblers do experience higher rates of gambling harms. Greater overall involvement in gambling appears to be predictive of harms. The purpose of this study was to examine differences between Internet gamblers with a single or multiple online gambling accounts, including their gambling behaviours, factors influencing their online gambling and risk of experiencing gambling problems. Internet gamblers (3178) responding to an online survey that assessed their gambling behaviour, and use of single or multiple online gambling accounts. Results revealed that multiple account holders were more involved gamblers, gambling on more activities and more frequently, and had higher rates of gambling problems than single account holders. Multiple account holders selected gambling sites based on price, betting options, payout rates and game experience, whereas single account holders prioritized legality and consumer protection features. Results suggest two different types of Internet gamblers: one motivated to move between sites to optimize preferred experiences with a tendency to gamble in a more volatile manner; and a smaller, but more stable group less influenced by promotions and experiences, and seeking a reputable and safe gambling experience. As the majority of Internet gamblers use multiple accounts, more universal responsible gambling strategies are needed to assist gamblers to track and control their expenditure to reduce risks of harm. © The Author 2015. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Exploring metabolic dysfunction in chronic kidney disease

PubMed Central

2012-01-01

Impaired kidney function and chronic kidney disease (CKD) leading to kidney failure and end-stage renal disease (ESRD) is a serious medical condition associated with increased morbidity, mortality, and in particular cardiovascular disease (CVD) risk. CKD is associated with multiple physiological and metabolic disturbances, including hypertension, dyslipidemia and the anorexia-cachexia syndrome which are linked to poor outcomes. Specific hormonal, inflammatory, and nutritional-metabolic factors may play key roles in CKD development and pathogenesis. These include raised proinflammatory cytokines, such as interleukin-1 and −6, tumor necrosis factor, altered hepatic acute phase proteins, including reduced albumin, increased C-reactive protein, and perturbations in normal anabolic hormone responses with reduced growth hormone-insulin-like growth factor-1 axis activity. Others include hyperactivation of the renin-angiotensin aldosterone system (RAAS), with angiotensin II and aldosterone implicated in hypertension and the promotion of insulin resistance, and subsequent pharmacological blockade shown to improve blood pressure, metabolic control and offer reno-protective effects. Abnormal adipocytokine levels including leptin and adiponectin may further promote the insulin resistant, and proinflammatory state in CKD. Ghrelin may be also implicated and controversial studies suggest activities may be reduced in human CKD, and may provide a rationale for administration of acyl-ghrelin. Poor vitamin D status has also been associated with patient outcome and CVD risk and may indicate a role for supplementation. Glucocorticoid activities traditionally known for their involvement in the pathogenesis of a number of disease states are increased and may be implicated in CKD-associated hypertension, insulin resistance, diabetes risk and cachexia, both directly and indirectly through effects on other systems including activation of the mineralcorticoid receptor. Insight into the multiple factors altered in CKD may provide useful information on disease pathogenesis, clinical assessment and treatment rationale such as potential pharmacological, nutritional and exercise therapies. PMID:22537670

Underlying risk factors for prescribing errors in long-term aged care: a qualitative study.

PubMed

Tariq, Amina; Georgiou, Andrew; Raban, Magdalena; Baysari, Melissa Therese; Westbrook, Johanna

2016-09-01

To identify system-related risk factors perceived to contribute to prescribing errors in Australian long-term care settings, that is, residential aged care facilities (RACFs). The study used qualitative methods to explore factors that contribute to unsafe prescribing in RACFs. Data were collected at three RACFs in metropolitan Sydney, Australia between May and November 2011. Participants included RACF managers, doctors, pharmacists and RACF staff actively involved in prescribing-related processes. Methods included non-participant observations (74 h), in-depth semistructured interviews (n=25) and artefact analysis. Detailed process activity models were developed for observed prescribing episodes supplemented by triangulated analysis using content analysis methods. System-related factors perceived to increase the risk of prescribing errors in RACFs were classified into three overarching themes: communication systems, team coordination and staff management. Factors associated with communication systems included limited point-of-care access to information, inadequate handovers, information storage across different media (paper, electronic and memory), poor legibility of charts, information double handling, multiple faxing of medication charts and reliance on manual chart reviews. Team factors included lack of established lines of responsibility, inadequate team communication and limited participation of doctors in multidisciplinary initiatives like medication advisory committee meetings. Factors related to staff management and workload included doctors' time constraints and their accessibility, lack of trained RACF staff and high RACF staff turnover. The study highlights several system-related factors including laborious methods for exchanging medication information, which often act together to contribute to prescribing errors. Multiple interventions (eg, technology systems, team communication protocols) are required to support the collaborative nature of RACF prescribing. 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/

Cardiovascular risk factors are associated with increased lesion burden and brain atrophy in multiple sclerosis.

PubMed

Kappus, Natalie; Weinstock-Guttman, Bianca; Hagemeier, Jesper; Kennedy, Cheryl; Melia, Rebecca; Carl, Ellen; Ramasamy, Deepa P; Cherneva, Mariya; Durfee, Jacqueline; Bergsland, Niels; Dwyer, Michael G; Kolb, Channa; Hojnacki, David; Ramanathan, Murali; Zivadinov, Robert

2016-02-01

Cardiovascular (CV) risk factors have been associated with changes in clinical outcomes in patients with multiple sclerosis (MS). To investigate the frequency of CV risks in patients with MS and their association with MRI outcomes. In a prospective study, 326 patients with relapsing-remitting MS and 163 patients with progressive MS, 61 patients with clinically isolated syndrome (CIS) and 175 healthy controls (HCs) were screened for CV risks and scanned on a 3T MRI scanner. Examined CV risks included hypertension, heart disease, smoking, overweight/obesity and type 1 diabetes. MRI measures assessed lesion volumes (LVs) and brain atrophy. Association between individual or multiple CV risks and MRI outcomes was examined adjusting for age, sex, race, disease duration and treatment status. Patients with MS showed increased frequency of smoking (51.7% vs 36.5%, p = 0.001) and hypertension (33.9% vs 24.7%, p=0.035) compared with HCs. In total, 49.9% of patients with MS and 36% of HCs showed ≥ 2 CV risks (p = 0.003), while the frequency of ≥ 3 CV risks was 18.8% in the MS group and 8.6% in the HCs group (p = 0.002). In patients with MS, hypertension and heart disease were associated with decreased grey matter (GM) and cortical volumes (p < 0.05), while overweight/obesity was associated with increased T1-LV (p < 0.39) and smoking with decreased whole brain volume (p = 0.049). Increased lateral ventricle volume was associated with heart disease (p = 0.029) in CIS. Patients with MS with one or more CV risks showed increased lesion burden and more advanced brain atrophy. 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/

Application of risk-based multiple criteria decision analysis for selection of the best agricultural scenario for effective watershed management.

PubMed

Javidi Sabbaghian, Reza; Zarghami, Mahdi; Nejadhashemi, A Pouyan; Sharifi, Mohammad Bagher; Herman, Matthew R; Daneshvar, Fariborz

2016-03-01

Effective watershed management requires the evaluation of agricultural best management practice (BMP) scenarios which carefully consider the relevant environmental, economic, and social criteria involved. In the Multiple Criteria Decision-Making (MCDM) process, scenarios are first evaluated and then ranked to determine the most desirable outcome for the particular watershed. The main challenge of this process is the accurate identification of the best solution for the watershed in question, despite the various risk attitudes presented by the associated decision-makers (DMs). This paper introduces a novel approach for implementation of the MCDM process based on a comparative neutral risk/risk-based decision analysis, which results in the selection of the most desirable scenario for use in the entire watershed. At the sub-basin level, each scenario includes multiple BMPs with scores that have been calculated using the criteria derived from two cases of neutral risk and risk-based decision-making. The simple additive weighting (SAW) operator is applied for use in neutral risk decision-making, while the ordered weighted averaging (OWA) and induced OWA (IOWA) operators are effective for risk-based decision-making. At the watershed level, the BMP scores of the sub-basins are aggregated to calculate each scenarios' combined goodness measurements; the most desirable scenario for the entire watershed is then selected based on the combined goodness measurements. Our final results illustrate the type of operator and risk attitudes needed to satisfy the relevant criteria within the number of sub-basins, and how they ultimately affect the final ranking of the given scenarios. The methodology proposed here has been successfully applied to the Honeyoey Creek-Pine Creek watershed in Michigan, USA to evaluate various BMP scenarios and determine the best solution for both the stakeholders and the overall stream health. Copyright © 2015 Elsevier Ltd. All rights reserved.

Reproductive Issues in Women with Turner Syndrome.

PubMed

Folsom, Lisal J; Fuqua, John S

2015-12-01

Turner syndrome is one of the most common chromosomal abnormalities affecting female infants. The severity of clinical manifestations varies and it affects multiple organ systems. Women with Turner syndrome have a 3-fold increase in mortality, which becomes even more pronounced in pregnancy. Reproductive options include adoption or surrogacy, assisted reproductive techniques, and in rare cases spontaneous pregnancy. Risks for women with Turner syndrome during pregnancy include aortic disorders, hepatic disease, thyroid disease, type 2 diabetes, and cesarean section delivery. Providers must be familiar with the risks and recommendations in caring for women with Turner syndrome of reproductive age. Copyright © 2015 Elsevier Inc. All rights reserved.

Estimating risk of foreign exchange portfolio: Using VaR and CVaR based on GARCH-EVT-Copula model

NASA Astrophysics Data System (ADS)

Wang, Zong-Run; Chen, Xiao-Hong; Jin, Yan-Bo; Zhou, Yan-Ju

2010-11-01

This paper introduces GARCH-EVT-Copula model and applies it to study the risk of foreign exchange portfolio. Multivariate Copulas, including Gaussian, t and Clayton ones, were used to describe a portfolio risk structure, and to extend the analysis from a bivariate to an n-dimensional asset allocation problem. We apply this methodology to study the returns of a portfolio of four major foreign currencies in China, including USD, EUR, JPY and HKD. Our results suggest that the optimal investment allocations are similar across different Copulas and confidence levels. In addition, we find that the optimal investment concentrates on the USD investment. Generally speaking, t Copula and Clayton Copula better portray the correlation structure of multiple assets than Normal Copula.

Heart rate variability.

PubMed

Cygankiewicz, Iwona; Zareba, Wojciech

2013-01-01

Heart rate variability (HRV) provides indirect insight into autonomic nervous system tone, and has a well-established role as a marker of cardiovascular risk. Recent decades brought an increasing interest in HRV assessment as a diagnostic tool in detection of autonomic impairment, and prediction of prognosis in several neurological disorders. Both bedside analysis of simple markers of HRV, as well as more sophisticated HRV analyses including time, frequency domain and nonlinear analysis have been proven to detect early autonomic involvement in several neurological disorders. Furthermore, altered HRV parameters were shown to be related with cardiovascular risk, including sudden cardiac risk, in patients with neurological diseases. This chapter aims to review clinical and prognostic application of HRV analysis in diabetes, stroke, multiple sclerosis, muscular dystrophies, Parkinson's disease and epilepsy. © 2013 Elsevier B.V. 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.

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.

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…

Mitochondrial DNA and trade data support multiple origins of Helicoverpa armigera (Lepidoptera, Noctuidae) in Brazil

PubMed Central

Tay, Wee Tek; Walsh, Thomas K.; Downes, Sharon; Anderson, Craig; Jermiin, Lars S.; Wong, Thomas K. F.; Piper, Melissa C.; Chang, Ester Silva; Macedo, Isabella Barony; Czepak, Cecilia; Behere, Gajanan T.; Silvie, Pierre; Soria, Miguel F.; Frayssinet, Marie; Gordon, Karl H. J.

2017-01-01

The Old World bollworm Helicoverpa armigera is now established in Brazil but efforts to identify incursion origin(s) and pathway(s) have met with limited success due to the patchiness of available data. Using international agricultural/horticultural commodity trade data and mitochondrial DNA (mtDNA) cytochrome oxidase I (COI) and cytochrome b (Cyt b) gene markers, we inferred the origins and incursion pathways into Brazil. We detected 20 mtDNA haplotypes from six Brazilian states, eight of which were new to our 97 global COI-Cyt b haplotype database. Direct sequence matches indicated five Brazilian haplotypes had Asian, African, and European origins. We identified 45 parsimoniously informative sites and multiple substitutions per site within the concatenated (945 bp) nucleotide dataset, implying that probabilistic phylogenetic analysis methods are needed. High diversity and signatures of uniquely shared haplotypes with diverse localities combined with the trade data suggested multiple incursions and introduction origins in Brazil. Increasing agricultural/horticultural trade activities between the Old and New Worlds represents a significant biosecurity risk factor. Identifying pest origins will enable resistance profiling that reflects countries of origin to be included when developing a resistance management strategy, while identifying incursion pathways will improve biosecurity protocols and risk analysis at biosecurity hotspots including national ports. PMID:28350004

Mitochondrial DNA and trade data support multiple origins of Helicoverpa armigera (Lepidoptera, Noctuidae) in Brazil.

PubMed

Tay, Wee Tek; Walsh, Thomas K; Downes, Sharon; Anderson, Craig; Jermiin, Lars S; Wong, Thomas K F; Piper, Melissa C; Chang, Ester Silva; Macedo, Isabella Barony; Czepak, Cecilia; Behere, Gajanan T; Silvie, Pierre; Soria, Miguel F; Frayssinet, Marie; Gordon, Karl H J

2017-03-28

The Old World bollworm Helicoverpa armigera is now established in Brazil but efforts to identify incursion origin(s) and pathway(s) have met with limited success due to the patchiness of available data. Using international agricultural/horticultural commodity trade data and mitochondrial DNA (mtDNA) cytochrome oxidase I (COI) and cytochrome b (Cyt b) gene markers, we inferred the origins and incursion pathways into Brazil. We detected 20 mtDNA haplotypes from six Brazilian states, eight of which were new to our 97 global COI-Cyt b haplotype database. Direct sequence matches indicated five Brazilian haplotypes had Asian, African, and European origins. We identified 45 parsimoniously informative sites and multiple substitutions per site within the concatenated (945 bp) nucleotide dataset, implying that probabilistic phylogenetic analysis methods are needed. High diversity and signatures of uniquely shared haplotypes with diverse localities combined with the trade data suggested multiple incursions and introduction origins in Brazil. Increasing agricultural/horticultural trade activities between the Old and New Worlds represents a significant biosecurity risk factor. Identifying pest origins will enable resistance profiling that reflects countries of origin to be included when developing a resistance management strategy, while identifying incursion pathways will improve biosecurity protocols and risk analysis at biosecurity hotspots including national ports.

Mitochondrial DNA and trade data support multiple origins of Helicoverpa armigera (Lepidoptera, Noctuidae) in Brazil

NASA Astrophysics Data System (ADS)

Tay, Wee Tek; Walsh, Thomas K.; Downes, Sharon; Anderson, Craig; Jermiin, Lars S.; Wong, Thomas K. F.; Piper, Melissa C.; Chang, Ester Silva; Macedo, Isabella Barony; Czepak, Cecilia; Behere, Gajanan T.; Silvie, Pierre; Soria, Miguel F.; Frayssinet, Marie; Gordon, Karl H. J.

2017-03-01

The Old World bollworm Helicoverpa armigera is now established in Brazil but efforts to identify incursion origin(s) and pathway(s) have met with limited success due to the patchiness of available data. Using international agricultural/horticultural commodity trade data and mitochondrial DNA (mtDNA) cytochrome oxidase I (COI) and cytochrome b (Cyt b) gene markers, we inferred the origins and incursion pathways into Brazil. We detected 20 mtDNA haplotypes from six Brazilian states, eight of which were new to our 97 global COI-Cyt b haplotype database. Direct sequence matches indicated five Brazilian haplotypes had Asian, African, and European origins. We identified 45 parsimoniously informative sites and multiple substitutions per site within the concatenated (945 bp) nucleotide dataset, implying that probabilistic phylogenetic analysis methods are needed. High diversity and signatures of uniquely shared haplotypes with diverse localities combined with the trade data suggested multiple incursions and introduction origins in Brazil. Increasing agricultural/horticultural trade activities between the Old and New Worlds represents a significant biosecurity risk factor. Identifying pest origins will enable resistance profiling that reflects countries of origin to be included when developing a resistance management strategy, while identifying incursion pathways will improve biosecurity protocols and risk analysis at biosecurity hotspots including national ports.

Methods and strategies for future reactor safety goals

NASA Astrophysics Data System (ADS)

Arndt, Steven Andrew

There have been significant discussions over the past few years by the United States Nuclear Regulatory Commission (NRC), the Advisory Committee on Reactor Safeguards (ACRS), and others as to the adequacy of the NRC safety goals for use with the next generation of nuclear power reactors to be built in the United States. The NRC, in its safety goals policy statement, has provided general qualitative safety goals and basic quantitative health objectives (QHOs) for nuclear reactors in the United States. Risk metrics such as core damage frequency (CDF) and large early release frequency (LERF) have been used as surrogates for the QHOs. In its review of the new plant licensing policy the ACRS has looked at the safety goals, as has the NRC. A number of issues have been raised including what the Commission had in mind when it drafted the safety goals and QHOs, how risk from multiple reactors at a site should be combined for evaluation, how the combination of a new and old reactor at the same site should be evaluated, what the criteria for evaluating new reactors should be, and whether new reactors should be required to be safer than current generation reactors. As part of the development and application of the NRC safety goal policy statement the Commissioners laid out the expectations for the safety of a nuclear power plant but did not address the risk associated with current multi-unit sites, potential modular reactor sites, and hybrid sites that could contain current generation reactors, new passive reactors, and/or modular reactors. The NRC safety goals and the QHOs refer to a "nuclear power plant," but do not discuss whether a "plant" refers to only a single unit or all of the units on a site. There has been much discussion on this issue recently due to the development of modular reactors. Additionally, the risk of multiple reactor accidents on the same site has been largely ignored in the probabilistic risk assessments (PRAs) done to date, and in most risk-informed analyses and discussions. This dissertation examines potential approaches to updating the safety goals that include the establishment of new quantitative safety goal associated with the comparative risk of generating electricity by viable competing technologies and modifications of the goals to account for multi-plant reactor sites, and issues associated with the use of safety goals in both initial licensing and operational decision making. This research develops a new quantitative health objective that uses a comparable benefit risk metric based on the life-cycle risk of the construction, operation and decommissioning of a comparable non-nuclear electric generation facility, as well as the risks associated with mining and transportation. This dissertation also evaluates the effects of using various methods for aggregating site risk as a safety metric, as opposed to using single plant safety goals. Additionally, a number of important assumptions inherent in the current safety goals, including the effect of other potential negative societal effects such as the generation of greenhouse gases (e.g., carbon dioxide) have on the risk of electric power production and their effects on the setting of safety goals, is explored. Finally, the role risk perception should play in establishing safety goals has been explored. To complete this evaluation, a new method to analytically compare alternative technologies of generating electricity was developed, including development of a new way to evaluate risk perception, and a new method was developed for evaluating the risk at multiple units on a single site. To test these modifications to the safety goals a number of possible reactor designs and configurations were evaluated using these new proposed safety goals to determine the goals' usefulness and utility. The results of the analysis showed that the modifications provide measures that more closely evaluate the potential risk to the public from the operation of nuclear power plants than the current safety goals, while still providing a straight-forward process for assessment of reactor design and operation.

Young people's and stakeholders' perspectives of adolescent sexual risk behavior in Kilifi County, Kenya: A qualitative study.

PubMed

Ssewanyana, Derrick; Mwangala, Patrick N; Marsh, Vicki; Jao, Irene; van Baar, Anneloes; Newton, Charles R; Abubakar, Amina

2018-02-01

A lack of research exists around the most common forms of sexual risk behaviors among adolescents, including their underlying factors, in Sub-Saharan Africa. Using an Ecological Model of Adolescent Behavior, we explore the perceptions of 85 young people and 10 stakeholders on sexual risk behavior of adolescents in Kilifi County on the coast of Kenya. Our findings show that transactional sex, early sexual debut, coerced sex, and multiple sexual partnerships are prevalent. An urgent need exists to develop measures to counter sexual risk behaviors. The results contribute to understanding the range of risks and protective factors in differing contexts, tackling underlying issues at individual, family, local institutional, wider socio-economic, and political levels.

Young people’s and stakeholders’ perspectives of adolescent sexual risk behavior in Kilifi County, Kenya: A qualitative study

PubMed Central

Ssewanyana, Derrick; Mwangala, Patrick N; Marsh, Vicki; Jao, Irene; van Baar, Anneloes; Newton, Charles R; Abubakar, Amina

2017-01-01

A lack of research exists around the most common forms of sexual risk behaviors among adolescents, including their underlying factors, in Sub-Saharan Africa. Using an Ecological Model of Adolescent Behavior, we explore the perceptions of 85 young people and 10 stakeholders on sexual risk behavior of adolescents in Kilifi County on the coast of Kenya. Our findings show that transactional sex, early sexual debut, coerced sex, and multiple sexual partnerships are prevalent. An urgent need exists to develop measures to counter sexual risk behaviors. The results contribute to understanding the range of risks and protective factors in differing contexts, tackling underlying issues at individual, family, local institutional, wider socio-economic, and political levels. PMID:29076401

Preclinical studies in support of defibrotide for the treatment of multiple myeloma and other neoplasias.

PubMed

Mitsiades, Constantine S; Rouleau, Cecile; Echart, Cinara; Menon, Krishna; Teicher, Beverly; Distaso, Maria; Palumbo, Antonio; Boccadoro, Mario; Anderson, Kenneth C; Iacobelli, Massimo; Richardson, Paul G

2009-02-15

Defibrotide, an orally bioavailable polydisperse oligonucleotide, has promising activity in hepatic veno-occlusive disease, a stem cell transplantation-related toxicity characterized by microangiopathy. The antithrombotic properties of defibrotide and its minimal hemorrhagic risk could serve for treatment of cancer-associated thrombotic complications. Given its cytoprotective effect on endothelium, we investigated whether defibrotide protects tumor cells from cytotoxic antitumor agents. Further, given its antiadhesive properties, we evaluated whether defibrotide modulates the protection conferred to multiple myeloma cells by bone marrow stromal cells. Defibrotide lacks significant single-agent in vitro cytotoxicity on multiple myeloma or solid tumor cells and does not attenuate their in vitro response to dexamethasone, bortezomib, immunomodulatory thalidomide derivatives, and conventional chemotherapeutics, including melphalan and cyclophosphamide. Importantly, defibrotide enhances in vivo chemosensitivity of multiple myeloma and mammary carcinoma xenografts in animal models. In cocultures of multiple myeloma cells with bone marrow stromal cells in vitro, defibrotide enhances the multiple myeloma cell sensitivity to melphalan and dexamethasone, and decreases multiple myeloma-bone marrow stromal cell adhesion and its sequelae, including nuclear factor-kappaB activation in multiple myeloma and bone marrow stromal cells, and associated cytokine production. Moreover, defibrotide inhibits expression and/or function of key mediators of multiple myeloma interaction with bone marrow stromal cell and endothelium, including heparanase, angiogenic cytokines, and adhesion molecules. Defibrotide's in vivo chemosensitizing properties and lack of direct in vitro activity against tumor cells suggest that it favorably modulates antitumor interactions between bone marrow stromal cells and endothelia in the tumor microenvironment. These data support clinical studies of defibrotide in combination with conventional and novel therapies to potentially improve patient outcome in multiple myeloma and other malignancies.

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.

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

Enhanced project management tool

NASA Technical Reports Server (NTRS)

Hsu, Chen-Jung (Inventor); Patel, Hemil N. (Inventor); Maluf, David A. (Inventor); Moh Hashim, Jairon C. (Inventor); Tran, Khai Peter B. (Inventor)

2012-01-01

A system for managing a project that includes multiple tasks and a plurality of workers. Input information includes characterizations based upon a human model, a team model and a product model. Periodic reports, such as one or more of a monthly report, a task plan report, a schedule report, a budget report and a risk management report, are generated and made available for display or further analysis or collection into a customized report template. An extensible database allows searching for information based upon context and upon content. Seven different types of project risks are addressed, including non-availability of required skill mix of workers. The system can be configured to exchange data and results with corresponding portions of similar project analyses, and to provide user-specific access to specified information.

Reported gum disease as a cardiovascular risk factor in adults with intellectual disabilities.

PubMed

Hsieh, K; Murthy, S; Heller, T; Rimmer, J H; Yen, G

2018-03-01

Several risk factors for cardiovascular disease (CVD) have been identified among adults with intellectual disabilities (ID). Periodontitis has been reported to increase the risk of developing a CVD in the general population. Given that individuals with ID have been reported to have a higher prevalence of poor oral health than the general population, the purpose of this study was to determine whether adults with ID with informant reported gum disease present greater reported CVD than those who do not have reported gum disease and whether gum disease can be considered a risk factor for CVD. Using baseline data from the Longitudinal Health and Intellectual Disability Study from which informant survey data were collected, 128 participants with reported gum disease and 1252 subjects without reported gum disease were identified. A series of univariate logistic regressions was conducted to identify potential confounding factors for a multiple logistic regression. The series of univariate logistic regressions identified age, Down syndrome, hypercholesterolemia, hypertension, reported gum disease, daily consumption of fruits and vegetables and the addition of table salt as significant risk factors for reported CVD. When the significant factors from the univariate logistic regression were included in the multiple logistic analysis, reported gum disease remained as an independent risk factor for reported CVD after adjusting for the remaining risk factors. Compared with the adults with ID without reported gum disease, adults in the gum disease group demonstrated a significantly higher prevalence of reported CVD (19.5% vs. 9.7%; P = .001). After controlling for other risk factors, reported gum disease among adults with ID may be associated with a higher risk of CVD. However, further research that also includes clinical indices of periodontal disease and CVD for this population is needed to determine if there is a causal relationship between gum disease and CVD. © 2017 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

Risk-benefit considerations in the treatment of relapsing-remitting multiple sclerosis

PubMed Central

Lugaresi, Alessandra; di Ioia, Maria; Travaglini, Daniela; Pietrolongo, Erika; Pucci, Eugenio; Onofrj, Marco

2013-01-01

Multiple sclerosis (MS) is a chronic demyelinating disease of the central nervous system and mainly affects young adults. Its natural history has changed in recent years with the advent of disease-modifying drugs, which have been available since the early 1990s. The increasing number of first-line and second-line treatment options, together with the variable course of the disease and patient lifestyles and expectations, makes the therapeutic decision a real challenge. The aim of this review is to give a comprehensive overview of the main present and some future drugs for relapsing-remitting MS, including risk-benefit considerations, to enable readers to draw their own conclusions regarding the risk-benefit assessment of personalized treatment strategies, taking into account not only treatment-related but also disease-related risks. We performed a Medline literature search to identify studies on the treatment of MS with risk stratification and risk-benefit considerations. We focused our attention on studies of disease-modifying, immunomodulating, and immunosuppressive drugs, including monoclonal antibodies. Here we offer personal considerations, stemming from long-term experience in the treatment of MS and thorough discussions with other neurologists closely involved in the care of patients with the disease. MS specialists need to know not only the specific risks and benefits of single drugs, but also about drug interactions, either in simultaneous or serial combination therapy, and patient comorbidities, preferences, and fears. This has to be put into perspective, considering also the risks of untreated disease in patients with different clinical and radiological characteristics. There is no single best treatment strategy, but therapy has to be tailored to the patient. This is a time-consuming task, rich in complexity, and influenced by the attitude towards risk on the parts of both the patient and the clinical team. The broader the MS drug market becomes, the harder it will be for the clinician to help the patient decide which therapeutic strategy to opt for. PMID:23836975

Incidence and Risk of Cardiac Events in Patients With Previously Treated Multiple Myeloma Versus Matched Patients Without Multiple Myeloma: An Observational, Retrospective, Cohort Study.

PubMed

Kistler, Kristin D; Kalman, Jill; Sahni, Gagan; Murphy, Brian; Werther, Winifred; Rajangam, Kanya; Chari, Ajai

2017-02-01

Multiple myeloma (MM) patients have age-, disease-, and treatment-related risk factors for cardiac events. We analyzed the 2006 to 2011 MarketScan database to determine whether the risk of cardiac events is greater in MM patients than in non-MM patients. Included were 1723 MM patients treated with corticosteroids and ≥ 3 drugs (bortezomib, immunomodulatory derivatives, and alkylating agents or anthracyclines). The index date (ID) was the date on which the 3-drug exposure criterion was met. Also included were 8615 age- and gender-matched non-MM patients (5:1). The distribution of non-MM patients' IDs matched that of the MM patients' IDs. Baseline was 6 months before the ID. The follow-up duration was from the ID to study end (ie, 2011 or end of enrollment or prescription drug coverage). Hazard ratios (HRs) and 95% confidence intervals (CIs) were adjusted for baseline variables when the univariate analyses showed a 10% difference. The median duration of observation was 9 months (range, 0-60 months) for MM patients and 19 months (range, 0-66 months) for non-MM patients. The risk of any cardiac event (HR, 2.2; 95% CI, 1.9-2.5), dysrhythmia (HR, 4.1; 95% CI, 3.5-4.8), congestive heart failure (HR, 2.9; 95% CI, 2.2-3.7), cardiomyopathy (HR, 2.6; 95% CI, 1.8-3.8), and conduction disorders (HR, 1.7; 95% CI, 1.2-2.5) was significantly greater for MM than for non-MM patients. The incidence of hypertensive or arterial events and ischemic heart disease was similar between the 2 groups. The present study provides the first known comparison of cardiac event risk in patients with MM versus age- and gender-matched patients without MM. The cardiac event risk was greater in MM patients with ≥ 3 previous drugs for any cardiac event, dysrhythmias, congestive heart failure, cardiomyopathy, and conduction disorders compared with patients without MM. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Sleep and circadian disruption and incident breast cancer risk: An evidence-based and theoretical review.

PubMed

Samuelsson, Laura B; Bovbjerg, Dana H; Roecklein, Kathryn A; Hall, Martica H

2018-01-01

Opportunities for restorative sleep and optimal sleep-wake schedules are becoming luxuries in industrialized cultures, yet accumulating research has revealed multiple adverse health effects of disruptions in sleep and circadian rhythms, including increased risk of breast cancer. The literature on breast cancer risk has focused largely on adverse effects of night shift work and exposure to light at night (LAN), without considering potential effects of associated sleep disruptions. As it stands, studies on breast cancer risk have not considered the impact of both sleep and circadian disruption, and the possible interaction of the two through bidirectional pathways, on breast cancer risk in the population at large. We review and synthesize this literature, including: 1) studies of circadian disruption and incident breast cancer; 2) evidence for bidirectional interactions between sleep and circadian systems; 3) studies of sleep and incident breast cancer; and 4) potential mechanistic pathways by which interrelated sleep and circadian disruption may contribute to the etiology of breast cancer. Copyright © 2017. Published by Elsevier Ltd.

Developing a Roadmap for Integrating Computational and In Vitro Approaches in Risk-Based Chemical Safety Decisions (SSCT-SweTox)

EPA Science Inventory

Multiple drivers shape the types of chemical assessments performed within many regulatory agencies including economic considerations, data availability, and the ultimate application of the assessment. The result is that chemical assessments are “fit-for-purpose” ranging from pri...

Pathogenic landscape of transboundary zoonotic diseases in the Mexico-U.S. border along the Rio Grande

USDA-ARS?s Scientific Manuscript database

Transboundary zoonotic diseases, several of which are vector borne, can maintain a dynamic focus and have pathogens circulating in geographic regions encircling multiple geopolitical boundaries. Global change is intensifying transboundary problems, including the spatial variation of the risk and inc...

Helping Young People Engage with Scientists

ERIC Educational Resources Information Center

Leggett, Maggie; Sykes, Kathy

2014-01-01

There can be multiple benefits of scientists engaging with young people, including motivation and inspiration for all involved. But there are risks, particularly if scientists do not consider the interests and needs of young people or listen to what they have to say. We argue that "dialogue" between scientists, young people and teachers…

DEVELOPMENT AND PEER REVIEW OF TIME-TO-EFFECT MODELS FOR THE ANALYSIS OF NEUROTOXICITY AND OTHER TIME DEPENDENT DATA

EPA Science Inventory

Neurobehavioral studies pose unique challenges for dose-response modeling, including small sample size and relatively large intra-subject variation, repeated measurements over time, multiple endpoints with both continuous and ordinal scales, and time dependence of risk characteri...

Mullahs, Guards, and Bonyads: An Exploration of Iranian Leadership Dynamics

DTIC Science & Technology

2009-01-01

Rafsanjani, the foundation became a huge con- glomerate of multiple businesses and industries, including tourism , real estate, agriculture, petrochemicals...facility at Natanz in particular, were made public, there was a clear risk that the IAEA Board of Gover - nors would refer the matter to the UN Security

Developmental Precursors of Young School-Age Children's Hostile Attribution Bias

ERIC Educational Resources Information Center

Choe, Daniel Ewon; Lane, Jonathan D.; Grabell, Adam S.; Olson, Sheryl L.

2013-01-01

This prospective longitudinal study provides evidence of preschool-age precursors of hostile attribution bias in young school-age children, a topic that has received little empirical attention. We examined multiple risk domains, including laboratory and observational assessments of children's social-cognition, general cognitive functioning,…

The Commission Game: An Ethics Activity for Professional Selling Courses

ERIC Educational Resources Information Center

Milewicz, Chad

2012-01-01

The Commission Game is an experiment-based experiential learning activity designed to elicit students' sincere ethical decision making in an ambiguous sales context. The activity includes multiple relevant stakeholders as well as tangible, shared risk/reward elements. The activity's design encourages students to contemplate their own personal code…

Individual and Neighborhood Stressors, Air Pollution and Cardiovascular Disease

PubMed Central

Hazlehurst, Marnie F.; Nurius, Paula S.; Hajat, Anjum

2018-01-01

Psychosocial and environmental stress exposures across the life course have been shown to be relevant in the development of cardiovascular disease (CVD). Assessing more than one stressor from different domains (e.g., individual and neighborhood) and across the life course moves us towards a more integrated picture of how stress affects health and well-being. Furthermore, these individual and neighborhood psychosocial stressors act on biologic pathways, including immune function and inflammatory response, which are also impacted by ubiquitous environmental exposures such as air pollution. The objective of this study is to evaluate the interaction between psychosocial stressors, at both the individual and neighborhood level, and air pollution on CVD. This study used data from the 2009–2011 Behavioral Risk Factor Surveillance System (BRFSS) from Washington State. Adverse childhood experiences (ACEs) measured at the individual level, and neighborhood deprivation index (NDI) measured at the zip code level, were the psychosocial stressors of interest. Exposures to three air pollutants—particulate matter (both PM2.5 and PM10) and nitrogen dioxide (NO2)—were also calculated at the zip code level. Outcome measures included several self-reported CVD-related health conditions. Both multiplicative and additive interaction quantified using the relative excess risk due to interaction (RERI), were evaluated. This study included 32,151 participants in 502 unique zip codes. Multiplicative and positive additive interactions were observed between ACEs and PM10 for diabetes, in models adjusted for NDI. The prevalence of diabetes was 1.58 (95% CI: 1.40, 1.79) times higher among those with both high ACEs and high PM10 compared to those with low ACEs and low PM10 (p-value = 0.04 for interaction on the multiplicative scale). Interaction was also observed between neighborhood-level stressors (NDI) and air pollution (NO2) for the stroke and diabetes outcomes on both multiplicative and additive scales. Modest interaction was observed between NDI and air pollution, supporting prior literature on the importance of neighborhood-level stressors in cardiovascular health and reinforcing the importance of NDI on air pollution health effects. ACEs may exert health effects through selection into disadvantaged neighborhoods and more work is needed to understand the accumulation of risk in multiple domains across the life course. PMID:29518012

Source preference and ambiguity aversion: models and evidence from behavioral and neuroimaging experiments.

PubMed

Chew, Soo Hong; Li, King King; Chark, Robin; Zhong, Songfa

2008-01-01

This experimental economics study using brain imaging techniques investigates the risk-ambiguity distinction in relation to the source preference hypothesis (Fox & Tversky, 1995) in which identically distributed risks arising from different sources of uncertainty may engender distinct preferences for the same decision maker, contrary to classical economic thinking. The use of brain imaging enables sharper testing of the implications of different models of decision-making including Chew and Sagi's (2008) axiomatization of source preference. Using fMRI, brain activations were observed when subjects make 48 sequential binary choices among even-chance lotteries based on whether the trailing digits of a number of stock prices at market closing would be odd or even. Subsequently, subjects rate familiarity of the stock symbols. When contrasting brain activation from more familiar sources with those from less familiar ones, regions appearing to be more active include the putamen, medial frontal cortex, and superior temporal gyrus. ROI analysis showed that the activation patterns in the familiar-unfamiliar and unfamiliar-familiar contrasts are similar to those in the risk-ambiguity and ambiguity-risk contrasts reported by Hsu et al. (2005). This supports the conjecture that the risk-ambiguity distinction can be subsumed by the source preference hypothesis. Our odd-even design has the advantage of inducing the same "unambiguous" probability of half for each subject in each binary comparison. Our finding supports the implications of the Chew-Sagi model and rejects models based on global probabilistic sophistication, including rank-dependent models derived from non-additive probabilities, e.g., Choquet expected utility and cumulative prospect theory, as well as those based on multiple priors, e.g., alpha-maxmin. The finding in Hsu et al. (2005) that orbitofrontal cortex lesion patients display neither ambiguity aversion nor risk aversion offers further support to the Chew-Sagi model. Our finding also supports the Levy et al. (2007) contention of a single valuation system encompassing risk and ambiguity aversion. This is the first neuroimaging study of the source preference hypothesis using a design which can discriminate among decision models ranging from risk-based ones to those relying on multiple priors.

Risk Management for the International Space Station

NASA Technical Reports Server (NTRS)

Sebastian, J.; Brezovic, Philip

2002-01-01

The International Space Station (ISS) is an extremely complex system, both technically and programmatically. The Space Station must support a wide range of payloads and missions. It must be launched in numerous launch packages and be safely assembled and operated in the harsh environment of space. It is being designed and manufactured by many organizations, including the prime contractor, Boeing, the NASA institutions, and international partners and their contractors. Finally, the ISS has multiple customers, (e.g., the Administration, Congress, users, public, international partners, etc.) with contrasting needs and constraints. It is the ISS Risk Management Office strategy to proactively and systematically manages risks to help ensure ISS Program success. ISS program follows integrated risk management process (both quantitative and qualitative) and is integrated into ISS project management. The process and tools are simple and seamless and permeate to the lowest levels (at a level where effective management can be realized) and follows the continuous risk management methodology. The risk process assesses continually what could go wrong (risks), determine which risks need to be managed, implement strategies to deal with those risks, and measure effectiveness of the implemented strategies. The process integrates all facets of risk including cost, schedule and technical aspects. Support analysis risk tools like PRA are used to support programatic decisions and assist in analyzing risks.

Biopsychosocial Predictors of Fall Events among Older African Americans

PubMed Central

Nicklett, Emily Joy; Taylor, Robert Joseph; Rostant, Ola; Johnson, Kimson E.; Evans, Linnea

2016-01-01

This study identifies risk and protective factors for falls among older, community-dwelling African Americans. Drawing upon the biopsychosocial perspective (Engel, 1997), we conducted a series of sex- and age-adjusted multinomial logistic regression analyses to identify the correlates of fall events among older African Americans. Our sample consisted of 1,442 community-dwelling African Americans aged 65 and older, participating in the 2010-12 rounds of the Health and Retirement Study. Biophysical characteristics associated with greater relative risk of experiencing single and/or multiple falls included greater functional limitations, poorer self-rated health, poorer self-rated vision, chronic illnesses (high blood pressure, diabetes, cancer, lung disease, heart problems, stroke, and arthritis), greater chronic illness comorbidity, older age, and female sex. Physical activity was negatively associated with recurrent falls. Among the examined psychosocial characteristics, greater depressive symptoms were associated with greater relative risk of experiencing single and multiple fall events. Implications for clinicians and future studies are discussed. PMID:28285579

The Evolutionary Landscape of Localized Prostate Cancers Drives Clinical Aggression.

PubMed

Espiritu, Shadrielle Melijah G; Liu, Lydia Y; Rubanova, Yulia; Bhandari, Vinayak; Holgersen, Erle M; Szyca, Lesia M; Fox, Natalie S; Chua, Melvin L K; Yamaguchi, Takafumi N; Heisler, Lawrence E; Livingstone, Julie; Wintersinger, Jeff; Yousif, Fouad; Lalonde, Emilie; Rouette, Alexandre; Salcedo, Adriana; Houlahan, Kathleen E; Li, Constance H; Huang, Vincent; Fraser, Michael; van der Kwast, Theodorus; Morris, Quaid D; Bristow, Robert G; Boutros, Paul C

2018-05-03

The majority of newly diagnosed prostate cancers are slow growing, with a long natural life history. Yet a subset can metastasize with lethal consequences. We reconstructed the phylogenies of 293 localized prostate tumors linked to clinical outcome data. Multiple subclones were detected in 59% of patients, and specific subclonal architectures associate with adverse clinicopathological features. Early tumor development is characterized by point mutations and deletions followed by later subclonal amplifications and changes in trinucleotide mutational signatures. Specific genes are selectively mutated prior to or following subclonal diversification, including MTOR, NKX3-1, and RB1. Patients with low-risk monoclonal tumors rarely relapse after primary therapy (7%), while those with high-risk polyclonal tumors frequently do (61%). The presence of multiple subclones in an index biopsy may be necessary, but not sufficient, for relapse of localized prostate cancer, suggesting that evolution-aware biomarkers should be studied in prospective studies of low-risk tumors suitable for active surveillance. Copyright © 2018 Elsevier Inc. All rights reserved.

Reviewing Bayesian Networks potentials for climate change impacts assessment and management: A multi-risk perspective.

PubMed

Sperotto, Anna; Molina, José-Luis; Torresan, Silvia; Critto, Andrea; Marcomini, Antonio

2017-11-01

The evaluation and management of climate change impacts on natural and human systems required the adoption of a multi-risk perspective in which the effect of multiple stressors, processes and interconnections are simultaneously modelled. Despite Bayesian Networks (BNs) are popular integrated modelling tools to deal with uncertain and complex domains, their application in the context of climate change still represent a limited explored field. The paper, drawing on the review of existing applications in the field of environmental management, discusses the potential and limitation of applying BNs to improve current climate change risk assessment procedures. Main potentials include the advantage to consider multiple stressors and endpoints in the same framework, their flexibility in dealing and communicate with the uncertainty of climate projections and the opportunity to perform scenario analysis. Some limitations (i.e. representation of temporal and spatial dynamics, quantitative validation), however, should be overcome to boost BNs use in climate change impacts assessment and management. Copyright © 2017 Elsevier Ltd. All rights reserved.

Preventing Paraffin-Related Injury

PubMed Central

C. Schwebel, David; Swart, Dehran

2009-01-01

Abstract: Paraffin (called kerosene in North America and other parts of the world) is the most commonly used fuel in ‎non-electrified dwellings worldwide. It is especially popular in Africa and South Asia. Although paraffin ‎offers many advantages-especially its comparatively low cost to produce-it poses two major risks of ‎injury. First, paraffin poisoning is common, either through ingestion or through inhalation of smoke and ‎fumes. Second, paraffin is highly flammable, and poses fire risk through multiple causes. This commentary ‎discusses strategies to prevent paraffin-related injury. Prevention of paraffin-related injury must be through ‎multiple strategies, and should include policy-oriented change, changes to the safety of home environments, ‎and behavioral changes targeting how individuals store and use paraffin and paraffin appliances. We review ‎successful prevention strategies in each of these domains and discuss appropriate research and community ‎initiatives that should be implemented to improve paraffin safety among at-risk populations. PMID:21483184

Integrative assessment of multiple pesticides as risk factors for non-Hodgkin's lymphoma among men.

PubMed

De Roos, A J; Zahm, S H; Cantor, K P; Weisenburger, D D; Holmes, F F; Burmeister, L F; Blair, A

2003-09-01

An increased rate of non-Hodgkin's lymphoma (NHL) has been repeatedly observed among farmers, but identification of specific exposures that explain this observation has proven difficult. During the 1980s, the National Cancer Institute conducted three case-control studies of NHL in the midwestern United States. These pooled data were used to examine pesticide exposures in farming as risk factors for NHL in men. The large sample size (n = 3417) allowed analysis of 47 pesticides simultaneously, controlling for potential confounding by other pesticides in the model, and adjusting the estimates based on a prespecified variance to make them more stable. Reported use of several individual pesticides was associated with increased NHL incidence, including organophosphate insecticides coumaphos, diazinon, and fonofos, insecticides chlordane, dieldrin, and copper acetoarsenite, and herbicides atrazine, glyphosate, and sodium chlorate. A subanalysis of these "potentially carcinogenic" pesticides suggested a positive trend of risk with exposure to increasing numbers. Consideration of multiple exposures is important in accurately estimating specific effects and in evaluating realistic exposure scenarios.

Child, Parent, and Peer Predictors of Early-Onset Substance Use: A Multisite Longitudinal Study

PubMed Central

Kaplow, Julie B.; Curran, Patrick J.; Dodge, Kenneth A.

2009-01-01

The purpose of this study was to identify kindergarten-age predictors of early-onset substance use from demographic, environmental, parenting, child psychological, behavioral, and social functioning domains. Data from a longitudinal study of 295 children were gathered using multiple-assessment methods and multiple informants in kindergarten and 1st grade. Annual assessments at ages 10, 11, and 12 reflected that 21% of children reported having initiated substance use by age 12. Results from longitudinal logistic regression models indicated that risk factors at kindergarten include being male, having a parent who abused substances, lower levels of parental verbal reasoning, higher levels of overactivity, more thought problems, and more social problem solving skills deficits. Children with no risk factors had less than a 10% chance of initiating substance use by age 12, whereas children with 2 or more risk factors had greater than a 50% chance of initiating substance use. Implications for typology, etiology, and prevention are discussed. PMID:12041707

Promoting Healthy Outcomes Among Youth with Multiple Risks: Innovative Approaches

PubMed Central

Greenberg, Mark T.; Lippold, Melissa A.

2015-01-01

Adolescent behavior problems such as substance use, antisocial behavior problems, and mental health problems have extremely high social costs and lead to overburdened mental health and juvenile justice systems in the United States and Europe. The prevalence of these problems is substantial, and at-risk youth often present with a combination of concerns. An understanding of risk and protective factors at multiple levels, including the child, family, peer, school, and community, has influenced intervention development. At the individual and family levels, the most effective and cost-effective programs work intensively with youth and their families or use individual and group cognitive-behavioral approaches. However, there is a paucity of careful studies of effective policies and programs in the juvenile justice system. Research is needed that focuses on adoption, financing, implementation, and sustainable use of evidence-based programs in public service systems. In addition, the field needs to understand better for whom current programs are most effective to create the next generation of more effective and efficient programs. PMID:23297659

Cardiovascular Disease Death Before Age 65 in 168 Countries Correlated Statistically with Biometrics, Socioeconomic Status, Tobacco, Gender, Exercise, Macronutrients, and Vitamin K

PubMed Central

Agutter, Paul S

2016-01-01

Background Nutrition researchers recently recognized that deficiency of vitamin K2 (menaquinone: MK-4–MK-13) is widespread and contributes to cardiovascular disease (CVD). The deficiency of vitamin K2 or vitamin K inhibition with warfarin leads to calcium deposition in the arterial blood vessels. Methods Using publicly available sources, we collected food commodity availability data and derived nutrient profiles including vitamin K2 for people from 168 countries. We also collected female and male cohort data on early death from CVD (ages 15–64 years), insufficient physical activity, tobacco, biometric CVD risk markers, socioeconomic risk factors for CVD, and gender. The outcome measures included (1) univariate correlations of early death from CVD with each risk factor, (2) a multiple regression-derived formula relating early death from CVD (dependent variable) to macronutrient profile, vitamin K1 and K2 and other risk factors (independent variables), (3) for each risk factor appearing in the multiple regression formula, the portion of CVD risk attributable to that factor, and (4) similar univariate and multivariate analyses of body mass index (BMI), fasting blood sugar (FBS) (simulated from diabetes prevalence), systolic blood pressure (SBP), and cholesterol/ HDL-C ratio (simulated from serum cholesterol) (dependent variables) and dietary and other risk factors (independent variables). Results Female and male cohorts in countries that have vitamin K2 < 5µg per 2000 kcal/day per capita (n = 70) had about 2.2 times the rate of early CVD deaths as people in countries with > 24 µg/day of vitamin K2 per 2000 kcal/day (n = 72). A multiple regression-derived formula relating early death from CVD to dietary nutrients and other risk factors accounted for about 50% of the variance between cohorts in early CVD death. The attributable risks of the variables in the CVD early death formula were: too much alcohol (0.38%), too little vitamin K2 (6.95%), tobacco (6.87%), high blood pressure (9.01%), air pollution (9.15%), early childhood death (3.64%), poverty (7.66%), and male gender (6.13%). Conclusions Worldwide dietary vitamin K2 data derived from food commodities add much understanding to the analysis of CVD risk factors and the etiology of CVD. Vitamin K2 in food products should be systematically quantified. Public health programs should be considered to increase the intake of vitamin K2-containing fermented plant foods such as sauerkraut, miso, and natto. PMID:27688985

Cardiovascular Disease Death Before Age 65 in 168 Countries Correlated Statistically with Biometrics, Socioeconomic Status, Tobacco, Gender, Exercise, Macronutrients, and Vitamin K.

PubMed

Cundiff, David K; Agutter, Paul S

2016-08-24

Nutrition researchers recently recognized that deficiency of vitamin K2 (menaquinone: MK-4-MK-13) is widespread and contributes to cardiovascular disease (CVD). The deficiency of vitamin K2 or vitamin K inhibition with warfarin leads to calcium deposition in the arterial blood vessels. Using publicly available sources, we collected food commodity availability data and derived nutrient profiles including vitamin K2 for people from 168 countries. We also collected female and male cohort data on early death from CVD (ages 15-64 years), insufficient physical activity, tobacco, biometric CVD risk markers, socioeconomic risk factors for CVD, and gender. The outcome measures included (1) univariate correlations of early death from CVD with each risk factor, (2) a multiple regression-derived formula relating early death from CVD (dependent variable) to macronutrient profile, vitamin K1 and K2 and other risk factors (independent variables), (3) for each risk factor appearing in the multiple regression formula, the portion of CVD risk attributable to that factor, and (4) similar univariate and multivariate analyses of body mass index (BMI), fasting blood sugar (FBS) (simulated from diabetes prevalence), systolic blood pressure (SBP), and cholesterol/ HDL-C ratio (simulated from serum cholesterol) (dependent variables) and dietary and other risk factors (independent variables). Female and male cohorts in countries that have vitamin K2 < 5µg per 2000 kcal/day per capita (n = 70) had about 2.2 times the rate of early CVD deaths as people in countries with > 24 µg/day of vitamin K2 per 2000 kcal/day (n = 72). A multiple regression-derived formula relating early death from CVD to dietary nutrients and other risk factors accounted for about 50% of the variance between cohorts in early CVD death. The attributable risks of the variables in the CVD early death formula were: too much alcohol (0.38%), too little vitamin K2 (6.95%), tobacco (6.87%), high blood pressure (9.01%), air pollution (9.15%), early childhood death (3.64%), poverty (7.66%), and male gender (6.13%). Worldwide dietary vitamin K2 data derived from food commodities add much understanding to the analysis of CVD risk factors and the etiology of CVD. Vitamin K2 in food products should be systematically quantified. Public health programs should be considered to increase the intake of vitamin K2-containing fermented plant foods such as sauerkraut, miso, and natto.

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.

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.

Multiple Sclerosis and Catastrophic Health Expenditure in Iran.

PubMed

Juyani, Yaser; Hamedi, Dorsa; Hosseini Jebeli, Seyede Sedighe; Qasham, Maryam

2016-09-01

There are many disabling medical conditions which can result in catastrophic health expenditure. Multiple Sclerosis is one of the most costly medical conditions through the world which encounter families to the catastrophic health expenditures. This study aims to investigate on what extent Multiple sclerosis patients face catastrophic costs. This study was carried out in Ahvaz, Iran (2014). The study population included households that at least one of their members suffers from MS. To analyze data, Logit regression model was employed by using the default software STATA12. 3.37% of families were encountered with catastrophic costs. Important variables including brand of drug, housing, income and health insurance were significantly correlated with catastrophic expenditure. This study suggests that although a small proportion of MS patients met the catastrophic health expenditure, mechanisms that pool risk and cost (e.g. health insurance) are required to protect them and improve financial and access equity in health care.

Nutrigenomics, the Microbiome, and Gene-Environment Interactions: New Directions in Cardiovascular Disease Research, Prevention, and Treatment: A Scientific Statement From the American Heart Association.

PubMed

Ferguson, Jane F; Allayee, Hooman; Gerszten, Robert E; Ideraabdullah, Folami; Kris-Etherton, Penny M; Ordovás, José M; Rimm, Eric B; Wang, Thomas J; Bennett, Brian J

2016-06-01

Cardiometabolic diseases are the leading cause of death worldwide and are strongly linked to both genetic and nutritional factors. The field of nutrigenomics encompasses multiple approaches aimed at understanding the effects of diet on health or disease development, including nutrigenetic studies investigating the relationship between genetic variants and diet in modulating cardiometabolic risk, as well as the effects of dietary components on multiple "omic" measures, including transcriptomics, metabolomics, proteomics, lipidomics, epigenetic modifications, and the microbiome. Here, we describe the current state of the field of nutrigenomics with respect to cardiometabolic disease research and outline a direction for the integration of multiple omics techniques in future nutrigenomic studies aimed at understanding mechanisms and developing new therapeutic options for cardiometabolic disease treatment and prevention. © 2016 American Heart Association, Inc.

Physical therapy intervention for an adolescent with a knee flexion contracture and diagnosis of multiple pterygium syndrome.

PubMed

Bellamy, Sandra Gail; Gibbs, Karen; Lazaro, Rolando

2007-01-01

The purpose of this case report is to describe a course of physical therapy for a client with a rare genetic condition, multiple pterygium syndrome (MPS). MPS is a rare genetic disorder characterized by connective tissue webbing across multiple joints, dysmorphic facies, and various visceral and skeletal deformities. Before the patient commenced physical therapy, surgical amputation was recommended for the client's knee flexion contracture. The client's treatment plan included stretching, manual therapy, and resisted exercise. Long-term outcomes were decreased back and knee pain and improved range of motion, strength, and ambulation. Therapists using techniques to improve joint range of motion in clients with MPS should be aware that pterygia may include contractile tissue, nerves, and blood vessels and there may be underlying skeletal deformity or weakness in these areas. Children with MPS are at high risk of developing scoliosis and should be appropriately assessed in early childhood.

Multiple signals at the extended 8p23 locus are associated with susceptibility to systemic lupus erythematosus.

PubMed

Demirci, F Yesim; Wang, Xingbin; Morris, David L; Feingold, Eleanor; Bernatsky, Sasha; Pineau, Christian; Clarke, Ann; Ramsey-Goldman, Rosalind; Manzi, Susan; Vyse, Timothy J; Kamboh, M I

2017-06-01

A major systemic lupus erythematosus (SLE) susceptibility locus lies within a common inversion polymorphism region (encompassing 3.8 - 4.5  Mb) located at 8p23. Initially implicated genes included FAM167A-BLK and XKR6 , of which BLK received major attention due to its known role in B-cell biology. Recently, additional SLE risk carried in non-inverted background was also reported. In this case -control study, we further investigated the 'extended' 8p23 locus (~ 4  Mb) where we observed multiple SLE signals and assessed these signals for their relation to the inversion affecting this region. The study involved a North American discovery data set ( ~ 1200  subjects) and a replication data set (> 10 000  subjects) comprising European-descent individuals. Meta-analysis of 8p23 SNPs, with p < 0.05 in both data sets, identified 51 genome-wide significant SNPs (p < 5.0 × 10 -8 ). While most of these SNPs were related to previously implicated signals ( XKR6-FAM167A-BLK subregion), our results also revealed two 'new' SLE signals, including SGK223-CLDN23-MFHAS1 (6.06 × 10 -9 ≤ meta p ≤ 4.88 × 10 -8 ) and CTSB (meta p = 4.87 × 10 -8 ) subregions that are located > 2 Mb upstream and ~ 0.3  Mb downstream from previously reported signals. Functional assessment of relevant SNPs indicated putative cis -effects on the expression of various genes at 8p23. Additional analyses in discovery sample, where the inversion genotypes were inferred, replicated the association of non-inverted status with SLE risk and suggested that a number of SLE risk alleles are predominantly carried in non-inverted background. Our results implicate multiple (known+novel) SLE signals/genes at the extended 8p23 locus, beyond previously reported signals/genes, and suggest that this broad locus contributes to SLE risk through the effects of multiple genes/pathways. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

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

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.

Project management tool

NASA Technical Reports Server (NTRS)

Maluf, David A. (Inventor); Bell, David G. (Inventor); Gurram, Mohana M. (Inventor); Gawdiak, Yuri O. (Inventor)

2009-01-01

A system for managing a project that includes multiple tasks and a plurality of workers. Input information includes characterizations based upon a human model, a team model and a product model. Periodic reports, such as a monthly report, a task plan report, a budget report and a risk management report, are generated and made available for display or further analysis. An extensible database allows searching for information based upon context and upon content.

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

Quantitative risk assessment system (QRAS)

NASA Technical Reports Server (NTRS)

Tan, Zhibin (Inventor); Mosleh, Ali (Inventor); Weinstock, Robert M (Inventor); Smidts, Carol S (Inventor); Chang, Yung-Hsien (Inventor); Groen, Francisco J (Inventor); Swaminathan, Sankaran (Inventor)

2001-01-01

A quantitative risk assessment system (QRAS) builds a risk model of a system for which risk of failure is being assessed, then analyzes the risk of the system corresponding to the risk model. The QRAS performs sensitivity analysis of the risk model by altering fundamental components and quantifications built into the risk model, then re-analyzes the risk of the system using the modifications. More particularly, the risk model is built by building a hierarchy, creating a mission timeline, quantifying failure modes, and building/editing event sequence diagrams. Multiplicities, dependencies, and redundancies of the system are included in the risk model. For analysis runs, a fixed baseline is first constructed and stored. This baseline contains the lowest level scenarios, preserved in event tree structure. The analysis runs, at any level of the hierarchy and below, access this baseline for risk quantitative computation as well as ranking of particular risks. A standalone Tool Box capability exists, allowing the user to store application programs within QRAS.

Supplementation with multiple micronutrients for breastfeeding women for improving outcomes for the mother and baby.

PubMed

Abe, Sarah K; Balogun, Olukunmi O; Ota, Erika; Takahashi, Kenzo; Mori, Rintaro

2016-02-18

Globally, more than two billion people are estimated to be deficient in key vitamins and minerals, particularly iodine, iron and zinc. The majority of these people live in low-income settings and are typically deficient in more than one micronutrient. However, micronutrient deficiency among breastfeeding mothers and their infants also remains an issue in high-income settings, specifically among women who avoid meat and/or milk, women who may lack sufficient supplies of vitamin B12 and vitamin D, and/or women who are iron-deficient. Young children, pregnant and lactating women are particularly vulnerable to micronutrient deficiencies. They not only have a relatively greater need for vitamins and minerals because of their physiological state, but are also more susceptible to the harmful consequences of deficiencies. Multiple-micronutrient supplementation might be an option to solve these problems. The objective of this review was to evaluate the effects of multiple-micronutrient supplementation in breastfeeding mothers on maternal and infant outcomes. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2015) and reference lists of retrieved studies. Randomised controlled trials of multiple-micronutrient supplementation of three or more micronutrients versus placebo, no supplementation or supplementation with two or fewer micronutrients, irrespective of dosage of micronutrients, in breastfeeding mothers. Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We found no studies that compared multiple-micronutrient supplementation (with three or more micronutrients) versus supplementation with two or fewer micronutrients.Two small studies (involving a total of 52 women) were included. One study compared multiple micronutrients with placebo and the other study compared multiple micronutrients with a group who received no supplementation. The studies were carried out in Brazil (36 adolescent mothers) and the USA (16 women) and included women with a low socioeconomic status. A lack of information in the study reports meant that risk of bias could not be adequately assessed (unclear risk of bias for many domains). There were no quantitative data for any of this review's outcomes so meta-analysis was not possible.Neither of the studies reported on the primary outcomes of interest in this review: maternal morbidity (febrile illness, respiratory tract infection, diarrhoea), adverse effects of micronutrients within three days of receiving the supplement, infant mortality (defined as a child dying before completing the first year of age).One study reported qualitatively on maternal anaemia (a secondary outcome of this review) - the study found that multiple-micronutrient supplementation was effective for recuperating from anaemia but there were no data for inclusion in our analyses. Maternal satisfaction was not reported in the included studies. Similarly, none of this review's infant secondary outcomes were reported in the included studies: clinical micronutrient deficiency; morbidity episodes (febrile illness, respiratory tract infection, diarrhoea, other), adverse effects of micronutrients within three days of receiving the supplement. We found no evidence to quantitatively assess the effectiveness of multiple-micronutrient supplementation in improving health outcomes in mother and baby. The results of this review are limited by the small numbers of studies available, small sample sizes and the studies not reporting on the outcomes of interest in this review. There is no evidence to evaluate potential adverse effects of multiple-micronutrient supplements, particularly excess dosages.There is a need for high-quality studies to assess the effectiveness and safety of multiple-micronutrient supplementation for breastfeeding women for improving outcomes for the mother and her baby. Further research should focus on whether multiple-micronutrient supplementation during lactation compared with none, a placebo or supplementation with fewer than two micronutrients is beneficial to maternal and infant health outcomes. Future studies should collect data on outcomes beyond micronutrient concentrations, for example: maternal and infant morbidity, adverse effects, maternal satisfaction, the risks of excess supplementation, and potential adverse interactions between the micronutrients and the other outcomes. This would help to bridge the gap between research on intermediary outcomes and health outcomes in order to develop sound policy in this field. Future studies could more precisely assess a variety of multiple-micronutrient combinations and different dosages and look at how these affect maternal and infant health outcomes. Larger studies with longer follow-up would improve the quality of studies and provide stronger evidence. In most of the included studies, bias could not be adequately assessed due to lack of information, therefore attention should be given to adequate methods of randomisation and allocation concealment, adequate methods of blinding of the participants, providers and the outcome assessors to improve the methodological quality of studies in this field.

Association of Antenatal Corticosteroids With Mortality, Morbidity, and Neurodevelopmental Outcomes in Extremely Preterm Multiple Gestation Infants.

PubMed

Boghossian, Nansi S; McDonald, Scott A; Bell, Edward F; Carlo, Waldemar A; Brumbaugh, Jane E; Stoll, Barbara J; Laptook, Abbot R; Shankaran, Seetha; Walsh, Michele C; Das, Abhik; Higgins, Rosemary D

2016-06-01

Little is known about the effects of antenatal corticosteroids (ANS) on extremely preterm multiples. To examine if use of ANS is associated with improvement in major outcomes in extremely preterm multiples. Infants with a gestational age between 22 and 28 weeks born at a National Institute of Child Health and Human Development Neonatal Research Network center were studied between January 1998 and December 2013. Generalized estimating equation models were used to generate adjusted relative risks (aRR) controlling for important maternal and neonatal variables. Antenatal corticosteroids. In-hospital mortality and the composite outcome of neurodevelopmental impairment at 18 to 22 months' corrected age or death before assessment. A total of 6925 multiple-birth infants were studied; 5775 of 6925 (83.4%) were twins, and 4276 (61.7%) were white. Of the total study population, 6094 (88%) were born to women who received ANS. In-hospital mortality was lower among infants with exposure to ANS vs no exposure (aRR = 0.87; 95% CI, 0.78-0.96). Neurodevelopmental impairment or death was not significantly lower among those exposed to ANS vs no exposure (aRR = 0.93; 95% CI, 0.84-1.03). Other adverse outcomes that occurred less frequently among infants of women receiving ANS included severe intraventricular hemorrhage (aRR = 0.68; 95% CI, 0.58-0.78) and the combined outcomes of necrotizing enterocolitis or death and severe intraventricular hemorrhage or death. Subgroup analyses indicated that exposure to ANS was associated with a lower risk of mortality and a lower composite of neurodevelopmental impairment or mortality among nonsmall for gestational age multiples (aRR = 0.82; 95% CI, 0.74-0.92; and aRR = 0.89; 95% CI, 0.80-0.98, respectively) and a higher risk among small for gestational age multiples (aRR = 1.40; 95% CI, 1.02-1.93; and aRR = 1.62; 95% CI, 1.22-2.16, respectively). Antenatal corticosteroids were associated with higher neurodevelopmental impairment or mortality among multiple-birth infants of mothers with diabetes (aRR = 1.55; 95% CI, 1.00-2.38) but not among infants of mothers without diabetes (aRR = 0.91; 95% CI, 0.83-1.01). Compared with no exposure, exposure to ANS was associated with a lower risk of mortality in extremely preterm multiples, with no significant differences in the composite of neurodevelopmental impairment or death. Future research should investigate the increased risks of mortality and the composite of neurodevelopmental impairment or death associated with exposure to corticosteroids among small for gestational age multiples.

Infection after pacemaker implantation: infection rates and risk factors associated with infection in a population-based cohort study of 46299 consecutive patients

PubMed Central

Johansen, Jens Brock; Jørgensen, Ole Dan; Møller, Mogens; Arnsbo, Per; Mortensen, Peter Thomas; Nielsen, Jens Cosedis

2011-01-01

Aims Infection is a serious complication of pacemaker (PM) systems. Although the rate of infection has been debated, the figures are largely unknown. We therefore studied the incidence of PM infection and its associated risk factors in the Danish population. Methods and results Since 1982, all PM implantation and removal procedures performed in Denmark have been prospectively recorded in the Danish Pacemaker Register. All patients (n = 46299) who underwent implantation between 1982 and 2007 were included. The total length of surveillance was 236 888 PM-years. The incidence of infection was calculated according to the total number of PM-years. The incidence of surgical site infection (≤365 days after PM implantation) was compared with later infection in first implant and replacement procedures. Multiple-record and multiple-event-per-subject proportional hazards analyses were used to identify the independent risk factors of PM infection. Surgical site infection occurred in 192 cases after first implantation (incidence rate 4.82/1000 PM-years), and in 133 cases after replacement (12.12/1000 PM-years). Infections occurring more than 365 days after the first implantation occurred in 153 cases (1.02/1000 PM-years), and in 118 cases after replacement (3.26/1000 PM-years). Independent factors associated with an increased risk of PM infection were a greater number of PM operations (including replacements), male sex, younger age, implantation during the earliest part of the study period, and absence of antibiotics (P< 0.001). Conclusion The overall risk of infection after PM implantation was low. A greater number of operations augmented the risk of infection. This should be taken into account when considering revisions of PM systems. PMID:21252172

No Evidence for Synergy Between Human Papillomavirus Genotypes for the Risk of High-Grade Squamous Intraepithelial Lesions in a Large Population-Based Study

PubMed Central

Wentzensen, Nicolas; Nason, Martha; Schiffman, Mark; Dodd, Lori; Hunt, William C.; Wheeler, Cosette M.

2014-01-01

Background. Multiple human papillomavirus (HPV) genotypes may be independently or synergistically associated with risk of high-grade squamous intraepithelial lesions (HSILs). We evaluated the risk of HSIL in women concomitantly infected with multiple HPV genotypes. Methods. A population-based stratified sample of 59 664 cervical cytology specimens from women residing in New Mexico were evaluated for cytologic abnormalities and HPV genotypes. We calculated the risk of HSIL in women infected with a single HPV genotype and the risk in those infected with multiple HPV genotypes. Results. The highest risk of HSIL was observed for HPV-16 (0.036), followed by HPV-33 (0.028), HPV-58 (0.024), and HPV-18 (0.022). For most types, we observed a greater risk of HSIL in women infected with multiple carcinogenic HPV types. In contrast, the risk of HSIL was similar in women infected with HPV-16 and other types, compared with women infected with HPV-16 only. We observed an increased but plateauing risk of HSIL in women infected with multiple types, compared with those infected with a single type, with risk ratios of 1.5 (95% confidence interval [CI], 1.2–1.8), 1.7 (95% CI, 1.3–2.4), and 1.4 (95% CI, 0.83–2.5) for women infected with 2, 3, and ≥4 genotypes, respectively. Conclusions. In the largest population-based study of HPV genotypes and cytologic outcomes so far, we did not see more than additive effects of HPV types on the risk of HSIL in women infected with multiple types. PMID:24179110

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

Church ladies, good girls, and locas: stigma and the intersection of gender, ethnicity, mental illness, and sexuality in relation to HIV risk.

PubMed

Collins, Pamela Y; von Unger, Hella; Armbrister, Adria

2008-08-01

Inner city women with severe mental illness may carry multiple stigmatized statuses. In some contexts these include having a mental illness, being a member of an ethnic minority group, being an immigrant, being poor, and being a woman who does not live up to gendered expectations. These potentially stigmatizing identities influence both the way women's sexuality is viewed and their risk for HIV infection. This qualitative study applies the concept of intersectionality to facilitate understanding of how these multiple identities intersect to influence women's sexuality and HIV risk. We report the firsthand accounts of 24 Latina women living with severe mental illness in New York City. In examining the interlocking domains of these women's sexual lives, we find that the women seek identities that define them in opposition to the stigmatizing label of "loca" (Spanish for crazy) and bestow respect and dignity. These identities have unfolded through the additional themes of "good girls" and "church ladies". Therefore, in spite of their association with the "loca", the women also identify with faith and religion ("church ladies") and uphold more traditional gender norms ("good girls") that are often undermined by the realities of life with a severe mental illness and the stigma attached to it. However, the participants fall short of their gender ideals and engage in sexual relationships that they experience as disempowering and unsatisfying. The effects of their multiple identities as poor Latina women living with severe mental illness in an urban ethnic minority community are not always additive, but the interlocking effects can facilitate increased HIV risks. Interventions should acknowledge women's multiple layers of vulnerability, both individual and structural, and stress women's empowerment in and beyond the sexual realm.

Natural history of allergic sensitization in infants with early-onset atopic dermatitis: results from ORCA Study.

PubMed

Just, Jocelyne; Deslandes-Boutmy, Emmanuelle; Amat, Flore; Desseaux, Kristell; Nemni, Ariane; Bourrat, Emmanuelle; Sahraoui, Fatia; Pansé, Isabelle; Bagot, Martine; Fouéré, Sébastien

2014-11-01

Early-onset atopic dermatitis (AD) is a particular phenotype that may convey a risk of developing multiple sensitizations to allergens but little is known about the pathway of sensitization. The aims of this study were to describe the natural history of sensitization to allergens for this phenotype and to identify the most predictive marker associated with the risk of developing sensitization to inhaled allergens in a well-selected cohort of infants with AD. Infants with active AD were enrolled and prospectively explored for biological markers of atopy every year until the age of 6 yr. Allergic sensitization was defined as the presence of positive specific IgEs to allergens and multiple sensitizations as being sensitized to ≥2 allergens. Elevated blood eosinophilia was defined as an eosinophil blood count ≥470 eosinophils/mm(3) and elevated total IgE as a serum IgE level ≥45 kU/l. Two hundred and twenty-nine infants were included. Elevated blood eosinophilia was observed at baseline in 60 children (26.2%) and elevated total IgE in 85 (37.1%). When elevated at baseline, eosinophilia and IgE levels remained significantly higher during the follow-up period. Sensitization to food allergens decreased from 58% to 34%, whereas sensitization to inhaled allergens increased over time from 17% to 67%. Initial multiple sensitizations to food allergens were the most predictive factor for the risk of developing sensitization to inhaled allergens at 6 yr (OR 3.72 [1.68-8.30] p < 0.001). In the early-onset AD phenotype, multiple sensitization to food allergens conveys a higher risk of sensitization to inhaled allergens than single sensitization. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Acute kidney injury after percutaneous nephrolithotomy for stones in solitary kidneys.

PubMed

El-Nahas, Ahmed R; Taha, Diaa-Eldin; Ali, Hussien M; Elshal, Ahmed M; Zahran, Mohamed H; El-Tabey, Nasr A; El-Assmy, Ahmed M; Harraz, Ahmed M; Moawad, Hazem E; Othman, Mahmoud M

2017-04-01

The aim of this study was to report the incidence, severity, outcome and risk factors of acute kidney injury (AKI) following percutaneous nephrolithotomy (PNL) in solitary kidneys. The study included consecutive adult patients who underwent PNL for treatment of calculi in a solitary kidney between May 2012 and July 2015. Patients with congenital renal anomalies or with stages 4 and 5 chronic kidney disease (CKD) were excluded. Serum creatinine levels were measured the day before PNL, daily after PNL for 2-5 days and after 3 months. AKI was depicted according to changes in early postoperative serum creatinine levels and its severity was determined based on the Acute Kidney Injury Network (AKIN) classification. The outcome of AKI was evaluated after 3 months by changes in the stage of CKD. Univariate and multivariate statistical analyses were conducted to determine risk factors for developing AKI. The study included 100 patients (62 males) with a mean ± SD age of 50 ± 11.7 years. Complications were reported for 27 patients. AKI developed in 25 patients; at the 3 month follow-up, 23 of them (92%) had completely recovered from AKI and two (8%) had developed stage 4 CKD. Independent risk factors for developing AKI were multiple PNL tracts and postoperative ureteric obstruction (relative risks were 14 and 22, respectively). The incidence of AKI was 25% after PNL for a solitary kidney. The likelihood of renal function recovery was 92%. Multiple PNL tracts and postoperative ureteric obstruction were risk factors for developing AKI.

Risk and protective factors for recreational and hard drug use among Malaysian adolescents and young adults.

PubMed

Razali, Muzafar Mohd; Kliewer, Wendy

2015-11-01

This study investigated risk and protective factors for recreational and hard drug use in Malaysian adolescents and young adults. Participants (n = 859; M age = 17.24 years, SD = 2.75 years, range = 13-25 years; 59% male) were recruited from secondary schools, technical colleges, a juvenile detention center and a national training center in Malaysia. A version of the Communities That Care survey validated for use in Malaysia (Razali & Kliewer, 2015) was used to assess study constructs. One in 6 adolescents and 1 in 3 young adults reported lifetime recreational and hard drug use, with greater use reported by males across all drug categories. Structural equation modeling was used to determine the strongest risk and protective factors for recreational and hard drug use. The overall pattern of findings was similar for recreational and hard drug use. Shared risk factors for lifetime recreational and hard drug use included early initiation of antisocial behavior, peer antisocial behavior, and peer reinforcement for engaging in antisocial behavior; shared protective factors included religious practices and opportunities for prosocial school involvement. Multiple group analyses comparing adolescents and young adults indicated that patterns of risk and protective factors predicting drug use differed across these age groups. There were fewer significant predictors of either recreational or hard drug use for young adults relative to adolescents. Results suggest that interventions should target multiple microsystems (e.g., peer groups, family systems, school environments) and be tailored to the developmental stage of the individual. Copyright © 2015. Published by Elsevier Ltd.

Planar Cell Polarity Pathway Genes and Risk for Spina Bifida

PubMed Central

Wen, Shu; Zhu, Huiping; Lu, Wei; Mitchell, Laura E.; Shaw, Gary M.; Lammer, Edward J.; Finnell, Richard H.

2009-01-01

Spina bifida, a neural tube closure defect (NTD) involving the posterior portion of what will ultimately give rise to the spinal cord, is one of the most common and serious birth defects. The etiology of spina bifida is thought to be multi-factorial and involve multiple interacting genes and environmental factors. The causes of this congenital malformation remain largely unknown. However, several candidate genes for spina bifida have been identified in lower vertebrates, including the planar cell polarity (PCP) genes. We used data from a case-control study conducted in California to evaluate the association between variation within several key PCP genes and the risk of spina bifida. The PCP genes included in this study were the human homologues of the Xenopus genes Flamingo, Strabismus, Prickle, Dishevelled and Scrib, two of the homologues of Xenopus Wnt genes, WNT5A and WNT11, and two of the homologues of Xenopus Frizzled, FZD3 and FZD6. None of the 172 SNPs that were evaluated were significantly associated with spina bifida in any racial/ethnic group after correction for multiple testing. However, several SNPs in the PRICKLE2 gene had unadjusted p value<0.01. In conclusion our results, though largely negative, suggest that the PRICKLE2 gene may potentially modify the risk of spina bifida and deserves further investigation. PMID:20101694

Bow-tie diagrams for risk management in anaesthesia.

PubMed

Culwick, M D; Merry, A F; Clarke, D M; Taraporewalla, K J; Gibbs, N M

2016-11-01

Bow-tie analysis is a risk analysis and management tool that has been readily adopted into routine practice in many high reliability industries such as engineering, aviation and emergency services. However, it has received little exposure so far in healthcare. Nevertheless, its simplicity, versatility, and pictorial display may have benefits for the analysis of a range of healthcare risks, including complex and multiple risks and their interactions. Bow-tie diagrams are a combination of a fault tree and an event tree, which when combined take the shape of a bow tie. Central to bow-tie methodology is the concept of an undesired or 'Top Event', which occurs if a hazard progresses past all prevention controls. Top Events may also occasionally occur idiosyncratically. Irrespective of the cause of a Top Event, mitigation and recovery controls may influence the outcome. Hence the relationship of hazard to outcome can be viewed in one diagram along with possible causal sequences or accident trajectories. Potential uses for bow-tie diagrams in anaesthesia risk management include improved understanding of anaesthesia hazards and risks, pre-emptive identification of absent or inadequate hazard controls, investigation of clinical incidents, teaching anaesthesia risk management, and demonstrating risk management strategies to third parties when required.

An Inverse U-Shaped Curve of Resting-State Networks in Individuals at High Risk of Alzheimer's Disease.

PubMed

Ye, Qing; Chen, Haifeng; Su, Fan; Shu, Hao; Gong, Liang; Xie, Chunming; Zhou, Hong; Bai, Feng

Higher functional connectivity (FC) in resting-state networks has been shown in individuals at risk of Alzheimer's disease (AD) by many studies. However, the longitudinal trajectories of the FC remain unknown. The present 35-month follow-up study aimed to explore longitudinal changes in higher FC in multiple resting-state networks in subjects with the apolipoprotein E ε4 allele (ApoE4) and/or amnestic mild cognitive impairment (aMCI). Fifty-one subjects with aMCI and 64 cognitively normal (CN) subjects underwent neuropsychological tests and resting-state functional magnetic resonance imaging (fMRI) scans twice from April 2011 to June 2015. Subjects were divided into 4 groups according to diagnosis and ApoE4 status. The CN non-ApoE4 group served as a control group, and other groups served as AD risk groups. The cross-sectional and longitudinal patterns of multiple resting-state networks, including default mode network, hippocampus network, executive control network, and salience network, were explored by comparing FC data between groups and between time points, respectively. At baseline, compared with the control group, the AD risk groups showed higher FC with 8 regions in multiple networks. At follow-up, 6 of the regions displayed longitudinally decreased FC in AD risk groups. In contrast, the FC with all of these regions was maintained in the control group. Notably, among the 3 risk groups, most of the higher FC at baseline (5 of the 8 regions) and longitudinally decreased FC at follow-up (4 of the 6 regions) were shown in the aMCI ApoE4 group. Higher resting-state FC is followed by a decline in subjects at AD risk, and this inverse U-shaped trajectory is more notable in subjects with higher risk. © Copyright 2018 Physicians Postgraduate Press, Inc.

Shift work at young age is associated with increased risk of multiple sclerosis in a Danish population.

PubMed

Gustavsen, S; Søndergaard, H B; Oturai, D B; Laursen, B; Laursen, J H; Magyari, M; Ullum, H; Larsen, M H; Sellebjerg, F; Oturai, A B

2016-09-01

Epidemiological studies suggest an important role for environmental factors in developing multiple sclerosis (MS). Furthermore several studies have indicated that the effect of environmental factors may be especially pronounced in adolescents. Recently only one study investigated and found that shift work at young age is associated with an increased risk of developing MS. In this study we focused on the effect of shift work in the vulnerable period between 15-19 years. The aim of this study was to investigate the association between shift work at young age and the risk of developing MS. We performed a large case-control study including 1723 patients diagnosed with MS and 4067 controls. MS patients were recruited from the Danish Multiple Sclerosis Biobank and controls from The Danish Blood Donor Study. Information on working patterns and lifestyle factors was obtained using a comprehensive lifestyle-environmental factor questionnaire with participants enrolled between 2009 and 2014. Logistic regression models were used to investigate the association between shift work at age 15-19 years and the subsequent risk of MS and were controlled for effects due to established MS risk factors. We found a statistically significant association when total numbers of night shifts were compared with non-shift workers. For every additional 100 night shifts the odds ratio (OR) for MS was 1.20 (95% confidence interval (CI), 1.08-1.34, p=0.001). Increasing intensity of shift work also increased MS risk. For every additional night per month the OR was 1.04 (95% CI, 1.01-1.06, p=0.002). Duration of shift work in years was not associated with risk of MS. This study supports a statistically significant association between shift work at age 15-19 years and MS risk. Copyright © 2016 Elsevier B.V. All rights reserved.

The consumption of two or more fall risk-increasing drugs rather than polypharmacy is associated with falls.

PubMed

Zia, Anam; Kamaruzzaman, Shahrul B; Tan, Maw P

2017-03-01

The presemt study aimed to determine the association between the risk of recurrent and injurious falls with polypharmacy, fall risk-increasing drugs (FRID) and FRID count among community-dwelling older adults. Participants (n = 202) were aged ≥65 years with two or more falls or one injurious fall in the past year, whereas controls (n = 156) included volunteers aged ≥65 years with no falls in the past year. A detailed medication history was obtained alongside demographic data. Polypharmacy was defined as "regular use of five or more prescription drugs." FRID were identified as cardiovascular agents, central nervous system drugs, analgesics and endocrine drugs; multiple FRID were defined as two or more FRID. Multiple logistic regression analyses were used to adjust for confounders. The use of non-steroidal anti-inflammatory drugs was independently associated with an increased risk of falls. Univariate analyses showed both polypharmacy (OR 2.23, 95% CI 1.39-3.56; P = 0.001) and the use of two or more FRID (OR 2.9, 95% CI 1.9-4.5; P = 0.0001) were significantly more likely amongst fallers. After adjustment for age, sex and comorbidities, blood pressure, and physical performance scores, polypharmacy was no longer associated with falls (OR 1.6, 95% CI 0.9-2.9; P = 0.102), whereas the consumption of two or more FRID remained a significant predictor for falls (OR 2.8, 95% CI 1.4-5.3; P = 0.001). Among high risk fallers, the use of two or more FRID was an independent risk factor for falls instead of polypharmacy. Our findings will inform clinical practice in terms of medication reviews among older adults at higher risk of falls. Future intervention studies will seek to confirm whether avoidance or withdrawal of multiple FRID reduces the risk of future falls. Geriatr Gerontol Int 2017; 17: 463-470. © 2016 Japan Geriatrics Society.

Trade-Space Analysis Tool for Constellations (TAT-C)

NASA Technical Reports Server (NTRS)

Le Moigne, Jacqueline; Dabney, Philip; de Weck, Olivier; Foreman, Veronica; Grogan, Paul; Holland, Matthew; Hughes, Steven; Nag, Sreeja

2016-01-01

Traditionally, space missions have relied on relatively large and monolithic satellites, but in the past few years, under a changing technological and economic environment, including instrument and spacecraft miniaturization, scalable launchers, secondary launches as well as hosted payloads, there is growing interest in implementing future NASA missions as Distributed Spacecraft Missions (DSM). The objective of our project is to provide a framework that facilitates DSM Pre-Phase A investigations and optimizes DSM designs with respect to a-priori Science goals. In this first version of our Trade-space Analysis Tool for Constellations (TAT-C), we are investigating questions such as: How many spacecraft should be included in the constellation? Which design has the best costrisk value? The main goals of TAT-C are to: Handle multiple spacecraft sharing a mission objective, from SmallSats up through flagships, Explore the variables trade space for pre-defined science, cost and risk goals, and pre-defined metrics Optimize cost and performance across multiple instruments and platforms vs. one at a time.This paper describes the overall architecture of TAT-C including: a User Interface (UI) interacting with multiple users - scientists, missions designers or program managers; an Executive Driver gathering requirements from UI, then formulating Trade-space Search Requests for the Trade-space Search Iterator first with inputs from the Knowledge Base, then, in collaboration with the Orbit Coverage, Reduction Metrics, and Cost Risk modules, generating multiple potential architectures and their associated characteristics. TAT-C leverages the use of the Goddard Mission Analysis Tool (GMAT) to compute coverage and ancillary data, streamlining the computations by modeling orbits in a way that balances accuracy and performance.TAT-C current version includes uniform Walker constellations as well as Ad-Hoc constellations, and its cost model represents an aggregate model consisting of Cost Estimating Relationships (CERs) from widely accepted models. The Knowledge Base supports both analysis and exploration, and the current GUI prototype automatically generates graphics representing metrics such as average revisit time or coverage as a function of cost.

Pediatric multiple sclerosis: current perspectives on health behaviors.

PubMed

Sikes, Elizabeth Morghen; Motl, Robert W; Ness, Jayne M

2018-01-01

Pediatric-onset multiple sclerosis (POMS) accounts for ~5% of all multiple sclerosis cases, and has a prevalence of ~10,000 children in the USA. POMS is associated with a higher relapse rate, and results in irreversible disability on average 10 years earlier than adult-onset multiple sclerosis. Other manifestations of POMS include mental and physical fatigue, cognitive impairment, and depression. We believe that the health behaviors of physical activity, diet, and sleep may have potential benefits in POMS, and present a scoping review of the existing literature. We identified papers by searching three electronic databases (PubMed, GoogleScholar, and CINAHL). Search terms included: pediatric multiple sclerosis OR pediatric onset multiple sclerosis OR POMS AND health behavior OR physical activity OR sleep OR diet OR nutrition OR obesity. Papers were included in this review if they were published in English, referenced nutrition, diet, obesity, sleep, exercise, or physical activity, and included pediatric-onset multiple sclerosis as a primary population. Twenty papers were identified via the literature search that addressed health-promoting behaviors in POMS, and 11, 8, and 3 papers focused on diet, activity, and sleep, respectively. Health-promoting behaviors were associated with markers of disease burden in POMS. Physical activity participation was associated with reduced relapse rate, disease burden, and sleep/rest fatigue symptoms. Nutritional factors, particularly vitamin D intake, may be associated with relapse rate. Obesity has been associated with increased risk of developing POMS. POMS is associated with better sleep hygiene, and this may benefit fatigue and quality of life. Participation in health behaviors, particularly physical activity, diet, and sleep, may have benefits for POMS. Nevertheless, there are currently no interventions targeting promotion of these behaviors and examining the benefits of managing the primary and secondary manifestations of POMS.

Risk Profiles of Children Entering Residential Care: A Cluster Analysis

ERIC Educational Resources Information Center

Hagaman, Jessica L.; Trout, Alexandra L.; Chmelka, M. Beth; Thompson, Ronald W.; Reid, Robert

2010-01-01

Children in residential care are a heterogeneous population, presenting various combinations of risks. Existing studies on these children suggest high variability across multiple domains (e.g., academics, behavior). Given this heterogeneity, it is important to begin to identify the combinations and patterns of multiple risks, or risk profiles,…

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.

Cognitive processing speed is related to fall frequency in older adults with multiple sclerosis.

PubMed

Sosnoff, Jacob J; Balantrapu, Swathi; Pilutti, Lara A; Sandroff, Brian M; Morrison, Steven; Motl, Robert W

2013-08-01

To examine mobility, balance, fall risk, and cognition in older adults with multiple sclerosis (MS) as a function of fall frequency. Retrospective, cross-sectional design. University research laboratory. Community-dwelling persons with MS (N=27) aged between 50 and 75 years were divided into 2 groups-single-time (n=11) and recurrent (n=16; >2 falls/12 mo) fallers-on the basis of fall history. Not applicable. Mobility was assessed using a variety of measures including Multiple Sclerosis Walking Scale-12, walking speed (Timed 25-Foot Walk test), endurance (6-Minute Walk test), and functional mobility (Timed Up and Go test). Balance was assessed with the Berg Balance Scale, posturography, and self-reported balance confidence. Fall risk was assessed with the Physiological Profile Assessment. Cognitive processing speed was quantified with the Symbol Digit Modalities Test and the Paced Auditory Serial Addition Test. Recurrent fallers had slower cognitive processing speed than single-time fallers (P ≤.01). There was no difference in mobility, balance, or fall risk between recurrent and single-time fallers (P>.05). Results indicated that cognitive processing speed is associated with fall frequency and may have implications for fall prevention strategies targeting recurrent fallers with MS. Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Second-site prosthetic joint infection in patients with multiple prosthetic joints.

PubMed

Clesham, Kevin; Hughes, Andrew J; O' hEireamhoin, Sven; Fleming, Catherine; Murphy, Colin G

2018-04-10

Prosthetic joint infections (PJIs) are among the most serious complications in arthroplasty. A second-site PJI in patients with multiple prosthetic joints increases morbidity, with many requiring further revision procedures. We aimed to establish why some patients with multiple joints develop second-site infections. Our institution's arthroplasty database was reviewed from 2004 to 2017. All PJIs were identified, and all patients with more than one prosthetic joint in situ were included. We recorded risk factors, causative organisms, number of procedures and length of stay. Forty-four patients meeting the criteria were identified. Four patients (9.1%) developed second-site infection. Eight patients (18.2%) developed re-infection of the primary PJI. Positive MRSA carrier status and PJI of a total knee replacement were associated with an increased risk of a second episode of infection. Patients who developed further infection had more frequent admission and longer lengths of stay than isolated PJIs. Higher morbidity and use of hospital resources are associated with this cohort of patients. PJIs in total knee replacements and positive MRSA status are associated with higher rates of second infection. Identifying this vulnerable cohort of patients at an early stage is critical to ensure measures are taken to reduce the risks of further infection.

Which modifiable health risk behaviours are related? A systematic review of the clustering of Smoking, Nutrition, Alcohol and Physical activity ('SNAP') health risk factors.

PubMed

Noble, Natasha; Paul, Christine; Turon, Heidi; Oldmeadow, Christopher

2015-12-01

There is a growing body of literature examining the clustering of health risk behaviours, but little consensus about which risk factors can be expected to cluster for which sub groups of people. This systematic review aimed to examine the international literature on the clustering of smoking, poor nutrition, excess alcohol and physical inactivity (SNAP) health behaviours among adults, including associated socio-demographic variables. A literature search was conducted in May 2014. Studies examining at least two SNAP risk factors, and using a cluster or factor analysis technique, or comparing observed to expected prevalence of risk factor combinations, were included. Fifty-six relevant studies were identified. A majority of studies (81%) reported a 'healthy' cluster characterised by the absence of any SNAP risk factors. More than half of the studies reported a clustering of alcohol with smoking, and half reported clustering of all four SNAP risk factors. The methodological quality of included studies was generally weak to moderate. Males and those with greater social disadvantage showed riskier patterns of behaviours; younger age was less clearly associated with riskier behaviours. Clustering patterns reported here reinforce the need for health promotion interventions to target multiple behaviours, and for such efforts to be specifically designed and accessible for males and those who are socially disadvantaged. Copyright © 2015 Elsevier Inc. All rights reserved.

Alcohol intoxication and sexual risk behaviors among rural-to-urban migrants in China

PubMed Central

Lin, Danhua; Li, Xiaoming; Yang, Hongmei; Fang, Xiaoyi; Stanton, Bonita; Chen, Xinguang; Abbey, Antonia; Liu, Hongjie

2007-01-01

Background The migrant population in China is at high risk for sexual risk behavior and alcohol intoxication. Information about the prevalence of alcohol intoxication and its association with sexual risk behavior among migrants is needed for designing effective intervention prevention programs for reduction in alcohol abuse and HIV infection. Methods Cross-sectional data were collected from 2153 sexually experienced young rural-to-urban migrants in Beijing and Nanjing, China, in 2002. Results Approximately one-third of the participants had been intoxicated with alcohol at least once during the previous month, with more males than females reporting intoxication (40.2% versus 23.7%, p < 0.001). Compared to non-intoxicated participants, respondents with alcohol intoxication in previous 30 days reported more psychological problems, including higher depression scores, lower levels of satisfaction with life and work, and higher perception of peer involvement in risk behavior. Intoxicated respondents were more likely to engage in premarital sex than non-intoxicated respondents (76% versus 60.2%, p < 0.001), have multiple sexual partners (13.4% versus 5.2%, p < 0.001), purchase sex (12.6% versus 4.9%, p < 0.001), and sell sex (10.1% versus 3.7%, p < 0.001). However, there was no association between alcohol intoxication and inconsistent/non-use of condoms. Multivariate analysis controlling for depression, peer risk involvement, age, gender, and other socio-demographic variables indicated that alcohol intoxication was independently correlated with premarital sex, multiple sexual partners, and buying and selling sex. Conclusions Compared to the general Chinese population, levels of intoxication were elevated among Chinese rural-to-urban migrants. Alcohol intoxication was associated with sexual risk behaviors. HIV/AIDS prevention and intervention efforts should include components of alcohol use/abuse prevention for an effective reduction of sexual risk among young rural-to-urban migrants in China. PMID:15943949

Effects of high-intensity aerobic interval training on cardiovascular disease risk in testicular cancer survivors: A phase 2 randomized controlled trial.

PubMed

Adams, Scott C; DeLorey, Darren S; Davenport, Margie H; Stickland, Michael K; Fairey, Adrian S; North, Scott; Szczotka, Alexander; Courneya, Kerry S

2017-10-15

Testicular cancer survivors (TCS) have an increased risk of treatment-related cardiovascular disease (CVD), which may limit their overall survival. We evaluated the effects of high-intensity aerobic interval training (HIIT) on traditional and novel CVD risk factors and surrogate markers of mortality in a population-based sample of TCS. This phase 2 trial (ClinicalTrials.gov identifier NCT02459132) randomly assigned 63 TCS to usual care (UC) or 12 weeks of supervised HIIT (ie, alternating periods of vigorous-intensity and light-intensity aerobic exercise). The primary outcome was peak aerobic fitness (VO 2peak ) assessed via a treadmill-based maximal cardiorespiratory exercise test. Secondary endpoints included CVD risk (eg, Framingham Risk Score), arterial health, parasympathetic nervous system function, and blood-based biomarkers. Postintervention VO 2peak data were obtained for 61 participants (97%). HIIT participants attended 99% of the exercise sessions and achieved 98% of the target exercise intensity. Analysis of covariance demonstrated that HIIT was superior to UC for improving VO 2peak (adjusted between-group mean difference, 3.7 mL O 2 /kg/min; 95% confidence interval, 2.4-5.1 [P<.001]) and multiple secondary outcomes including CVD risk (P = .011), arterial thickness (P<.001), arterial stiffness (P<.001), postexercise parasympathetic reactivation (P = .001), inflammation (P = .045), and low-density lipoprotein (P = .014). Overall, HIIT reduced the prevalence of modifiable CVD risk factors by 20% compared with UC. This randomized trial provides the first evidence that HIIT improves cardiorespiratory fitness, multiple pathways of CVD risk, and surrogate markers of mortality in TCS. These findings have important implications for the management of TCS. Further research concerning the long-term effects of HIIT on CVD morbidity and mortality in TCS is warranted. Cancer 2017;123:4057-65. © 2017 American Cancer Society. © 2017 American Cancer Society.

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.

[High risk groups in health behavior defined by clustering of smoking, alcohol, and exercise habits: National Heath and Nutrition Examination Survey].

PubMed

Kang, Kiwon; Sung, Joohon; Kim, Chang Yup

2010-01-01

We investigated the clustering of selected lifestyle factors (cigarette smoking, heavy alcohol consumption, lack of physical exercise) and identified the population characteristics associated with increasing lifestyle risks. Data on lifestyle risk factors, sociodemographic characteristics, and history of chronic diseases were obtained from 7,694 individuals >/=20 years of age who participated in the 2005 Korea National Health and Nutrition Examination Survey (KNHANES). Clustering of lifestyle risks involved the observed prevalence of multiple risks and those expected from marginal exposure prevalence of the three selected risk factors. Prevalence odds ratio was adopted as a measurement of clustering. Multiple correspondence analysis, Kendall tau correlation, Man-Whitney analysis, and ordinal logistic regression analysis were conducted to identify variables increasing lifestyle risks. In both men and women, increased lifestyle risks were associated with clustering of: (1) cigarette smoking and excessive alcohol consumption, and (2) smoking, excessive alcohol consumption, and lack of physical exercise. Patterns of clustering for physical exercise were different from those for cigarette smoking and alcohol consumption. The increased unhealthy clustering was found among men 20-64 years of age with mild or moderate stress, and among women 35-49 years of age who were never-married, with mild stress, and increased body mass index (>30 kg/m(2)). Addressing a lack of physical exercise considering individual characteristics including gender, age, employment activity, and stress levels should be a focus of health promotion efforts.

Utilizing toxicogenomic data to understand chemical mechanism of action in risk assessment

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

Wilson, Vickie S., E-mail: wilson.vickie@epa.gov; Keshava, Nagalakshmi; Hester, Susan

2013-09-15

The predominant role of toxicogenomic data in risk assessment, thus far, has been one of augmentation of more traditional in vitro and in vivo toxicology data. This article focuses on the current available examples of instances where toxicogenomic data has been evaluated in human health risk assessment (e.g., acetochlor and arsenicals) which have been limited to the application of toxicogenomic data to inform mechanism of action. This article reviews the regulatory policy backdrop and highlights important efforts to ultimately achieve regulatory acceptance. A number of research efforts on specific chemicals that were designed for risk assessment purposes have employed mechanismmore » or mode of action hypothesis testing and generating strategies. The strides made by large scale efforts to utilize toxicogenomic data in screening, testing, and risk assessment are also discussed. These efforts include both the refinement of methodologies for performing toxicogenomics studies and analysis of the resultant data sets. The current issues limiting the application of toxicogenomics to define mode or mechanism of action in risk assessment are discussed together with interrelated research needs. In summary, as chemical risk assessment moves away from a single mechanism of action approach toward a toxicity pathway-based paradigm, we envision that toxicogenomic data from multiple technologies (e.g., proteomics, metabolomics, transcriptomics, supportive RT-PCR studies) can be used in conjunction with one another to understand the complexities of multiple, and possibly interacting, pathways affected by chemicals which will impact human health risk assessment.« less

Good Self-Control as a Buffering Agent for Adolescent Substance Use

PubMed Central

Wills, Thomas A.; Ainette, Michael G.

2008-01-01

We tested the prediction that self-control will have buffering effects for adolescent substance use (tobacco, alcohol, and marijuana) with regard to three risk factors: family life events, adolescent life events, and peer substance use. Participants were a sample of public school students (N = 1,767) who were surveyed at four yearly intervals between 6th grade and 9th grade. Good self-control was assessed with multiple indicators including planning and problem solving. Results showed that the impact of all three risk factors on substance use was reduced among persons with higher scores on good self-control. Buffering was found in cross-sectional analyses with multiple regression and in longitudinal analyses in a latent growth model with time-varying covariates. Implications for addressing self-control in prevention programs are discussed. PMID:19071971

Common colorectal cancer risk alleles contribute to the multiple colorectal adenoma phenotype, but do not influence colonic polyposis in FAP.

PubMed

Cheng, Timothy H T; Gorman, Maggie; Martin, Lynn; Barclay, Ella; Casey, Graham; Saunders, Brian; Thomas, Huw; Clark, Sue; Tomlinson, Ian

2015-02-01

The presence of multiple (5-100) colorectal adenomas suggests an inherited predisposition, but the genetic aetiology of this phenotype is undetermined if patients test negative for Mendelian polyposis syndromes such as familial adenomatous polyposis (FAP) and MUTYH-associated polyposis (MAP). We investigated whether 18 common colorectal cancer (CRC) predisposition single-nucleotide polymorphisms (SNPs) could help to explain some cases with multiple adenomas who phenocopied FAP or MAP, but had no pathogenic APC or MUTYH variant. No multiple adenoma case had an outlying number of CRC SNP risk alleles, but multiple adenoma patients did have a significantly higher number of risk alleles than population controls (P=5.7 × 10(-7)). The association was stronger in those with ≥10 adenomas. The CRC SNPs accounted for 4.3% of the variation in multiple adenoma risk, with three SNPs (rs6983267, rs10795668, rs3802842) explaining 3.0% of the variation. In FAP patients, the CRC risk score did not differ significantly from the controls, as we expected given the overwhelming effect of pathogenic germline APC variants on the phenotype of these cases. More unexpectedly, we found no evidence that the CRC SNPs act as modifier genes for the number of colorectal adenomas in FAP patients. In conclusion, common colorectal tumour risk alleles contribute to the development of multiple adenomas in patients without pathogenic germline APC or MUTYH variants. This phenotype may have 'polygenic' or monogenic origins. The risk of CRC in relatives of multiple adenoma cases is probably much lower for cases with polygenic disease, and this should be taken into account when counselling such patients.

Modeling the Potential Effects of New Tobacco Products and Policies. A Dynamic Population Model for Multiple Product Use and Harm

DOE PAGES

Vugrin, Eric D.; Rostron, Brian L.; Verzi, Stephen J.; ...

2015-03-27

Background Recent declines in US cigarette smoking prevalence have coincided with increases in use of other tobacco products. Multiple product tobacco models can help assess the population health impacts associated with use of a wide range of tobacco products. Methods and Findings We present a multi-state, dynamical systems population structure model that can be used to assess the effects of tobacco product use behaviors on population health. The model incorporates transition behaviors, such as initiation, cessation, switching, and dual use, related to the use of multiple products. The model tracks product use prevalence and mortality attributable to tobacco use formore » the overall population and by sex and age group. The model can also be used to estimate differences in these outcomes between scenarios by varying input parameter values. We demonstrate model capabilities by projecting future cigarette smoking prevalence and smoking-attributable mortality and then simulating the effects of introduction of a hypothetical new lower-risk tobacco product under a variety of assumptions about product use. Sensitivity analyses were conducted to examine the range of population impacts that could occur due to differences in input values for product use and risk. We demonstrate that potential benefits from cigarette smokers switching to the lower-risk product can be offset over time through increased initiation of this product. Model results show that population health benefits are particularly sensitive to product risks and initiation, switching, and dual use behaviors. Conclusion Our model incorporates the variety of tobacco use behaviors and risks that occur with multiple products. As such, it can evaluate the population health impacts associated with the introduction of new tobacco products or policies that may result in product switching or dual use. Further model development will include refinement of data inputs for non-cigarette tobacco products and inclusion of health outcomes such as morbidity and disability.« less

Modeling the Potential Effects of New Tobacco Products and Policies: A Dynamic Population Model for Multiple Product Use and Harm

PubMed Central

Vugrin, Eric D.; Rostron, Brian L.; Verzi, Stephen J.; Brodsky, Nancy S.; Brown, Theresa J.; Choiniere, Conrad J.; Coleman, Blair N.; Paredes, Antonio; Apelberg, Benjamin J.

2015-01-01

Background Recent declines in US cigarette smoking prevalence have coincided with increases in use of other tobacco products. Multiple product tobacco models can help assess the population health impacts associated with use of a wide range of tobacco products. Methods and Findings We present a multi-state, dynamical systems population structure model that can be used to assess the effects of tobacco product use behaviors on population health. The model incorporates transition behaviors, such as initiation, cessation, switching, and dual use, related to the use of multiple products. The model tracks product use prevalence and mortality attributable to tobacco use for the overall population and by sex and age group. The model can also be used to estimate differences in these outcomes between scenarios by varying input parameter values. We demonstrate model capabilities by projecting future cigarette smoking prevalence and smoking-attributable mortality and then simulating the effects of introduction of a hypothetical new lower-risk tobacco product under a variety of assumptions about product use. Sensitivity analyses were conducted to examine the range of population impacts that could occur due to differences in input values for product use and risk. We demonstrate that potential benefits from cigarette smokers switching to the lower-risk product can be offset over time through increased initiation of this product. Model results show that population health benefits are particularly sensitive to product risks and initiation, switching, and dual use behaviors. Conclusion Our model incorporates the variety of tobacco use behaviors and risks that occur with multiple products. As such, it can evaluate the population health impacts associated with the introduction of new tobacco products or policies that may result in product switching or dual use. Further model development will include refinement of data inputs for non-cigarette tobacco products and inclusion of health outcomes such as morbidity and disability. PMID:25815840

Alcohol and aldehyde dehydrogenase gene polymorphisms and oropharyngolaryngeal, esophageal and stomach cancers in Japanese alcoholics.

PubMed

Yokoyama, A; Muramatsu, T; Omori, T; Yokoyama, T; Matsushita, S; Higuchi, S; Maruyama, K; Ishii, H

2001-03-01

Alcohol dehydrogenase-2 (ADH2) and aldehyde dehydrogenase-2 (ALDH2) gene polymorphisms play roles in ethanol metabolism, drinking behavior and esophageal carcinogenesis in Japanese; however, the combined influence of ADH2 and ALDH2 genotypes on other aerodigestive tract cancers have not been investigated. ADH2/ALDH2 genotyping was performed on lymphocyte DNA samples from Japanese alcoholic men (526 cancer-free; 159 with solitary or multiple aerodigestive tract cancers, including 33 oropharyngolaryngeal, 112 esophageal, 38 stomach and 22 multiple primary cancers in two or three organs). After adjustment for age, drinking and smoking habits, and ADH2/ALDH2 genotypes, the presence of either ADH2*1/2*1 or ALDH2*1/2*2 significantly increased the risk for oropharyngolaryngeal cancer [odds ratios (ORs), 6.68 with ADH2*1/2*1 and 18.52 with ALDH2*1/2*2] and esophageal cancer (ORs, 2.64 and 13.50, respectively). For patients with both ADH2*1/2*1 and ALDH2*1/2*2, the risks for oropharyngolaryngeal and esophageal cancers were enhanced in a multiplicative fashion (OR = 121.77 and 40.40, respectively). A positive association with ALDH2*1/2*2 alone was observed for stomach cancer patients who also had oropharyngolaryngeal and/or esophageal cancer (OR = 110.58), but it was not observed for those with stomach cancer alone. Furthermore, in the presence of ALDH2*1/2*2, the risks for multiple intra-esophageal cancers (OR = 3.43) and for esophageal cancer with oropharyngolaryngeal and/or stomach cancer (OR = 3.95) were higher than the risks for solitary intra-esophageal cancer and for esophageal cancer alone, but these tendencies were not observed for ADH2*1/2*1 genotype. Alcoholics' population attributable risks due to ADH2/ALDH2 polymorphisms were estimated to be 82.0% for oropharyngolaryngeal cancer and 63.9% for esophageal cancer.

Modeling the potential effects of new tobacco products and policies: a dynamic population model for multiple product use and harm.

PubMed

Vugrin, Eric D; Rostron, Brian L; Verzi, Stephen J; Brodsky, Nancy S; Brown, Theresa J; Choiniere, Conrad J; Coleman, Blair N; Paredes, Antonio; Apelberg, Benjamin J

2015-01-01

Recent declines in US cigarette smoking prevalence have coincided with increases in use of other tobacco products. Multiple product tobacco models can help assess the population health impacts associated with use of a wide range of tobacco products. We present a multi-state, dynamical systems population structure model that can be used to assess the effects of tobacco product use behaviors on population health. The model incorporates transition behaviors, such as initiation, cessation, switching, and dual use, related to the use of multiple products. The model tracks product use prevalence and mortality attributable to tobacco use for the overall population and by sex and age group. The model can also be used to estimate differences in these outcomes between scenarios by varying input parameter values. We demonstrate model capabilities by projecting future cigarette smoking prevalence and smoking-attributable mortality and then simulating the effects of introduction of a hypothetical new lower-risk tobacco product under a variety of assumptions about product use. Sensitivity analyses were conducted to examine the range of population impacts that could occur due to differences in input values for product use and risk. We demonstrate that potential benefits from cigarette smokers switching to the lower-risk product can be offset over time through increased initiation of this product. Model results show that population health benefits are particularly sensitive to product risks and initiation, switching, and dual use behaviors. Our model incorporates the variety of tobacco use behaviors and risks that occur with multiple products. As such, it can evaluate the population health impacts associated with the introduction of new tobacco products or policies that may result in product switching or dual use. Further model development will include refinement of data inputs for non-cigarette tobacco products and inclusion of health outcomes such as morbidity and disability.

Modeling the Potential Effects of New Tobacco Products and Policies. A Dynamic Population Model for Multiple Product Use and Harm

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

Vugrin, Eric D.; Rostron, Brian L.; Verzi, Stephen J.

Background Recent declines in US cigarette smoking prevalence have coincided with increases in use of other tobacco products. Multiple product tobacco models can help assess the population health impacts associated with use of a wide range of tobacco products. Methods and Findings We present a multi-state, dynamical systems population structure model that can be used to assess the effects of tobacco product use behaviors on population health. The model incorporates transition behaviors, such as initiation, cessation, switching, and dual use, related to the use of multiple products. The model tracks product use prevalence and mortality attributable to tobacco use formore » the overall population and by sex and age group. The model can also be used to estimate differences in these outcomes between scenarios by varying input parameter values. We demonstrate model capabilities by projecting future cigarette smoking prevalence and smoking-attributable mortality and then simulating the effects of introduction of a hypothetical new lower-risk tobacco product under a variety of assumptions about product use. Sensitivity analyses were conducted to examine the range of population impacts that could occur due to differences in input values for product use and risk. We demonstrate that potential benefits from cigarette smokers switching to the lower-risk product can be offset over time through increased initiation of this product. Model results show that population health benefits are particularly sensitive to product risks and initiation, switching, and dual use behaviors. Conclusion Our model incorporates the variety of tobacco use behaviors and risks that occur with multiple products. As such, it can evaluate the population health impacts associated with the introduction of new tobacco products or policies that may result in product switching or dual use. Further model development will include refinement of data inputs for non-cigarette tobacco products and inclusion of health outcomes such as morbidity and disability.« less

Hormone replacement therapy in young women with primary ovarian insufficiency and early menopause.

PubMed

Sullivan, Shannon D; Sarrel, Philip M; Nelson, Lawrence M

2016-12-01

Primary ovarian insufficiency (POI) is a rare but important cause of ovarian hormone deficiency and infertility in women. In addition to causing infertility, POI is associated with multiple health risks, including bothersome menopausal symptoms, decreased bone density and increased risk of fractures, early progression of cardiovascular disease, psychologic impact that may include depression, anxiety, and decreased perceived psychosocial support, potential early decline in cognition, and dry eye syndrome. Appropriate hormone replacement therapy (HRT) to replace premenopausal levels of ovarian sex steroids is paramount to increasing quality of life for women with POI and ameliorating associated health risks. In this review, we discuss POI and complications associated with this disorder, as well as safe and effective HRT options. To decrease morbidity associated with POI, we recommend using HRT formulations that most closely mimic normal ovarian hormone production and continuing HRT until the normal age of natural menopause, ∼50 years. We address special populations of women with POI, including women with Turner syndrome, women with increased risk of breast or ovarian cancer, women approaching the age of natural menopause, and breastfeeding women. Published by Elsevier Inc.

Hormone replacement therapy in young women with primary ovarian insufficiency and early menopause

PubMed Central

Sullivan, Shannon D.; Sarrel, Philip M.; Nelson, Lawrence M.

2016-01-01

Primary ovarian insufficiency (POI) is a rare but important cause of ovarian hormone deficiency and infertility in women. In addition to causing infertility, POI is associated with multiple health risks, including bothersome menopausal symptoms, decreased bone density and increased risk of fractures, early progression of cardiovascular disease, psychological impact that may include depression, anxiety, and decreased perceived psychosocial support, potential early decline in cognition, and dry eye syndrome. Appropriate hormone replacement therapy to replace premenopausal levels of ovarian sex steroids is paramount to increasing quality of life for women with POI and ameliorating associated health risks. In this review, we discuss POI and complications associated with this disorder, as well as safe and effective hormone replacement therapy options. To decrease morbidity associated with POI, we recommend using HRT formulations that most closely mimic normal ovarian hormone production and continuing HRT until the normal age of natural menopause, ~50 years. We address special populations of women with POI, including women with Turner Syndrome, women with increased risk of breast or ovarian cancer, women approaching the age of natural menopause, and breastfeeding women. PMID:27912889

Update on Multiple Ovulations in Dairy Cattle

PubMed Central

Macmillan, Kira; Kastelic, John P.

2018-01-01

Simple Summary Multiple ovulations (MOV) in cattle can lead to twin pregnancies, which negatively affects the health, production, and reproduction of cows. Despite many studies, the causal mechanisms behind MOV are still not well understood. There is a general agreement that MOV are more likely during periods of low progesterone (P4), which may increase the luteinizing hormone (LH) release at the time of selection, resulting in more than one follicle becoming dominant. The MOV rate also increases in older cows and when the selection of a dominant follicle occurs concurrently with a high milk yield. Additional risk factors for MOV are ovarian cysts, diet, season, and genetics. A better understanding of the mechanisms underlying MOV may help to mitigate twinning, perhaps through the appropriate reproductive management protocols or genetic selection. Abstract This review updates the causal mechanisms and risk factors for multiple ovulations (MOV) in cattle. Clearly, MOV can lead to twin pregnancies, which negatively affects the health, production, and reproduction of cows. Therefore, a better understanding of the factors causing MOV may help to reduce twinning. Multiple ovulations occur after two or more follicles deviate and achieve codominance. The MOV rate is influenced by a complex network of hormones. For example, MOV is more common during periods of low progesterone (P4), that is, in anovulatory cattle or when luteolysis coincides with the selection of the future ovulatory follicle. There is also strong evidence for the luteinizing hormone (LH) being the primary factor leading to codominance, as high P4 concentrations suppress the transient LH surges and can reduce the ovulation rate in cattle or even inhibit deviation. Rates of MOV are increased in older and higher-producing dairy cows. Increased milk production and dry matter intake (DMI) increases hormone clearance, including P4; however, the association between milk yield and MOV has not been consistent. Additional risk factors for MOV include ovarian cysts, diet, season, and genetics. PMID:29695075

Kinetic therapy in multiple trauma patients with severe blunt chest trauma: an analysis at a level-1 trauma center.

PubMed

Zeckey, C; Wendt, K; Mommsen, P; Winkelmann, M; Frömke, C; Weidemann, J; Stübig, T; Krettek, C; Hildebrand, F

2015-01-01

Chest trauma is a relevant risk factor for mortality after multiple trauma. Kinetic therapy (KT) represents a potential treatment option in order to restore pulmonary function. Decision criteria for performing kinetic therapy are not fully elucidated. The purpose of this study was to investigate the decision making process to initiate kinetic therapy in a well defined multiple trauma cohort. A retrospective analysis (2000-2009) of polytrauma patients (age > 16 years, ISS ⩾ 16) with severe chest trauma (AIS(Chest) ⩾ 3) was performed. Patients with AIS(Head) ⩾ 3 were excluded. Patients receiving either kinetic (KT+) or lung protective ventilation strategy (KT-) were compared. Chest trauma was classified according to the AIS(Chest), Pulmonary Contusion Score (PCS), Wagner Jamieson Score and Thoracic Trauma Severity Score (TTS). There were multiple outcome parameters investigated included mortality, posttraumatic complications and clinical data. A multivariate regression analysis was performed. Two hundred and eighty-three patients were included (KT+: n=160; KT-: n=123). AIS(Chest), age and gender were comparable in both groups. There were significant higher values of the ISS, PCS, Wagner Jamieson Score and TTS in group KT+. The incidence of posttraumatic complications and mortality was increased compared to group KT- (p< 0.05). Despite that, kinetic therapy failed to be an independent risk factor for mortality in multivariate logistic regression analysis. Kinetic therapy is an option in severely injured patients with severe chest trauma. Decision making is not only based on anatomical aspects such as the AIS(Chest), but on overall injury severity, pulmonary contusions and physiological deterioration. It could be assumed that the increased mortality in patients receiving KT is primarily caused by these factors and does not reflect an independent adverse effect of KT. Furthermore, KT was not shown to be an independent risk factor for mortality.

Perceptions among women with gestational diabetes.

PubMed

Parsons, Judith; Ismail, Khalida; Amiel, Stephanie; Forbes, Angus

2014-04-01

Women with gestational diabetes are at high risk of developing type 2 diabetes, which could be prevented or delayed by lifestyle modification. Lifestyle interventions need to take into account the specific situation of women with gestational diabetes. We aimed to gain a deeper understanding of women's experiences of gestational diabetes, their diabetes risk perceptions, and their views on type 2 diabetes prevention, to inform future lifestyle interventions. We conducted a metasynthesis that included 16 qualitative studies and identified 11 themes. Factors that require consideration when developing a type 2 diabetes prevention intervention in this population include addressing the emotional impact of gestational diabetes; providing women with clear and timely information about future diabetes risk; and offering an intervention that fits with women's multiple roles as caregivers, workers, and patients, and focuses on the health of the whole family.

Clinical characteristics of patients who overdose on multiple psychotropic drugs in Tokyo.

PubMed

Hori, Satoshi; Kinoshita, Kosaku

2016-01-01

The purpose of this study was to identify the clinical aspects leading to overdose of multiple psychotropic drugs, in order to determine areas which need attention in the proper treatment of overdose patients. Patients who were treated for overdose of psychotropic drugs at our emergency and critical center over two years were targeted. The clinical data was gathered from the medical records and database of all patients, including age, gender, vital signs, and laboratory data, drugs, and medical complications during hospital stay. In addition primary patient care at the emergency department was examined. Among the 277 patients treated during this study period, 255 (74.0%) used two or more types of psychotropic drugs. Risk factors associated with endotracheal intubation and aspiration pneumonitis included the use of antipsychotics and/or barbiturates as types of overdose drugs. The mean number of days in the ICU was 3.4 days. Seventy-four patients (26.7%) stayed 4 days or more in the ICU of which 16 patients (5.8%) still had suicidal thoughts. A significantly higher incidence of extended ICU stay or endotracheal intubation and aspiration pneumonitis was observed in the group who overdosed on more than 50 or 60 tablets of psychotropic drugs, respectively. Patients who ingested an overdose of more than 60 tablets of psychotropic drugs should be considered a high-risk group requiring intensive care with extended ICU stay. In case of including antipsychotics and/or barbiturates, the patient should be observed carefully due to a higher risk of medical complications.

Predicting type 2 diabetes using genetic and environmental risk factors in a multi-ethnic Malaysian cohort.

PubMed

Abdullah, N; Abdul Murad, N A; Mohd Haniff, E A; Syafruddin, S E; Attia, J; Oldmeadow, C; Kamaruddin, M A; Abd Jalal, N; Ismail, N; Ishak, M; Jamal, R; Scott, R J; Holliday, E G

2017-08-01

Malaysia has a high and rising prevalence of type 2 diabetes (T2D). While environmental (non-genetic) risk factors for the disease are well established, the role of genetic variations and gene-environment interactions remain understudied in this population. This study aimed to estimate the relative contributions of environmental and genetic risk factors to T2D in Malaysia and also to assess evidence for gene-environment interactions that may explain additional risk variation. This was a case-control study including 1604 Malays, 1654 Chinese and 1728 Indians from the Malaysian Cohort Project. The proportion of T2D risk variance explained by known genetic and environmental factors was assessed by fitting multivariable logistic regression models and evaluating McFadden's pseudo R 2 and the area under the receiver-operating characteristic curve (AUC). Models with and without the genetic risk score (GRS) were compared using the log likelihood ratio Chi-squared test and AUCs. Multiplicative interaction between genetic and environmental risk factors was assessed via logistic regression within and across ancestral groups. Interactions were assessed for the GRS and its 62 constituent variants. The models including environmental risk factors only had pseudo R 2 values of 16.5-28.3% and AUC of 0.75-0.83. Incorporating a genetic score aggregating 62 T2D-associated risk variants significantly increased the model fit (likelihood ratio P-value of 2.50 × 10 -4 -4.83 × 10 -12 ) and increased the pseudo R 2 by about 1-2% and AUC by 1-3%. None of the gene-environment interactions reached significance after multiple testing adjustment, either for the GRS or individual variants. For individual variants, 33 out of 310 tested associations showed nominal statistical significance with 0.001 < P < 0.05. This study suggests that known genetic risk variants contribute a significant but small amount to overall T2D risk variation in Malaysian population groups. If gene-environment interactions involving common genetic variants exist, they are likely of small effect, requiring substantially larger samples for detection. Copyright © 2017 The Royal Society for Public Health. All rights reserved.

Maternal side-effects after multiple courses of antenatal corticosteroids (MACS): the three-month follow-up of women in the randomized controlled trial of MACS for preterm birth study.

PubMed

Murphy, Kellie E; Hannah, Mary E; Willan, Andrew R; Ohlsson, Arne; Kelly, Edmond N; Matthews, Stephen G; Saigal, Saroj; Asztalos, Elizabeth; Ross, Sue; Delisle, Marie-France; Tomat, Laura; Amankwah, Kofi; Guselle, Patricia; Gafni, Amiram; Lee, Shoo K; Armson, B Anthony

2011-09-01

A single course of antenatal corticosteroids (ACS) is associated with a reduction in respiratory distress syndrome and neonatal death. Multiple Courses of Antenatal Corticosteroids Study (MACS), a study involving 1858 women, was a multicentre randomized placebo-controlled trial of multiple courses of ACS, given every 14 days until 33+6 weeks or birth, whichever came first. The primary outcome of the study, a composite of neonatal mortality and morbidity, was similar for the multiple ACS and placebo groups (12.9% vs. 12.5%), but infants exposed to multiple courses of ACS weighed less, were shorter, and had smaller head circumferences. Thus for women who remain at increased risk of preterm birth, multiple courses of ACS (every 14 days) are not recommended. Chronic use of corticosteroids is associated with numerous side effects including weight gain and depression. The aim of this postpartum assessment was to ascertain if multiple courses of ACS were associated with maternal side effects. Three months postpartum, women who participated in MACS were asked to complete a structured questionnaire that asked about maternal side effects of corticosteroid use during MACS and included the Edinburgh Postnatal Depression Scale. Women were also asked to evaluate their study participation. Of the 1858 women randomized, 1712 (92.1%) completed the postpartum questionnaire. There were no significant differences in the risk of maternal side effects between the two groups. Large numbers of women met the criteria for postpartum depression (14.1% in the ACS vs. 16.0% in the placebo group). Most women (94.1%) responded that they would participate in the trial again. In pregnancy, corticosteroids are given to women for fetal lung maturation and for the treatment of various maternal diseases. In this international multicentre randomized controlled trial, multiple courses of ACS (every 14 days) were not associated with maternal side effects, and the majority of women responded that they would participate in such a study again.

Association between metformin use and progression of monoclonal gammopathy of undetermined significance to multiple myeloma in US veterans with diabetes mellitus: a population-based retrospective cohort study.

PubMed

Chang, Su-Hsin; Luo, Suhong; O'Brian, Katiuscia K; Thomas, Theodore S; Colditz, Graham A; Carlsson, Nils P; Carson, Kenneth R

2015-01-01

Multiple myeloma is one of the most common haematological malignancies in the USA and is consistently preceded by monoclonal gammopathy of undetermined significance (MGUS). We aimed to assess the association between metformin use and progression of MGUS to multiple myeloma. We did a retrospective cohort study of patients registered in the US Veterans Health Administration database and diagnosed with MGUS between Oct 1, 1999, and Dec 31, 2009. We included patients (aged >18 years) with at least one International Classification of Diseases (9th revision) code for diabetes mellitus and one treatment for their diabetes before MGUS diagnosis. We reviewed patient-level clinical data to verify diagnoses and extract any available data for size of baseline M-protein and type of MGUS. We defined metformin users as patients with diabetes who were given metformin consistently for 4 years after their diabetes diagnosis and before multiple myeloma development, death, or censorship. Our primary outcome was time from MGUS diagnosis to multiple myeloma diagnosis. We used Kaplan-Meier curves and Cox models to analyse the association between metformin use and MGUS progression. We obtained data for 3287 patients, of whom 2003 (61%) were included in the final analytical cohort. Median follow-up was 69 months (IQR 49–96). 463 (23%) participants were metformin users and 1540 (77%) participants were non-users. 13 (3%) metformin users progressed to multiple myeloma compared with 74 (5%) non-users. After adjustment, metformin use was associated with a reduced risk of progression to multiple myeloma (hazard ratio 0·47, 95% CI 0·25–0·87). For patients with diabetes diagnosed with MGUS, metformin use for 4 years or longer was associated with a reduced risk of progression of MGUS to multiple myeloma. Prospective studies are needed to establish whether this association is causal and whether these results can be extrapolated to non-diabetic individuals. Barnes-Jewish Hospital Foundation, National Institutes of Health, Agency for Healthcare Research and Quality, American Cancer Society.

Multiple overlapping systematic reviews facilitate the origin of disputes: the case of thrombolytic therapy for pulmonary embolism.

PubMed

Riva, Nicoletta; Puljak, Livia; Moja, Lorenzo; Ageno, Walter; Schünemann, Holger; Magrini, Nicola; Squizzato, Alessandro

2018-05-01

To explore disagreements in multiple systematic reviews (SRs) assessing the benefit-to-harm ratio of thrombolytic therapy in patients with intermediate-risk pulmonary embolism (PE). MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, and Database of Abstracts and Reviews of Effectiveness were searched up to April 14, 2016. We included SRs and guidelines that evaluated thrombolytic therapy, compared with anticoagulation alone, in intermediate-risk PE. We calculated pooled risk ratio (RR) and absolute risk difference (RD), with interquartile range (IQR), for all-cause mortality, recurrent PE, and major bleeding. We marked the Pulmonary Embolism Thrombolysis trial, the largest trial, as a research milestone. Since its release in 2014, 12 SRs (2-15 included trials) and two major guidelines were published. Studies were concordant in reporting that thrombolysis reduced all-cause mortality (median RD -1.55%, IQR -1.60% to -1.40%; median RR 0.55, IQR 0.48-0.61). Discordant results were found for major bleeding (median RD 4.70%, IQR 0.90%-5.70%), with SRs reporting results in opposite directions. Relevant magnitude of effects and precision for benefits and harms were never prespecified. Fourteen evidence syntheses were published within 25 months. Conclusions suggested mortality reduction associated with thrombolytics. Therapy harm was more dispersed and alternatively considered. Interpretation of the benefit-to-harm ratio was elusive, and modest incremental advantages might or not be important, facilitating the origin of disputes. Copyright © 2017 Elsevier Inc. All rights reserved.

Physician practices of bone density testing and drug prescribing to prevent or treat osteoporosis during androgen deprivation therapy.

PubMed

Tanvetyanon, Tawee

2005-01-15

Androgen deprivation therapy (ADT) is a strong risk factor for osteoporosis. The current study identified physician practices in preventing or treating osteoporosis during ADT. The practices of interest are the uses of dual-energy X-ray absorptiometry (DXA) scans, bisphosphonates, calcium or vitamin D supplement, calcitonin, or estrogen. A retrospective medical record review was conducted. Patients were included if they had received ADT with goserelin injection for >/= 1 year. Multivariable logistic regression analysis was performed to identify independent predictors of receiving at least one intervention. Analyses included 184 patients. Most were the elderly with multiple risk factors for osteoporosis. Only 8.7% (95% confidence interval [CI], 4.6-13.0%) of patients received a DXA scan at least once during the past 3 years. Oral and intravenous bisphosphonates were prescribed in 4.9% (95%CI, 1.8-8.0%) and 0.5% (95%CI, 0-2.0%) of patients, respectively, during the past year. Overall, 14.7% of patients (95%CI, 9.5-20.0%) received at least one intervention. Concurrent risk factors for osteoporosis, including smoking, alcoholism, advanced age, low body mass index, long duration of ADT, multiple comorbidities, history of fractures, and steroid use, were not independent predictors of having received interventions. However, bone metastasis was, with a hazard ratio of 5.6 (95%CI, 1.99-15.6%). Primary care physicians provided the greatest number of interventions and cancer-related specialists provided the fewest. The majority of patients with prostate carcinoma undergoing ADT did not receive interventions to prevent or treat osteoporosis. Having other concurrent risk factors for osteoporosis was not predictive of receiving these few interventions. (c) 2004 American Cancer Society.

Intergenerational Transmission of Maltreatment: A Multilevel Examination

PubMed Central

Leve, Leslie D.; Khurana, Atika; Reich, Emily B.

2015-01-01

Despite the commonly held belief that there is a high degree of intergenerational continuity in maltreatment, studies to date suggest a mixed pattern of findings. One reason for the variance in findings may be related to the measurement approach used, which includes a range of self-report and official indicators of maltreatment and both cross-sectional and longitudinal designs. This study attempted to shed light on the phenomenon of intergenerational continuity of maltreatment by examining multiple indicators of perpetration of maltreatment in young adults and multiple risk factors across different levels within an individual’s social ecology. The sample included 166 women who had been placed in out-of-home care as adolescents (>85% had a substantiated maltreatment incident) and followed into young adulthood, and included three waves of adolescent data and six waves of young adult data collected across 10 years. The participants were originally recruited during adolescence as part of a randomized controlled trial examining the efficacy of the Treatment Foster Care Oregon intervention. Analyses revealed weak to modest associations between the three indicators of perpetration of maltreatment in young adulthood, i.e., official child welfare records, self-reported child welfare system involvement, and self-reported maltreatment (r = .03–.51). Further, different patterns of prediction emerged as a function of the measurement approach. Adolescent delinquency was a significant predictor of subsequent self-reported child welfare contact, and young adult partner risk was a significant predictor of perpetration of maltreatment as indexed by both official child welfare records and self-reported child welfare contact. In addition, women who were originally assigned to the intervention condition reported perpetrating less maltreatment during young adulthood. Implications for measurement and interventions related to reducing the risk for intergenerational transmission of risk are discussed. PMID:26535935

The role of conviction in personal disease risk perceptions: What can we learn from research on attitude strength?

PubMed Central

Taber, Jennifer M.; Klein, William M.P.

2016-01-01

Perceived risk for disease is included as a predictor of intentions and behavior in many health behavior theories. However, perceived risk is not always a strong predictor of intentions and behaviors. One reason may be suboptimal conceptualization and measurement of risk perceptions; in particular, research may not capture the conviction and certainty with which a risk perception is held. The rich and independent literature on attitudes might be leveraged to explore whether conviction is an important moderator of the effects of risk perceptions on intentions and behavior. Attitudes are more predictive of intentions when they are high in multiple aspects of attitude strength, including attitude certainty and being more accessible and stable over time. Working from the assumption that risk perceptions have a similar structure and function to attitudes, we consider whether factors known to strengthen the attitude-behavior correspondence might also strengthen the risk perception-behavior correspondence. Although by strict definition risk perceptions are not evaluations (a critical component of attitudes), the predictive validity of risk perceptions may be increased by attention to one’s “conviction” or certainty of perceived risk. We also review recent strategies designed to improve risk perception measurement, including affective and experiential assessments of perceived risk and the importance of allowing people to indicate that they “don’t know” their disease risk. The aim of this paper is to connect two disparate literatures—attitudes and persuasion in social psychology with risk perceptions in health psychology and decision science—in an attempt to stimulate more work on characteristics and proper measurement of risk perceptions. PMID:27127537

Making assessments while taking repeated risks: a pattern of multiple response pathways.

PubMed

Pleskac, Timothy J; Wershbale, Avishai

2014-02-01

Beyond simply a decision process, repeated risky decisions also require a number of cognitive processes including learning, search and exploration, and attention. In this article, we examine how multiple response pathways develop over repeated risky decisions. Using the Balloon Analogue Risk Task (BART) as a case study, we show that 2 different response pathways emerge over the course of the task. The assessment pathway is a slower, more controlled pathway where participants deliberate over taking a risk. The 2nd pathway is a faster, more automatic process where no deliberation occurs. Results imply the slower assessment pathway is taken as choice conflict increases and that the faster automatic response is a learned response. Based on these results, we modify an existing formal cognitive model of decision making during the BART to account for these dual response pathways. The slower more deliberative response process is modeled with a sequential sampling process where evidence is accumulated to a threshold, while the other response is given automatically. We show that adolescents with conduct disorder and substance use disorder symptoms not only evaluate risks differently during the BART but also differ in the rate at which they develop the more automatic response. More broadly, our results suggest cognitive models of judgment decision making need to transition from treating observed decisions as the result of a single response pathway to the result of multiple response pathways that change and develop over time.

Exposure to Multiple Pesticides and Risk of Non-Hodgkin Lymphoma in Men from Six Canadian Provinces

PubMed Central

Hohenadel, Karin; Harris, Shelley A.; McLaughlin, John R.; Spinelli, John J.; Pahwa, Punam; Dosman, James A.; Demers, Paul A.; Blair, Aaron

2011-01-01

Non-Hodgkin lymphoma (NHL) has been linked to several agricultural exposures, including some commonly used pesticides. Although there is a significant body of literature examining the effects of exposure to individual pesticides on NHL, the impact of exposure to multiple pesticides or specific pesticide combinations has not been explored in depth. Data from a six-province Canadian case-control study conducted between 1991 and 1994 were analyzed to investigate the relationship between NHL, the total number of pesticides used and some common pesticide combinations. Cases (n = 513) were identified through hospital records and provincial cancer registries and controls (n = 1,506), frequency matched to cases by age and province of residence, were obtained through provincial health records, telephone listings, or voter lists. In multiple logistic regression analyses, risk of NHL increased with the number of pesticides used. Similar results were obtained in analyses restricted to herbicides, insecticides and several pesticide classes. Odds ratios increased further when only ‘potentially carcinogenic’ pesticides were considered (OR[one pesticide] = 1.30, 95% CI = 0.90–1.88; OR[two to four] = 1.54, CI = 1.11–2.12; OR[five or more] = 1.94, CI = 1.17–3.23). Elevated risks were also found among those reporting use of malathion in combination with several other pesticides. These analyses support and extend previous findings that the risk of NHL increases with the number of pesticides used and some pesticide combinations. PMID:21776232

Maternal Mental Illness and the Safety and Stability of Maltreated Children

ERIC Educational Resources Information Center

Kohl, Patricia L.; Jonson-Reid, Melissa; Drake, Brett

2011-01-01

Objective: Children of mothers with mental illness are at risk for multiple untoward outcomes, including child maltreatment and foster care placement. The purpose of this analysis was to determine the association between maternal mental illness and children's long term safety and stability. Methods: A multi-sector administrative dataset from the…

The Legacy of Hobbs and Gray: Research on the Development and Prevention of Conduct Problems.

ERIC Educational Resources Information Center

Dodge, Kenneth A.

1996-01-01

Describes research on the development of chronic conduct problems in childhood and adolescence, examining a multiple risk-factor model that includes biological predispositions, ecological context, family processes, peer influences, academic performance, and social information processing as factors leading to conduct problems. The paper describes a…

Expedited Permanency Planning: Evaluation of the Kentucky Adoptions Opportunities Project.

ERIC Educational Resources Information Center

Martin, Mavin H.; Barbee, Anita P.; Antle, Becky F.; Sar, Bibhuti

2002-01-01

Presents evaluation findings of a 3-year Kentucky Adoptions Opportunities Project. Notes that a majority of children had one or both parents coping with multiple risk factors including mental illness, substance abuse, mental retardation, or family violence. Discusses major barriers to permanency, as well as policy and practice implications in the…

A simulation study to determine the attenuation and bias in health risk estimates due to exposure measurement error in bi-pollutant models

EPA Science Inventory

To understand the combined health effects of exposure to ambient air pollutant mixtures, it is becoming more common to include multiple pollutants in epidemiologic models. However, the complex spatial and temporal pattern of ambient pollutant concentrations and related exposures ...

Development and Application of a Human PBPK Model for Bromodichloromethane (BDCM) to Investigate Impacts of Multi-Route Exposure

EPA Science Inventory

Due to its presence in water as a volatile disinfection byproduct, BDCM, which is mutagenic and a rodent carcinogen, poses a risk for exposure via multiple routes. We developed a refined human PBPK model for BDCM (including new chemical-specific human parameters) to evaluate the...

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…

Health risks of employees working in pesticide retail shops: An exploratory study.

PubMed

Kesavachandran, C; Pathak, M K; Fareed, M; Bihari, V; Mathur, N; Srivastava, A K

2009-12-01

Shop keepers dealing with pesticides are exposed to multiple pesticides that include organophosphates, organochlorines, carbamates, pyrethroids. Hence an exploratory health study was conducted on shopkeepers selling pesticides in urban areas of Lucknow and Barabanki District, Uttar Pradesh, India. Detailed information regarding socio-economic status, family history, personal habits and work practices were recorded for 20 subjects and controls by the investigator on a pre-tested questionnaire. Clinical examination including neurological studies of the shopkeepers and control subjects was done. The study revealed significant slowing of motor nerve conduction velocity and low peak expiratory flow rate among shopkeepers as compared to control subjects. Prevalence of significantly higher gastro-intestinal problems was also observed among exposed subjects. Neurological, ocular, cardiovascular and musculo-skeletal symptoms were also found to be higher among shopkeepers. This was not statistically significant. Significantly higher relative risk for sickness related to systems viz., cardio-vasular, genito-urinary, respiratory, nervous and dermal was observed among exposed subjects compared to controls. These findings provide a prima facie evidence of clinical manifestations because of multiple exposures to pesticides and poor safety culture at work place.

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

Joint association of nicotinic acetylcholine receptor variants with abdominal obesity in American Indians: the Strong Heart Family Study.

PubMed

Zhu, Yun; Yang, Jingyun; Yeh, Fawn; Cole, Shelley A; Haack, Karin; Lee, Elisa T; Howard, Barbara V; Zhao, Jinying

2014-01-01

Cigarette smoke is a strong risk factor for obesity and cardiovascular disease. The effect of genetic variants involved in nicotine metabolism on obesity or body composition has not been well studied. Though many genetic variants have previously been associated with adiposity or body fat distribution, a single variant usually confers a minimal individual risk. The goal of this study is to evaluate the joint association of multiple variants involved in cigarette smoke or nicotine dependence with obesity-related phenotypes in American Indians. To achieve this goal, we genotyped 61 tagSNPs in seven genes encoding nicotine acetylcholine receptors (nAChRs) in 3,665 American Indians participating in the Strong Heart Family Study. Single SNP association with obesity-related traits was tested using family-based association, adjusting for traditional risk factors including smoking. Joint association of all SNPs in the seven nAChRs genes were examined by gene-family analysis based on weighted truncated product method (TPM). Multiple testing was controlled by false discovery rate (FDR). Results demonstrate that multiple SNPs showed weak individual association with one or more measures of obesity, but none survived correction for multiple testing. However, gene-family analysis revealed significant associations with waist circumference (p = 0.0001) and waist-to-hip ratio (p = 0.0001), but not body mass index (p = 0.20) and percent body fat (p = 0.29), indicating that genetic variants are jointly associated with abdominal, but not general, obesity among American Indians. The observed combined genetic effect is independent of cigarette smoking per se. In conclusion, multiple variants in the nAChR gene family are jointly associated with abdominal obesity in American Indians, independent of general obesity and cigarette smoking per se.

Parallels and problems of normalization in rehabilitation and universal design: enabling connectivities

PubMed Central

2014-01-01

Purpose Universal design (UD) is oriented to creating products, buildings, outdoor spaces and services for use by all people to the fullest extent possible according to principles of enabling equal citizenship. Nevertheless its theoretical basis has been under-explored, a critique that has also been leveled at rehabilitation. This commentary explores parallels between UD and dominant rehabilitation discourses that risk privileging or discrediting particular ways of being and doing. Methods Commentary. Results Drawing from examples that explore the intersection of bodies, places and technologies with disabled people, I examined how practices of normalization risk reproducing the universalized body and legitimated forms of mobility, and in so doing perpetuates the “othering” of difference. To address these limitations, I explored the postmodern notion of multiple creative “assemblages” that are continually made and broken over time and space. Assemblages resist normalization tendencies by acknowledging and fostering multiple productive dependencies between human and non-human elements that include diverse bodies, not just those labeled disabled. Conclusion In exploring the potential of enhancing creative assemblages and multiple dependencies, space opens up in UD and rehabilitation for acknowledging, developing, and promoting a multiplicity of bodily forms and modes of mobility. Implications for Rehabilitation Universal design and rehabilitation both risk perpetuating particular ideas about what disabled people should be, do, and value, that privilege a limited range of particular bodily forms. The notion of “assemblages” provides a conceptual tool for rethinking negative views of dependence and taken for granted independence goals. In exploring the potential of enhancing various dependencies, space opens up for reconsidering disability, mobility and multiple ways of “doing-in-the-world”. PMID:24564357

Decision making under uncertainty, therapeutic inertia, and physicians' risk preferences in the management of multiple sclerosis (DIScUTIR MS).

PubMed

Saposnik, Gustavo; Sempere, Angel Perez; Raptis, Roula; Prefasi, Daniel; Selchen, Daniel; Maurino, Jorge

2016-05-04

The management of multiple sclerosis (MS) is rapidly changing by the introduction of new and more effective disease-modifying agents. The importance of risk stratification was confirmed by results on disease progression predicted by different risk score systems. Despite these advances, we know very little about medical decisions under uncertainty in the management of MS. The goal of this study is to i) identify whether overconfidence, tolerance to risk/uncertainty, herding influence medical decisions, and ii) to evaluate the frequency of therapeutic inertia (defined as lack of treatment initiation or intensification in patients not at goals of care) and its predisposing factors in the management of MS. This is a prospective study comprising a combination of case-vignettes and surveys and experiments from Neuroeconomics/behavioral economics to identify cognitive distortions associated with medical decisions and therapeutic inertia. Participants include MS fellows and MS experts from across Spain. Each participant will receive an individual link using Qualtrics platform(©) that includes 20 case-vignettes, 3 surveys, and 4 behavioral experiments. The total time for completing the study is approximately 30-35 min. Case vignettes were selected to be representative of common clinical encounters in MS practice. Surveys and experiments include standardized test to measure overconfidence, aversion to risk and ambiguity, herding (following colleague's suggestions even when not supported by the evidence), physicians' reactions to uncertainty, and questions from the Socio-Economic Panel Study (SOEP) related to risk preferences in different domains. By applying three different MS score criteria (modified Rio, EMA, Prosperini's scheme) we take into account physicians' differences in escalating therapy when evaluating medical decisions across case-vignettes. The present study applies an innovative approach by combining tools to assess medical decisions with experiments from Neuroeconomics that applies to common scenarios in MS care. Our results will help advance the field by providing a better understanding on the influence of cognitive factors (e.g., overconfidence, aversion to risk and uncertainty, herding) on medical decisions and therapeutic inertia in the management of MS which could lead to better outcomes.

Flood Risk Assessment and Forecasting for the Ganges-Brahmaputra-Meghna River Basins

NASA Astrophysics Data System (ADS)

Hopson, T. M.; Priya, S.; Young, W.; Avasthi, A.; Clayton, T. D.; Brakenridge, G. R.; Birkett, C. M.; Riddle, E. E.; Broman, D.; Boehnert, J.; Sampson, K. M.; Kettner, A.; Singh, D.

2017-12-01

During the 2017 South Asia monsoon, torrential rains and catastrophic floods affected more than 45 million people, including 16 million children, across the Ganges-Brahmaputra-Meghna (GBM) basins. The basin is recognized as one of the world's most disaster-prone regions, with severe floods occurring almost annually causing extreme loss of life and property. In light of this vulnerability, the World Bank and collaborators have contributed toward reducing future flood impacts through recent developments to improve operational preparedness for such events, as well as efforts in more general preparedness and resilience building through planning based on detailed risk assessments. With respect to improved event-specific flood preparedness through operational warnings, we discuss a new forecasting system that provides probability-based flood forecasts developed for more than 85 GBM locations. Forecasts are available online, along with near-real-time data maps of rainfall (predicted and actual) and river levels. The new system uses multiple data sets and multiple models to enhance forecasting skill, and provides improved forecasts up to 16 days in advance of the arrival of high waters. These longer lead times provide the opportunity to save both lives and livelihoods. With sufficient advance notice, for example, farmers can harvest a threatened rice crop or move vulnerable livestock to higher ground. Importantly, the forecasts not only predict future water levels but indicate the level of confidence in each forecast. Knowing whether the probability of a danger-level flood is 10 percent or 90 percent helps people to decide what, if any, action to take. With respect to efforts in general preparedness and resilience building, we also present a recent flood risk assessment, and how it provides, for the first time, a numbers-based view of the impacts of different size floods across the Ganges basin. The findings help identify priority areas for tackling flood risks (for example, relocating levees, improving flood warning systems, or boosting overall economic resilience). The assessment includes the locations and numbers of people at risk, as well as the locations and value of buildings, roads and railways, and crops at risk. An accompanying atlas includes easy-to-use risk maps and tables for the Ganges basins.

CKD and Sudden Cardiac Death: Epidemiology, Mechanisms, and Therapeutic Approaches

PubMed Central

Whitman, Isaac R.; Feldman, Harold I.

2012-01-01

Multiple studies demonstrate a strong independent association between CKD and cardiovascular events including death, heart failure, and myocardial infarction. This review focuses on recent clinical studies that expand this spectrum of adverse cardiovascular events to include ventricular arrhythmias and sudden cardiac death. In addition, experimental models suggest structural remodeling of the heart and electrophysiologic changes in this population. These processes may explain the increased arrhythmic risk in kidney disease and aid in identifying patients who are at higher risk for sudden cardiac death. Finally, we review here the data to support the use of pharmacologic and device-based therapies for both the primary and secondary prevention of sudden cardiac death. PMID:23100219

Mexican American Adolescents' Profiles of Risk and Mental Health: A Person-Centered Longitudinal Approach

ERIC Educational Resources Information Center

Zeiders, Katharine H.; Roosa, Mark W.; Knight, George P.; Gonzales, Nancy A.

2013-01-01

Although Mexican American adolescents experience multiple risk factors in their daily lives, most research examines the influences of risk factors on adjustment independently, ignoring the additive and interactive effects of multiple risk factors. Guided by a person-centered perspective and utilizing latent profile analysis, this study identified…

Gender Differences in Risk/Protection Profiles for Low Academic Performance

ERIC Educational Resources Information Center

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

2010-01-01

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.,…

Associations of School Connectedness With Adolescent Suicidality: Gender Differences and the Role of Risk of Depression

PubMed Central

Langille, Donald B; Asbridge, Mark; Cragg, Amber; Rasic, Daniel

2015-01-01

Objective: Previous studies have not examined associations of school connectedness with adolescent suicidal behaviours stratified by gender, while including a measure of depression. We analyzed survey data to determine whether there are independent protective associations of higher school connectedness with suicidal behaviours in Canadian adolescents, while controlling for potential confounders, including risk of depression; and whether such associations differ by gender. Method: Using data from a stratified cluster sample of randomly selected classes of students in schools in 3 of Canada’s Atlantic provinces, we used multiple logistic regression to examine whether associations of risk of depression, measured using the 12-item Center for Epidemiologic Studies–Depression scale, lessened protective associations of higher school connectedness with suicidal behaviours in grades 10 and 12 students, while stratifying by gender. Results: After adjusting for risk of depression, higher school connectedness was independently associated with decreased suicidal ideation in both genders and with suicidal attempt in females. In males, higher connectedness was no longer protective for suicide attempt when risk of depression was included in the model. Conclusions: School connectedness, which is felt to have positive influences on many types of adolescent behaviour, appears to also be both directly and indirectly protective for suicidality. These effects may occur through different pathways in females and males. Given the protection it offers both genders, including those at risk and not at risk of depression, increasing school connectedness should be considered as a universal adolescent mental health strategy. Studies that examine school connectedness should include analyses that examine potential differences between males and females. PMID:26175323

State of the Art: Blood Biomarkers for Risk Stratification in Patients with Stable Ischemic Heart Disease.

PubMed

Omland, Torbjørn; White, Harvey D

2017-01-01

Multiple circulating biomarkers have been associated with the incidence of cardiovascular events and proposed as potential tools for risk stratification in stable ischemic heart disease (IHD), yet current guidelines do not make any firm recommendations concerning the use of biomarkers for risk stratification in this setting. This state-of-the-art review provides an overview of biomarkers for risk stratification in stable IHD. Circulating biomarkers associated with the risk of cardiovascular events in patients with stable IHD reflect different pathophysiological processes, including myocardial injury, myocardial stress and remodeling, metabolic status, vascular inflammation, and oxidative stress. Compared to the primary prevention setting, biomarkers reflecting end-organ damage and future risk of heart failure development and cardiovascular death may play more important roles in the stable IHD setting. Accordingly, biomarkers that reflect chronic, low-grade myocardial injury, and stress, i.e., high-sensitivity cardiac troponins and natriuretic peptides, provide graded and incremental prognostic information to conventional risk markers. In contrast, in stable IHD patients the prognostic value of traditional metabolic biomarkers, including serum lipids, is limited. Among several novel biomarkers, growth-differentiation factor-15 may provide the most robust prognostic information, whereas most inflammatory markers provide limited incremental prognostic information to risk factor models that include conventional risk factors, natriuretic peptides, and high-sensitivity troponins. Circulating biomarkers hold promise as useful tools for risk stratification in stable IHD, but their future incorporation into clinically useful risk scores will depend on prospective, rigorously performed clinical trials that document enhanced risk prediction. © 2016 American Association for Clinical Chemistry.

A multiple biomarker risk score for guiding clinical decisions using a decision curve approach.

PubMed

Hughes, Maria F; Saarela, Olli; Blankenberg, Stefan; Zeller, Tanja; Havulinna, Aki S; Kuulasmaa, Kari; Yarnell, John; Schnabel, Renate B; Tiret, Laurence; Salomaa, Veikko; Evans, Alun; Kee, Frank

2012-08-01

We assessed whether a cardiovascular risk model based on classic risk factors (e.g. cholesterol, blood pressure) could refine disease prediction if it included novel biomarkers (C-reactive protein, N-terminal pro-B-type natriuretic peptide, troponin I) using a decision curve approach which can incorporate clinical consequences. We evaluated whether a model including biomarkers and classic risk factors could improve prediction of 10 year risk of cardiovascular disease (CVD; chronic heart disease and ischaemic stroke) against a classic risk factor model using a decision curve approach in two prospective MORGAM cohorts. This included 7739 men and women with 457 CVD cases from the FINRISK97 cohort; and 2524 men with 259 CVD cases from PRIME Belfast. The biomarker model improved disease prediction in FINRISK across the high-risk group (20-40%) but not in the intermediate risk group, at the 23% risk threshold net benefit was 0.0033 (95% CI 0.0013-0.0052). However, in PRIME Belfast the net benefit of decisions guided by the decision curve was improved across intermediate risk thresholds (10-20%). At p(t) = 10% in PRIME, the net benefit was 0.0059 (95% CI 0.0007-0.0112) with a net increase in 6 true positive cases per 1000 people screened and net decrease of 53 false positive cases per 1000 potentially leading to 5% fewer treatments in patients not destined for an event. The biomarker model improves 10-year CVD prediction at intermediate and high-risk thresholds and in particular, could be clinically useful at advising middle-aged European males of their CVD risk.

Profile of atrial fibrillation inpatients: Cardiovascular risk factors and cardiac rehabilitation programme delivery and referral patterns.

PubMed

Gallagher, Robyn; Zhang, Ling; Roach, Kellie; Sadler, Leonie; Belshaw, Julie; Kirkness, Ann; Proctor, Ross; Neubeck, Lis

2015-12-01

Atrial fibrillation (AF) is increasingly common; however, the cardiovascular risk factor profile and the patterns of delivery and referral to cardiac rehabilitation (CR) in this population are poorly described. We conducted an audit of medical records (n = 145) of patients admitted with AF in one local health district in Sydney, Australia. Patients were aged a mean 72 years, and 51% were male. Lack of risk factor documentation was common. Despite this, 65% had two or more modifiable cardiovascular risk factors, including hypertension (63%) and hypercholesterolaemia (52%). Referral to Phase II CR occurred for 25% and was decreased with permanent AF diagnosis and increased with more risk factors. AF patients admitted to hospital have multiple cardiovascular risk factors but limited risk factor screening and/or referral to outpatient CR programmes. © 2014 Wiley Publishing Asia Pty Ltd.

[Fitness of workers with particular sensitivity to non-ionizing radiation].

PubMed

Moccaldi, R; Grandi, C

2011-01-01

Chapter IV and V of Title VIII of D.Lgs 81/2008, implementing the Directives 2004/40/EC respectively (protection of workers exposed to electromagnetic fields) and 2006/25/EC (protection of workers exposed to artificial optical radiation), make frequent reference to the workers as "at particular risk" namely those workers who, by their biological or pathological characteristics, lifestyles, multiple exposure to other risk factors, may be more susceptible to the effects of electromagnetic fields or optical radiation. The identification of workers with particular sensitivity is essential for health surveillance, in particular regarding the determination of fitness. The operational guidance on Title VIII of D.Lgs 81/2008 drafted by the Italian Technical Coordination for Safety in the workplace of Regions and Autonomous Provinces (Document No. 1-2009), in collaboration with ISPESL and ISS, includes a preliminary identification of the categories of workers considered most susceptible to the risk from exposure to electromagnetic fields and optical radiation. On the basis of this information the authors identified more focused and structured classes of workers to be considered as "particularly sensitive to risk", it is not only related to a specific wavelength, but based on a comprehensive risk assessment in individual exposure situation, with regard to the exposure levels, any multiple exposures, the possibility of adequate personal protection.

Involvement in Specific HIV Risk Practices among Men Who Use the Internet to Find Male Partners for Unprotected Sex

PubMed Central

2013-01-01

Purpose. Men who have sex with other men (MSM) account for more than one-half of all new HIV infections in the USA. This study reports on the prevalence of a variety of HIV risk behaviors in one specific subpopulation of risk-seeking MSM. Methods. The study was based on a national sample of 332 MSM who use the Internet to find partners for unprotected sex. Data collection was conducted via telephone interviews between January 2008 and May 2009. Results. Unprotected oral and anal sex was commonplace among study participants. Men engaged in a large number of other risky behaviors as well, including having had multiple recent sex partners (mean number = 11), simultaneous double-penile penetration of the anus (16%), eating semen out of another man's anus (17%), engaging in multiple-partner sexual encounters (47%), engaging in anonymous sex (51%), and having sex while “under the influence” (52%). Conclusions. HIV intervention and prevention programs need to address numerous behaviors that place MSM at risk for contracting/transmitting HIV. Merely focusing on unprotected anal sex does a disservice to members of this community, who typically engage in many types of behavioral risks, each of which requires addressing if HIV transmission rates are to be reduced. PMID:24826369

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

PubMed Central

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

2011-01-01

Regulatory agencies are under increased pressure to consider broader public health concerns that extend to multiple pollutant exposures, multiple exposure pathways, and vulnerable populations. Specifically, cumulative risk assessment initiatives have stressed the importance of considering both chemical and non-chemical stressors, such as socioeconomic status (SES) and related psychosocial stress, in evaluating health risks. The integration of non-chemical stressors into a cumulative risk assessment framework has been largely driven by evidence of health disparities across different segments of society that may also bear a disproportionate risk from chemical exposures. This review will discuss current efforts to advance the field of cumulative risk assessment, highlighting some of the major challenges, discussed within the construct of the traditional risk assessment paradigm. Additionally, we present a summary of studies of potential interactions between social stressors and air pollutants on health as an example of current research that supports the incorporation of non-chemical stressors into risk assessment. The results from these studies, while suggestive of possible interactions, are mixed and hindered by inconsistent application of social stress indicators. Overall, while there have been significant advances, further developments across all of the risk assessment stages (i.e., hazard identification, exposure assessment, dose-response, and risk characterization) are necessary to provide a scientific basis for regulatory actions and effective community interventions, particularly when considering non-chemical stressors. A better understanding of the biological underpinnings of social stress on disease and implications for chemical-based dose-response relationships is needed. Furthermore, when considering non-chemical stressors, an appropriate metric, or series of metrics, for risk characterization is also needed. Cumulative risk assessment research will benefit from coordination of information from several different scientific disciplines, including, for example, toxicology, epidemiology, nutrition, neurotoxicology, and the social sciences. PMID:21776216

Individual Differences in Diabetes Risk: Role of Sleep Disturbances

DTIC Science & Technology

2010-08-01

and have been shown by multiple groups, including us, to be affected by sleep deprivation. So far, we have indeed measured levels of leptin and ghrelin ...for leptin and ghrelin . The new procedure described below will cut these cost by 75%. This technology will also increase the scientific output of the...the manufacturer a custom supplied panel of assays that includes insulin, pancreatic polypeptide (PP), leptin, active ghrelin , as well as the two

Assessing and Managing Multiple Risks in a Changing World – the Roskilde Recommendations

EPA Science Inventory

Roskilde University hosted a November 2015 workshop on “Environmental Risk – Assessing and Managing Multiple Risks in a Changing World”. Thirty attendees from 9 countries developed consensus recommendations regarding: implementation of a common currency (ecosyst...

A multi-disciplinary approach for the integrated assessment of multiple risks in delta areas.

NASA Astrophysics Data System (ADS)

Sperotto, Anna; Torresan, Silvia; Critto, Andrea; Marcomini, Antonio

2016-04-01

The assessment of climate change related risks is notoriously difficult due to the complex and uncertain combinations of hazardous events that might happen, the multiplicity of physical processes involved, the continuous changes and interactions of environmental and socio-economic systems. One important challenge lies in predicting and modelling cascades of natural and man -made hazard events which can be triggered by climate change, encompassing different spatial and temporal scales. Another regard the potentially difficult integration of environmental, social and economic disciplines in the multi-risk concept. Finally, the effective interaction between scientists and stakeholders is essential to ensure that multi-risk knowledge is translated into efficient adaptation and management strategies. The assessment is even more complex at the scale of deltaic systems which are particularly vulnerable to global environmental changes, due to the fragile equilibrium between the presence of valuable natural ecosystems and relevant economic activities. Improving our capacity to assess the combined effects of multiple hazards (e.g. sea-level rise, storm surges, reduction in sediment load, local subsidence, saltwater intrusion) is therefore essential to identify timely opportunities for adaptation. A holistic multi-risk approach is here proposed to integrate terminology, metrics and methodologies from different research fields (i.e. environmental, social and economic sciences) thus creating shared knowledge areas to advance multi risk assessment and management in delta regions. A first testing of the approach, including the application of Bayesian network analysis for the assessment of impacts of climate change on key natural systems (e.g. wetlands, protected areas, beaches) and socio-economic activities (e.g. agriculture, tourism), is applied in the Po river delta in Northern Italy. The approach is based on a bottom-up process involving local stakeholders early in different stages of the multi-risk assessment process (i.e. identification of objectives, collection of data, definition of risk thresholds and indicators). The results of the assessment will allow the development of multi-risk scenarios enabling the evaluation and prioritization of risk management and adaptation options under changing climate conditions.

Association between exposure to farm animals and pets and risk of Multiple Sclerosis.

PubMed

Siejka, Dylan; Taylor, Bruce; Ponsonby, Anne-Louise; Dwyer, Terence; van der Mei, Ingrid

2016-11-01

There exists inconsistent evidence regarding animals including pets as risk factors for the development of Multiple Sclerosis (MS). We investigated the association between farm animals and pets as possible environmental factors in MS development. Population based case-control study with 136 clinically definite MS cases and 272 controls randomly chosen from the community matched on sex and age. Data was collected from both questionnaire and a lifetime calendar detailing residence, occupation and pet/animal exposure over the course of participant's lives. Exposure to farming, livestock, specific farm animals and remoteness of residence showed no significant association with MS risk. Exposure to cats prior to disease onset was associated with a greater risk of MS (Adjusted Odds Ratio 2.46 (1.17-5.18)) but without a clear dose-response (test for trend, p=0.76). In contrast to other literature, farming and exposure to farm animals were not associated with MS. While we identified an association between cat exposure and MS, there was no dose-response relationship, and previous studies showed inconsistent results, leaving us to conclude that there is no strong evidence that exposure to cats is associated with MS. Copyright © 2016 Elsevier B.V. All rights reserved.

A systematic review of dynamics in climate risk and vulnerability assessments

NASA Astrophysics Data System (ADS)

Jurgilevich, Alexandra; Räsänen, Aleksi; Groundstroem, Fanny; Juhola, Sirkku

2017-01-01

Understanding climate risk is crucial for effective adaptation action, and a number of assessment methodologies have emerged. We argue that the dynamics of the individual components in climate risk and vulnerability assessments has received little attention. In order to highlight this, we systematically reviewed 42 sub-national climate risk and vulnerability assessments. We analysed the assessments using an analytical framework with which we evaluated (1) the conceptual approaches to vulnerability and exposure used, (2) if current or future risks were assessed, and (3) if and how changes over time (i.e. dynamics) were considered. Of the reviewed assessments, over half addressed future risks or vulnerability; and of these future-oriented studies, less than 1/3 considered both vulnerability and exposure dynamics. While the number of studies that include dynamics is growing, and while all studies included socio-economic aspects, often only biophysical dynamics was taken into account. We discuss the challenges of assessing socio-economic and spatial dynamics, particularly the poor availability of data and methods. We suggest that future-oriented studies assessing risk dynamics would benefit from larger stakeholder involvement, discussion of the assessment purpose, the use of multiple methods, inclusion of uncertainty/sensitivity analyses and pathway approaches.

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.

Financial well-being of older Australians with multiple health conditions.

PubMed

Temple, Jeromey B; Williams, Ruth

2018-06-01

Given recent rises in out-of-pocket health expenses, we examined the financial well-being of older Australians with multiple health conditions and disabilities. The 2014 General Social Survey was used to measure the: (i) current financial position; (ii) propensity to experience financial difficulties; and (iii) types of behaviours older people with multiple health conditions engage in to improve financial resilience. Compared to older Australians with no health conditions, respondents with multiple health conditions had lower incomes and assets and a higher propensity to hold consumer debt (once controls were included). They were at a higher risk of cash flow difficulties, dissaving to meet day-to-day living expenses and exclusion from financial providers. However, the majority of people with multiple health conditions engaged in financially resilient behaviours. Many older Australians with multiple health conditions were in a financially precarious situation with implications for the ability to afford ongoing increases in out-of-pocket health-care costs. © 2018 AJA Inc.

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

PubMed Central

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

2014-01-01

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

Stability of Core Language Skill across the First Decade of Life in Children at Biological and Social Risk

PubMed Central

Bornstein, Marc H.; Hahn, Chun-Shin; Putnick, Diane L.

2016-01-01

Background Command of language is a fundamental skill, a cornerstone of multiple cognitive and socioemotional aspects of development, and a necessary ingredient of successful adjustment and functioning in society. Little is known about the developmental stability of language in at-risk youth or which biological and social risk factors moderate stability. Methods This four-wave 10-year prospective longitudinal study evaluated stability of core language skill in 1780 children in varying categories of biological and social risk in a multiage, multidomain, multimeasure, and multireporter framework. Results Structural equation modeling supported loadings of diverse age-appropriate measures of child language on single latent variables of core language skill at 15 and 25 months and 5 and 11 years, respectively. Core language skill was stable over the first decade of life; significant and comparable stability coefficients were obtained for children with diverse biological and social risks, including poor health, welfare status, teen motherhood, ethnicity, gender, birth order, and families that changed in income and maternal education over the study period; stability in language was strong even accounting for child nonverbal intelligence and social competence, maternal education and language, and the family home environment. Conclusions Core language skill varies in stability with age but is robustly stable in children regardless of multiple biological and social risk factors. PMID:27605246

Gene-Environment Interplay in Internalizing Disorders: Consistent Findings across Six Environmental Risk Factors

PubMed Central

Hicks, Brian M.; DiRago, Ana C.; Iacono, William G.; McGue, Matt

2009-01-01

Background Newer behavior genetic methods can better elucidate gene-environment (G-E) interplay in the development of internalizing (INT) disorders (i.e., major depression and anxiety disorders). However, no study to date has conducted a comprehensive analysis examining multiple environmental risks with the purpose of delineating how general G-E mechanisms influence the development of INT disorders. Methods The sample consisted of 1315 male and female twin pairs participating in the age 17 assessment of the Minnesota Twin Family Study. Quantitative G-E interplay models were used to examine how genetic and environmental risk for INT disorders changes as a function of environmental context. Multiple measures and informants were employed to construct composite measures of INT disorders and 6 environmental risk factors including: stressful life events, mother-child and father-child relationship problems, antisocial and prosocial peer affiliation, and academic achievement and engagement. Results Significant moderation effects were detected between each environmental risk factor and INT such that in the context of greater environmental adversity, nonshared environmental factors became more important in the etiology of INT symptoms. Conclusion Our results are consistent with the interpretation that environmental stressors have a causative effect on the emergence of INT disorders. The consistency of our results suggests a general mechanism of environmental influence on INT disorders regardless of the specific form of environmental risk. PMID:19594836

Gene-environment interplay in internalizing disorders: consistent findings across six environmental risk factors.

PubMed

Hicks, Brian M; DiRago, Ana C; Iacono, William G; McGue, Matt

2009-10-01

Behavior genetic methods can help to elucidate gene-environment (G-E) interplay in the development of internalizing (INT) disorders (i.e., major depression and anxiety disorders). To date, however, no study has conducted a comprehensive analysis examining multiple environmental risk factors with the purpose of delineating general mechanisms of G-E influence in the development of INT disorders. The sample consisted of 1315 male and female twin pairs participating in the age 17 assessment of the Minnesota Twin Family Study. Quantitative G-E interplay models were used to examine how genetic and environmental risk for INT disorders changes as a function of environmental context. Multiple measures and informants were employed to construct composite measures of INT disorders and six environmental risk factors including: stressful life events, mother-child and father-child relationship problems, antisocial and prosocial peer affiliation, and academic achievement and engagement. Significant moderation effects were detected between each environmental risk factor and INT such that in the context of greater environmental adversity, nonshared environmental factors became more important in the etiology of INT symptoms. Our results are consistent with the interpretation that environmental stressors have a causative effect on the emergence of INT disorders. The consistency of our results suggests a general mechanism of environmental influence on INT disorders regardless of the specific form of environmental risk.

Violence, abuse, alcohol and drug use, and sexual behaviors in street children of Greater Cairo and Alexandria, Egypt.

PubMed

Nada, Khaled H; Suliman, El Daw A

2010-07-01

To measure the prevalence of HIV/AIDS risk behaviors and related factors in a large, probability-based sample of boys and girls aged 12-17 years living on the streets of Egypt's largest urban centers of Greater Cairo and Alexandria. Time-location sampling (TLS) was used to recruit a cross-sectional sample of street children. Procedures entailed using key informants and field observation to create a sampling frame of locations at predetermined time intervals of the day, where street children congregate in the two cities, selecting a random sample of time-locations from the complete list, and intercepting children in the selected time-locations to assess eligibility and conduct interviews. Interviews gathered basic demographic information, life events on the street (including violence, abuse, forced sex), sexual and drug use behaviors, and HIV/AIDS knowledge. A total of 857 street children were enrolled in the two cities, with an age, sex, and time-location composition matching the sampling frame. The majority of these children had faced harassment or abuse (93%) typically by police and other street children, had used drugs (62%), and, among the older adolescents, were sexually active (67%). Among the sexually active 15-17-year-olds, most reported multiple partners (54%) and never using condoms (52%). Most girls (53% in Greater Cairo and 90% in Alexandria) had experienced sexual abuse. The majority of street children experienced more than one of these risks. Overlaps with populations at highest risk for HIV were substantial, namely men who have sex with men, commercial sex workers, and injection drug users. Our study using a randomized TLS approach produced a rigorous, diverse, probability-based sample of street children and documented very high levels of multiple concurrent risks. Our findings strongly advocate for multiple services including those addressing HIV and STI prevention and care, substance use, shelters, and sensitization of authorities to the plight of street children in Egypt.

Factors for Preterm Births in Germany - An Analysis of Representative German Data (KiGGS).

PubMed

Weichert, A; Weichert, T M; Bergmann, R L; Henrich, W; Kalache, K D; Richter, R; Neymeyer, J; Bergmann, K E

2015-08-01

Introduction: Preterm birth is a global scourge, the leading cause of perinatal mortality and morbidity. This study set out to identify the principal risk factors for preterm birth, based on the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). A range of possible factors influencing preterm birth were selected for inclusion in the questionnaire, covering factors such as gender, national origin, immigrant background, demography, living standard, family structure, parental education and vocational training. Methods: All data were taken from the aforementioned KiGGS survey conducted between 2003 and 2006. A total of 17 641 children and adolescents (8656 girls and 8985 boys) drawn from 167 German towns and municipalities deemed to be representative of the Federal Republic of Germany were included in the study. Gestational age at birth was available for 14 234 datasets. The questionnaire included questions from the following areas as possible factors influencing preterm birth: gender, national origins, immigrant background, demography, living standard, family structure, parental education and vocational training. Results: The preterm birth rate was 11.6 %, higher than that of other national statistical evaluations. Around 57.4 % of multiple pregnancies and 10 % of singleton pregnancies resulted in preterm delivery. Multiple pregnancy was found to be the most important risk factor (OR 13.116). With regard to national origins and immigration background, mothers from Turkey, the Middle East, and North Africa had a higher incidence of preterm birth. Preterm birth was more prevalent in cities and large towns than in small towns and villages. Conclusion: Risk factors associated with preterm birth were identified. These should help with the early identification of pregnant women at risk. The preterm birth rate in our survey was higher than that found in other national statistical evaluations based on process data. More than half of all multiple pregnancies ended in preterm birth.

Benefit-Risk Analysis for Decision-Making: An Approach.

PubMed

Raju, G K; Gurumurthi, K; Domike, R

2016-12-01

The analysis of benefit and risk is an important aspect of decision-making throughout the drug lifecycle. In this work, the use of a benefit-risk analysis approach to support decision-making was explored. The proposed approach builds on the qualitative US Food and Drug Administration (FDA) approach to include a more explicit analysis based on international standards and guidance that enables aggregation and comparison of benefit and risk on a common basis and a lifecycle focus. The approach is demonstrated on six decisions over the lifecycle (e.g., accelerated approval, withdrawal, and traditional approval) using two case studies: natalizumab for multiple sclerosis (MS) and bedaquiline for multidrug-resistant tuberculosis (MDR-TB). © 2016 American Society for Clinical Pharmacology and Therapeutics.

Surrogate endpoints in clinical trials of chronic kidney disease progression: moving from single to multiple risk marker response scores.

PubMed

Schievink, Bauke; Mol, Peter G M; Lambers Heerspink, Hiddo J

2015-11-01

There is increased interest in developing surrogate endpoints for clinical trials of chronic kidney disease progression, as the established clinically meaningful endpoint end-stage renal disease requires large and lengthy trials to assess drug efficacy. We describe recent developments in the search for novel surrogate endpoints. Declines in estimated glomerular filtration rate (eGFR) of 30% or 40% and albuminuria have been proposed as surrogates for end-stage renal disease. However, changes in eGFR or albuminuria may not be valid under all circumstances as drugs always have effects on multiple renal risk markers. Changes in each of these other 'off-target' risk markers can alter renal risk (either beneficially or adversely), and can thereby confound the relationship between surrogates that are based on single risk markers and renal outcome. Risk algorithms that integrate the short-term drug effects on multiple risk markers to predict drug effects on hard renal outcomes may therefore be more accurate. The validity of these risk algorithms is currently investigated. Given that drugs affect multiple renal risk markers, risk scores that integrate these effects are a promising alternative to using eGFR decline or albuminuria. Proper validation is required before these risk scores can be implemented.

Informed decision-making in elective major vascular surgery: analysis of 145 surgeon-patient consultations.

PubMed

Etchells, Edward; Ferrari, Michel; Kiss, Alex; Martyn, Nikki; Zinman, Deborah; Levinson, Wendy

2011-06-01

Prior studies show significant gaps in the informed decision-making process, a central goal of surgical care. These studies have been limited by their focus on low-risk decisions, single visits rather than entire consultations, or both. Our objectives were, first, to rate informed decision-making for major elective vascular surgery based on audiotapes of actual physician-patient conversations and, second, to compare ratings of informed decision-making for first visits to ratings for multiple visits by the same patient over time. We prospectively enrolled patients for whom vascular surgical treatment was a potential option at a tertiary care outpatient vascular surgery clinic. We audio-taped all surgeon-patient conversations, including multiple visits when necessary, until a decision was made. Using an existing method, we evaluated the transcripts for elements of decision-making, including basic elements (e.g., an explanation of the clinical condition), intermediate elements (e.g., risks and benefits) and complex elements (e.g., uncertainty around the decision). We analyzed 145 surgeon-patient consultations. Overall, 45% of consultations contained complex elements, whereas 23% did not contain the basic elements of decision-making. For the 67 consultations that involved multiple visits, ratings were significantly higher when evaluating all visits (50% complex elements) compared with evaluating only the first visit (33% complex elements, p < 0.001.) We found that 45% of consultations contained complex elements, which is higher than prior studies with similar methods. Analyzing decision-making over multiple visits yielded different results than analyzing decision-making for single visits.

Programs to reduce teen pregnancy, sexually transmitted infections, and associated sexual risk behaviors: a systematic review.

PubMed

Goesling, Brian; Colman, Silvie; Trenholm, Christopher; Terzian, Mary; Moore, Kristin

2014-05-01

This systematic review provides a comprehensive, updated assessment of programs with evidence of effectiveness in reducing teen pregnancy, sexually transmitted infections (STIs), or associated sexual risk behaviors. The review was conducted in four steps. First, multiple literature search strategies were used to identify relevant studies released from 1989 through January 2011. Second, identified studies were screened against prespecified eligibility criteria. Third, studies were assessed by teams of two trained reviewers for the quality and execution of their research designs. Fourth, for studies that passed the quality assessment, the review team extracted and analyzed information on the research design, study sample, evaluation setting, and program impacts. A total of 88 studies met the review criteria for study quality and were included in the data extraction and analysis. The studies examined a range of programs delivered in diverse settings. Most studies had mixed-gender and predominately African-American research samples (70% and 51%, respectively). Randomized controlled trials accounted for the large majority (87%) of included studies. Most studies (76%) included multiple follow-ups, with sample sizes ranging from 62 to 5,244. Analysis of the study impact findings identified 31 programs with evidence of effectiveness. Research conducted since the late 1980s has identified more than two dozen teen pregnancy and STI prevention programs with evidence of effectiveness. Key strengths of this research are the large number of randomized controlled trials, the common use of multiple follow-up periods, and attention to a broad range of programs delivered in diverse settings. Two main gaps are a lack of replication studies and the need for more research on Latino youth and other high-risk populations. In addressing these gaps, researchers must overcome common limitations in study design, analysis, and reporting that have negatively affected prior research. Copyright © 2014 Society for Adolescent Health and Medicine. All rights reserved.

Pre-operative factors indicating risk of multiple operations versus a single operation in women undergoing surgery for screen detected breast cancer.

PubMed

O'Flynn, E A M; Currie, R J; Mohammed, K; Allen, S D; Michell, M J

2013-02-01

We aim to identify preoperative factors at diagnosis which could predict whether women undergoing wide local excision (WLE) would require further operations. 1593 screen-detected invasive and non-invasive breast cancers were reviewed. Age, presence of ductal carcinoma in situ (DCIS), invasive cancer size on mammography, mammographic sign, tumour type, grade and confidence of the radiologist in malignancy were compared. 83%(1315/1593) of women had a WLE. Of these, 70%(919/1315) had a single operation, and 30%(396/1315) multiple operations. These included repeat WLE to clear margins (60%(238/396)), mastectomy (34%(133/396)) and axillary dissection (6%(25/396)). The presence of mammographic microcalcification, lobular carcinoma and grade 2 malignancy on core biopsy were independent risk factors for multiple operations on multivariate analysis. Women with mammographic DCIS >30 mm were 3.4 times more likely to undergo repeat surgery than those with smaller foci. The multidisciplinary team should pay particular attention to these factors when planning surgery. Copyright © 2012 Elsevier Ltd. All rights reserved.

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.

A Meta-Analysis of Observational Studies of the Association Between Chronic Occupational Exposure to Lead and Amyotrophic Lateral Sclerosis

PubMed Central

Gomes, James; Cashman, Neil R.; Little, Julian; Krewski, Daniel

2014-01-01

Objective: The association between occupational exposure to lead and amyotrophic lateral sclerosis (ALS) was examined through systematic review and meta-analyses of relevant epidemiological studies and reported according to PRISMA guidelines. Methods: Relevant studies were searched in multiple bibliographic databases through September 2013; additional articles were tracked through PubMed until submission. All records were screened in DistillerSR, and the data extracted from included articles were synthesized with meta-analysis. Results: The risk of developing ALS among individuals with a history of exposure to lead was almost doubled (odds ratio, 1.81; 95% confidence interval, 1.39 to 2.36) on the basis of nine included case-control studies with specific lead exposure information, with no apparent heterogeneity across included studies (I2 = 14%). The attributable risk of ALS because of exposure to lead was estimated to be 5%. Conclusions: Previous exposure to lead may be a risk factor for ALS. PMID:25479292

Using a multidimensional unfolding approach to assess multiple sclerosis patient preferences for disease-modifying therapy: a pilot study

PubMed Central

Sempere, Angel Perez; Vera-Lopez, Vanesa; Gimenez-Martinez, Juana; Ruiz-Beato, Elena; Cuervo, Jesús; Maurino, Jorge

2017-01-01

Purpose Multidimensional unfolding is a multivariate method to assess preferences using a small sample size, a geometric model locating individuals and alternatives as points in a joint space. The objective was to evaluate relapsing–remitting multiple sclerosis (RRMS) patient preferences toward key disease-modifying therapy (DMT) attributes using multidimensional unfolding. Patients and methods A cross-sectional pilot study in RRMS patients was conducted. Drug attributes included relapse prevention, disease progression prevention, side-effect risk and route and schedule of administration. Assessment of preferences was performed through a five-card game. Patients were asked to value attributes from 1 (most preferred) to 5 (least preferred). Results A total of 37 patients were included; the mean age was 38.6 years, and 78.4% were female. Disease progression prevention was the most important factor (51.4%), followed by relapse prevention (40.5%). The frequency of administration had the lowest preference rating for 56.8% of patients. Finally, 19.6% valued the side-effect risk attribute as having low/very low importance. Conclusion Patients’ perspective for DMT attributes may provide valuable information to facilitate shared decision-making. Efficacy attributes were the most important drug characteristics for RRMS patients. Multidimensional unfolding seems to be a feasible approach to assess preferences in multiple sclerosis patients. Further elicitation studies using multidimensional unfolding with other stated choice methods are necessary to confirm these findings. PMID:28615928

Assessing the Safety of Vitamin A Delivered Through Large-Scale Intervention Programs: Workshop Report on Setting the Research Agenda.

PubMed

Tanumihardjo, Sherry A; Mokhtar, Najat; Haskell, Marjorie J; Brown, Kenneth H

2016-06-01

Vitamin A (VA) deficiency (VAD) is still a concern in many parts of the world, and multiple intervention strategies are being implemented to reduce the prevalence of VAD and associated morbidity and mortality. Because some individuals within a population may be exposed to multiple VA interventions, concerns have been raised about the possible risk of hypervitaminosis A. A consultative meeting was held in Vienna, Austria, in March 2014 to (1) review current knowledge concerning the safety and effectiveness of large-scale programs to control VAD, (2) develop a related research agenda, and (3) review current available methods to assess VA status and risk of hypervitaminosis A. Multiple countries were represented and shared their experiences using a variety of assessment methods, including retinol isotope dilution (RID) techniques. Discussion included next steps to refine assessment methodology, investigate RID limitations under different conditions, and review programmatic approaches to ensure VA adequacy and avoid excessive intakes. Fortification programs have resulted in adequate VA status in Guatemala, Zambia, and parts of Cameroon. Dietary patterns in several countries revealed that some people may consume excessive preformed VA from fortified foods. Additional studies are needed to compare biomarkers of tissue damage to RID methods during hypervitaminosis A and to determine what other biomarkers can be used to assess excessive preformed VA intake. © The Author(s) 2016.

Duchenne Muscular Dystrophy: a Survey of Perspectives on Carrier Testing and Communication Within the Family.

PubMed

Hayes, Brenna; Hassed, Susan; Chaloner, Jae Lindsay; Aston, Christopher E; Guy, Carrie

2016-06-01

Carrier testing is widely available for multiple genetic conditions, and several professional organizations have created practice guidelines regarding appropriate clinical application and the testing of minors. Previous research has focused on carrier screening, predictive testing, and testing for X-linked conditions. However, family perspectives on carrier testing for X-linked lethal diseases have yet to be described. In this study, we explored communication within the family about carrier testing and the perspectives of mothers of sons with an X-linked lethal disease, Duchenne muscular dystrophy (DMD). Twenty-five mothers of sons with DMD participated in an anonymous online survey. Survey questions included multiple choice, Likert scale, and open ended, short answer questions. Analysis of the multiple choice and Likert scale questions revealed that most mothers preferred a gradual style of communication with their daughters regarding risk status. In addition, most participants reported having consulted with a genetic counselor and found it helpful. Comparisons between groups, analyzed using Fisher's exact tests, found no differences in preferred style due to mother's carrier status or having a daughter. Thematic analysis was conducted on responses to open ended questions. Themes identified included the impact of family implications, age and maturity, and a desire for autonomy regarding the decision to discuss and undergo carrier testing with at-risk daughters, particularly timing of these discussions. Implications for genetic counseling practice are discussed.

Repetitive traumatic brain injury, psychological symptoms, and suicide risk in a clinical sample of deployed military personnel.

PubMed

Bryan, Craig J; Clemans, Tracy A

2013-07-01

Traumatic brain injury (TBI) is believed to be one factor contributing to rising suicide rates among military personnel and veterans. This study investigated the association of cumulative TBIs with suicide risk in a clinical sample of deployed military personnel referred for a TBI evaluation. To determine whether suicide risk is more frequent and heightened among military personnel with multiple lifetime TBIs than among those with no TBIs or a single TBI. Patients completed standardized self-report measures of depression, posttraumatic stress disorder (PTSD), and suicidal thoughts and behaviors; clinical interview; and physical examination. Group comparisons of symptom scores according to number of lifetime TBIs were made, and generalized regression analyses were used to determine the association of cumulative TBIs with suicide risk. Patients included 161 military personnel referred for evaluation and treatment of suspected head injury at a military hospital's TBI clinic in Iraq. Behavioral Health Measure depression subscale, PTSD Checklist-Military Version, concussion symptoms, and Suicide Behaviors Questionnaire-Revised. Depression, PTSD, and TBI symptom severity significantly increased with the number of TBIs. An increased incidence of lifetime suicidal thoughts or behaviors was associated with the number of TBIs (no TBIs, 0%; single TBI, 6.9%; and multiple TBIs, 21.7%; P = .009), as was suicidal ideation within the past year (0%, 3.4%, and 12.0%, respectively; P = .04). The number of TBIs was associated with greater suicide risk (β [SE] = .214 [.098]; P = .03) when the effects of depression, PTSD, and TBI symptom severity were controlled for. A significant interaction between depression and cumulative TBIs was also found (β  = .580 [.283]; P = .04). Suicide risk is higher among military personnel with more lifetime TBIs, even after controlling for clinical symptom severity. Results suggest that multiple TBIs, which are common among military personnel, may contribute to increased risk for suicide.

Upper Gastrointestinal Complications and Cardiovascular/Gastrointestinal Risk Calculator in Patients with Myocardial Infarction Treated with Aspirin.

PubMed

Wen, Lei

2017-08-20

Aspirin is widely used for the prevention of cardiovascular and cerebrovascular diseases for the past few years. However, much attention has been paid to the adverse effects associated with aspirin such as gastrointestinal bleeding. How to weigh the benefits and hazards? The current study aimed to assess the feasibility of a cardiovascular/gastrointestinal risk calculator, AsaRiskCalculator, in predicting gastrointestinal events in Chinese patients with myocardial infarction (MI), determining unique risk factor(s) for gastrointestinal events to be considered in the calculator. The MI patients who visited Shapingba District People's Hospital between January 2012 and January 2016 were retrospectively reviewed. Based on gastroscopic data, the patients were divided into two groups: gastrointestinal and nongastrointestinal groups. Demographic and clinical data of the patients were then retrieved for statistical analysis. Univariate and multiple logistic regression analyses were used to identify independent risk factors for gastrointestinal events. The receiver operating characteristic (ROC) curves were used to assess the predictive value of AsaRiskCalculator for gastrointestinal events. A total of 400 MI patients meeting the eligibility criteria were analyzed, including 94 and 306 in the gastrointestinal and nongastrointestinal groups, respectively. The data showed that age, male gender, predicted gastrointestinal events, and Helicobacter pylori (HP) infection were positively correlated with gastrointestinal events. In multiple logistic regression analysis, predicted gastrointestinal events and HP infection were identified as risk factors for actual gastrointestinal events. HP infection was highly predictive in Chinese patients; the ROC curve indicated an area under the curve of 0.822 (95% confidence interval: 0.774-0.870). The best diagnostic cutoff point of predicted gastrointestinal events was 68.0‰, yielding sensitivity and specificity of 60.6% and 93.1%, respectively, for predicting gastrointestinal events in Chinese patients with MI. AsaRiskCalculator had a predictive value for gastrointestinal events in Chinese patients with MI. HP infection seemed to be an independent risk factor for gastrointestinal events caused by long-term aspirin treatment in Chinese patients with MI, and it should be included in the risk calculator adapted for Chinese patients.

Normative beliefs and sexual risk in China.

PubMed

Li, Li; Ding, Ying Ying; Wu, Zunyou; Rotheram-Borus, Mary Jane; Guo, Sam

2011-08-01

We examined normative beliefs about multiple sexual partners and social status in China and their association with risky sexual behaviors and sexually transmitted infections (STIs). Self-reported and biological markers of sexual risk were examined among 3,716 market vendors from a city in eastern China. Men who were older or with less education believed having multiple sexual partners was linked to higher social status. Adjusting for demographic characteristics, normative beliefs were significantly associated with having multiple sexual partners, while having multiple sexual partners was significantly associated with STIs. Normative beliefs regarding sexual behaviors may play an important role in individual risk behaviors. Future HIV/STI interventions must address community beliefs about the positive meaning of sexual risks, particularly among men with traditional beliefs about gender roles.

Stroke in Saudi children. Epidemiology, clinical features and risk factors.

PubMed

Salih, Mustafa A; Abdel-Gader, Abdel-Galil M; Al-Jarallah, Ahmed A; Kentab, Amal Y; Alorainy, Ibrahim A; Hassan, Hamdy H; Bahakim, Hassan M; Kurbaan, Khadija M; Zahraa, Jihad N; Al-Nasser, Mohammed N; Nasir, Ali A; Khoja, Waleed A; Kabiraj, Mohammad M

2006-03-01

To describe the epidemiology and clinical features of stroke in a prospective and retrospective cohort of Saudi children and ascertain the causes, pathogenesis, and risk factors. The Retrospective Study Group (RSG) included children with stroke who were evaluated at the Division of Pediatric Neurology, or admitted to King Khalid University Hospital, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia during the period July 1992 to February 2001. The Prospective Study Group (PSG) included those seen between February 2001 and March 2003. During the combined study periods of 10 years and 7 months, 117 children (61 males and 56 females, aged one month-12 years) were evaluated; the majority (89%) of these were Saudis. The calculated annual hospital frequency rate of stroke was 27.1/100,000 of the pediatric (1 month-12 years) population. The mean age at onset of the initial stroke in the 104 Saudi children was 27.1 months (SD = 39.3 months) and median was 6 months. Ischemic strokes accounted for the majority of cases (76%). Large-vessel infarcts (LVI, 51.9%) were more common than small-vessel lacunar lesions (SVLL, 19.2%). Five patients (4.8%) had combined LVI and SVLL. Intracranial hemorrhage was less common (18.2%), whereas sinovenous thrombosis was diagnosed in 6 (5.8%) patients. A major risk factor was identified in 94 of 104 (89.4%) Saudi children. Significantly more hematologic disorders and coagulopathies were identified in the PSG compared to the RSG (p=0.001), reflecting a better yield following introduction of more comprehensive hematologic and coagulation laboratory tests during the prospective study period. Hematologic disorders were the most common risk factor (46.2%), presumed perinatal ischemic cerebral injury was a risk factor in 23 children (22.1%) and infectious and inflammatory disorders of the circulatory system in 18 (17.3%). Congenital and genetic cerebrovascular anomalies were the underlying cause in 7 patients (6.7%) and cardiac diseases in 6 (5.8%). Six patients (5.8%) had moyamoya syndrome, which was associated with another disease in all of them. Inherited metabolic disorders (3.8%) included 3 children with Leigh syndrome and a 29-month-old girl with mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes. Systemic vascular disease was a risk factor in 3 children (2.9%) including 2 who had hypernatremic dehydration; and post-traumatic arterial dissection was causative in 3 cases (2.9%). Several patients had multiple risk factors, whereas no risk factor could be identified in 11 (10.6%). Due to the high prevalence and importance of multiple risk factors, a comprehensive investigation, including hematologic, neuroimaging and metabolic studies should be considered in every child with stroke.

Prevalence of Risk Factors for Coronary Artery Disease in Pennsylvania (USA) Firefighters.

PubMed

Risavi, Brian L; Staszko, Jason

2016-02-01

Firefighting is a physically demanding profession. Heart disease remains the number one killer of firefighters. Many firefighters have multiple risk factors, putting them at risk for sudden cardiac events. The purpose of this study was to describe the prevalence of risk factors for heart disease in a convenience sample of Pennsylvania (USA) firefighters. A convenience sample of 160 firefighters in western Pennsylvania had height, weight, waist circumference, blood pressure, and body mass index (BMI) assessed, and then were surveyed to measure their knowledge of cardiovascular risk factors. Data analysis included subgroup comparisons of age, BMI, waist circumference, and exercise for their impact on health risks in the study cohort. In particular, the researchers were interested in understanding whether the knowledge of risk was associated with lower measures of risk. Eighteen firefighters (4%) reported a history of coronary artery disease (including stents/interventions). In this group, 69% to 82% correctly identified age, hypertension (HTN), high cholesterol, smoking, obesity, sedentary lifestyle, and family history as risk factors for coronary artery disease. Fourteen percent were smokers, 41% had HTN, 38% had pre-HTN with only 12% receiving treatment, and 13.5% were treated for high cholesterol. Fifty-eight percent exercised regularly. While a majority of firefighters were able to identify risk factors for coronary artery disease, many could not. Eighteen (4%) had a history of coronary artery disease, including interventions. Many had several of the risk factors indicated, which highlights the need for an organized national approach to address the medical screening/evaluation, nutrition, and exercise components of firefighter fitness.

Risk Factors for Invasive Fungal Disease in Pediatric Cancer and Hematopoietic Stem Cell Transplantation: A Systematic Review.

PubMed

Fisher, Brian T; Robinson, Paula D; Lehrnbecher, Thomas; Steinbach, William J; Zaoutis, Theoklis E; Phillips, Bob; Sung, Lillian

2017-05-26

Although a number of risk factors have been associated with invasive fungal disease (IFD), a systematic review of the literature to document pediatric-specific factors has not been performed. We used the Ovid SP platform to search Medline, Medline In-Process, and Embase for studies that identified risk factors for IFD in children with cancer or those who undergo hematopoietic stem cell transplantation (HSCT). We included studies if they consisted of children or adolescents (<25 years) who were receiving treatment for cancer or undergoing HSCT and if the study evaluated risk factors among patients with and those without IFD. Among the 3566 studies screened, 22 studies were included. A number of pediatric factors commonly associated with an increased risk for IFD were confirmed, including prolonged neutropenia, high-dose steroid exposure, intensive-timing chemotherapy for acute myeloid leukemia, and acute and chronic graft-versus-host disease. Increasing age, a factor not commonly associated with IFD risk, was identified as a risk factor in multiple published cohorts. With this systematic review, we have confirmed IFD risk factors that are considered routinely in daily clinical practice. Increasing age should also be considered when assessing patient risk for IFD. Future efforts should focus on defining more precise thresholds for a particular risk factor (ie, age, neutropenia duration) and on development of prediction rules inclusive of individual factors to further refine the risk prediction. © The Author 2017. Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

A 3S Risk ?3SR? Assessment Approach for Nuclear Power: Safety Security and Safeguards.

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

Forrest, Robert; Reinhardt, Jason Christian; Wheeler, Timothy A.

Safety-focused risk analysis and assessment approaches struggle to adequately include malicious, deliberate acts against the nuclear power industry's fissile and waste material, infrastructure, and facilities. Further, existing methods do not adequately address non- proliferation issues. Treating safety, security, and safeguards concerns independently is inefficient because, at best, it may not take explicit advantage of measures that provide benefits against multiple risk domains, and, at worst, it may lead to implementations that increase overall risk due to incompatibilities. What is needed is an integrated safety, security and safeguards risk (or "3SR") framework for describing and assessing nuclear power risks that canmore » enable direct trade-offs and interactions in order to inform risk management processes -- a potential paradigm shift in risk analysis and management. These proceedings of the Sandia ePRA Workshop (held August 22-23, 2017) are an attempt to begin the discussions and deliberations to extend and augment safety focused risk assessment approaches to include security concerns and begin moving towards a 3S Risk approach. Safeguards concerns were not included in this initial workshop and are left to future efforts. This workshop focused on four themes in order to begin building out a the safety and security portions of the 3S Risk toolkit: 1. Historical Approaches and Tools 2. Current Challenges 3. Modern Approaches 4. Paths Forward and Next Steps This report is organized along the four areas described above, and concludes with a summary of key points. 2 Contact: rforres@sandia.gov; +1 (925) 294-2728« less

77 FR 35852 - Safety Zones; Multiple Firework Displays in Captain of the Port, Puget Sound Zone

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-15

... 13045, Protection of Children from Environmental Health Risks and Safety Risks. This rule is not an economically significant rule and does not create an environmental risk to health or risk to safety that may... 1625-AA00 Safety Zones; Multiple Firework Displays in Captain of the Port, Puget Sound Zone AGENCY...

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 of consistent condom use with various types of sex partners and associated factors among money boys in Changsha, China.

PubMed

Wang, Lian-Hong; Yan, Jin; Yang, Guo-Li; Long, Shuo; Yu, Yong; Wu, Xi-Lin

2015-04-01

Money boys with inconsistent condom use (less than 100% of the time) are at high risk of infection by human immunodeficiency virus (HIV) or sexually transmitted infection (STI), but relatively little research has examined their risk behaviors. We investigated the prevalence of consistent condom use (100% of the time) and associated factors among money boys. A cross-sectional study using a structured questionnaire was conducted among money boys in Changsha, China, between July 2012 and January 2013. Independent variables included socio-demographic data, substance abuse history, work characteristics, and self-reported HIV and STI history. Dependent variables included the consistent condom use with different types of sex partners. Among the participants, 82.4% used condoms consistently with male clients, 80.2% with male sex partners, and 77.1% with female sex partners in the past 3 months. A multiple stepwise logistic regression model identified four statistically significant factors associated with lower likelihoods of consistent condom use with male clients: age group, substance abuse, lack of an "employment" arrangement, and having no HIV test within the prior 6 months. In a similar model, only one factor associated significantly with lower likelihoods of consistent condom use with male sex partners was identified in multiple stepwise logistic regression analyses: having no HIV test within the prior six months. As for female sex partners, two significant variables were statistically significant in the multiple stepwise logistic regression analysis: having no HIV test within the prior 6 months and having STI history. Interventions which are linked with more realistic and acceptable HIV prevention methods are greatly warranted and should increase risk awareness and the behavior of consistent condom use in both commercial and personal relationship. © 2015 International Society for Sexual Medicine.

Cardiovascular benefits of dietary fiber.

PubMed

Satija, Ambika; Hu, Frank B

2012-12-01

The relationship between dietary fiber and risk of cardiovascular disease (CVD) has been extensively studied. There is considerable epidemiological evidence indicating an inverse association between dietary fiber intake and CVD risk. The association has been found to be stronger for cereal fiber than for fruit or vegetable fiber, and several studies have also found increased whole grain consumption to be associated with CVD risk reduction. In light of this evidence, recent US dietary guidelines have endorsed increased consumption of fiber rich whole grains. Regular consumption of dietary fiber, particularly fiber from cereal sources, may improve CVD health through multiple mechanisms including lipid reduction, body weight regulation, improved glucose metabolism, blood pressure control, and reduction of chronic inflammation. Future research should focus on various food sources of fiber, including different types of whole grains, legumes, fruits, vegetables, and nuts, as well as resistant starch in relation to CVD risk and weight control; explore the biological mechanisms underlying the cardioprotective effect of fiber-rich diets; and study different ethnic groups and populations with varying sources of dietary fiber.

Families at risk of poor parenting: a model for service delivery, assessment, and intervention.

PubMed

Ayoub, C; Jacewitz, M M

1982-01-01

The At Risk Parent Child Program is a multidisciplinary network agency designed for the secondary prevention of poor parenting and the extremes of child abuse and neglect. This model system of service delivery emphasizes (1) the coordination of existing community resources to access a target population of families at risk of parenting problems, (2) the provision of multiple special services in a neutral location (ambulatory pediatric clinic), and (3) the importance of intensive individual contact with a clinical professional who serves as primary therapist, social advocate and service coordinator for client families. Identification and assessment of families is best done during prenatal and perinatal periods. Both formal and informal procedures for screening for risk factors are described, and a simple set of at risk criteria for use by hospital nursing staff is provided. Preventive intervention strategies include special medical, psychological, social and developmental services, offered in an inpatient; outpatient, or in-home setting. Matching family needs to modality and setting of treatment is a major program concern. All direct services to at risk families are supplied by professionals employed within existing local agencies (hospital, public health department, state guidance center, and medical school pediatric clinic). Multiple agency involvement allows a broad-based screening capacity which allows thousands of families routine access to program services. The administrative center of the network stands as an independent, community-funded core which coordinates and monitors direct clinical services, and provides local political advocacy for families at risk of parenting problems.

Does the Type of Metal Instrumentation Affect the Risk of Surgical Site Infection in Pediatric Scoliosis Surgery?

PubMed

Wright, Margaret L; Skaggs, David L; Matsumoto, Hiroko; Woon, Regina P; Trocle, Ashley; Flynn, John M; Vitale, Michael G

2016-05-01

Retrospective cohort study. To determine the association of implant metal composition with the risk of surgical site infection (SSI) following pediatric spine surgery. SSI is a well-described complication following pediatric spine surgery. Many risk factors have been identified in the literature, but controversy remains regarding metal composition as a risk factor. This was a retrospective study of patients who underwent posterior spinal instrumentation procedures between January 1, 2006, and December 31, 2008, at three large children's hospitals for any etiology of scoliosis and had at least 1 year of postoperative follow-up. Procedures included posterior spinal fusion, growth-friendly instrumentation, and revision of spinal instrumentation. The Centers for Disease Control and Prevention definition of SSI was used. A chi-squared test was performed to determine the relationship between type of metal instrumentation and development of an SSI. The study included 874 patients who underwent 1,156 total procedures. Overall, 752 (65%) procedures used stainless steel instrumentation, 238 (21%) procedures used titanium instrumentation, and the remaining 166 (14%) procedures used cobalt chrome and titanium hybrid instrumentation. The overall risk of infection was 6.1% (70/1,156) per procedure, with 5.9% (44/752) for stainless steel, 6.7% (12/238) for titanium, and 6.0% (10/166) for cobalt chrome. The multiple regression analysis found no significant differences in the metal type used between patients with and without infection (p = .886) adjusting for etiology, instrumentation to pelvis, and type of procedures. When stratified based on etiology, the multiple regression analyses also found no significant difference in SSI between two metal type groups. This study found no difference in risk of infection with stainless steel, titanium, or cobalt chrome/titanium instrumentation and is adequately powered to detect a true difference in risk of SSI. Level II, prognostic. Copyright © 2016 Scoliosis Research Society. Published by Elsevier Inc. All rights reserved.

Assessing the potential impact of non-proprietary drug copies on quality of medicine and treatment in patients with relapsing multiple sclerosis: the experience with fingolimod.

PubMed

Correale, Jorge; Chiquete, Erwin; Milojevic, Snezana; Frider, Nadina; Bajusz, Imre

2014-01-01

Fingolimod is a once-daily oral treatment for relapsing multiple sclerosis, the proprietary production processes of which are tightly controlled, owing to its susceptibility to contamination by impurities, including genotoxic impurities. Many markets produce nonproprietary medicines; assessing their efficacy and safety is difficult as regulators may approve nonproprietary drugs without bioequivalence data, genotoxic evaluation, or risk management plans (RMPs). This assessment is especially important for fingolimod given its solubility/bioavailability profile, genotoxicity risk, and low-dose final product (0.5 mg). This paper presents an evaluation of the quality of proprietary and nonproprietary fingolimod variants. Proprietary fingolimod was used as a reference substance against which eleven nonproprietary fingolimod copies were assessed. The microparticle size distribution of each compound was assessed by laser light diffraction, and inorganic impurity content by sulfated ash testing. Heavy metals content was quantified using inductively coupled plasma optical emission spectrometry, and levels of unspecified impurities by high-performance liquid chromatography. Solubility was assessed in a range of solvents at different pH values. Key information from the fingolimod RMP is also presented. Nonproprietary fingolimod variants exhibited properties out of proprietary or internationally accepted specifications, including differences in particle size distribution and levels of impurities such as heavy metals. For microparticle size and heavy metals, all tested fingolimod copies were out-of-specification by several-fold magnitudes. Proprietary fingolimod has a well-defined RMP, highlighting known and potential mid- to long-term safety risks, and risk-minimization and pharmacovigilance procedures. Nonproprietary fingolimod copies produced by processes less well controlled than or altered from proprietary production processes may reduce product reproducibility and quality, potentially presenting risks to patients. Safety data and risk-minimization strategies for proprietary fingolimod may not apply to the nonproprietary fingolimod copies evaluated here. Market authorization of nonproprietary fingolimod copies should require an appropriate RMP to minimize risks to patients.

Risk Prediction Models for Other Cancers or Multiple Sites

Cancer.gov

Developing statistical models that estimate the probability of developing other multiple cancers over a defined period of time will help clinicians identify individuals at higher risk of specific cancers, allowing for earlier or more frequent screening and counseling of behavioral changes to decrease risk.

[Communication on health and safety risk control in contemporary society: an interdisciplinary approach].

PubMed

Rangel-S, Maria Ligia

2007-01-01

This paper discusses communication as a technology for risk control with health and safety protection and promotion, within the context of a "risk society". As a component of Risk Analysis, risk communication is a technology that appears in risk literature, with well defined objectives, principles and models. These aspects are described and the difficulties are stressed, taking into consideration the multiple rationales related to risks in the culture and the many different aspects of risk regulation and control in the so-called "late modernity". Consideration is also given to the complexity of the communications process, guided by theoretical and methodological discussions in the field. In order to understand the true value of the communications field for risk control with health and safety protection and promotion, this paper also offers an overview of communication theories that support discussions of this matter, proposing a critical approach to models that include the dimensions of power and culture in the context of a capitalist society.

Shifting orders among suppliers considering risk, price and transportation cost

NASA Astrophysics Data System (ADS)

Revitasari, C.; Pujawan, I. N.

2018-04-01

Supplier order allocation is an important supply chain decision for an enterprise. It is related to the supplier’s function as a raw material provider and other supporting materials that will be used in production process. Most of works on order allocation has been based on costs and other supply chain performance, but very limited of them taking risks into consideration. In this paper we address the problem of order allocation of a single commodity sourced from multiple suppliers considering supply risks in addition to the attempt of minimizing transportation costs. The supply chain risk was investigated and a procedure was proposed in the risk mitigation phase as a form of risk profile. The objective including risk profile in order allocation is to maximize the product flow from a risky supplier to a relatively less risky supplier. The proposed procedure is applied to a sugar company. The result suggests that order allocations should be maximized to suppliers that have a relatively low risk and minimized to suppliers that have a relatively larger risks.

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.

When Is It Too Early for Single Sport Specialization?

PubMed

Feeley, Brian T; Agel, Julie; LaPrade, Robert F

2016-01-01

Over the past 15 years, there has been an increase in youth sports participation with a concomitant increase in early year-round training in a single sport. Many factors contribute to the desire of parents and coaches to encourage early single sport specialization, including the desire to give the young athlete an edge in competition, pursuit of scholarships, and potential professional status, and the ability to label a young athlete as elite at an early age. Despite these perceived advantages, some data suggest that early sport specialization does not lead to a competitive advantage over athletes who participate in multiple sports. Although the data are limited, there is some evidence that early sport specialization may put the young athlete at risk for overuse injuries. The focus of this review is to highlight the evidence regarding early sport specialization and risk for injury; discuss the risk factors for overuse injury in high-risk sports including ice hockey, swimming, gymnastics, and baseball; and discuss future potential research that would help define the risk of injury for young athletes who participate in early sport specialization. © 2015 The Author(s).

Reversal of Hartmann's procedure: a high-risk operation?

PubMed

Schmelzer, Thomas M; Mostafa, Gamal; Norton, H James; Newcomb, William L; Hope, William W; Lincourt, Amy E; Kercher, Kent W; Kuwada, Timothy S; Gersin, Keith S; Heniford, B Todd

2007-10-01

Patients who undergo Hartmann's procedure often do not have their colostomy closed based on the perceived risk of the operation. This study evaluated the outcome of reversal of Hartmann's procedure based on preoperative risk factors. We retrospectively reviewed adult patients who underwent reversal of Hartmann's procedure at our tertiary referral institution. Patient outcomes were compared based on identified risk factors (age >60 years, American Society of Anesthesiologists [ASA] score >2, and >2 preoperative comorbidities). One-hundred thirteen patients were included. Forty-four patients (39%) had an ASA score of >or=3. The mean hospital duration of stay was 6.8 days. There were 28 (25%) postoperative complications and no mortality. Patients >60 years old had significantly longer LOS compared with the rest of the group (P = .02). There were no differences in outcomes between groups based on ASA score or the presence of multiple preoperative comorbidities. An albumin level of <3.5 was the only significant predictor of postoperative complications (P = .04). The reversal of Hartmann's operation appears to be a safe operation with acceptable morbidity rates and can be considered in patients, including those with significant operative risk factors.

Profiles of Cognitive Appraisals and Triangulation into Interparental Conflict: Implications for Adolescent Adjustment

PubMed Central

Fosco, Gregory M.; Bray, Bethany C.

2016-01-01

Youth appraisals and triangulation into conflicts are key mechanisms by which interparental conflict places youth at risk for psychological maladjustment. Although evidence suggests that there are multiple mechanisms at work (e.g., Fosco & Feinberg, 2015; Grych, Harold, & Miles, 2003), this body of work has relied on variable-centered analyses that are limited to the unique contributions of each process to the variance in outcomes. In reality, it is possible that different combinations of these risk mechanisms may account for multifinality in risk outcomes. Using latent profile analysis (LPA) we examined profiles of threat appraisals, self-blaming attributions, and triangulation in relation to internalizing and externalizing problems in a sample of 285, ethnically diverse high school students. The current analyses revealed five distinct profiles of appraisals and triangulation, including an overall low-risk group and a global high-risk group, in which all three processes were below average or above average, respectively. Additional profiles included combinations of threat and blame, threat and triangulation, and blame and triangulation. Links between these profiles and emotional distress, problem behavior, and academic outcomes are discussed. PMID:26963695

Alcohol demand and risk preference.

PubMed

Dave, Dhaval; Saffer, Henry

2008-12-01

Both economists and psychologists have studied the concept of risk preference. Economists categorize individuals as more or less risk-tolerant based on the marginal utility of income. Psychologists categorize individuals' propensity towards risk based on harm avoidance, novelty seeking and reward dependence traits. The two concepts of risk are related, although the instruments used for empirical measurement are quite different. Psychologists have found risk preference to be an important determinant of alcohol consumption; however economists have not included risk preference in studies of alcohol demand. This is the first study to examine the effect of risk preference on alcohol consumption in the context of a demand function. The specifications employ multiple waves from the Panel Study of Income Dynamics (PSID) and the Health and Retirement Study (HRS), which permit the estimation of age-specific models based on nationally representative samples. Both of these data sets include a unique and consistent survey instrument designed to directly measure risk preference in accordance with the economist's definition. This study estimates the direct impact of risk preference on alcohol demand and also explores how risk preference affects the price elasticity of demand. The empirical results indicate that risk preference has a significant negative effect on alcohol consumption, with the prevalence and consumption among risk-tolerant individuals being 6-8% higher. Furthermore, the tax elasticity is similar across both risk-averse and risk-tolerant individuals. This suggests that tax policies are as equally effective in deterring alcohol consumption among those who have a higher versus a lower propensity for alcohol use.

Sexual health risk reduction interventions for people with severe mental illness: a systematic review.

PubMed

Pandor, Abdullah; Kaltenthaler, Eva; Higgins, Agnes; Lorimer, Karen; Smith, Shubulade; Wylie, Kevan; Wong, Ruth

2015-02-12

Despite variability in sexual activity among people with severe mental illness, high-risk sexual behavior (e.g. unprotected intercourse, multiple partners, sex trade and illicit drug use) is common. Sexual health risk reduction interventions (such as educational and behavioral interventions, motivational exercises, counselling and service delivery), developed and implemented for people with severe mental illness, may improve participants' knowledge, attitudes, beliefs behaviors or practices (including assertiveness skills) and could lead to a reduction in risky sexual behavior. This systematic review evaluates the effectiveness of sexual health risk reduction interventions for people with severe mental illness. Thirteen electronic databases (including MEDLINE, EMBASE and PsycINFO) were searched to August 2014, and supplemented by hand-searching relevant articles and contacting experts. All controlled trials (randomized or non-randomized) comparing the effectiveness of sexual health risk reduction interventions with usual care for individuals living in the community with severe mental illness were included. Outcomes included a range of biological, behavioral and proxy endpoints. Narrative synthesis was used to combine the evidence. Thirteen controlled trials (all from the USA) were included. Although there was no clear and consistent evidence that interventions reduce the total number of sex partners or improved behavioral intentions in sexual risk behavior, positive effects were generally observed in condom use, condom protected intercourse and on measures of HIV knowledge, attitudes to condom use and sexual behaviors and practices. However, the robustness of these findings is low due to the large between study variability, small sample sizes and low-to-moderate quality of included studies. There is insufficient evidence at present to fully support or reject the identified sexual health risk reduction interventions for people with severe mental illness. Given the serious consequences of high-risk sexual behaviors, there is an urgent need for well-designed UK based trials, as well as training and support for staff implementing sexual health risk reduction interventions. PROSPERO CRD42013003674 .