Proposals for enhanced health risk assessment and stratification in an integrated care scenario.

PubMed

Dueñas-Espín, Ivan; Vela, Emili; Pauws, Steffen; Bescos, Cristina; Cano, Isaac; Cleries, Montserrat; Contel, Joan Carles; de Manuel Keenoy, Esteban; Garcia-Aymerich, Judith; Gomez-Cabrero, David; Kaye, Rachelle; Lahr, Maarten M H; Lluch-Ariet, Magí; Moharra, Montserrat; Monterde, David; Mora, Joana; Nalin, Marco; Pavlickova, Andrea; Piera, Jordi; Ponce, Sara; Santaeugenia, Sebastià; Schonenberg, Helen; Störk, Stefan; Tegner, Jesper; Velickovski, Filip; Westerteicher, Christoph; Roca, Josep

2016-04-15

Population-based health risk assessment and stratification are considered highly relevant for large-scale implementation of integrated care by facilitating services design and case identification. The principal objective of the study was to analyse five health-risk assessment strategies and health indicators used in the five regions participating in the Advancing Care Coordination and Telehealth Deployment (ACT) programme (http://www.act-programme.eu). The second purpose was to elaborate on strategies toward enhanced health risk predictive modelling in the clinical scenario. The five ACT regions: Scotland (UK), Basque Country (ES), Catalonia (ES), Lombardy (I) and Groningen (NL). Responsible teams for regional data management in the five ACT regions. We characterised and compared risk assessment strategies among ACT regions by analysing operational health risk predictive modelling tools for population-based stratification, as well as available health indicators at regional level. The analysis of the risk assessment tool deployed in Catalonia in 2015 (GMAs, Adjusted Morbidity Groups) was used as a basis to propose how population-based analytics could contribute to clinical risk prediction. There was consensus on the need for a population health approach to generate health risk predictive modelling. However, this strategy was fully in place only in two ACT regions: Basque Country and Catalonia. We found marked differences among regions in health risk predictive modelling tools and health indicators, and identified key factors constraining their comparability. The research proposes means to overcome current limitations and the use of population-based health risk prediction for enhanced clinical risk assessment. The results indicate the need for further efforts to improve both comparability and flexibility of current population-based health risk predictive modelling approaches. Applicability and impact of the proposals for enhanced clinical risk assessment require prospective evaluation. 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/

Sexual orientation and suicidal behaviour in adolescents and young adults: systematic review and meta-analysis.

PubMed

Miranda-Mendizábal, A; Castellví, P; Parés-Badell, O; Almenara, J; Alonso, I; Blasco, M J; Cebrià, A; Gabilondo, A; Gili, M; Lagares, C; Piqueras, J A; Roca, M; Rodríguez-Marín, J; Rodríguez-Jiménez, T; Soto-Sanz, V; Vilagut, G; Alonso, J

2017-08-01

Background Research suggests that lesbian, gay and bisexual (LGB) adolescents have a higher risk of suicidal behaviours than their heterosexual peers, but little is known about specific risk factors. Aims To assess sexual orientation as a risk factor for suicidal behaviours, and to identify other risk factors among LGB adolescents and young adults. Method A systematic search was made of six databases up to June 2015, including a grey literature search. Population-based longitudinal studies considering non-clinical populations aged 12-26 years and assessing being LGB as a risk factor for suicidal behaviour compared with being heterosexual, or evaluating risk factors for suicidal behaviour within LGB populations, were included. Random effect models were used in meta-analysis. Results Sexual orientation was significantly associated with suicide attempts in adolescents and youths (OR = 2.26, 95% CI 1.60-3.20). Gay or bisexual men were more likely to report suicide attempts compared with heterosexual men (OR = 2.21, 95% CI 1.21-4.04). Based on two studies, a non-significant positive association was found between depression and suicide attempts in LGB groups. Conclusions Sexual orientation is associated with a higher risk of suicide attempt in young people. Further research is needed to assess completed suicide, and specific risk factors affecting the LGB population. © The Royal College of Psychiatrists 2017.

Developing an Integrated, Brief Biobehavioral HIV Prevention Intervention for High-Risk Drug Users in Treatment: The Process and Outcome of Formative Research

PubMed Central

Shrestha, Roman; Altice, Frederick; Karki, Pramila; Copenhaver, Michael

2017-01-01

To date, HIV prevention efforts have largely relied on singular strategies (e.g., behavioral or biomedical approaches alone) with modest HIV risk-reduction outcomes for people who use drugs (PWUD), many of whom experience a wide range of neurocognitive impairments (NCI). We report on the process and outcome of our formative research aimed at developing an integrated biobehavioral approach that incorporates innovative strategies to address the HIV prevention and cognitive needs of high-risk PWUD in drug treatment. Our formative work involved first adapting an evidence-based behavioral intervention—guided by the Assessment–Decision–Administration–Production–Topical experts–Integration–Training–Testing model—and then combining the behavioral intervention with an evidence-based biomedical intervention for implementation among the target population. This process involved eliciting data through structured focus groups (FGs) with key stakeholders—members of the target population (n = 20) and treatment providers (n = 10). Analysis of FG data followed a thematic analysis approach utilizing several qualitative data analysis techniques, including inductive analysis and cross-case analysis. Based on all information, we integrated the adapted community-friendly health recovery program—a brief evidence-based HIV prevention behavioral intervention—with the evidence-based biomedical component [i.e., preexposure prophylaxis (PrEP)], an approach that incorporates innovative strategies to accommodate individuals with NCI. This combination approach—now called the biobehavioral community-friendly health recovery program—is designed to address HIV-related risk behaviors and PrEP uptake and adherence as experienced by many PWUD in treatment. This study provides a complete example of the process of selecting, adapting, and integrating the evidence-based interventions—taking into account both empirical evidence and input from target population members and target organization stakeholders. The resultant brief evidence-based biobehavioral approach could significantly advance primary prevention science by cost-effectively optimizing PrEP adherence and HIV risk reduction within common drug treatment settings. PMID:28553295

Which population groups are most unaware of CVD risks associated with sitting time?

PubMed

Duncan, Mitch J; Gilson, Nicholas; Vandelanotte, Corneel

2014-08-01

Prolonged sitting is an emerging risk factor for poor health yet few studies have examined awareness of the risks associated with sitting behaviours. This study identifies the population subgroups with the highest levels of unawareness regarding the cardiovascular disease (CVD) risks associated with sitting behaviours. Adults (n=1256) living in Queensland, Australia completed a telephone-based survey in 2011, analysis conducted in 2013. The survey assessed participant's socio-demographic characteristics, physical activity, sitting behaviours and awareness of CVD risks associated with three sitting behaviours: 1) sitting for prolonged periods, 2), sitting for prolonged periods whilst also engaging in regular physical activity, and 3) breaking up periods of prolonged sitting with short activity breaks. Population sub-groups with the highest levels of unawareness were identified based on socio-demographic and behavioural characteristics using signal detection analysis. Unawareness ranged from 23.3% to 67.0%. Age was the most important variable in differentiating awareness levels; younger adults had higher levels of unawareness. Body mass index, physical activity, TV viewing, employment status and time spent at work also identified population sub-groups. Unawareness of CVD risk for prolonged sitting was moderately high overall. Younger adults had high levels of unawareness on all of the outcomes examined. Copyright © 2014 Elsevier Inc. All rights reserved.

Influence of arterial hypertension, type 2 diabetes and cardiovascular risk factors on ALS outcome: a population-based study.

PubMed

Moglia, Cristina; Calvo, Andrea; Canosa, Antonio; Bertuzzo, Davide; Cugnasco, Paolo; Solero, Luca; Grassano, Maurizio; Bersano, Enrica; Cammarosano, Stefania; Manera, Umberto; Pisano, Fabrizio; Mazzini, Letizia; Dalla Vecchia, Laura A; Mora, Gabriele; Chiò, Adriano

2017-11-01

To assess the prognostic influence of pre-morbid type 2 diabetes mellitus, arterial hypertension and cardiovascular (CV) risk profile on ALS phenotype and outcome in a population-based cohort of Italian patients. A total of 650 ALS patients from the Piemonte/Valle d'Aosta Register for ALS, incident in the 2007-2011 period, were recruited. Information about premorbid presence of type 2 diabetes mellitus, arterial hypertension was collected at the time of diagnosis. Patients' CV risk profile was calculated according to the Joint British Societies' guidelines on prevention of cardiovascular disease in clinical practice (JBS2). At the univariate analysis, the presence of pre-morbid arterial hypertension was associated with a higher age at onset of ALS and a shorter survival, and patients with a high CV risk profile had a worse prognosis than those with a low CV risk profile. The Cox multivariable analysis did not confirm such findings. Type 2 diabetes mellitus did not modify either the phenotype or the prognosis of ALS patients. This study performed on a large population-based cohort of ALS patients has demonstrated that arterial hypertension, type 2 diabetes and CV risk factors, calculated using the Framingham equation, do not influence ALS phenotype and prognosis.

Risk of colorectal cancer in patients with ulcerative colitis: a meta-analysis of population-based cohort studies.

PubMed

Jess, Tine; Rungoe, Christine; Peyrin-Biroulet, Laurent

2012-06-01

Patients with ulcerative colitis (UC) have an increased risk of developing colorectal cancer (CRC). Studies examining the magnitude of this association have yielded conflicting results. We performed a meta-analysis of population-based cohort studies to determine the risk of CRC in patients with UC. We used MEDLINE, EMBASE, Cochrane, and CINAHL to perform a systematic literature search. We included 8 studies in the meta-analysis on the basis of strict inclusion and exclusion criteria. We calculated pooled standardized incidence ratios (SIRs) with 95% confidence intervals (CIs) for risk of CRC in patients with UC and performed meta-regression analyses of the effect of cohort size, calendar period, observation time, percentage with proctitis, and rates of colectomy on the risk of CRC. An average of 1.6% of patients with UC was diagnosed with CRC during 14 years of follow-up. SIRs ranged from 1.05 to 3.1, with a pooled SIR of 2.4 (95% CI, 2.1-2.7). Men with UC had a greater risk of CRC (SIR, 2.6; 95% CI, 2.2-3.0) than women (SIR, 1.9; 95% CI, 1.5-2.3). Young age was a risk factor for CRC (SIR, 8.6; 95% CI, 3.8-19.5; although this might have resulted from small numbers), as was extensive colitis (SIR, 4.8; 95% CI, 3.9-5.9). In meta-regression analyses, only cohort size was associated with risk of CRC. In population-based cohorts, UC increases the risk of CRC 2.4-fold. Male sex, young age at diagnosis with UC, and extensive colitis increase the risk. Copyright © 2012 AGA Institute. Published by Elsevier Inc. All rights reserved.

Validation of a new mortality risk prediction model for people 65 years and older in northwest Russia: The Crystal risk score.

PubMed

Turusheva, Anna; Frolova, Elena; Bert, Vaes; Hegendoerfer, Eralda; Degryse, Jean-Marie

2017-07-01

Prediction models help to make decisions about further management in clinical practice. This study aims to develop a mortality risk score based on previously identified risk predictors and to perform internal and external validations. In a population-based prospective cohort study of 611 community-dwelling individuals aged 65+ in St. Petersburg (Russia), all-cause mortality risks over 2.5 years follow-up were determined based on the results obtained from anthropometry, medical history, physical performance tests, spirometry and laboratory tests. C-statistic, risk reclassification analysis, integrated discrimination improvement analysis, decision curves analysis, internal validation and external validation were performed. Older adults were at higher risk for mortality [HR (95%CI)=4.54 (3.73-5.52)] when two or more of the following components were present: poor physical performance, low muscle mass, poor lung function, and anemia. If anemia was combined with high C-reactive protein (CRP) and high B-type natriuretic peptide (BNP) was added the HR (95%CI) was slightly higher (5.81 (4.73-7.14)) even after adjusting for age, sex and comorbidities. Our models were validated in an external population of adults 80+. The extended model had a better predictive capacity for cardiovascular mortality [HR (95%CI)=5.05 (2.23-11.44)] compared to the baseline model [HR (95%CI)=2.17 (1.18-4.00)] in the external population. We developed and validated a new risk prediction score that may be used to identify older adults at higher risk for mortality in Russia. Additional studies need to determine which targeted interventions improve the outcomes of these at-risk individuals. Copyright © 2017 Elsevier B.V. All rights reserved.

ANALYSIS TO ACCOUNT FOR SMALL AGE RANGE CATEGORIES IN DISTRIBUTIONS OF WATER CONSUMPTION AND BODY WEIGHT IN THE U.S. USING CSFII DATA

EPA Science Inventory

Statistical population based estimates of water ingestion play a vital role in many types of exposure and risk analysis. A significant large scale analysis of water ingestion by the population of the United States was recently completed and is documented in the report titled ...

Presenting health risk information in different formats: the effect on participants' cognitive and emotional evaluation and decisions.

PubMed

Timmermans, Daniëlle R M; Ockhuysen-Vermey, Caroline F; Henneman, Lidewij

2008-12-01

Effective communication of health risks plays an important role in enabling patients to make adequate decisions. There is little--though contradictory--evidence to indicate which format is most effective for communicating risks, and which risk format is preferred by counselees. In an experiment, subjects were presented health scenarios and risk information in different formats (percentages, frequencies, and population figures) and asked to evaluate the risks and make a decision based on these. Different risk formats had different effects on respondents' evaluation of the health risks presented. Contrary to our expectation, population figures were not evaluated as being the easiest format for all decision problems. Population figures were shown to have the biggest affective impact, and risks presented as population figures were also evaluated as significantly greater than the risks presented in other formats. The format of the presented risks influenced their decision in only one out of four decision-making situations, although in a second situation there was a similar trend. This study suggests that the risk format plays a role in the decision-making process, although it remains unclear which format is the most effective in terms of understanding. More experimental studies based on a theoretical analysis of the factors that promote effective risk communication are needed in the general population as well as in clinical settings with patients actually experiencing the risks and making the decisions.

Apolipoprotein C3 Gene Polymorphisms Are Not a Risk Factor for Developing Non-Alcoholic Fatty Liver Disease: A Meta-Analysis

PubMed Central

Zhang, Haiying; Chen, Lizhen; Xin, Yongning; Lou, Yuangui; Liu, Yang; Xuan, Shiying

2014-01-01

Context: Our objective was to evaluate the effect of gene polymorphisms of apolipoprotein C3 (APOC3) on the development of non-alcoholic fatty liver disease (NAFLD) in different populations. Evidence Acquisition: We performed a meta-analysis of all relevant studies published in the literature. A total of 115 clinical trials or reports were identified, but only seven trials met our inclusion criteria. A meta-analysis was performed according to the Cochrane Reviewers’ Handbook recommendations. Results: Five hospital-based and two population-based case-control studies were included in the final analysis. The overall frequency of APOC3 gene polymorphisms was 67.5% (1177/1745) in NAFLD and 68.8% (988/1437) in controls. The summary odds ratio for the association of gene polymorphisms of APOC3 and the risk of NAFLD was 1.03 (95% CI: 0.89-1.22),which was not statistically significant (P > 0.05). Conclusions: Our meta-analysis, while not ruling out possible publication bias, showed no association between gene polymorphisms of APOC3 and the risk of NAFLD development in different populations in the world. PMID:25477977

Cost-effectiveness of population based BRCA testing with varying Ashkenazi Jewish ancestry.

PubMed

Manchanda, Ranjit; Patel, Shreeya; Antoniou, Antonis C; Levy-Lahad, Ephrat; Turnbull, Clare; Evans, D Gareth; Hopper, John L; Macinnis, Robert J; Menon, Usha; Jacobs, Ian; Legood, Rosa

2017-11-01

Population-based BRCA1/BRCA2 testing has been found to be cost-effective compared with family history-based testing in Ashkenazi-Jewish women were >30 years old with 4 Ashkenazi-Jewish grandparents. However, individuals may have 1, 2, or 3 Ashkenazi-Jewish grandparents, and cost-effectiveness data are lacking at these lower BRCA prevalence estimates. We present an updated cost-effectiveness analysis of population BRCA1/BRCA2 testing for women with 1, 2, and 3 Ashkenazi-Jewish grandparents. Decision analysis model. Lifetime costs and effects of population and family history-based testing were compared with the use of a decision analysis model. 56% BRCA carriers are missed by family history criteria alone. Analyses were conducted for United Kingdom and United States populations. Model parameters were obtained from the Genetic Cancer Prediction through Population Screening trial and published literature. Model parameters and BRCA population prevalence for individuals with 3, 2, or 1 Ashkenazi-Jewish grandparent were adjusted for the relative frequency of BRCA mutations in the Ashkenazi-Jewish and general populations. Incremental cost-effectiveness ratios were calculated for all Ashkenazi-Jewish grandparent scenarios. Costs, along with outcomes, were discounted at 3.5%. The time horizon of the analysis is "life-time," and perspective is "payer." Probabilistic sensitivity analysis evaluated model uncertainty. Population testing for BRCA mutations is cost-saving in Ashkenazi-Jewish women with 2, 3, or 4 grandparents (22-33 days life-gained) in the United Kingdom and 1, 2, 3, or 4 grandparents (12-26 days life-gained) in the United States populations, respectively. It is also extremely cost-effective in women in the United Kingdom with just 1 Ashkenazi-Jewish grandparent with an incremental cost-effectiveness ratio of £863 per quality-adjusted life-years and 15 days life gained. Results show that population-testing remains cost-effective at the £20,000-30000 per quality-adjusted life-years and $100,000 per quality-adjusted life-years willingness-to-pay thresholds for all 4 Ashkenazi-Jewish grandparent scenarios, with ≥95% simulations found to be cost-effective on probabilistic sensitivity analysis. Population-testing remains cost-effective in the absence of reduction in breast cancer risk from oophorectomy and at lower risk-reducing mastectomy (13%) or risk-reducing salpingo-oophorectomy (20%) rates. Population testing for BRCA mutations with varying levels of Ashkenazi-Jewish ancestry is cost-effective in the United Kingdom and the United States. These results support population testing in Ashkenazi-Jewish women with 1-4 Ashkenazi-Jewish grandparent ancestry. Copyright © 2017 Elsevier Inc. All rights reserved.

Methylenetetrahydrofolate reductase polymorphisms and susceptibility to acute lymphoblastic leukemia in a Chinese population: a meta-analysis.

PubMed

Xiao, Yi; Deng, Tao-Ran; Su, Chang-Liang; Shang, Zhen

2014-01-01

Although many epidemiologic studies have investigated the methylenetetrahydrofolate reductase (MTHFR) gene polymorphisms and their association with acute lymphoblastic leukemia (ALL), definitive conclusions cannot be drawn. To clarify the effects of MTHFR polymorphisms on the risk of ALL, a meta-analysis was performed in a Chinese population. A computerized literature search was carried out in PubMed, the Chinese Biomedicine (CBM) database, China National Knowledge Infrastructure (CNKI) platform, and the Wanfang database (Chinese) to collect relevant articles. A total of 11 articles including 1,738 ALL cases and 2,438 controls were included in this meta-analysis. Overall, a significantly decreased association was found between the MTHFR C677T polymorphism and ALL risk when all studies in Chinese populations were pooled into the meta-analysis. In subgroup analyses stratified by age, ethnicity, and source of controls, the same results were observed in children, in population-based studies, and in people with no stated ethnicity. However, a significantly increased association was also found for MTHFR C677T in hospital-based studies, and for MTHFR A1298C in people with no stated ethnicity. Our results suggest that the MTHFR C677T and A1298C polymorphisms may be potential biomarkers for ALL risk in Chinese populations, and studies with a larger sample size and wider population spectrum are required before definitive conclusions can be drawn. © 2014 S. Karger GmbH, Freiburg.

GEO Collisional Risk Assessment Based on Analysis of NASA-WISE Data and Modeling

DTIC Science & Technology

2015-10-18

GEO Collisional Risk Assessment Based on Analysis of NASA -WISE Data and Modeling Jeremy Murray Krezan1, Samantha Howard1, Phan D. Dao1, Derek...Surka2 1AFRL Space Vehicles Directorate,2Applied Technology Associates Incorporated From December 2009 through 2011 the NASA Wide-Field Infrared...of known debris. The NASA -WISE GEO belt debris population adds potentially thousands previously uncataloged objects. This paper describes

Postoperative radioactive iodine-131 ablation is not necessary among patients with intermediate-risk differentiated thyroid carcinoma: a population-based study.

PubMed

Zhang, Hong; Cai, Yuechang; Zheng, Li; Zhang, Zhanlei; Jiang, Ningyi

2017-01-01

To assess the effectiveness of radioactive iodine (RAI) ablation among patients with intermediate-risk differentiated thyroid cancer (DTC) following surgery. This population based study obtained information from the Surveillance, Epidemiology, and End Results (SEER) Program Research Data (1973-2013). National Cancer Institute, DCCPS, Surveillance Research Programme, Surveillance Systems Branch, released April 2016, based on the November 2015 submission. A total of 93,530 patients with primary thyroid cancer were identified in the SEER database during the period of 2004-2013 and focused on patients with DTC post-operatively treated or not treated with radioactive iodine (RAI). From these 9,127 patients were selected who had intermediate-risk DTC. A total of 8,601 patients were included in this study. For the overall population, the mean age of the population was 47.3 years and the majority were female (70.5%). Kaplan-Meier analysis found the mean overall survival time (os) for subjects with no radiation therapy which was 112.9 months and 114.9 months for those who received RAI ablation treatment (P<0.001). However, thyroid cancer-specific survival was not significantly different between treatment groups (117.7 vs. 118.0 months, log-rank test P=0.164). Overall survival and thyroid cancer-specific 1 year, 5 years, and 10-years survival rates were ≥89.8% and were similar between both treated groups. Multivariate analysis found age, gender, histologic type, and degree of lymph node metastases to be associated with OS, and age, gender, degree of lymph node metastasis and extra-thyroid tumor spread were independent factors for cancer-specific survival. In DTC patients with intermediate cancer risk multivariate analysis found that RAI was associated with a reduced risk of mortality compared with no radiation therapy (HR=0.710, 95% CI: 0.562-0.897, P=0.004) but no significant difference was seen in cancer-specific survival, either based on whole study population or on tumor size category. In DTC patients with intermediate cancer risk although postoperative RAI ablation following surgery showed a benefit in overall survival, no significant difference was seen in cancer-specific survival, either based on whole study population or on tumor size category.

Cancer Incidence in Physicians: A Taiwan National Population-based Cohort Study.

PubMed

Lee, Yu-Sung; Hsu, Chien-Chin; Weng, Shih-Feng; Lin, Hung-Jung; Wang, Jhi-Joung; Su, Shih-Bin; Huang, Chien-Cheng; Guo, How-Ran

2015-11-01

Cancer has been the leading cause of death in Taiwan since 1982. Physicians have many health-related risk factors which may contribute to cancer, such as rotating night shift, radiation, poor lifestyle, and higher exposure risk to infection and potential carcinogenic drugs. However, the cancer risk in physicians is not clear. In Taiwan's National Health Insurance Research Database, we identified 14,889 physicians as the study cohort and randomly selected 29,778 nonmedical staff patients as the comparison cohort for this national population-based cohort study. Cox proportional-hazard regression was used to compare the cancer risk between physicians and comparisons. Physician subgroups were also analyzed. Physicians had a lower all-cancer risk than did the comparisons (hazard ratio [HR] 0.86, 95% confidence interval [CI] 0.76-0.97). In the sex-based analysis, male physicians had a lower all-cancer risk than did male comparisons (HR 0.82, 95% CI 0.73-0.94); and female physicians did not (HR 1.29, 95% CI 0.88-1.91). In the cancer-type analysis, male physicians had a higher risk of prostate cancer (HR 1.72, 95% CI 1.12-2.65) and female physicians had twice the risk of breast cancer (HR 2.00, 95% CI 1.11-3.62) than did comparisons. Cancer risk was not significantly associated with physician specialties. Physicians in Taiwan had a lower all-cancer risk but higher risks for prostate and breast cancer than did the general population. These new epidemiological findings require additional study to clarify possible mechanisms.

A serotonin transporter gene (SLC6A4) polymorphism is associated with reduced risk of irritable bowel syndrome in American and Asian population: a meta-analysis.

PubMed

Areeshi, Mohammed Y; Haque, Shafiul; Panda, Aditya K; Mandal, Raju K

2013-01-01

Association studies of serotonin transporter gene SLC6A4 I/S polymorphism and irritable bowel syndrome (IBS) have shown inconsistent and contradictory results among different populations. In the present study, meta-analysis was performed to evaluate the association between SLC6A4 I/S polymorphism and IBS susceptibility. Systemic assessment was performed for the published studies based on the association of SLC6A4 I/S polymorphism and IBS risk from PubMed (Medline), EMBASE search. A meta-analysis was done to appraise the said association. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for allele contrast, homozygous, heterozygous, dominant and recessive genetic model. A total of twelve studies comprising 2068 IBS cases and 2076 controls were included in this meta-analysis. Overall, no significant results were obtained for S allele carrier (S vs. I: p=0.488; OR=1.073, 95% CI=0.879 to 1.311) Co-dominant (SS vs. II; p=0.587; OR=1.112, 95% CI=0.758 to 1.631), (IS vs. II; p=0.361; OR=0.878, 95% CI=0.665 to 1.160). Similarly, dominant (SS+IS vs. II: p=0.853; OR=0.974, 95% CI=0.736 to 1.288) and recessive (SS vs. II+IS: p=0.267; OR=1.172, 95% CI=0.886 to 1.522) genetic models did not demonstrate risk. In the subgroup population based analysis, reduced risks were found in American (IS vs. II: p=0.009; OR=0.685, 95% CI=0.516 to 0.908) and Asian (SS+IS vs. II; p=0.001; OR=0.116, 95% CI=0.068 to 0.197) population. However, no risk was observed in European population. This investigation clearly demonstrates that SLC6A4 (Ins/Del) polymorphism is associated with reduced risk of IBS in American and Asian population. However, future well-designed studies with stratified case control and biological characterization will be needed to validate this finding.

Is the association between flow-mediated dilation and cardiovascular risk limited to low-risk populations?

PubMed

Witte, Daniel R; Westerink, Jan; de Koning, Eelco J; van der Graaf, Yolanda; Grobbee, Diederick E; Bots, Michiel L

2005-06-21

The aim of this research was to study whether the relation between endothelial function measured by flow-mediated dilation (FMD) of the brachial artery and cardiovascular risk factors is affected by the baseline cardiovascular risk. Flow-mediated dilation of the brachial artery is widely used as a measure of endothelial function. Relations between FMD and most cardiovascular risk factors have been described. We performed a meta-regression analysis of 211 selected articles (399 populations) reporting on FMD and cardiovascular risk factors. Mean values of FMD; age; proportion of men; proportion of smokers; blood pressure; lipids; glucose; and the presence of diabetes mellitus, of hyperlipidemia, and of hypertension were retrieved from the articles. The 10-year risk of coronary heart disease (CHD) for each population was estimated based on the Framingham risk score. The relation between FMD and cardiovascular risk factors was assessed within each risk category by linear regression analysis, adjusting for age and gender, and weighted for the study size. A relation between FMD and cardiovascular risk factors was most clear in the category with lowest baseline risk (below 2.8% per decade). In populations with low baseline risk, for each % increase in Framingham risk, FMD decreased by 1.42% (95% confidence interval: 0.65 to 2.19). In medium- and high-risk populations, FMD was not related to risk (-0.02% [-0.27 to 0.22] and 0.06% [-0.02 to 0.13], respectively). These findings were independent of differences in brachial lumen diameter and technical aspects of the FMD measurement. Only in populations at low risk, endothelial function measured by FMD is related to the principal cardiovascular risk factors, and to the estimated 10-year risk of CHD.

Genetic Polymorphism of Angiotensin-Converting Enzyme and Chronic Obstructive Pulmonary Disease Risk: An Updated Meta-Analysis

PubMed Central

Kang, Sang Wook; Kim, Su Kang; Jung, Hee-Jae; Kim, Kwan-Il; Kim, Jinju

2016-01-01

The relationship between polymorphism of the angiotensin I converting enzyme (ACE) gene and chronic obstructive pulmonary disease (COPD) has been examined in many previous studies. However, their results were controversial. Therefore, we performed a meta-analysis to evaluate the relationship between the ACE gene and the risk of COPD. Fourteen case-control studies were included in this meta-analysis. The pooled p value, odds ratio (OR), and 95% confidence interval (95% CI) were used to investigate the strength of the association. The meta-analysis was performed using comprehensive meta-analysis software. Our meta-analysis results revealed that ACE polymorphisms were not related to the risk of COPD (p > 0.05 in each model). In further analyses based on ethnicity, we observed an association between insertion/deletion polymorphism of the ACE gene and risk of COPD in the Asian population (codominant 2, OR = 3.126, 95% CI = 1.919–5.093, p < 0.001; recessive, OR = 3.326, 95% CI = 2.190–5.050, p < 0.001) but not in the Caucasian population (p > 0.05 in each model). In conclusion, the present meta-analysis indicated that the insertion/deletion polymorphism of the ACE gene may be associated with susceptibility to COPD in the Asian population but not in the Caucasian population. However, the results of the present meta-analysis need to be confirmed in a larger sample. PMID:27830153

Race, APOL1 Risk, and eGFR Decline in the General Population

PubMed Central

Rebholz, Casey M.; Chen, Yuan; Rawlings, Andreea M.; Estrella, Michelle M.; Selvin, Elizabeth; Appel, Lawrence J.; Tin, Adrienne; Coresh, Josef

2016-01-01

The APOL1 high-risk genotype, present in approximately 13% of blacks in the United States, is a risk factor for kidney function decline in populations with CKD. It is unknown whether genetic screening is indicated in the general population. We evaluated the prognosis of APOL1 high-risk status in participants in the population-based Atherosclerosis Risk in Communities (ARIC) study, including associations with eGFR decline, variability in eGFR decline, and related adverse health events (AKI, ESRD, hypertension, diabetes, cardiovascular disease, pre-ESRD and total hospitalization rate, and mortality). Among 15,140 ARIC participants followed from 1987–1989 (baseline) to 2011–2013, 75.3% were white, 21.5% were black/APOL1 low-risk, and 3.2% were black/APOL1 high-risk. In a demographic-adjusted analysis, blacks had a higher risk for all assessed adverse health events; however, in analyses adjusted for comorbid conditions and socioeconomic status, blacks had a higher risk for hypertension, diabetes, and ESRD only. Among blacks, the APOL1 high-risk genotype associated only with higher risk of ESRD in a fully adjusted analysis. Black race and APOL1 high-risk status were associated with faster eGFR decline (P<0.001 for each). However, we detected substantial overlap among the groups: median (10th–90th percentile) unadjusted eGFR decline was 1.5 (1.0–2.2) ml/min per 1.73 m2 per year for whites, 2.1 (1.4–3.1) ml/min per 1.73 m2 per year for blacks with APOL1 low-risk status, and 2.3 (1.5–3.5) ml/min per 1.73 m2 per year for blacks with APOL1 high-risk status. The high variability in eGFR decline among blacks with and without the APOL1 high-risk genotype suggests that population-based screening is not yet justified. PMID:26966015

Race, APOL1 Risk, and eGFR Decline in the General Population.

PubMed

Grams, Morgan E; Rebholz, Casey M; Chen, Yuan; Rawlings, Andreea M; Estrella, Michelle M; Selvin, Elizabeth; Appel, Lawrence J; Tin, Adrienne; Coresh, Josef

2016-09-01

The APOL1 high-risk genotype, present in approximately 13% of blacks in the United States, is a risk factor for kidney function decline in populations with CKD. It is unknown whether genetic screening is indicated in the general population. We evaluated the prognosis of APOL1 high-risk status in participants in the population-based Atherosclerosis Risk in Communities (ARIC) study, including associations with eGFR decline, variability in eGFR decline, and related adverse health events (AKI, ESRD, hypertension, diabetes, cardiovascular disease, pre-ESRD and total hospitalization rate, and mortality). Among 15,140 ARIC participants followed from 1987-1989 (baseline) to 2011-2013, 75.3% were white, 21.5% were black/APOL1 low-risk, and 3.2% were black/APOL1 high-risk. In a demographic-adjusted analysis, blacks had a higher risk for all assessed adverse health events; however, in analyses adjusted for comorbid conditions and socioeconomic status, blacks had a higher risk for hypertension, diabetes, and ESRD only. Among blacks, the APOL1 high-risk genotype associated only with higher risk of ESRD in a fully adjusted analysis. Black race and APOL1 high-risk status were associated with faster eGFR decline (P<0.001 for each). However, we detected substantial overlap among the groups: median (10th-90th percentile) unadjusted eGFR decline was 1.5 (1.0-2.2) ml/min per 1.73 m(2) per year for whites, 2.1 (1.4-3.1) ml/min per 1.73 m(2) per year for blacks with APOL1 low-risk status, and 2.3 (1.5-3.5) ml/min per 1.73 m(2) per year for blacks with APOL1 high-risk status. The high variability in eGFR decline among blacks with and without the APOL1 high-risk genotype suggests that population-based screening is not yet justified. Copyright © 2016 by the American Society of Nephrology.

Occupation and malignant lymphoma: a population based case control study in Germany

PubMed Central

Mester, B; Nieters, A; Deeg, E; Elsner, G; Becker, N; Seidler, A

2006-01-01

Aims To identify occupations suspected to be associated with malignant lymphoma and to generate new hypotheses about occupational risks in a multicentre, population based case control study. Methods Male and female patients with malignant lymphoma (n = 710) aged 18–80 years of age were prospectively recruited in six study regions in Germany. For each newly recruited lymphoma case, a sex, region, and age matched control was drawn from the population registers. Odds ratios and 95% confidence intervals for major occupations and industries were calculated using conditional logistic regression analysis, adjusted for smoking (in pack‐years) and alcohol consumption. Patients with specific lymphoma subentities were additionally compared with the entire control group using unconditional logistic regression analysis. Results The following economic/industrial sectors were positively associated with lymphoma: food products, beverages, tobacco; paper products, publishing and printing; and metals. Chemicals; real estate, renting, and business activities were negatively associated with lymphoma diagnosis. The authors observed an increased overall lymphoma risk among architects; maids; farmers; glass formers; and construction workers. Shoemaking and leather goods making was negatively associated with the lymphoma diagnosis (although based on small numbers). In the occupational group analysis of lymphoma subentities, Hodgkin's lymphoma was significantly associated only with rubber and plastic products making; diffuse large B cell lymphoma risk was considerably increased among metal processors; follicular lymphoma showed highly significant risk increases for several occupational groups (medical, dental, and veterinary workers; sales workers; machinery fitters; and electrical fitters); and multiple myeloma showed a particularly pronounced risk increase for farmers as well as for agriculture and animal husbandry workers. Conclusions The results partly confirm previously defined occupational risks. Occupational risk factors for follicular lymphomas might differ from the overall risk factors for malignant lymphoma. PMID:16361401

Clinical significance of cerebral microbleeds on MRI: A comprehensive meta-analysis of risk of intracerebral hemorrhage, ischemic stroke, mortality, and dementia in cohort studies (v1).

PubMed

Charidimou, Andreas; Shams, Sara; Romero, Jose R; Ding, Jie; Veltkamp, Roland; Horstmann, Solveig; Eiriksdottir, Gudny; van Buchem, Mark A; Gudnason, Vilmundur; Himali, Jayandra J; Gurol, M Edip; Viswanathan, Anand; Imaizumi, Toshio; Vernooij, Meike W; Seshadri, Sudha; Greenberg, Steven M; Benavente, Oscar R; Launer, Lenore J; Shoamanesh, Ashkan

2018-01-01

Background Cerebral microbleeds can confer a high risk of intracerebral hemorrhage, ischemic stroke, death and dementia, but estimated risks remain imprecise and often conflicting. We investigated the association between cerebral microbleeds presence and these outcomes in a large meta-analysis of all published cohorts including: ischemic stroke/TIA, memory clinic, "high risk" elderly populations, and healthy individuals in population-based studies. Methods Cohorts (with > 100 participants) that assessed cerebral microbleeds presence on MRI, with subsequent follow-up (≥3 months) were identified. The association between cerebral microbleeds and each of the outcomes (ischemic stroke, intracerebral hemorrhage, death, and dementia) was quantified using random effects models of (a) unadjusted crude odds ratios and (b) covariate-adjusted hazard rations. Results We identified 31 cohorts ( n = 20,368): 19 ischemic stroke/TIA ( n = 7672), 4 memory clinic ( n = 1957), 3 high risk elderly ( n = 1458) and 5 population-based cohorts ( n = 11,722). Cerebral microbleeds were associated with an increased risk of ischemic stroke (OR: 2.14; 95% CI: 1.58-2.89 and adj-HR: 2.09; 95% CI: 1.71-2.57), but the relative increase in future intracerebral hemorrhage risk was greater (OR: 4.65; 95% CI: 2.68-8.08 and adj-HR: 3.93; 95% CI: 2.71-5.69). Cerebral microbleeds were an independent predictor of all-cause mortality (adj-HR: 1.36; 95% CI: 1.24-1.48). In three population-based studies, cerebral microbleeds were independently associated with incident dementia (adj-HR: 1.35; 95% CI: 1.00-1.82). Results were overall consistent in analyses stratified by different populations, but with different degrees of heterogeneity. Conclusions Our meta-analysis shows that cerebral microbleeds predict an increased risk of stroke, death, and dementia and provides up-to-date effect sizes across different clinical settings. These pooled estimates can inform clinical decisions and trials, further supporting cerebral microbleeds role as biomarkers of underlying subclinical brain pathology in research and clinical settings.

Multiple Primary Cancer Monograph

Cancer.gov

To identify groups of cancer survivors that are at increased risk for multiple primary cancers, investigators led an effort to provide the first comprehensive population-based analysis of the risk of subsequent cancer in the U.S., resulting in a monograph.

The priority group index: a proposed new method incorporating high risk and population burden to identify target populations for public health interventions.

PubMed

Zhang, Bo; Cohen, Joanna E; OʼConnor, Shawn

2014-01-01

Selection of priority groups is important for health interventions. However, no quantitative method has been developed. To develop a quantitative method to support the process of selecting priority groups for public health interventions based on both high risk and population health burden. Secondary data analysis of the 2010 Canadian Community Health Survey. Canadian population. Survey respondents. We identified priority groups for 3 diseases: heart disease, stroke, and chronic lower respiratory diseases. Three measures--prevalence, population counts, and adjusted odds ratios (OR)--were calculated for subpopulations (sociodemographic characteristics and other risk factors). A Priority Group Index (PGI) was calculated by summing the rank scores of these 3 measures. Of the 30 priority groups identified by the PGI (10 for each of the 3 disease outcomes), 7 were identified on the basis of high prevalence only, 5 based on population count only, 3 based on high OR only, and the remainder based on combinations of these. The identified priority groups were all in line with the literature as risk factors for the 3 diseases, such as elderly people for heart disease and stroke and those with low income for chronic lower respiratory diseases. The PGI was thus able to balance both high risk and population burden approaches in selecting priority groups, and thus it would address health inequities as well as disease burden in the overall population. The PGI is a quantitative method to select priority groups for public health interventions; it has the potential to enhance the effective use of limited public resources.

Chi-squared Automatic Interaction Detection Decision Tree Analysis of Risk Factors for Infant Anemia in Beijing, China

PubMed Central

Ye, Fang; Chen, Zhi-Hua; Chen, Jie; Liu, Fang; Zhang, Yong; Fan, Qin-Ying; Wang, Lin

2016-01-01

Background: In the past decades, studies on infant anemia have mainly focused on rural areas of China. With the increasing heterogeneity of population in recent years, available information on infant anemia is inconclusive in large cities of China, especially with comparison between native residents and floating population. This population-based cross-sectional study was implemented to determine the anemic status of infants as well as the risk factors in a representative downtown area of Beijing. Methods: As useful methods to build a predictive model, Chi-squared automatic interaction detection (CHAID) decision tree analysis and logistic regression analysis were introduced to explore risk factors of infant anemia. A total of 1091 infants aged 6–12 months together with their parents/caregivers living at Heping Avenue Subdistrict of Beijing were surveyed from January 1, 2013 to December 31, 2014. Results: The prevalence of anemia was 12.60% with a range of 3.47%–40.00% in different subgroup characteristics. The CHAID decision tree model has demonstrated multilevel interaction among risk factors through stepwise pathways to detect anemia. Besides the three predictors identified by logistic regression model including maternal anemia during pregnancy, exclusive breastfeeding in the first 6 months, and floating population, CHAID decision tree analysis also identified the fourth risk factor, the maternal educational level, with higher overall classification accuracy and larger area below the receiver operating characteristic curve. Conclusions: The infant anemic status in metropolis is complex and should be carefully considered by the basic health care practitioners. CHAID decision tree analysis has demonstrated a better performance in hierarchical analysis of population with great heterogeneity. Risk factors identified by this study might be meaningful in the early detection and prompt treatment of infant anemia in large cities. PMID:27174328

Chi-squared Automatic Interaction Detection Decision Tree Analysis of Risk Factors for Infant Anemia in Beijing, China.

PubMed

Ye, Fang; Chen, Zhi-Hua; Chen, Jie; Liu, Fang; Zhang, Yong; Fan, Qin-Ying; Wang, Lin

2016-05-20

In the past decades, studies on infant anemia have mainly focused on rural areas of China. With the increasing heterogeneity of population in recent years, available information on infant anemia is inconclusive in large cities of China, especially with comparison between native residents and floating population. This population-based cross-sectional study was implemented to determine the anemic status of infants as well as the risk factors in a representative downtown area of Beijing. As useful methods to build a predictive model, Chi-squared automatic interaction detection (CHAID) decision tree analysis and logistic regression analysis were introduced to explore risk factors of infant anemia. A total of 1091 infants aged 6-12 months together with their parents/caregivers living at Heping Avenue Subdistrict of Beijing were surveyed from January 1, 2013 to December 31, 2014. The prevalence of anemia was 12.60% with a range of 3.47%-40.00% in different subgroup characteristics. The CHAID decision tree model has demonstrated multilevel interaction among risk factors through stepwise pathways to detect anemia. Besides the three predictors identified by logistic regression model including maternal anemia during pregnancy, exclusive breastfeeding in the first 6 months, and floating population, CHAID decision tree analysis also identified the fourth risk factor, the maternal educational level, with higher overall classification accuracy and larger area below the receiver operating characteristic curve. The infant anemic status in metropolis is complex and should be carefully considered by the basic health care practitioners. CHAID decision tree analysis has demonstrated a better performance in hierarchical analysis of population with great heterogeneity. Risk factors identified by this study might be meaningful in the early detection and prompt treatment of infant anemia in large cities.

The East London glaucoma prediction score: web-based validation of glaucoma risk screening tool

PubMed Central

Stephen, Cook; Benjamin, Longo-Mbenza

2013-01-01

AIM It is difficult for Optometrists and General Practitioners to know which patients are at risk. The East London glaucoma prediction score (ELGPS) is a web based risk calculator that has been developed to determine Glaucoma risk at the time of screening. Multiple risk factors that are available in a low tech environment are assessed to provide a risk assessment. This is extremely useful in settings where access to specialist care is difficult. Use of the calculator is educational. It is a free web based service. Data capture is user specific. METHOD The scoring system is a web based questionnaire that captures and subsequently calculates the relative risk for the presence of Glaucoma at the time of screening. Three categories of patient are described: Unlikely to have Glaucoma; Glaucoma Suspect and Glaucoma. A case review methodology of patients with known diagnosis is employed to validate the calculator risk assessment. RESULTS Data from the patient records of 400 patients with an established diagnosis has been captured and used to validate the screening tool. The website reports that the calculated diagnosis correlates with the actual diagnosis 82% of the time. Biostatistics analysis showed: Sensitivity = 88%; Positive predictive value = 97%; Specificity = 75%. CONCLUSION Analysis of the first 400 patients validates the web based screening tool as being a good method of screening for the at risk population. The validation is ongoing. The web based format will allow a more widespread recruitment for different geographic, population and personnel variables. PMID:23550097

Looking beyond borders: integrating best practices in benefit-risk analysis into the field of food and nutrition.

PubMed

Tijhuis, M J; Pohjola, M V; Gunnlaugsdóttir, H; Kalogeras, N; Leino, O; Luteijn, J M; Magnússon, S H; Odekerken-Schröder, G; Poto, M; Tuomisto, J T; Ueland, O; White, B C; Holm, F; Verhagen, H

2012-01-01

An integrated benefit-risk analysis aims to give guidance in decision situations where benefits do not clearly prevail over risks, and explicit weighing of benefits and risks is thus indicated. The BEPRARIBEAN project aims to advance benefit-risk analysis in the area of food and nutrition by learning from other fields. This paper constitutes the final stage of the project, in which commonalities and differences in benefit-risk analysis are identified between the Food and Nutrition field and other fields, namely Medicines, Food Microbiology, Environmental Health, Economics and Marketing-Finance, and Consumer Perception. From this, ways forward are characterized for benefit-risk analysis in Food and Nutrition. Integrated benefit-risk analysis in Food and Nutrition may advance in the following ways: Increased engagement and communication between assessors, managers, and stakeholders; more pragmatic problem-oriented framing of assessment; accepting some risk; pre- and post-market analysis; explicit communication of the assessment purpose, input and output; more human (dose-response) data and more efficient use of human data; segmenting populations based on physiology; explicit consideration of value judgments in assessment; integration of multiple benefits and risks from multiple domains; explicit recognition of the impact of consumer beliefs, opinions, views, perceptions, and attitudes on behaviour; and segmenting populations based on behaviour; the opportunities proposed here do not provide ultimate solutions; rather, they define a collection of issues to be taken account of in developing methods, tools, practices and policies, as well as refining the regulatory context, for benefit-risk analysis in Food and Nutrition and other fields. Thus, these opportunities will now need to be explored further and incorporated into benefit-risk practice and policy. If accepted, incorporation of these opportunities will also involve a paradigm shift in Food and Nutrition benefit-risk analysis towards conceiving the analysis as a process of creating shared knowledge among all stakeholders. Copyright © 2011 Elsevier Ltd. All rights reserved.

High coffee consumption and different brewing methods in relation to postmenopausal endometrial cancer risk in the Norwegian women and cancer study: a population-based prospective study.

PubMed

Gavrilyuk, Oxana; Braaten, Tonje; Skeie, Guri; Weiderpass, Elisabete; Dumeaux, Vanessa; Lund, Eiliv

2014-03-25

Coffee and its compounds have been proposed to inhibit endometrial carcinogenesis. Studies in the Norwegian population can be especially interesting due to the high coffee consumption and increasing incidence of endometrial cancer in the country. A total of 97 926 postmenopausal Norwegian women from the population-based prospective Norwegian Women and Cancer (NOWAC) Study, were included in the present analysis. We evaluated the general association between total coffee consumption and endometrial cancer risk as well as the possible impact of brewing method. Multivariate Cox regression analysis was used to estimate risks, and heterogeneity tests were performed to compare brewing methods. During an average of 10.9 years of follow-up, 462 incident endometrial cancer cases were identified. After multivariate adjustment, significant risk reduction was found among participants who drank ≥8 cups/day of coffee with a hazard ratio of 0.52 (95% confidence interval, CI 0.34-0.79). However, we did not observe a significant dose-response relationship. No significant heterogeneity in risk was found when comparing filtered and boiled coffee brewing methods. A reduction in endometrial cancer risk was observed in subgroup analyses among participants who drank ≥8 cups/day and had a body mass index ≥25 kg/m2, and in current smokers. These data suggest that in this population with high coffee consumption, endometrial cancer risk decreases in women consuming ≥8 cups/day, independent of brewing method.

To Prevent, React, and Rebuild: Health Research and the Prevention of Genocide

PubMed Central

Adler, Reva N; Smith, James; Fishman, Paul; Larson, Eric B

2004-01-01

Objective To develop an approach to the primary prevention of genocide, based on established public health-based violence prevention methods derived from a variety of high-risk settings. Data Sources (1) Peer-reviewed literature in the fields of public health, violence/injury prevention, medicine, economics, sociology, psychology, history, and genocide studies, (2) demographic and health data bases made available by governments and international organizations, (3) reports on recent episodes of genocide published by international and nongovernmental organizations, (4) newspaper and journalistic accounts of recent and past genocides, (5) archival testimonies of genocide victims and perpetrators, and (6) court transcripts of international genocide prosecutions. Study Design The research was conducted as a medical-historical policy analysis synthesizing data within the following framework: (1) Assessment of current violence and injury prevention models for suitability in the prevention of extreme, population-wide violence, (2) analysis of morbidity and mortality data to quantify the impact of genocide on the health of populations, (3) making an inventory of the known societal risk factors for genocidal violence, (4) identification of the theorized, modifiable attitudinal risk factors for genocidal behavior within a population health model, and (5) assessment of existing projects targeting primary violence and injury prevention in high risk jurisdictions, for future adaptation within a structured, public health approach. Principal Findings Mortality rates due to genocidal violence are far in excess of other public health emergencies including malaria and HIV/AIDS. The immediate and long-range health consequences of genocide include the sequelae of infectious diseases, organ system failure, and psychiatric disorders, conferring an increased burden of disease on affected populations for multiple subsequent generations. The impact of genocide on local health economies is catastrophic, and the opportunity costs of diverting scarce global health dollars toward ameliorating genocide related outcomes are substantial. Structural risk factors for genocide within societies include: totalitarian government, exclusionary ideologies, armed conflict, economic hardship, and inaction of bystander nations. Proposed psychological risk factors for genocidal behavior include: moral exclusion, authority orientation, action in self-interest, desensitization, and compartmentalized thinking. Violence and injury prevention models, incorporating what is currently known about the societal and behavioral risk factors for genocide in high-risk populations, may be modified to address the primary prevention of catastrophic violence on a population-wide scale. A number of existent global peace building initiatives may serve as models for the design of future prevention initiatives in high-risk, pre-genocide jurisdictions. Conclusions Our analysis suggests that genocide is one of the most pressing threats to the health of populations in the twenty-first century. Recent advances in the public health discipline of violence prevention provide a blueprint for approaches to primary genocide prevention based on epidemiological methods. PMID:15544643

Refining and validating a two-stage and web-based cancer risk assessment tool for village doctors in China.

PubMed

Shen, Xing-Rong; Chai, Jing; Feng, Rui; Liu, Tong-Zhu; Tong, Gui-Xian; Cheng, Jing; Li, Kai-Chun; Xie, Shao-Yu; Shi, Yong; Wang, De-Bin

2014-01-01

The big gap between efficacy of population level prevention and expectations due to heterogeneity and complexity of cancer etiologic factors calls for selective yet personalized interventions based on effective risk assessment. This paper documents our research protocol aimed at refining and validating a two-stage and web- based cancer risk assessment tool, from a tentative one in use by an ongoing project, capable of identifying individuals at elevated risk for one or more types of the 80% leading cancers in rural China with adequate sensitivity and specificity and featuring low cost, easy application and cultural and technical sensitivity for farmers and village doctors. The protocol adopted a modified population-based case control design using 72, 000 non-patients as controls, 2, 200 cancer patients as cases, and another 600 patients as cases for external validation. Factors taken into account comprised 8 domains including diet and nutrition, risk behaviors, family history, precancerous diseases, related medical procedures, exposure to environment hazards, mood and feelings, physical activities and anthropologic and biologic factors. Modeling stresses explored various methodologies like empirical analysis, logistic regression, neuro-network analysis, decision theory and both internal and external validation using concordance statistics, predictive values, etc..

Finding Groups Using Model-Based Cluster Analysis: Heterogeneous Emotional Self-Regulatory Processes and Heavy Alcohol Use Risk

ERIC Educational Resources Information Center

Mun, Eun Young; von Eye, Alexander; Bates, Marsha E.; Vaschillo, Evgeny G.

2008-01-01

Model-based cluster analysis is a new clustering procedure to investigate population heterogeneity utilizing finite mixture multivariate normal densities. It is an inferentially based, statistically principled procedure that allows comparison of nonnested models using the Bayesian information criterion to compare multiple models and identify the…

Health care professionals' attitudes towards population-based genetic testing and risk-stratification for ovarian cancer: a cross-sectional survey.

PubMed

Hann, Katie E J; Fraser, Lindsay; Side, Lucy; Gessler, Sue; Waller, Jo; Sanderson, Saskia C; Freeman, Madeleine; Jacobs, Ian; Lanceley, Anne

2017-12-16

Ovarian cancer is usually diagnosed at a late stage when outcomes are poor. Personalised ovarian cancer risk prediction, based on genetic and epidemiological information and risk stratified management in adult women could improve outcomes. Examining health care professionals' (HCP) attitudes to ovarian cancer risk stratified management, willingness to support women, self-efficacy (belief in one's own ability to successfully complete a task), and knowledge about ovarian cancer will help identify training needs in anticipation of personalised ovarian cancer risk prediction being introduced. An anonymous survey was distributed online to HCPs via relevant professional organisations in the UK. Kruskal-Wallis tests and pairwise comparisons were used to compare knowledge and self-efficacy scores between different types of HCPs, and attitudes toward population-based genetic testing and risk stratified management were described. Content analysis was undertaken of free text responses concerning HCPs willingness to discuss risk management options with women. One hundred forty-six eligible HCPs completed the survey: oncologists (31%); genetics clinicians (30%); general practitioners (22%); gynaecologists (10%); nurses (4%); and 'others'. Scores for knowledge of ovarian cancer and genetics, and self-efficacy in conducting a cancer risk consultation were generally high but significantly lower for general practitioners compared to genetics clinicians, oncologists, and gynaecologists. Support for population-based genetic testing was not high (<50%). Attitudes towards ovarian cancer risk stratification were mixed, although the majority of participants indicated a willingness to discuss management options with patients. Larger samples are required to investigate attitudes to population-based genetic testing for ovarian cancer risk and to establish why some HCPs are hesitant to offer testing to all adult female patients. If ovarian cancer risk assessment using genetic testing and non-genetic information including epidemiological information is rolled out on a population basis, training will be needed for HCPs in primary care to enable them to provide appropriate support to women at each stage of the process.

Impact of obesity-related genes in Spanish population

PubMed Central

2013-01-01

Background The objective was to investigate the association between BMI and single nucleotide polymorphisms previously identified of obesity-related genes in two Spanish populations. Forty SNPs in 23 obesity-related genes were evaluated in a rural population characterized by a high prevalence of obesity (869 subjects, mean age 46 yr, 62% women, 36% obese) and in an urban population (1425 subjects, mean age 54 yr, 50% women, 19% obese). Genotyping was assessed by using SNPlex and PLINK for the association analysis. Results Polymorphisms of the FTO were significantly associated with BMI, in the rural population (beta 0.87, p-value <0.001). None of the other SNPs showed significant association after Bonferroni correction in the two populations or in the pooled analysis. A weighted genetic risk score (wGRS) was constructed using the risk alleles of the Tag-SNPs with a positive Beta parameter in both populations. From the first to the fifth quintile of the score, the BMI increased 0.45 kg/m2 in Hortega and 2.0 kg/m2 in Pizarra. Overall, the obesity predictive value was low (less than 1%). Conclusion The risk associated with polymorphisms is low and the overall effect on BMI or obesity prediction is minimal. A weighted genetic risk score based on genes mainly acting through central nervous system mechanisms was associated with BMI but it yields minimal clinical prediction for the obesity risk in the general population. PMID:24267414

Impact of obesity-related genes in Spanish population.

PubMed

Martínez-García, Fernando; Mansego, María L; Rojo-Martínez, Gemma; De Marco-Solar, Griselda; Morcillo, Sonsoles; Soriguer, Federico; Redón, Josep; Pineda Alonso, Monica; Martín-Escudero, Juan C; Cooper, Richard S; Chaves, Felipe J

2013-11-23

The objective was to investigate the association between BMI and single nucleotide polymorphisms previously identified of obesity-related genes in two Spanish populations. Forty SNPs in 23 obesity-related genes were evaluated in a rural population characterized by a high prevalence of obesity (869 subjects, mean age 46 yr, 62% women, 36% obese) and in an urban population (1425 subjects, mean age 54 yr, 50% women, 19% obese). Genotyping was assessed by using SNPlex and PLINK for the association analysis. Polymorphisms of the FTO were significantly associated with BMI, in the rural population (beta 0.87, p-value <0.001). None of the other SNPs showed significant association after Bonferroni correction in the two populations or in the pooled analysis. A weighted genetic risk score (wGRS) was constructed using the risk alleles of the Tag-SNPs with a positive Beta parameter in both populations. From the first to the fifth quintile of the score, the BMI increased 0.45 kg/m2 in Hortega and 2.0 kg/m2 in Pizarra. Overall, the obesity predictive value was low (less than 1%). The risk associated with polymorphisms is low and the overall effect on BMI or obesity prediction is minimal. A weighted genetic risk score based on genes mainly acting through central nervous system mechanisms was associated with BMI but it yields minimal clinical prediction for the obesity risk in the general population.

Genetic Polymorphisms of Glutathione-Related Enzymes (GSTM1, GSTT1, and GSTP1) and Schizophrenia Risk: A Meta-Analysis

PubMed Central

Kim, Su Kang; Kang, Sang Wook; Chung, Joo-Ho; Park, Hae Jeong; Cho, Kyu Bong; Park, Min-Su

2015-01-01

The association between polymorphisms of glutathione-related enzyme (GST) genes and the risk of schizophrenia has been investigated in many published studies. However, their results were inconclusive. Therefore, we performed a meta-analysis to explore the association between the GSTM1, GSTT1, and GSTP1 polymorphisms and the risk of schizophrenia. Twelve case-control studies were included in this meta-analysis. The odds ratio (OR) and 95% confidence interval (95% CI) were used to investigate the strength of the association. Our meta-analysis results revealed that GSTM1, GSTT1, and GSTP1 polymorphisms were not related to risk of schizophrenia (p > 0.05 in each model). Further analyses based on ethnicity, GSTM polymorphism showed weak association with schizophrenia in East Asian population (OR = 1.314, 95% CI = 1.025–1.684, p = 0.031). In conclusion, our meta-analysis indicated the GSTM1 polymorphism may be the only genetic risk factor for schizophrenia in East Asian population. However, more meta-analysis with a larger sample size were needed to provide more precise evidence. PMID:26295386

Familial aggregation of age-related macular degeneration in the Utah population.

PubMed

Luo, Ling; Harmon, Jennifer; Yang, Xian; Chen, Haoyu; Patel, Shrena; Mineau, Geraldine; Yang, Zhenglin; Constantine, Ryan; Buehler, Jeanette; Kaminoh, Yuuki; Ma, Xiang; Wong, Tien Y; Zhang, Maonian; Zhang, Kang

2008-02-01

We examined familial aggregation and risk of age-related macular degeneration in the Utah population using a population-based case-control study. Over one million unique patient records were searched within the University of Utah Health Sciences Center and the Utah Population Database (UPDB), identifying 4764 patients with AMD. Specialized kinship analysis software was used to test for familial aggregation of disease, estimate the magnitude of familial risks, and identify families at high risk for disease. The population-attributable risk (PAR) for AMD was calculated to be 0.34. Recurrence risks in relatives indicate increased relative risks in siblings (2.95), first cousins (1.29), second cousins (1.13), and parents (5.66) of affected cases. There were 16 extended large families with AMD identified for potential use in genetic studies. Each family had five or more living affected members. The familial aggregation of AMD shown in this study exemplifies the merit of the UPDB and supports recent research demonstrating significant genetic contribution to disease development and progression.

Study of the propensity for hemorrhage in Hispanic Americans with stroke.

PubMed

Frey, James L; Jahnke, Heidi K; Goslar, Pamela W

2008-01-01

Multiple sources document a higher proportion of intraparenchymal hemorrhage (HEM) in Hispanic (HIS) than white (WHI) patients with stroke. We sought an explanation for this phenomenon through analysis of multiple variables in our hospital-based stroke population. We performed univariate and multivariate analysis of risk factors in our HIS and WHI patients with stroke to identify differences that might account for a greater propensity for HEM in HIS patients. Multivariate analysis disclosed that the risk of HEM correlated significantly with untreated hypertension (HTN), HIS ethnicity, and heavy alcohol intake. A negative correlation was found for hyperlipidemia and diabetes. Our HIS patients with stroke had a greater prevalence of untreated HTN and heavy alcohol intake, with HIS men being at greatest risk. HIS patients with stroke in our hospital-based population appear relatively more prone to HEM than do WHI patients. This risk correlates with a greater likelihood of having untreated HTN and heavy alcohol intake, more so for HIS men. The explanation appears to be a relative lack of health awareness and involvement in our health care system. The possibility that HIS ethnicity itself constitutes a biological risk factor for HEM remains a matter of speculation. Validation of this work with community data should lead to remediation through a community-based effort.

Area-level poverty and preterm birth risk: A population-based multilevel analysis

PubMed Central

DeFranco, Emily A; Lian, Min; Muglia, Louis A; Schootman, Mario

2008-01-01

Background Preterm birth is a complex disease with etiologic influences from a variety of social, environmental, hormonal, genetic, and other factors. The purpose of this study was to utilize a large population-based birth registry to estimate the independent effect of county-level poverty on preterm birth risk. To accomplish this, we used a multilevel logistic regression approach to account for multiple co-existent individual-level variables and county-level poverty rate. Methods Population-based study utilizing Missouri's birth certificate database (1989–1997). We conducted a multilevel logistic regression analysis to estimate the effect of county-level poverty on PTB risk. Of 634,994 births nested within 115 counties in Missouri, two levels were considered. Individual-level variables included demographics factors, prenatal care, health-related behavioral risk factors, and medical risk factors. The area-level variable included the percentage of the population within each county living below the poverty line (US census data, 1990). Counties were divided into quartiles of poverty; the first quartile (lowest rate of poverty) was the reference group. Results PTB < 35 weeks occurred in 24,490 pregnancies (3.9%). The rate of PTB < 35 weeks was 2.8% in counties within the lowest quartile of poverty and increased through the 4th quartile (4.9%), p < 0.0001. High county-level poverty was significantly associated with PTB risk. PTB risk (< 35 weeks) was increased for women who resided in counties within the highest quartile of poverty, adjusted odds ratio (adjOR) 1.18 (95% CI 1.03, 1.35), with a similar effect at earlier gestational ages (< 32 weeks), adjOR 1.27 (95% CI 1.06, 1.52). Conclusion Women residing in socioeconomically deprived areas are at increased risk of preterm birth, above other underlying risk factors. Although the risk increase is modest, it affects a large number of pregnancies. PMID:18793437

Area-level poverty and preterm birth risk: a population-based multilevel analysis.

PubMed

DeFranco, Emily A; Lian, Min; Muglia, Louis A; Schootman, Mario

2008-09-15

Preterm birth is a complex disease with etiologic influences from a variety of social, environmental, hormonal, genetic, and other factors. The purpose of this study was to utilize a large population-based birth registry to estimate the independent effect of county-level poverty on preterm birth risk. To accomplish this, we used a multilevel logistic regression approach to account for multiple co-existent individual-level variables and county-level poverty rate. Population-based study utilizing Missouri's birth certificate database (1989-1997). We conducted a multilevel logistic regression analysis to estimate the effect of county-level poverty on PTB risk. Of 634,994 births nested within 115 counties in Missouri, two levels were considered. Individual-level variables included demographics factors, prenatal care, health-related behavioral risk factors, and medical risk factors. The area-level variable included the percentage of the population within each county living below the poverty line (US census data, 1990). Counties were divided into quartiles of poverty; the first quartile (lowest rate of poverty) was the reference group. PTB < 35 weeks occurred in 24,490 pregnancies (3.9%). The rate of PTB < 35 weeks was 2.8% in counties within the lowest quartile of poverty and increased through the 4th quartile (4.9%), p < 0.0001. High county-level poverty was significantly associated with PTB risk. PTB risk (< 35 weeks) was increased for women who resided in counties within the highest quartile of poverty, adjusted odds ratio (adj OR) 1.18 (95% CI 1.03, 1.35), with a similar effect at earlier gestational ages (< 32 weeks), adj OR 1.27 (95% CI 1.06, 1.52). Women residing in socioeconomically deprived areas are at increased risk of preterm birth, above other underlying risk factors. Although the risk increase is modest, it affects a large number of pregnancies.

Cost effectiveness of population based BRCA1 founder mutation testing in Sephardi Jewish women.

PubMed

Patel, Shreeya; Legood, Rosa; Evans, D Gareth; Turnbull, Clare; Antoniou, Antonis C; Menon, Usha; Jacobs, Ian; Manchanda, Ranjit

2018-04-01

Population-based BRCA1/BRCA2 founder-mutation testing has been demonstrated as cost effective compared with family history based testing in Ashkenazi Jewish women. However, only 1 of the 3 Ashkenazi Jewish BRCA1/BRCA2 founder mutations (185delAG[c.68_69delAG]), 5382insC[c.5266dupC]), and 6174delT[c.5946delT]) is found in the Sephardi Jewish population (185delAG[c.68_69delAG]), and the overall prevalence of BRCA mutations in the Sephardi Jewish population is accordingly lower (0.7% compared with 2.5% in the Ashkenazi Jewish population). Cost-effectiveness analyses of BRCA testing have not previously been performed at these lower BRCA prevalence levels seen in the Sephardi Jewish population. Here we present a cost-effectiveness analysis for UK and US populations comparing population testing with clinical criteria/family history-based testing in Sephardi Jewish women. A Markov model was built comparing the lifetime costs and effects of population-based BRCA1 testing, with testing using family history-based clinical criteria in Sephardi Jewish women aged ≥30 years. BRCA1 carriers identified were offered magnetic resonance imaging/mammograms and risk-reducing surgery. Costs are reported at 2015 prices. Outcomes include breast cancer, ovarian cancer, and excess deaths from heart disease. All costs and outcomes are discounted at 3.5%. The time horizon is lifetime, and perspective is payer. The incremental cost-effectiveness ratio per quality-adjusted life-year was calculated. Parameter uncertainty was evaluated through 1-way and probabilistic sensitivity analysis. Population testing resulted in gain in life expectancy of 12 months (quality-adjusted life-year = 1.00). The baseline discounted incremental cost-effectiveness ratio for UK population-based testing was £67.04/quality-adjusted life-year and for US population was $308.42/quality-adjusted life-year. Results were robust in the 1-way sensitivity analysis. The probabilistic sensitivity analysis showed 100% of simulations were cost effective at £20,000/quality-adjusted life-year UK and the $100,000/quality-adjusted life-year US willingness-to-pay thresholds. Scenario analysis showed that population testing remains cost effective in UK and US populations, even if premenopausal oophorectomy does not reduce breast cancer risk or if hormone replacement therapy compliance is nil. Population-based BRCA1 testing is highly cost effective compared with clinical criteria-driven approach in Sephardi Jewish women. This supports changing the paradigm to population-based BRCA testing in the Jewish population, regardless of Ashkenazi/Sephardi ancestry. Copyright © 2017 Elsevier Inc. All rights reserved.

Resilience of aging populations after devastating earthquake event and its determinants - A case study of the Chi-Chi earthquake in Taiwan

NASA Astrophysics Data System (ADS)

Hung, Chih-Hsuan; Hung, Hung-Chih

2016-04-01

1.Background Major portions of urban areas in Asia are highly exposed and vulnerable to devastating earthquakes. Many studies identify ways to reduce earthquake risk by concentrating more on building resilience for the particularly vulnerable populations. By 2020, as the United Nations' warning, many Asian countries would become 'super-aged societies', such as Taiwan. However, local authorities rarely use resilience approach to frame earthquake disaster risk management and land use strategies. The empirically-based research about the resilience of aging populations has also received relatively little attention. Thus, a challenge arisen for decision-makers is how to enhance resilience of aging populations within the context of risk reduction. This study aims to improve the understanding of the resilience of aging populations and its changes over time in the aftermath of a destructive earthquake at the local level. A novel methodology is proposed to assess the resilience of aging populations and to characterize their changes of spatial distribution patterns, as well as to examine their determinants. 2.Methods and data An indicator-based assessment framework is constructed with the goal of identifying composite indicators (including before, during and after a disaster) that could serve as proxies for attributes of the resilience of aging populations. Using the recovery process of the Chi-Chi earthquake struck central Taiwan in 1999 as a case study, we applied a method combined a geographical information system (GIS)-based spatial statistics technique and cluster analysis to test the extent of which the resilience of aging populations is spatially autocorrelated throughout the central Taiwan, and to explain why clustering of resilient areas occurs in specific locations. Furthermore, to scrutinize the affecting factors of resilience, we develop an aging population resilience model (APRM) based on existing resilience theory. Using the APRM, we applied a multivariate regression analysis to identify and examine how various factors connect to the resilience of aging populations. To illustrate the proposed methodology, the study collected data on the resilience attributes, the disaster impacts and damages due to the Chi-Chi earthquake. The data were offered by the National Science and Technology Center for Disaster Reduction, Taiwan, as well as collected from the National Land Use Investigation, official census statistics and questionnaire surveys. 3.Results Integrating cluster analysis with GIS-based spatial statistical analysis, the resilience of aging populations were divided into five clusters of distribution patterns over the 10 years after the Chi-Chi earthquake. It shows that both population and elderly distributions were highly heterogeneous and spatial correlated across the study areas. We also demonstrated the 'hot spots' areas of the highly concentrated aging population across central Taiwan. Results of regression analysis disclosed the major factors that caused low resilience and changes of aging population distributions over time. These factors included the levels of seismic damage, infrastructure investments, as well as the land-use and socioeconomic attributes associated with the disaster areas. Finally, our findings provide stakeholders and policy-makers with better adaptive options to design and synthesize appropriate patchworks of planning measures for different types of resilience areas to reduce earthquake disaster risk.

Occupational exposure and risk of chronic obstructive pulmonary disease: a systematic review and meta-analysis.

PubMed

Alif, Sheikh M; Dharmage, Shyamali C; Bowatte, Gayan; Karahalios, Amalia; Benke, Geza; Dennekamp, Martine; Mehta, Amar J; Miedinger, David; Künzli, Nino; Probst-Hensch, Nicole; Matheson, Melanie C

2016-08-01

Due to contradictory literature we have performed a systematic review and meta-analyse of population-based studies that have used Job Exposure Matrices to assess occupational exposure and risk of Chronic Obstructive Pulmonary Disease (COPD). Two researchers independently searched databases for published articles using predefined inclusion criteria. Study quality was assessed, and results pooled for COPD and chronic bronchitis for exposure to biological dust, mineral dust, and gases/fumes using a fixed and random effect model. Five studies met predetermined inclusion criteria. The meta-analysis showed low exposure to mineral dust, and high exposure to gases/fumes were associated with an increased risk of COPD. We also found significantly increased the risk of chronic bronchitis for low and high exposure to biological dust and mineral dust. Expert commentary: The relationship between occupational exposure assessed by the JEM and the risk of COPD and chronic bronchitis shows significant association with occupational exposure. However, the heterogeneity of the meta-analyses suggests more wide population-based studies with older age groups and longitudinal phenotype assessment of COPD to clarify the role of occupational exposure to COPD risk.

The more from East-Asian, the better: risk prediction of colorectal cancer risk by GWAS-identified SNPs among Japanese.

PubMed

Abe, Makiko; Ito, Hidemi; Oze, Isao; Nomura, Masatoshi; Ogawa, Yoshihiro; Matsuo, Keitaro

2017-12-01

Little is known about the difference of genetic predisposition for CRC between ethnicities; however, many genetic traits common to colorectal cancer have been identified. This study investigated whether more SNPs identified in GWAS in East Asian population could improve the risk prediction of Japanese and explored possible application of genetic risk groups as an instrument of the risk communication. 558 Patients histologically verified colorectal cancer and 1116 first-visit outpatients were included for derivation study, and 547 cases and 547 controls were for replication study. Among each population, we evaluated prediction models for the risk of CRC that combined the genetic risk group based on SNPs from GWASs in European-population and a similarly developed model adding SNPs from GWASs in East Asian-population. We examined whether adding East Asian-specific SNPs would improve the discrimination. Six SNPs (rs6983267, rs4779584, rs4444235, rs9929218, rs10936599, rs16969681) from 23 SNPs by European-based GWAS and five SNPs (rs704017, rs11196172, rs10774214, rs647161, rs2423279) among ten SNPs by Asian-based GWAS were selected in CRC risk prediction model. Compared with a 6-SNP-based model, an 11-SNP model including Asian GWAS-SNPs showed improved discrimination capacity in Receiver operator characteristic analysis. A model with 11 SNPs resulted in statistically significant improvement in both derivation (P = 0.0039) and replication studies (P = 0.0018) compared with six SNP model. We estimated cumulative risk of CRC by using genetic risk group based on 11 SNPs and found that the cumulative risk at age 80 is approximately 13% in the high-risk group while 6% in the low-risk group. We constructed a more efficient CRC risk prediction model with 11 SNPs including newly identified East Asian-based GWAS SNPs (rs704017, rs11196172, rs10774214, rs647161, rs2423279). Risk grouping based on 11 SNPs depicted lifetime difference of CRC risk. This might be useful for effective individualized prevention for East Asian.

Risk of colorectal cancer and small bowel adenocarcinoma in Crohn's disease: a population-based study from western Hungary 1977-2008.

PubMed

Lakatos, Peter Laszlo; David, Gyula; Pandur, Tunde; Erdelyi, Zsuzsanna; Mester, Gabor; Balogh, Mihaly; Szipocs, Istvan; Molnar, Csaba; Komaromi, Erzsebet; Kiss, Lajos S; Lakatos, Laszlo

2011-04-01

Limited data are available on the incidence and predictors of colorectal (CRC) and small bowel adenocarcinoma (SBA) in patients with Crohn's disease (CD) from population-based cohorts. Since data are completely missing from Eastern Europe, our aim was to analyze the incidence and risk factors of CD associated CRC and SBA in the population-based, Veszprem province database, which included incident patients diagnosed between January 1, 1977 and December 31, 2008. The data of 506 incident CD patients were analyzed (age-at-diagnosis: 31.5, SD: 13.8 years). Both hospital and outpatient records were collected and comprehensively reviewed. CRC was diagnosed in five patients (5/5758 person-year-duration) during follow-up, while no patients developed SBA in this cohort. Standardized incidence ratio (SIR) of CRC was not increased overall with five cases observed vs. 5.02 expected (SIR: 0.99, 95% CI: 0.41-2.39); however, there was a tendency for increased incidence in males (five cases observed vs. 2.56 expected; SIR: 1.95, 95% CI: 0.81-4.70). Age at onset of CD (p<0.001), male gender (p=0.022) and stenosing disease behavior at diagnosis (p<0.001) but not disease location were identified as risk factors for developing CRC in univariate analysis and Kaplan-Meier analysis. The cumulative risk for developing CRC after a disease duration of 20 years was 1.1% (95% CI: 0.6-1.7%). The incidence of CRC and SBA was not increased in this population-based CD cohort. Age at onset of CD, male gender and stenosing disease behavior at diagnosis were identified as risk factors of CRC. Copyright © 2010 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.

Sex prevalence of major congenital anomalies in the United Kingdom: a national population-based study and international comparison meta-analysis.

PubMed

Sokal, Rachel; Tata, Laila J; Fleming, Kate M

2014-02-01

The aim of this study was to assess sex differences in major congenital anomaly (CA) diagnoses within a national population sample; to examine the influence of sociodemographic and maternal factors on these risks; and to conduct a meta-analysis using estimates from other population-based studies. We conducted a population-based study in a United Kingdom research database of prospectively collected primary care data (The Health Improvement Network) including children born 1990 to 2009 (n = 794,169) and identified major CA diagnoses using EUROCAT (European Surveillance of Congenital Anomalies) classification. Prevalence ratios (PR) were used to estimate the risk of CA in males compared with females for any CA, system-specific subgroups and specific CA diagnoses. In a subpopulation of children whose medical records were linked to their mothers', we assessed the effect of adjusting for sociodemographic and maternal factors on sex odds ratios. PRs were pooled with measures from previously published studies. The prevalence of any CA was 307/10,000 in males (95% CI, 302-313) and 243/10,000 in females (95% CI, 238-248). Overall the risk of any CA was 26% greater in males (PR (male: female) 1.26, 95% CI, 1.23-1.30) however there was considerable variation across specific diagnoses. The magnitude and direction of risk did not change for any specific CA upon adjustment for sociodemographic and maternal factors. Our PRs were highly consistent with those from previous studies. The overall risk of CA is greater in males than females, although this masked substantial variation by specific diagnoses. Sociodemographic and maternal factors do not appear to affect these risks. Copyright © 2014 The Authors. Birth Defects Research (Part A) published by Wiley Periodicals, Inc.

Comparative cost-effectiveness of metformin-based dual therapies associated with risk of cardiovascular diseases among Chinese patients with type 2 diabetes: Evidence from a population-based national cohort in Taiwan.

PubMed

Ou, Huang-Tz; Chen, Yen-Ting; Liu, Ya-Ming; Wu, Jin-Shang

2016-06-01

To assess the cost-effectiveness of metformin-based dual therapies associated with cardiovascular disease (CVD) risk in a Chinese population with type 2 diabetes. We utilized Taiwan's National Health Insurance Research Database (NHIRD) 1997-2011, which is derived from the claims of National Health Insurance, a mandatory-enrollment single-payer system that covers over 99% of Taiwan's population. Four metformin-based dual therapy cohorts were used, namely a reference group of metformin plus sulfonylureas (Metformin-SU) and metformin plus acarbose, metformin plus thiazolidinediones (Metformin-TZD), and metformin plus glinides (Metformin-glinides). Using propensity scores, each subject in a comparison cohort was 1:1 matched to a referent. The effectiveness outcome was CVD risk. Only direct medical costs were included. The Markov chain model was applied to project lifetime outcomes, discounted at 3% per annum. The bootstrapping technique was performed to assess uncertainty in analysis. Metformin-glinides was most cost-effective in the base-case analysis; Metformin-glinides saved $194 USD for one percentage point of reduction in CVD risk, as compared to Metformin-SU. However, for the elderly or those with severe diabetic complications, Metformin-TZD, especially pioglitazone, was more suitable; as compared to Metformin-SU, Metformin-TZD saved $840.1 USD per percentage point of reduction in CVD risk. Among TZDs, Metformin-pioglitazone saved $1831.5 USD per percentage point of associated CVD risk reduction, as compared to Metformin-rosiglitazone. When CVD is considered an important clinical outcome, Metformin-pioglitazone is cost-effective, in particular for the elderly and those with severe diabetic complications. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Personal history of keratinocyte carcinoma is associated with reduced risk of death from invasive melanoma in men.

PubMed

Song, Fengju; Chen, Steven T; Li, Xin; Han, Jiali

2018-05-01

Previous studies have found an increased risk for invasive cutaneous melanoma (CM) among those with a history of keratinocyte carcinoma (KC). The aim of this study was to evaluate the risk of CM death after KC. The study was based on the Health Professionals Follow-up Study. A Cox proportional hazards model was used to examine the hazard ratio (HR) of death due to CM associated with personal history of KC among the entire study population (primary analysis) and among participants with invasive CM (secondary analysis), respectively. We documented a total of 908 participants with invasive CM over a total of 0.7 million person-years of follow-up. Among all participants, the risk for development of either lethal or nonlethal invasive CM increased for those with a history of KC. The risk for death due to melanoma based on KC history was not significantly increased, with an HR of 1.53 (95% confidence interval, 0.95-2.46). In the case-only analysis, those with a history of KC had a significantly lower risk for death due to melanoma than those with no such history (HR, 0.60; 95% confidence interval, 0.35-0.94). Because the population covered by the Health Professionals Follow-up Study consists exclusively of male health professionals, the results of this study may not be extended to the entire population. Personal history of KC is associated with a decreased risk for melanoma-specific death among male patients with invasive CM. Copyright © 2018 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

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

PubMed

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

2015-12-01

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

High coffee consumption and different brewing methods in relation to postmenopausal endometrial cancer risk in the Norwegian Women and Cancer Study: a population-based prospective study

PubMed Central

2014-01-01

Background Coffee and its compounds have been proposed to inhibit endometrial carcinogenesis. Studies in the Norwegian population can be especially interesting due to the high coffee consumption and increasing incidence of endometrial cancer in the country. Methods A total of 97 926 postmenopausal Norwegian women from the population-based prospective Norwegian Women and Cancer (NOWAC) Study, were included in the present analysis. We evaluated the general association between total coffee consumption and endometrial cancer risk as well as the possible impact of brewing method. Multivariate Cox regression analysis was used to estimate risks, and heterogeneity tests were performed to compare brewing methods. Results During an average of 10.9 years of follow-up, 462 incident endometrial cancer cases were identified. After multivariate adjustment, significant risk reduction was found among participants who drank ≥8 cups/day of coffee with a hazard ratio of 0.52 (95% confidence interval, CI 0.34-0.79). However, we did not observe a significant dose-response relationship. No significant heterogeneity in risk was found when comparing filtered and boiled coffee brewing methods. A reduction in endometrial cancer risk was observed in subgroup analyses among participants who drank ≥8 cups/day and had a body mass index ≥25 kg/m2, and in current smokers. Conclusions These data suggest that in this population with high coffee consumption, endometrial cancer risk decreases in women consuming ≥8 cups/day, independent of brewing method. PMID:24666820

Spatio-temporal earthquake risk assessment for the Lisbon Metropolitan Area - A contribution to improving standard methods of population exposure and vulnerability analysis

NASA Astrophysics Data System (ADS)

Freire, Sérgio; Aubrecht, Christoph

2010-05-01

The recent 7.0 M earthquake that caused severe damage and destruction in parts of Haiti struck close to 5 PM (local time), at a moment when many people were not in their residences, instead being in their workplaces, schools, or churches. Community vulnerability assessment to seismic hazard relying solely on the location and density of resident-based census population, as is commonly the case, would grossly misrepresent the real situation. In particular in the context of global (climate) change, risk analysis is a research field increasingly gaining in importance whereas risk is usually defined as a function of hazard probability and vulnerability. Assessment and mapping of human vulnerability has however generally been lagging behind hazard analysis efforts. Central to the concept of vulnerability is the issue of human exposure. Analysis of exposure is often spatially tied to administrative units or reference objects such as buildings, spanning scales from the regional level to local studies for small areas. Due to human activities and mobility, the spatial distribution of population is time-dependent, especially in metropolitan areas. Accurately estimating population exposure is a key component of catastrophe loss modeling, one element of effective risk analysis and emergency management. Therefore, accounting for the spatio-temporal dynamics of human vulnerability correlates with recent recommendations to improve vulnerability analyses. Earthquakes are the prototype for a major disaster, being low-probability, rapid-onset, high-consequence events. Lisbon, Portugal, is subject to a high risk of earthquake, which can strike at any day and time, as confirmed by modern history (e.g. December 2009). The recently-approved Special Emergency and Civil Protection Plan (PEERS) is based on a Seismic Intensity map, and only contemplates resident population from the census as proxy for human exposure. In the present work we map and analyze the spatio-temporal distribution of population in the daily cycle to re-assess exposure to earthquake hazard in the Lisbon Metropolitan Area, home to almost three million people. New high-resolution (50 m grids) daytime and nighttime population distribution maps are developed using dasymetric mapping. The modeling approach uses areal interpolation to combine best-available census data and statistics with land use and land cover data. Mobility statistics are considered for mapping daytime distribution, and empirical parameters used for interpolation are obtained from a previous effort in high resolution population mapping of part of the study area. Finally, the population distribution maps are combined with the Seismic Hazard Intensity map to: (1) quantify and compare human exposure to seismic intensity levels in the daytime and nighttime periods, and (2) derive nighttime and daytime overall Earthquake Risk maps. This novel approach yields previously unavailable spatio-temporal population distribution information for the study area, enabling refined and more accurate earthquake risk mapping and assessment. Additionally, such population exposure datasets can be combined with different hazard maps to improve spatio-temporal assessment and risk mapping for any type of hazard, natural or man-made. We believe this improved characterization of vulnerability and risk can benefit all phases of the disaster management process where human exposure has to be considered, namely in emergency planning, risk mitigation, preparedness, and response to an event.

Predicting tuberculosis risk in the foreign-born population of British Columbia, Canada: study protocol for a retrospective population-based cohort study

PubMed Central

Ronald, Lisa A; Campbell, Jonathon R; Balshaw, Robert F; Roth, David Z; Romanowski, Kamila; Marra, Fawziah; Cook, Victoria J; Johnston, James C

2016-01-01

Introduction Improved understanding of risk factors for developing active tuberculosis (TB) will better inform decisions about diagnostic testing and treatment for latent TB infection (LTBI) in migrant populations in low-incidence regions. We aim to examine TB risk factors among the foreign-born population in British Columbia (BC), Canada, and to create and validate a clinically relevant multivariate risk score to predict active TB. Methods and analysis This retrospective population-based cohort study will include all foreign-born individuals who acquired permanent resident status in Canada between 1 January 1985 and 31 December 2013 and acquired healthcare coverage in BC at any point during this period. Multiple administrative databases and disease registries will be linked, including a National Immigration Database, BC Provincial Health Insurance Registration, physician billings, hospitalisations, drugs dispensed from community pharmacies, vital statistics, HIV testing and notifications, cancer, chronic kidney disease and dialysis treatment, and all TB and LTBI testing and treatment data in BC. Extended proportional hazards regression will be used to estimate risk factors for TB and to create a prognostic TB risk score. Ethics and dissemination Ethical approval for this study has been obtained from the University of British Columbia Clinical Ethics Review Board. Once completed, study findings will be presented at conferences and published in peer-reviewed journals. An online TB risk score calculator will also be created. PMID:27888179

An innovative expression model of human health risk based on the quantitative analysis of soil metals sources contribution in different spatial scales.

PubMed

Zhang, Yimei; Li, Shuai; Wang, Fei; Chen, Zhuang; Chen, Jie; Wang, Liqun

2018-09-01

Toxicity of heavy metals from industrialization poses critical concern, and analysis of sources associated with potential human health risks is of unique significance. Assessing human health risk of pollution sources (factored health risk) concurrently in the whole and the sub region can provide more instructive information to protect specific potential victims. In this research, we establish a new expression model of human health risk based on quantitative analysis of sources contribution in different spatial scales. The larger scale grids and their spatial codes are used to initially identify the level of pollution risk, the type of pollution source and the sensitive population at high risk. The smaller scale grids and their spatial codes are used to identify the contribution of various sources of pollution to each sub region (larger grid) and to assess the health risks posed by each source for each sub region. The results of case study show that, for children (sensitive populations, taking school and residential area as major region of activity), the major pollution source is from the abandoned lead-acid battery plant (ALP), traffic emission and agricultural activity. The new models and results of this research present effective spatial information and useful model for quantifying the hazards of source categories and human health a t complex industrial system in the future. Copyright © 2018 Elsevier Ltd. All rights reserved.

Parkinson's disease and occupation: differences in associations by case identification method suggest referral bias.

PubMed

Teschke, Kay; Marion, Stephen A; Tsui, Joseph K C; Shen, Hui; Rugbjerg, Kathrine; Harris, M Anne

2014-02-01

We used a population-based sample of 403 Parkinson's disease cases and 405 controls to examine risks by occupation. Results were compared to a previous clinic-based analysis. With censoring of jobs held within 10 years of diagnosis, the following had significantly or strongly increased risks: social science, law and library jobs (OR = 1.8); farming and horticulture jobs (OR = 2.0); gas station jobs (OR = 2.6); and welders (OR = 3.0). The following had significantly decreased risks: management and administration jobs (OR = 0.70); and other health care jobs (OR = 0.44). These results were consistent with other findings for social science and farming occupations. Risks for teaching, medicine and health occupations were not elevated, unlike our previous clinic-based study. This underscores the value of population-based over clinic-based samples. Occupational studies may be particularly susceptible to referral bias because social networks may spread preferentially via jobs. © 2013 Wiley Periodicals, Inc.

Long-Term Unemployment and Suicide: A Systematic Review and Meta-Analysis

PubMed Central

Milner, Allison; Page, Andrew; LaMontagne, Anthony D.

2013-01-01

Purpose There have been a number of reviews on the association+ between unemployment and suicide, but none have investigated how this relationship is influenced by duration of unemployment. Method A systematic review and meta-analysis was conducted of those studies that assessed duration of unemployment as a risk factor for suicide. Studies considered as eligible for inclusion were population-based cohort or case-control designs; population-based ecological designs, or hospital based clinical cohort or case-control designs published in the year 1980 or later. Results The review identified 16 eligible studies, out of a possible 10,358 articles resulting from a search of four databases: PubMed, Web of Knowledge, Scopus and Proquest. While all 16 studies measured unemployment duration in different ways, a common finding was that longer duration of unemployment was related to greater risk of suicide and suicide attempt. A random effects meta-analysis on a subsample of six cohort studies indicated that the pooled relative risk of suicide in relation to average follow-up time after unemployment was 1.70 (95% CI 1.22 to 2.18). However, results also suggested a possible habituation effect to unemployment over time, with the greatest risk of suicide occurring within five years of unemployment compared to the employed population (RR = 2.50, 95% CI 1.83 to 3.17). Relative risk appeared to decline in studies of those unemployed between 12 and 16 years compared to those currently employed (RR = 1.21, 95% CI 1.10 to 1.33). Conclusion Findings suggest that long-term unemployment is associated with greater incidence of suicide. Results of the meta-analysis suggest that risk is greatest in the first five years, and persists at a lower but elevated level up to 16 years after unemployment. These findings are limited by the paucity of data on this topic. PMID:23341881

Quantifying the dose-response of walking in reducing coronary heart disease risk: meta-analysis.

PubMed

Zheng, Henry; Orsini, Nicola; Amin, Janaki; Wolk, Alicja; Nguyen, Van Thi Thuy; Ehrlich, Fred

2009-01-01

The evidence for the efficacy of walking in reducing the risk of and preventing coronary heart disease (CHD) is not completely understood. This meta-analysis aimed to quantify the dose-response relationship between walking and CHD risk reduction for both men and women in the general population. Studies on walking and CHD primary prevention between 1954 and 2007 were identified through Medline, SportDiscus and the Cochrane Database of Systematic Reviews. Random-effect meta-regression models were used to pool the relative risks from individual studies. A total of 11 prospective cohort studies and one randomized control trial study met the inclusion criteria, with 295,177 participants free of CHD at baseline and 7,094 cases at follow-up. The meta-analysis indicated that an increment of approximately 30 min of normal walking a day for 5 days a week was associated with 19% CHD risk reduction (95% CI = 14-23%; P-heterogeneity = 0.56; I (2) = 0%). We found no evidence of heterogeneity between subgroups of studies defined by gender (P = 0.67); age of the study population (P = 0.52); or follow-up duration (P = 0.77). The meta-analysis showed that the risk for developing CHD decreases as walking dose increases. Walking should be prescribed as an evidence-based effective exercise modality for CHD prevention in the general population.

Cadmium exposure and risk of lung cancer: a meta-analysis of cohort and case-control studies among general and occupational populations.

PubMed

Chen, Cheng; Xun, Pengcheng; Nishijo, Muneko; He, Ka

2016-09-01

The association between cadmium exposure and risk of lung cancer is still unclear. We quantitatively reviewed the observational studies that investigated the association between cadmium exposure and lung cancer risk in both general and occupational populations published through April 2015. The final data set is comprised of three cohort studies in the general population totaling 22,551 participants (354 events) with a mean follow-up of 15 years, five occupational cohort studies including 4205 individuals (180 events) with an average follow-up of 31 years, and three occupational case-control studies including 4740 cases and 6268 controls. Comparing the highest to the lowest category of cadmium exposure, the weighted relative risk and 95% confidence interval of lung cancer in the general population was 1.42 (95% CI (0.91, 2.23)); the weighted risk estimates (95% CIs) of lung cancer in three occupational cohort studies and three case-control studies were 0.68 (95% CI (0.33, 1.41)) and 1.61 (95% CI (0.94, 2.75)), respectively. No linear association was found. When comparing participants exposed to cadmium with non-exposed based on available data, the association became statistically significant. According to findings from this meta-analysis, the possibility that cadmium exposure may increase risk of lung cancer cannot be completely ruled out in either general or occupational population.

Hereditary breast/ovarian cancer--pitfalls in genetic counseling.

PubMed

Dagan, E; Gershoni-Baruch, R

2001-10-01

Genetic counseling and risk assessment, given to women with a family history of breast/ovarian cancer, are regularly based on pedigree analysis. In the Ashkenazi Jewish population, hereditary breast/ovarian cancer is mainly attributed to three founder mutations, namely, 185delAG, 5382insC, and 6174delT, in BRCA1/2 genes. The overall frequency of these mutations, in the Jewish Ashkenazi population, is as high as 2.5%. Based on clinical and family history data, the results of BRCA molecular testing, in Ashkenazi individuals at risk, are appropriately anticipated in most cases. Here we report on five families, in which the segregation of BRCA1/2 mutations, in affected and unaffected family members, was unexpected, emphasizing the need to test, for founder mutations, every Ashkenazi individual at risk, irrespective of the genotype of affected family members. Ultimately, risk assessments and recommendations, in Ashkenazi women, should be invariably based on the results of genetic testing.

Injury risk functions based on population-based finite element model responses: Application to femurs under dynamic three-point bending.

PubMed

Park, Gwansik; Forman, Jason; Kim, Taewung; Panzer, Matthew B; Crandall, Jeff R

2018-02-28

The goal of this study was to explore a framework for developing injury risk functions (IRFs) in a bottom-up approach based on responses of parametrically variable finite element (FE) models representing exemplar populations. First, a parametric femur modeling tool was developed and validated using a subject-specific (SS)-FE modeling approach. Second, principal component analysis and regression were used to identify parametric geometric descriptors of the human femur and the distribution of those factors for 3 target occupant sizes (5th, 50th, and 95th percentile males). Third, distributions of material parameters of cortical bone were obtained from the literature for 3 target occupant ages (25, 50, and 75 years) using regression analysis. A Monte Carlo method was then implemented to generate populations of FE models of the femur for target occupants, using a parametric femur modeling tool. Simulations were conducted with each of these models under 3-point dynamic bending. Finally, model-based IRFs were developed using logistic regression analysis, based on the moment at fracture observed in the FE simulation. In total, 100 femur FE models incorporating the variation in the population of interest were generated, and 500,000 moments at fracture were observed (applying 5,000 ultimate strains for each synthesized 100 femur FE models) for each target occupant characteristics. Using the proposed framework on this study, the model-based IRFs for 3 target male occupant sizes (5th, 50th, and 95th percentiles) and ages (25, 50, and 75 years) were developed. The model-based IRF was located in the 95% confidence interval of the test-based IRF for the range of 15 to 70% injury risks. The 95% confidence interval of the developed IRF was almost in line with the mean curve due to a large number of data points. The framework proposed in this study would be beneficial for developing the IRFs in a bottom-up manner, whose range of variabilities is informed by the population-based FE model responses. Specifically, this method mitigates the uncertainties in applying empirical scaling and may improve IRF fidelity when a limited number of experimental specimens are available.

Indoor air quality investigation and health risk assessment at correctional institutions.

PubMed

Ofungwu, Joseph

2005-04-01

A comprehensive indoor air-quality (IAQ) investigation was conducted at a state correctional facility in New Jersey, USA with a lengthy history of IAQ problems. The IAQ investigation comprised preliminary indoor air screening using direct readout instrumentation, indoor air/surface wipe sampling and laboratory analysis, as well as a heating, ventilation, and air-conditioning system evaluation, and a building envelope survey. In addition to air sampling, a human health risk assessment was performed to evaluate the potential for exposure to site-related air contaminants with respect to the inmate and worker populations. The risk assessment results for the prison facility indicated the potential for significant health risks for the inmate population, possibly reflecting the effects of their confinement and extended exposure to indoor air contaminants, as compared to the prison guard and worker population. Based on the results of the risk assessment, several mitigation measures are recommended to minimize prison population health risks and improve indoor air quality at prison facilities.

A simple risk score for identifying individuals with impaired fasting glucose in the Southern Chinese population.

PubMed

Wang, Hui; Liu, Tao; Qiu, Quan; Ding, Peng; He, Yan-Hui; Chen, Wei-Qing

2015-01-23

This study aimed to develop and validate a simple risk score for detecting individuals with impaired fasting glucose (IFG) among the Southern Chinese population. A sample of participants aged ≥20 years and without known diabetes from the 2006-2007 Guangzhou diabetes cross-sectional survey was used to develop separate risk scores for men and women. The participants completed a self-administered structured questionnaire and underwent simple clinical measurements. The risk scores were developed by multiple logistic regression analysis. External validation was performed based on three other studies: the 2007 Zhuhai rural population-based study, the 2008-2010 Guangzhou diabetes cross-sectional study and the 2007 Tibet population-based study. Performance of the scores was measured with the Hosmer-Lemeshow goodness-of-fit test and ROC c-statistic. Age, waist circumference, body mass index and family history of diabetes were included in the risk score for both men and women, with the additional factor of hypertension for men. The ROC c-statistic was 0.70 for both men and women in the derivation samples. Risk scores of ≥28 for men and ≥18 for women showed respective sensitivity, specificity, positive predictive value and negative predictive value of 56.6%, 71.7%, 13.0% and 96.0% for men and 68.7%, 60.2%, 11% and 96.0% for women in the derivation population. The scores performed comparably with the Zhuhai rural sample and the 2008-2010 Guangzhou urban samples but poorly in the Tibet sample. The performance of pre-existing USA, Shanghai, and Chengdu risk scores was poorer in our population than in their original study populations. The results suggest that the developed simple IFG risk scores can be generalized in Guangzhou city and nearby rural regions and may help primary health care workers to identify individuals with IFG in their practice.

A Simple Risk Score for Identifying Individuals with Impaired Fasting Glucose in the Southern Chinese Population

PubMed Central

Wang, Hui; Liu, Tao; Qiu, Quan; Ding, Peng; He, Yan-Hui; Chen, Wei-Qing

2015-01-01

This study aimed to develop and validate a simple risk score for detecting individuals with impaired fasting glucose (IFG) among the Southern Chinese population. A sample of participants aged ≥20 years and without known diabetes from the 2006–2007 Guangzhou diabetes cross-sectional survey was used to develop separate risk scores for men and women. The participants completed a self-administered structured questionnaire and underwent simple clinical measurements. The risk scores were developed by multiple logistic regression analysis. External validation was performed based on three other studies: the 2007 Zhuhai rural population-based study, the 2008–2010 Guangzhou diabetes cross-sectional study and the 2007 Tibet population-based study. Performance of the scores was measured with the Hosmer-Lemeshow goodness-of-fit test and ROC c-statistic. Age, waist circumference, body mass index and family history of diabetes were included in the risk score for both men and women, with the additional factor of hypertension for men. The ROC c-statistic was 0.70 for both men and women in the derivation samples. Risk scores of ≥28 for men and ≥18 for women showed respective sensitivity, specificity, positive predictive value and negative predictive value of 56.6%, 71.7%, 13.0% and 96.0% for men and 68.7%, 60.2%, 11% and 96.0% for women in the derivation population. The scores performed comparably with the Zhuhai rural sample and the 2008–2010 Guangzhou urban samples but poorly in the Tibet sample. The performance of pre-existing USA, Shanghai, and Chengdu risk scores was poorer in our population than in their original study populations. The results suggest that the developed simple IFG risk scores can be generalized in Guangzhou city and nearby rural regions and may help primary health care workers to identify individuals with IFG in their practice. PMID:25625405

Inverse Association Between Gluteofemoral Obesity and Risk of Barrett's Esophagus in a Pooled Analysis.

PubMed

Kendall, Bradley J; Rubenstein, Joel H; Cook, Michael B; Vaughan, Thomas L; Anderson, Lesley A; Murray, Liam J; Shaheen, Nicholas J; Corley, Douglas A; Chandar, Apoorva K; Li, Li; Greer, Katarina B; Chak, Amitabh; El-Serag, Hashem B; Whiteman, David C; Thrift, Aaron P

2016-10-01

Gluteofemoral obesity (determined by measurement of subcutaneous fat in the hip and thigh regions) could reduce risks of cardiovascular and diabetic disorders associated with abdominal obesity. We evaluated whether gluteofemoral obesity also reduces the risk of Barrett's esophagus (BE), a premalignant lesion associated with abdominal obesity. We collected data from non-Hispanic white participants in 8 studies in the Barrett's and Esophageal Adenocarcinoma Consortium. We compared measures of hip circumference (as a proxy for gluteofemoral obesity) from cases of BE (n = 1559) separately with 2 control groups: 2557 population-based controls and 2064 individuals with gastroesophageal reflux disease (GERD controls). Study-specific odds ratios (ORs) and 95% confidence intervals (95% CIs) were estimated using individual participant data and multivariable logistic regression and combined using a random-effects meta-analysis. We found an inverse relationship between hip circumference and BE (OR per 5-cm increase, 0.88; 95% CI, 0.81-0.96), compared with population-based controls in a multivariable model that included waist circumference. This association was not observed in models that did not include waist circumference. Similar results were observed in analyses stratified by frequency of GERD symptoms. The inverse association with hip circumference was statistically significant only among men (vs population-based controls: OR, 0.85; 95% CI, 0.76-0.96 for men; OR, 0.93; 95% CI, 0.74-1.16 for women). For men, within each category of waist circumference, a larger hip circumference was associated with a decreased risk of BE. Increasing waist circumference was associated with an increased risk of BE in the mutually adjusted population-based and GERD control models. Although abdominal obesity is associated with an increased risk of BE, there is an inverse association between gluteofemoral obesity and BE, particularly among men. Copyright © 2016 AGA Institute. Published by Elsevier Inc. All rights reserved.

A quantitative evaluation of a qualitative risk assessment framework: Examining the assumptions and predictions of the Productivity Susceptibility Analysis (PSA)

PubMed Central

2018-01-01

Qualitative risk assessment frameworks, such as the Productivity Susceptibility Analysis (PSA), have been developed to rapidly evaluate the risks of fishing to marine populations and prioritize management and research among species. Despite being applied to over 1,000 fish populations, and an ongoing debate about the most appropriate method to convert biological and fishery characteristics into an overall measure of risk, the assumptions and predictive capacity of these approaches have not been evaluated. Several interpretations of the PSA were mapped to a conventional age-structured fisheries dynamics model to evaluate the performance of the approach under a range of assumptions regarding exploitation rates and measures of biological risk. The results demonstrate that the underlying assumptions of these qualitative risk-based approaches are inappropriate, and the expected performance is poor for a wide range of conditions. The information required to score a fishery using a PSA-type approach is comparable to that required to populate an operating model and evaluating the population dynamics within a simulation framework. In addition to providing a more credible characterization of complex system dynamics, the operating model approach is transparent, reproducible and can evaluate alternative management strategies over a range of plausible hypotheses for the system. PMID:29856869

Body-Mass Index and Pancreatic Cancer Incidence: A Pooled Analysis of Nine Population-Based Cohort Studies With More Than 340,000 Japanese Subjects.

PubMed

Koyanagi, Yuriko N; Matsuo, Keitaro; Ito, Hidemi; Tamakoshi, Akiko; Sugawara, Yumi; Hidaka, Akihisa; Wada, Keiko; Oze, Isao; Kitamura, Yuri; Liu, Rong; Mizoue, Tetsuya; Sawada, Norie; Nagata, Chisato; Wakai, Kenji; Nakayama, Tomio; Sadakane, Atsuko; Tanaka, Keitaro; Inoue, Manami; Tsugane, Shoichiro; Sasazuki, Shizuka

2018-05-05

A high body mass index (BMI) has been proposed as an important risk factor for pancreatic cancer. However, this association of BMI with pancreatic cancer risk has not been confirmed in Asian populations. We evaluated the association between BMI (either at baseline or during early adulthood) and pancreatic cancer risk by conducting a pooled analysis of nine population-based prospective cohort studies in Japan with more than 340,000 subjects. Summary hazard ratios (HRs) were estimated by pooling study-specific HRs for unified BMI categories with a random-effects model. Among Japanese men, being obese at baseline was associated with a higher risk of pancreatic cancer incidence (≥30 kg/m 2 compared with 23 to <25 kg/m 2 , adjusted HR 1.71; 95% confidence interval [CI], 1.03-2.86). A J-shaped association between BMI during early adulthood and pancreatic cancer incidence was seen in men. In contrast, we observed no clear association among women, although there may be a positive linear association between BMI at baseline and the risk of pancreatic cancer (per 1 kg/m 2 , adjusted HR 1.02; 95% CI, 1.00-1.05). Pooling of data from cohort studies with a considerable number of Japanese subjects revealed a significant positive association between obesity and pancreatic cancer risk among men. This information indicates that strategies that effectively prevent obesity among men might lead to a reduced burden of pancreatic cancer, especially in Asian populations.

A GWAS meta-analysis from 5 population-based cohorts implicates ion channel genes in the pathogenesis of irritable bowel syndrome.

PubMed

Bonfiglio, F; Henström, M; Nag, A; Hadizadeh, F; Zheng, T; Cenit, M C; Tigchelaar, E; Williams, F; Reznichenko, A; Ek, W E; Rivera, N V; Homuth, G; Aghdassi, A A; Kacprowski, T; Männikkö, M; Karhunen, V; Bujanda, L; Rafter, J; Wijmenga, C; Ronkainen, J; Hysi, P; Zhernakova, A; D'Amato, M

2018-04-19

Irritable bowel syndrome (IBS) shows genetic predisposition, however, large-scale, powered gene mapping studies are lacking. We sought to exploit existing genetic (genotype) and epidemiological (questionnaire) data from a series of population-based cohorts for IBS genome-wide association studies (GWAS) and their meta-analysis. Based on questionnaire data compatible with Rome III Criteria, we identified a total of 1335 IBS cases and 9768 asymptomatic individuals from 5 independent European genotyped cohorts. Individual GWAS were carried out with sex-adjusted logistic regression under an additive model, followed by meta-analysis using the inverse variance method. Functional annotation of significant results was obtained via a computational pipeline exploiting ontology and interaction networks, and tissue-specific and gene set enrichment analyses. Suggestive GWAS signals (P ≤ 5.0 × 10 -6 ) were detected for 7 genomic regions, harboring 64 gene candidates to affect IBS risk via functional or expression changes. Functional annotation of this gene set convincingly (best FDR-corrected P = 3.1 × 10 -10 ) highlighted regulation of ion channel activity as the most plausible pathway affecting IBS risk. Our results confirm the feasibility of population-based studies for gene-discovery efforts in IBS, identify risk genes and loci to be prioritized in independent follow-ups, and pinpoint ion channels as important players and potential therapeutic targets warranting further investigation. © 2018 John Wiley & Sons Ltd.

Chagas disease risk in Texas.

PubMed

Sarkar, Sahotra; Strutz, Stavana E; Frank, David M; Rivaldi, Chissa-Louise; Sissel, Blake; Sánchez-Cordero, Victor

2010-10-05

Chagas disease, caused by Trypanosoma cruzi, remains a serious public health concern in many areas of Latin America, including México. It is also endemic in Texas with an autochthonous canine cycle, abundant vectors (Triatoma species) in many counties, and established domestic and peridomestic cycles which make competent reservoirs available throughout the state. Yet, Chagas disease is not reportable in Texas, blood donor screening is not mandatory, and the serological profiles of human and canine populations remain unknown. The purpose of this analysis was to provide a formal risk assessment, including risk maps, which recommends the removal of these lacunae. The spatial relative risk of the establishment of autochthonous Chagas disease cycles in Texas was assessed using a five-stage analysis. 1. Ecological risk for Chagas disease was established at a fine spatial resolution using a maximum entropy algorithm that takes as input occurrence points of vectors and environmental layers. The analysis was restricted to triatomine vector species for which new data were generated through field collection and through collation of post-1960 museum records in both México and the United States with sufficiently low georeferenced error to be admissible given the spatial resolution of the analysis (1 arc-minute). The new data extended the distribution of vector species to 10 new Texas counties. The models predicted that Triatoma gerstaeckeri has a large region of contiguous suitable habitat in the southern United States and México, T. lecticularia has a diffuse suitable habitat distribution along both coasts of the same region, and T. sanguisuga has a disjoint suitable habitat distribution along the coasts of the United States. The ecological risk is highest in south Texas. 2. Incidence-based relative risk was computed at the county level using the Bayesian Besag-York-Mollié model and post-1960 T. cruzi incidence data. This risk is concentrated in south Texas. 3. The ecological and incidence-based risks were analyzed together in a multi-criteria dominance analysis of all counties and those counties in which there were as yet no reports of parasite incidence. Both analyses picked out counties in south Texas as those at highest risk. 4. As an alternative to the multi-criteria analysis, the ecological and incidence-based risks were compounded in a multiplicative composite risk model. Counties in south Texas emerged as those with the highest risk. 5. Risk as the relative expected exposure rate was computed using a multiplicative model for the composite risk and a scaled population county map for Texas. Counties with highest risk were those in south Texas and a few counties with high human populations in north, east, and central Texas showing that, though Chagas disease risk is concentrated in south Texas, it is not restricted to it. For all of Texas, Chagas disease should be designated as reportable, as it is in Arizona and Massachusetts. At least for south Texas, lower than N, blood donor screening should be mandatory, and the serological profiles of human and canine populations should be established. It is also recommended that a joint initiative be undertaken by the United States and México to combat Chagas disease in the trans-border region. The methodology developed for this analysis can be easily exported to other geographical and disease contexts in which risk assessment is of potential value.

Does Exposure to Agricultural Chemicals Increase the Risk of Prostate Cancer among Farmers?

PubMed Central

Parent, Marie-Élise; Désy, Marie; Siemiatycki, Jack

2009-01-01

Several studies suggest that farmers may be at increased risk of prostate cancer. The present analysis, based on a large population-based case-control study conducted among men in the Montreal area in the early 1980’s, aim at identifying occupational chemicals which may be responsible for such increases. The original study enrolled 449 prostate cancer cases, nearly 4,000 patients with other cancers, as well as 533 population controls. Subjects were interviewed about their occupation histories, and a team of industrial hygienists assigned their past exposures using a checklist of some 300 chemicals. The present analysis was restricted to a study base of men who had worked as farmers earlier in their lives. There were a total of 49 men with prostate cancers, 127 with other cancers and 56 population controls. We created a pool of 183 controls combining the patients with cancers at sites other than the prostate and the population controls. We then estimated the odds ratio for prostate cancer associated with exposure to each of 10 agricultural chemicals, i.e., pesticides, arsenic compounds, acetic acid, gasoline engine emissions, diesel engine emissions, polycyclic aromatic hydrocarbons from petroleum, lubricating oils and greases, alkanes with ≥18 carbons, solvents, and mononuclear aromatic hydrocarbons. Based on a model adjusting for age, ethnicity, education, and respondent status, there was evidence of a two-fold excess risk of prostate cancer among farmers with substantial exposure to pesticides [odds ratio (OR)=2.3, 95% confidence interval (CI) 1.1–5.1], as compared to unexposed farmers. There was some suggestion, based on few subjects, of increased risks among farmers ever exposed to diesel engine emissions (OR=5.7, 95% CI 1.2–26.5). The results for pesticides are particularly noteworthy in the light of findings from previous studies. Suggestions of trends for elevated risks were noted with other agricultural chemicals, but these are largely novel and need further confirmation in larger samples. PMID:19753293

Higher risk for thyroid diseases in physicians than in the general population: a Taiwan nationwide population-based secondary analysis study.

PubMed

Chen, T-Y; Hsu, C-C; Feng, I-J; Wang, J-J; Su, S-B; Guo, H-R; Huang, C-C; Lin, H-J

2017-03-01

Physicians have high work stress, responsibility for night shifts and chances of exposure to medical radiation, which may increase the risk for thyroid diseases. We conducted this study to assess the risk for thyroid diseases in physicians, which remain unclear. We used a secondary analysis of the Taiwan National Health Insurance Research Database for this study. After excluding thyroid diseases occurring before 2006 and residents, physicians and general population were identified by matching with age and sex in 2009 in a 1:2 ratio. The risk for thyroid diseases was compared between the physicians and general population and among physicians by tracing their medical histories between 2006 and 2012. In total, 28,649 physicians and 57,298 general population were identified. Physicians had a higher risk for overall thyroid diseases than the general population [odds ratio (OR): 1.27; 95% confidence interval (CI): 1.10-1.47], including individual thyroid disease: thyroid cancer (OR: 1.89; 95% CI: 1.22-2.95), hypothyroidism (OR: 1.64; 95% CI: 1.23-2.18) and thyroiditis (OR: 1.48; 95% CI: 1.00-2.19). We showed that physicians had a significantly higher risk for thyroid diseases than the general population. This reminds us to pay more attention to thyroid diseases in physicians. Further studies about the underlying mechanisms are warranted. © The Author 2016. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Cancer incidence among HIV-positive women in British Columbia, Canada: Heightened risk of virus-related malignancies.

PubMed

Salters, K A; Cescon, A; Zhang, W; Ogilvie, G; Murray, M C M; Coldman, A; Hamm, J; Chiu, C G; Montaner, J S G; Wiseman, S M; Money, D; Pick, N; Hogg, R S

2016-03-01

We used population-based data to identify incident cancer cases and correlates of cancer among women living with HIV/AIDS in British Columbia (BC), Canada between 1994 and 2008. Data were obtained from a retrospective population-based cohort created from linkage of two province-wide databases: (1) the database of the BC Cancer Agency, a province-wide population-based cancer registry, and (2) a database managed by the BC Centre for Excellence in HIV/AIDS, which contains data on all persons treated with antiretroviral therapy in BC. This analysis included women (≥ 19 years old) living with HIV in BC, Canada. Incident cancer diagnoses that occurred after highly active antiretroviral therapy (HAART) initiation were included. We obtained a general population comparison of cancer incidence among women from the BC Cancer Agency. Bivariate analysis (Pearson χ(2) , Fisher's exact or Wilcoxon rank-sum test) compared women with and without incident cancer across relevant clinical and sociodemographic variables. Standardized incidence ratios (SIRs) were calculated for selected cancers compared with the general population sample. We identified 2211 women with 12 529 person-years (PY) of follow-up who were at risk of developing cancer after HAART initiation. A total of 77 incident cancers (615/100 000 PY) were identified between 1994 and 2008. HIV-positive women with cancer, in comparison to the general population sample, were more likely to be diagnosed with invasive cervical cancer, Hodgkin's lymphoma, non-Hodgkin's lymphoma and Kaposi's sarcoma and less likely to be diagnosed with cancers of the digestive system. This study observed elevated rates of cancer among HIV-positive women compared to a general population sample. HIV-positive women may have an increased risk for cancers of viral-related pathogenesis. © 2015 British HIV Association.

Spatiotemporal analysis and mapping of oral cancer risk in changhua county (taiwan): an application of generalized bayesian maximum entropy method.

PubMed

Yu, Hwa-Lung; Chiang, Chi-Ting; Lin, Shu-De; Chang, Tsun-Kuo

2010-02-01

Incidence rate of oral cancer in Changhua County is the highest among the 23 counties of Taiwan during 2001. However, in health data analysis, crude or adjusted incidence rates of a rare event (e.g., cancer) for small populations often exhibit high variances and are, thus, less reliable. We proposed a generalized Bayesian Maximum Entropy (GBME) analysis of spatiotemporal disease mapping under conditions of considerable data uncertainty. GBME was used to study the oral cancer population incidence in Changhua County (Taiwan). Methodologically, GBME is based on an epistematics principles framework and generates spatiotemporal estimates of oral cancer incidence rates. In a way, it accounts for the multi-sourced uncertainty of rates, including small population effects, and the composite space-time dependence of rare events in terms of an extended Poisson-based semivariogram. The results showed that GBME analysis alleviates the noises of oral cancer data from population size effect. Comparing to the raw incidence data, the maps of GBME-estimated results can identify high risk oral cancer regions in Changhua County, where the prevalence of betel quid chewing and cigarette smoking is relatively higher than the rest of the areas. GBME method is a valuable tool for spatiotemporal disease mapping under conditions of uncertainty. 2010 Elsevier Inc. All rights reserved.

Applicability and feasibility of systematic review for performing evidence-based risk assessment in food and feed safety.

PubMed

Aiassa, E; Higgins, J P T; Frampton, G K; Greiner, M; Afonso, A; Amzal, B; Deeks, J; Dorne, J-L; Glanville, J; Lövei, G L; Nienstedt, K; O'connor, A M; Pullin, A S; Rajić, A; Verloo, D

2015-01-01

Food and feed safety risk assessment uses multi-parameter models to evaluate the likelihood of adverse events associated with exposure to hazards in human health, plant health, animal health, animal welfare, and the environment. Systematic review and meta-analysis are established methods for answering questions in health care, and can be implemented to minimize biases in food and feed safety risk assessment. However, no methodological frameworks exist for refining risk assessment multi-parameter models into questions suitable for systematic review, and use of meta-analysis to estimate all parameters required by a risk model may not be always feasible. This paper describes novel approaches for determining question suitability and for prioritizing questions for systematic review in this area. Risk assessment questions that aim to estimate a parameter are likely to be suitable for systematic review. Such questions can be structured by their "key elements" [e.g., for intervention questions, the population(s), intervention(s), comparator(s), and outcome(s)]. Prioritization of questions to be addressed by systematic review relies on the likely impact and related uncertainty of individual parameters in the risk model. This approach to planning and prioritizing systematic review seems to have useful implications for producing evidence-based food and feed safety risk assessment.

Global Prevalence of Elder Abuse: A Meta-analysis and Meta-regression.

PubMed

Ho, C Sh; Wong, S Y; Chiu, M M; Ho, R Cm

2017-06-01

Elder abuse is increasingly recognised as a global public health and social problem. There has been limited inter-study comparison of the prevalence and risk factors for elder abuse. This study aimed to estimate the pooled and subtype prevalence of elder abuse worldwide and identify significant associated risk factors. We conducted a meta-analysis and meta-regression of 34 population-based and 17 non-population-based studies. The pooled prevalences of elder abuse were 10.0% (95% confidence interval, 5.2%-18.6%) and 34.3% (95% confidence interval, 22.9%-47.8%) in population-based studies and third party- or caregiver-reported studies, respectively. Being in a marital relationship was found to be a significant moderator using random-effects model. This meta-analysis revealed that third parties or caregivers were more likely to report abuse than older abused adults. Subgroup analyses showed that females and those resident in non-western countries were more likely to be abused. Emotional abuse was the most prevalent elder abuse subtype and financial abuse was less commonly reported by third parties or caregivers. Heterogeneity in the prevalence was due to the high proportion of married older adults in the sample. Subgroup analysis showed that cultural factors, subtypes of abuse, and gender also contributed to heterogeneity in the pooled prevalence of elder abuse.

Dietary patterns and colorectal cancer: results from a Canadian population-based study.

PubMed

Chen, Zhi; Wang, Peizhong Peter; Woodrow, Jennifer; Zhu, Yun; Roebothan, Barbara; Mclaughlin, John R; Parfrey, Patrick S

2015-01-15

The relationship between major dietary patterns and colorectal cancer (CRC) in other populations largely remains consistent across studies. The objective of the present study is to assess if dietary patterns are associated with the risk of CRC in the population of Newfoundland and Labrador (NL). Data from a population based case-control study in the province of NL were analyzed, including 506 CRC patients (306 men and 200 women) and 673 controls (400 men and 273 women), aged 20-74 years. Dietary habits were assessed by a 169-item food frequency questionnaire (FFQ). Logistic regression analyses were performed to investigate the association between dietary patterns and the CRC risk. Three major dietary patterns were derived using factor analysis, namely a Meat-diet pattern, a Plant-based diet pattern and a Sugary-diet pattern. In combination the three dietary patterns explained 74% of the total variance in food intake. Results suggest that the Meat-diet and the Sugary-diet increased the risk of CRC with corresponding odds ratios (ORs) of 1.84 (95% CI: 1.19-2.86) and 2.26 (95% CI: 1.39-3.66) for people in the highest intake quintile compared to those in the lowest. Whereas plant-based diet pattern decreases the risk of CRC with a corresponding OR of 0.55 (95% CI: 0.35-0.87). Even though odds ratios (ORs) were not always statistically significant, largely similar associations across three cancer sites were found: the proximal colon, the distal colon, and the rectum. The finding that Meat-diet/Sugary-diet patterns increased and Plant-based diet pattern decreased the risk of CRC would guide the promotion of healthy eating for primary prevention of CRC in this population.

Using Geographical Information Systems to Identify Populations in Need of Improved Accessibility to Antivenom Treatment for Snakebite Envenoming in Costa Rica

PubMed Central

Hansson, Erik; Sasa, Mahmood; Mattisson, Kristoffer; Robles, Arodys; Gutiérrez, José María

2013-01-01

Introduction Snakebite accidents are an important health problem in rural areas of tropical countries worldwide, including Costa Rica, where most bites are caused by the pit-viper Bothrops asper. The treatment of these potentially fatal accidents is based on the timely administration of specific antivenom. In many regions of the world, insufficient health care systems and lack of antivenom in remote and poor areas where snakebites are common, means that efficient treatment is unavailable for many snakebite victims, leading to unnecessary mortality and morbidity. In this study, geographical information systems (GIS) were used to identify populations in Costa Rica with a need of improved access to antivenom treatment: those living in areas with a high risk of snakebites and long time to reach antivenom treatment. Method/Principal Findings Populations living in areas with high risk of snakebites were identified using two approaches: one based on the district-level reported incidence, and another based on mapping environmental factors favoring B. asper presence. Time to reach treatment using ambulance was estimated using cost surface analysis, thereby enabling adjustment of transportation speed by road availability and quality, topography and land use. By mapping populations in high risk of snakebites and the estimated time to treatment, populations with need of improved treatment access were identified. Conclusion/Significance This study demonstrates the usefulness of GIS for improving treatment of snakebites. By mapping reported incidence, risk factors, location of existing treatment resources, and the time estimated to reach these for at-risk populations, rational allocation of treatment resources is facilitated. PMID:23383352

Using geographical information systems to identify populations in need of improved accessibility to antivenom treatment for snakebite envenoming in Costa Rica.

PubMed

Hansson, Erik; Sasa, Mahmood; Mattisson, Kristoffer; Robles, Arodys; Gutiérrez, José María

2013-01-01

Snakebite accidents are an important health problem in rural areas of tropical countries worldwide, including Costa Rica, where most bites are caused by the pit-viper Bothrops asper. The treatment of these potentially fatal accidents is based on the timely administration of specific antivenom. In many regions of the world, insufficient health care systems and lack of antivenom in remote and poor areas where snakebites are common, means that efficient treatment is unavailable for many snakebite victims, leading to unnecessary mortality and morbidity. In this study, geographical information systems (GIS) were used to identify populations in Costa Rica with a need of improved access to antivenom treatment: those living in areas with a high risk of snakebites and long time to reach antivenom treatment. Populations living in areas with high risk of snakebites were identified using two approaches: one based on the district-level reported incidence, and another based on mapping environmental factors favoring B. asper presence. Time to reach treatment using ambulance was estimated using cost surface analysis, thereby enabling adjustment of transportation speed by road availability and quality, topography and land use. By mapping populations in high risk of snakebites and the estimated time to treatment, populations with need of improved treatment access were identified. This study demonstrates the usefulness of GIS for improving treatment of snakebites. By mapping reported incidence, risk factors, location of existing treatment resources, and the time estimated to reach these for at-risk populations, rational allocation of treatment resources is facilitated.

Basal cell skin cancer and the risk of second primary cancers: a cancer registry-based study in Lithuania.

PubMed

Krilaviciute, Agne; Vincerzevskiene, Ieva; Smailyte, Giedre

2016-07-01

The aim of this population-based cohort study was to determine the risk of second primary cancer in basal cell carcinoma (BCC) patients in Lithuania. This analysis was based on patients diagnosed with BCC in Lithuania between 1998 and 2007 and followed until 2011. Standardized incidence ratios for subsequent cancers as a ratio of observed number of cancer cases in people with previous BCC diagnosis to the expected number of cancer cases in the underlying general population were calculated. After diagnosis of BCC, 1442 new cases of selected cancers were diagnosed. Compared with the general population, the incidence of all new primaries combined after BCC was very close to expected. Statistically meaningful increase in developing subsequent cancer was obtained for Hodgkin's lymphoma, prostate cancer, and leukemia in men, and for cancers of the lip, lung, and breast in women. Risk of melanoma and thyroid cancer was significantly elevated in both sexes. Relative risk of cancer of the eye was increased although not significant. In our study, we found increased cancer risk for cancers related to sun exposure. In addition, increased risks were identified for Hodgkin's lymphoma, thyroid cancer, leukemia, prostate, and breast cancer in BCC patients. Copyright © 2016 Elsevier Inc. All rights reserved.

Association between MTHFR C677T polymorphism and depression: a meta-analysis in the Chinese population.

PubMed

Jiang, Wei; Xu, Jun; Lu, Xiao-Jie; Sun, Yang

2016-09-01

Depression is a worldwide public health issue, and its prevalence increases each year. Although a number of studies have been conducted on the association between MTHFR C677T polymorphism and depression in China, this association remains elusive and controversial. To clarify the impact of MTHFR C677T polymorphism on the risk of depression, a meta-analysis was performed in the Chinese population. Relevant studies were identified using PubMed, Springer Link, Ovid, Chinese Wanfang Data Knowledge Service Platform, Chinese National Knowledge Infrastructure and Chinese Biology Medicine through May 5, 2015. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were used to assess the strength of the associations. A total of 13 case-control studies including 1895 patients and 1913 controls were involved in this meta-analysis. Overall, T variant of MTHFR C677T gene polymorphism was significantly associated with an increased risk of depression in the Chinese population (T vs. C: OR = 1.52, 95% CI = 1.24-1.85; TT + CT vs. CC: OR = 1.64, 95% CI = 1.16-2.30; TT vs. CC: OR = 2.19, 95% CI = 1.49-3.24; TT vs. CC + CT: OR = 1.80, 95% CI = 1.31-2.46). In subgroup analyses stratified by geographic area and source of controls, the significant results were found in population-based studies, in hospital-based studies, in North and South China. The risk conferred by MTHFR C677T polymorphism is higher in North China than in South China. In conclusion, this meta-analysis suggests that MTHFR C677T polymorphism is associated with depression in the Chinese population, but these associations vary in different geographic locations.

Who is where at risk for Chronic Obstructive Pulmonary Disease? A spatial epidemiological analysis of health insurance claims for COPD in Northeastern Germany

PubMed Central

Maier, Werner; Schweikart, Jürgen; Keste, Andrea; Moskwyn, Marita

2018-01-01

Background Chronic obstructive pulmonary disease (COPD) has a high prevalence rate in Germany and a further increase is expected within the next years. Although risk factors on an individual level are widely understood, only little is known about the spatial heterogeneity and population-based risk factors of COPD. Background knowledge about broader, population-based processes could help to plan the future provision of healthcare and prevention strategies more aligned to the expected demand. The aim of this study is to analyze how the prevalence of COPD varies across northeastern Germany on the smallest spatial-scale possible and to identify the location-specific population-based risk factors using health insurance claims of the AOK Nordost. Methods To visualize the spatial distribution of COPD prevalence at the level of municipalities and urban districts, we used the conditional autoregressive Besag–York–Mollié (BYM) model. Geographically weighted regression modelling (GWR) was applied to analyze the location-specific ecological risk factors for COPD. Results The sex- and age-adjusted prevalence of COPD was 6.5% in 2012 and varied widely across northeastern Germany. Population-based risk factors consist of the proportions of insurants aged 65 and older, insurants with migration background, household size and area deprivation. The results of the GWR model revealed that the population at risk for COPD varies considerably across northeastern Germany. Conclusion Area deprivation has a direct and an indirect influence on the prevalence of COPD. Persons ageing in socially disadvantaged areas have a higher chance of developing COPD, even when they are not necessarily directly affected by deprivation on an individual level. This underlines the importance of considering the impact of area deprivation on health for planning of healthcare. Additionally, our results reveal that in some parts of the study area, insurants with migration background and persons living in multi-persons households are at elevated risk of COPD. PMID:29414997

Who is where at risk for Chronic Obstructive Pulmonary Disease? A spatial epidemiological analysis of health insurance claims for COPD in Northeastern Germany.

PubMed

Kauhl, Boris; Maier, Werner; Schweikart, Jürgen; Keste, Andrea; Moskwyn, Marita

2018-01-01

Chronic obstructive pulmonary disease (COPD) has a high prevalence rate in Germany and a further increase is expected within the next years. Although risk factors on an individual level are widely understood, only little is known about the spatial heterogeneity and population-based risk factors of COPD. Background knowledge about broader, population-based processes could help to plan the future provision of healthcare and prevention strategies more aligned to the expected demand. The aim of this study is to analyze how the prevalence of COPD varies across northeastern Germany on the smallest spatial-scale possible and to identify the location-specific population-based risk factors using health insurance claims of the AOK Nordost. To visualize the spatial distribution of COPD prevalence at the level of municipalities and urban districts, we used the conditional autoregressive Besag-York-Mollié (BYM) model. Geographically weighted regression modelling (GWR) was applied to analyze the location-specific ecological risk factors for COPD. The sex- and age-adjusted prevalence of COPD was 6.5% in 2012 and varied widely across northeastern Germany. Population-based risk factors consist of the proportions of insurants aged 65 and older, insurants with migration background, household size and area deprivation. The results of the GWR model revealed that the population at risk for COPD varies considerably across northeastern Germany. Area deprivation has a direct and an indirect influence on the prevalence of COPD. Persons ageing in socially disadvantaged areas have a higher chance of developing COPD, even when they are not necessarily directly affected by deprivation on an individual level. This underlines the importance of considering the impact of area deprivation on health for planning of healthcare. Additionally, our results reveal that in some parts of the study area, insurants with migration background and persons living in multi-persons households are at elevated risk of COPD.

Comparison between urine albumin-to-creatinine ratio and urine protein dipstick testing for prevalence and ability to predict the risk for chronic kidney disease in the general population (Iwate-KENCO study): a prospective community-based cohort study.

PubMed

Koeda, Yorihiko; Tanaka, Fumitaka; Segawa, Toshie; Ohta, Mutsuko; Ohsawa, Masaki; Tanno, Kozo; Makita, Shinji; Ishibashi, Yasuhiro; Itai, Kazuyoshi; Omama, Shin-Ichi; Onoda, Toshiyuki; Sakata, Kiyomi; Ogasawara, Kuniaki; Okayama, Akira; Nakamura, Motoyuki

2016-05-12

This study compared the combination of estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) vs. eGFR and urine protein reagent strip testing to determine chronic kidney disease (CKD) prevalence, and each method's ability to predict the risk for cardiovascular events in the general Japanese population. Baseline data including eGFR, UACR, and urine dipstick tests were obtained from the general population (n = 22 975). Dipstick test results (negative, trace, positive) were allocated to three levels of UACR (<30, 30-300, >300), respectively. In accordance with Kidney Disease Improving Global Outcomes CKD prognosis heat mapping, the cohort was classified into four risk grades (green: grade 1; yellow: grade 2; orange: grade 3, red: grade 4) based on baseline eGFR and UACR levels or dipstick tests. During the mean follow-up period of 5.6 years, 708 new onset cardiovascular events were recorded. For CKD identified by eGFR and dipstick testing (dipstick test ≥ trace and eGFR <60 mL/min/1.73 m(2)), the incidence of CKD was found to be 9 % in the general population. In comparison to non-CKD (grade 1), although cardiovascular risk was significantly higher in risk grades ≥3 (relative risk (RR) = 1.70; 95 % CI: 1.28-2.26), risk predictive ability was not significant in risk grade 2 (RR = 1.20; 95 % CI: 0.95-1.52). When CKD was defined by eGFR and UACR (UACR ≥30 mg/g Cr and eGFR <60 mL/min/1.73 m(2)), prevalence was found to be 29 %. Predictive ability in risk grade 2 (RR = 1.41; 95 % CI: 1.19-1.66) and risk grade ≥3 (RR = 1.76; 95 % CI: 1.37-2.28) were both significantly greater than for non-CKD. Reclassification analysis showed a significant improvement in risk predictive abilities when CKD risk grading was based on UACR rather than on dipstick testing in this population (p < 0.001). Although prevalence of CKD was higher when detected by UACR rather than urine dipstick testing, the predictive ability for cardiovascular events from UACR-based risk grading was superior to that of dipstick-based risk grading in the general population.

TP53 codon 72 polymorphism and susceptibility to cervical cancer in the Chinese population: an update meta-analysis

PubMed Central

Li, Bing; Wang, Xin; Chen, Hong; Shang, Li-Xin; Wu, Nan

2015-01-01

Background: Although many epidemiologic studies investigated the TP53 codon 72 polymorphism and its association with cervical cancer (CC), definite conclusions cannot be drawn. Aim of the study: To evaluate the association between TP53 codon 72 polymorphism and risk of cervical cancer in the Chinese population. Methods: A computerized literature search was carried out in PubMed, Springer Link, Ovid, Chinese Biomedical Database (CBM), Chinese National Knowledge Infrastructure (CNKI), and Chinese Wanfang Database to collect relevant articles. Odds ratios (ORs) with 95% confidence intervals (CIs) were used to calculate the strength of association. Results: A total of 16 studies including 1684 CC cases and 1178 controls were involved in this meta-analysis. Overall, significant increased association was found between the Pro/Pro carriers and CC risk when all studies in Chinese population pooled into the meta-analysis (heterozygous model: OR = 1.22, 95% CI: 1.01-1.46). In subgroup analyses stratified by ethnicity and source of controls, the same results were observed in Han and in hospital-based studies. Conclusion: Our results suggest that the TP53 codon 72 polymorphism may be potential biomarkers for CC risk in the Chinese population, especially for Han Chinese, and studies with wider spectrum of population are required for definite conclusions. PMID:26309559

PTEN IDENTIFIED AS IMPORTANT RISK FACTOR OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE

PubMed Central

Hosgood, H Dean; Menashe, Idan; He, Xingzhou; Chanock, Stephen; Lan, Qing

2009-01-01

Common genetic variation may play an important role in altering chronic obstructive pulmonary disease (COPD) risk. In Xuanwei, China, the COPD rate is more than twice the Chinese national average, and COPD is strongly associated with in-home coal use. To identify genetic variation that may be associated with COPD in a population with substantial in-home coal smoke exposures, we evaluated 1,261 single nucleotide polymorphisms (SNPs) in 380 candidate genes potentially relevant for cancer and other human diseases in a population-based case-control study in Xuanwei (53 cases; 107 controls). PTEN was the most significantly associated gene with COPD in a minP analysis using 20,000 permutations (P = 0.00005). SNP-based analyses found that homozygote variant carriers of PTEN rs701848 (ORTT = 0.12, 95%CI = 0.03 - 0.47) had a significant decreased risk of COPD. PTEN, or phosphatase and tensin homolog, is an important regulator of cell cycle progression and cellular survival via the AKT signaling pathway. Our exploratory analysis suggests that genetic variation in PTEN may be an important risk factor of COPD in Xuanwei. However, due to the small sample size, additional studies are needed to evaluate these associations within Xuanwei and other populations with coal smoke exposures. PMID:19625176

The association between dietary zinc intake and risk of pancreatic cancer: a meta-analysis.

PubMed

Li, Li; Gai, Xuesong

2017-06-30

Previous reports have suggested a potential association on dietary zinc intake with the risk of pancreatic cancer. Since the associations between different studies were controversial, we therefore conducted a meta-analysis to reassess the relationship between dietary zinc intake and pancreatic cancer risk. A comprehensive search from the databases of PubMed, Embase, Web of Science, and Medline was performed until January 31, 2017. Relative risk (RR) with 95% confidence intervals (CI) derived by using random effect model was used. Sensitivity analysis and publication bias were conducted. Our meta-analysis was based on seven studies involving 1659 cases, including two prospective cohort studies and five case-control studies. The total RR of pancreatic cancer risk for the highest versus the lowest categories of dietary zinc intake was 0.798 (0.621-0.984), with its significant heterogeneity among studies ( I 2 =58.2%, P =0.026). The average Newcastle-Ottawa scale (NOS) score was 7.29, suggesting a high quality. There was no publication bias in the meta-analysis about dietary zinc intake on the risk of pancreatic cancer. Subgroup analyses showed that dietary zinc intake could reduce the risk of pancreatic cancer in case-control studies and among American populations. In conclusion, we found that highest category of dietary zinc intake can significantly reduce the risk of pancreatic cancer, especially among American populations. © 2017 The Author(s).

Imputation-Based Meta-Analysis of Severe Malaria in Three African Populations

PubMed Central

Band, Gavin; Le, Quang Si; Jostins, Luke; Pirinen, Matti; Kivinen, Katja; Jallow, Muminatou; Sisay-Joof, Fatoumatta; Bojang, Kalifa; Pinder, Margaret; Sirugo, Giorgio; Conway, David J.; Nyirongo, Vysaul; Kachala, David; Molyneux, Malcolm; Taylor, Terrie; Ndila, Carolyne; Peshu, Norbert; Marsh, Kevin; Williams, Thomas N.; Alcock, Daniel; Andrews, Robert; Edkins, Sarah; Gray, Emma; Hubbart, Christina; Jeffreys, Anna; Rowlands, Kate; Schuldt, Kathrin; Clark, Taane G.; Small, Kerrin S.; Teo, Yik Ying; Kwiatkowski, Dominic P.; Rockett, Kirk A.; Barrett, Jeffrey C.; Spencer, Chris C. A.

2013-01-01

Combining data from genome-wide association studies (GWAS) conducted at different locations, using genotype imputation and fixed-effects meta-analysis, has been a powerful approach for dissecting complex disease genetics in populations of European ancestry. Here we investigate the feasibility of applying the same approach in Africa, where genetic diversity, both within and between populations, is far more extensive. We analyse genome-wide data from approximately 5,000 individuals with severe malaria and 7,000 population controls from three different locations in Africa. Our results show that the standard approach is well powered to detect known malaria susceptibility loci when sample sizes are large, and that modern methods for association analysis can control the potential confounding effects of population structure. We show that pattern of association around the haemoglobin S allele differs substantially across populations due to differences in haplotype structure. Motivated by these observations we consider new approaches to association analysis that might prove valuable for multicentre GWAS in Africa: we relax the assumptions of SNP–based fixed effect analysis; we apply Bayesian approaches to allow for heterogeneity in the effect of an allele on risk across studies; and we introduce a region-based test to allow for heterogeneity in the location of causal alleles. PMID:23717212

Central nervous system infections and stroke -- a population-based analysis.

PubMed

Chien, L-N; Chi, N-F; Hu, C-J; Chiou, H-Y

2013-10-01

Chronic central nervous system (CNS) infections have been found to associate with cerebrovascular complications. Acute CNS infections are more common than chronic CNS infections, but whether they could increase the risk of vascular diseases has not been studied. The study cohort comprised all adult patients with diagnoses of CNS infections from Taiwan National Health Insurance Research Database during 2000-2009 (n = 533). The comparison group were matched by age, sex, urbanization, diagnostic year, and vascular risk factors of cases (cases and controls = 1:5). Patients were tracked for at least 1 year. Kaplan-Meier analysis was used to compare the risk of stroke and acute myocardial infarction (AMI) after adjusting censoring subjects. After adjusting the patients demographic characteristics and comorbidities, the risk of patients with CNS infections developing stroke was 2.75-3.44 times greater than their comparison group. More than 70% of the stroke events were occurring within 1 year after CNS infections. The risk of AMI was not found as we compared patients with and without CNS infections. The population-based cohort study suggested that adult patients with CNS infections have higher risk to develop stroke but not AMI, and the risk is marked within a year after infections. © 2013 John Wiley & Sons A/S.

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

EPA Science Inventory

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

Higher migraine risk in healthcare professionals than in general population: a nationwide population-based cohort study in Taiwan.

PubMed

Kuo, Wan-Yin; Huang, Chien-Cheng; Weng, Shih-Feng; Lin, Hung-Jung; Su, Shih-Bin; Wang, Jhi-Joung; Guo, How-Ran; Hsu, Chien-Chin

2015-01-01

High stress levels and shift work probably trigger migraine in healthcare professionals (HCPs). However, the migraine risk differences between HCPs and the general population is unknown. This nationwide population-based cohort study used Taiwan's National Health Insurance Research Database. Physicians (50,226), nurses (122,357), and other HCPs (pharmacists, technicians, dietitians, rehabilitation therapists, social workers, etc.) (45,736) were enrolled for the study cohort, and randomly selected non-HCPs (218,319) were enrolled for the comparison cohort. Conditional logistical regression analysis was used to compare the migraine risks. Comparisons between HCPs and between physician specialties were also done. Physicians, nurses, and other HCPs had higher migraine risks than did the general population (adjusted odds ratio [AOR]: 1.672; 95 % confidence interval [CI]: 1.468-1.905, AOR: 1.621; 95 % CI: 1.532-1.714, and AOR: 1.254; 95 % CI: 1.124-1.399, respectively) after stroke, hypertension, epilepsy, anxiety, depression, and insomnia had been adjusted for. Nurses and physicians had higher migraine risks than did other HCPs (AOR: 1.303; 95 % CI: 1.206-1.408, and AOR: 1.193; 95 % CI: 1.069-1.332, respectively). Obstetricians and gynecologists had a lower migraine risk than did other physician specialists (AOR: 0.550; 95 % CI: 0.323-0.937). HCPs in Taiwan had a higher migraine risk than did the general population. Heavy workloads, emotional stress, and rotating night shift sleep disturbances appear to be the most important risk factors. These findings should provide an important reference for promoting occupational health in HCPs in Taiwan.

Strong evidence for a genetic contribution to late-onset Alzheimer's disease mortality: a population-based study.

PubMed

Kauwe, John S K; Ridge, Perry G; Foster, Norman L; Cannon-Albright, Lisa A

2013-01-01

Alzheimer's disease (AD) is an international health concern that has a devastating effect on patients and families. While several genetic risk factors for AD have been identified much of the genetic variance in AD remains unexplained. There are limited published assessments of the familiality of Alzheimer's disease. Here we present the largest genealogy-based analysis of AD to date. We assessed the familiality of AD in The Utah Population Database (UPDB), a population-based resource linking electronic health data repositories for the state with the computerized genealogy of the Utah settlers and their descendants. We searched UPDB for significant familial clustering of AD to evaluate the genetic contribution to disease. We compared the Genealogical Index of Familiality (GIF) between AD individuals and randomly selected controls and estimated the Relative Risk (RR) for a range of family relationships. Finally, we identified pedigrees with a significant excess of AD deaths. The GIF analysis showed that pairs of individuals dying from AD were significantly more related than expected. This excess of relatedness was observed for both close and distant relationships. RRs for death from AD among relatives of individuals dying from AD were significantly increased for both close and more distant relatives. Multiple pedigrees had a significant excess of AD deaths. These data strongly support a genetic contribution to the observed clustering of individuals dying from AD. This report is the first large population-based assessment of the familiality of AD mortality and provides the only reported estimates of relative risk of AD mortality in extended relatives to date. The high-risk pedigrees identified show a true excess of AD mortality (not just multiple cases) and are greater in depth and width than published AD pedigrees. The presence of these high-risk pedigrees strongly supports the possibility of rare predisposition variants not yet identified.

Risk-based audit selection of dairy farms.

PubMed

van Asseldonk, M A P M; Velthuis, A G J

2014-02-01

Dairy farms are audited in the Netherlands on numerous process standards. Each farm is audited once every 2 years. Increasing demands for cost-effectiveness in farm audits can be met by introducing risk-based principles. This implies targeting subpopulations with a higher risk of poor process standards. To select farms for an audit that present higher risks, a statistical analysis was conducted to test the relationship between the outcome of farm audits and bulk milk laboratory results before the audit. The analysis comprised 28,358 farm audits and all conducted laboratory tests of bulk milk samples 12 mo before the audit. The overall outcome of each farm audit was classified as approved or rejected. Laboratory results included somatic cell count (SCC), total bacterial count (TBC), antimicrobial drug residues (ADR), level of butyric acid spores (BAB), freezing point depression (FPD), level of free fatty acids (FFA), and cleanliness of the milk (CLN). The bulk milk laboratory results were significantly related to audit outcomes. Rejected audits are likely to occur on dairy farms with higher mean levels of SCC, TBC, ADR, and BAB. Moreover, in a multivariable model, maxima for TBC, SCC, and FPD as well as standard deviations for TBC and FPD are risk factors for negative audit outcomes. The efficiency curve of a risk-based selection approach, on the basis of the derived regression results, dominated the current random selection approach. To capture 25, 50, or 75% of the population with poor process standards (i.e., audit outcome of rejected), respectively, only 8, 20, or 47% of the population had to be sampled based on a risk-based selection approach. Milk quality information can thus be used to preselect high-risk farms to be audited more frequently. Copyright © 2014 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Co-occurrence of behavioral risk factors of common non-communicable diseases among urban slum dwellers in Nairobi, Kenya.

PubMed

Haregu, Tilahun Nigatu; Oti, Samuel; Egondi, Thaddaeus; Kyobutungi, Catherine

2015-01-01

The four common non-communicable diseases (NCDs) account for 80% of NCD-related deaths worldwide. The four NCDs share four common risk factors. As most of the existing evidence on the common NCD risk factors is based on analysis of a single factor at a time, there is a need to investigate the co-occurrence of the common NCD risk factors, particularly in an urban slum setting in sub-Saharan Africa. To determine the prevalence of co-occurrence of the four common NCDs risk factors among urban slum dwellers in Nairobi, Kenya. This analysis was based on the data collected as part of a cross-sectional survey to assess linkages among socio-economic status, perceived personal risk, and risk factors for cardiovascular and NCDs in a population of slum dwellers in Nairobi, Kenya, in 2008-2009. A total of 5,190 study subjects were included in the analysis. After selecting relevant variables for common NCD risk factors, we computed the prevalence of all possible combinations of the four common NCD risk factors. The analysis was disaggregated by relevant background variables. The weighted prevalences of unhealthy diet, insufficient physical activity, harmful use of alcohol, and tobacco use were found to be 57.2, 14.4, 10.1, and 12.4%, respectively. Nearly 72% of the study participants had at least one of the four NCD risk factors. About 52% of the study population had any one of the four NCD risk factors. About one-fifth (19.8%) had co-occurrence of NCD risk factors. Close to one in six individuals (17.6%) had two NCD risk factors, while only 2.2% had three or four NCD risk factors. One out of five of people in the urban slum settings of Nairobi had co-occurrence of NCD risk factors. Both comprehensive and differentiated approaches are needed for effective NCD prevention and control in these settings.

Retest of a Principal Components Analysis of Two Household Environmental Risk Instruments.

PubMed

Oneal, Gail A; Postma, Julie; Odom-Maryon, Tamara; Butterfield, Patricia

2016-08-01

Household Risk Perception (HRP) and Self-Efficacy in Environmental Risk Reduction (SEERR) instruments were developed for a public health nurse-delivered intervention designed to reduce home-based, environmental health risks among rural, low-income families. The purpose of this study was to test both instruments in a second low-income population that differed geographically and economically from the original sample. Participants (N = 199) were recruited from the Women, Infants, and Children (WIC) program. Paper and pencil surveys were collected at WIC sites by research-trained student nurses. Exploratory principal components analysis (PCA) was conducted, and comparisons were made to the original PCA for the purpose of data reduction. Instruments showed satisfactory Cronbach alpha values for all components. HRP components were reduced from five to four, which explained 70% of variance. The components were labeled sensed risks, unseen risks, severity of risks, and knowledge. In contrast to the original testing, environmental tobacco smoke (ETS) items was not a separate component of the HRP. The SEERR analysis demonstrated four components explaining 71% of variance, with similar patterns of items as in the first study, including a component on ETS, but some differences in item location. Although low-income populations constituted both samples, differences in demographics and risk exposures may have played a role in component and item locations. Findings provided justification for changing or reducing items, and for tailoring the instruments to population-level risks and behaviors. Although analytic refinement will continue, both instruments advance the measurement of environmental health risk perception and self-efficacy. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Seroprevalence of Hepatitis B Virus Infection and Its Risk Factors in the West of Iran: A Population-based Study

PubMed Central

Alavian, Seyed Moayed; Tabatabaei, Seyed Vahid; Ghadimi, Teyyeb; Beedrapour, Farzam; Kafi-abad, Sedigheh Amini; Gharehbaghian, Ahmad; Abolghasemi, Hassan

2012-01-01

Introduction: Hepatitis B virus (HBV) infection is a serious global public health problem affecting billions of people globally. The lack of information of its seroprevalence among the general population is an obstacle for formulating effective policies to reduce the burden viral hepatitis. Therefore, this population based serological survey was conducted in Kurdistan province, where no epidemiological data was available to determine the prevalence and risk factors of HBV infection. Methods: 1613 healthy subjects were selected from all districts of Kurdistan province (in the western of Iran) using random cluster sampling. The subjects’ age ranged from 6 to 65 years old. Serum samples were tested for HBcAb, HBsAg and anti-HDV antibody. Screening tests were carried out by the third generation of ELISA. Various risk factors were recorded and multivariate analysis was performed. Results: The prevalence of HBsAg and HBcAb in Kurdistan was before 0.80% (95% CI 0.44; 1.34) and 5.02% (95% CI 4.03; 6.17), respectively. None of HBsAg carriers had positive anti-HDV antibody. Predictors of HBsAg or HBcAb in multivariate analysis were: older age and marriage. We did not find any significant differences between males and females. Conclusion: Our population based study suggests that intrafamilial HBV transmission plays a major role in HBV transmission in Kurdistan province. Furthermore, approximately 5% of general population in this province has prior exposure to HBV and less than 1% is HBsAg carriers. However, we could not find any case of HDV infection among them. PMID:23189228

[Health diagnosis and risk perception: key elements of a proposed intervention for indigenous communities in Mexico].

PubMed

Terán-Hernández, Mónica; Díaz-Barriga, Fernando; Cubillas-Tejeda, Ana Cristina

2016-02-01

Objective To carry out a diagnosis of children's environmental health and an analysis of risk perception in indigenous communities of the Huasteca Sur region of San Luis Potosí, Mexico, in order to design an intervention strategy in line with their needs. Methods The study used mixed methods research, carried out in two phases. It was conducted in three indigenous communities of Tancanhuitz municipality from January 2005 to June 2006. In the adult population, risk perception was analyzed through focus groups, in-depth interviews, and questionnaires. In the child population, analysis of children's drawings was used to study perception. An assessment of health risks was carried out through biological monitoring and environmental monitoring of water and soil. Results The three communities face critical problems that reveal their vulnerability. When the results were triangulated and integrated, it was found that the principal problems relate to exposure to pathogenic microorganisms in water and soil, exposure to indoor wood smoke, exposure to smoke from the burning of refuse, use of insecticides, exposure to lead from the use of glazed ceramics, and alcoholism. Conclusions To ensure that the intervention strategy is adapted to the target population, it is essential to incorporate risk perception analysis and to promote the participation of community members. The proposed intervention strategy to address the detected problems is based on the principles of risk communication, community participation, and interinstitutional linkage.

Risk factors for operated carpal tunnel syndrome: a multicenter population-based case-control study

PubMed Central

Mattioli, Stefano; Baldasseroni, Alberto; Bovenzi, Massimo; Curti, Stefania; Cooke, Robin MT; Campo, Giuseppe; Barbieri, Pietro G; Ghersi, Rinaldo; Broccoli, Marco; Cancellieri, Maria Pia; Colao, Anna Maria; dell'Omo, Marco; Fateh-Moghadam, Pirous; Franceschini, Flavia; Fucksia, Serenella; Galli, Paolo; Gobba, Fabriziomaria; Lucchini, Roberto; Mandes, Anna; Marras, Teresa; Sgarrella, Carla; Borghesi, Stefano; Fierro, Mauro; Zanardi, Francesca; Mancini, Gianpiero; Violante, Francesco S

2009-01-01

Background Carpal tunnel syndrome (CTS) is a socially and economically relevant disease caused by compression or entrapment of the median nerve within the carpal tunnel. This population-based case-control study aims to investigate occupational/non-occupational risk factors for surgically treated CTS. Methods Cases (n = 220) aged 18-65 years were randomly drawn from 13 administrative databases of citizens who were surgically treated with carpal tunnel release during 2001. Controls (n = 356) were randomly sampled from National Health Service registry records and were frequency matched by age-gender-specific CTS hospitalization rates. Results At multivariate analysis, risk factors were blue-collar/housewife status, BMI ≥ 30 kg/m2, sibling history of CTS and coexistence of trigger finger. Being relatively tall (cut-offs based on tertiles: women ≥165 cm; men ≥175 cm) was associated with lower risk. Blue-collar work was a moderate/strong risk factor in both sexes. Raised risks were apparent for combinations of biomechanical risk factors that included frequent repetitivity and sustained force. Conclusion This study strongly underlines the relevance of biomechanical exposures in both non-industrial and industrial work as risk factors for surgically treated CTS. PMID:19758429

Chromosomal microarray findings in pregnancies with an isolated pelvic kidney.

PubMed

Sagi-Dain, Lena; Singer, Amihood; Frumkin, Ayala; Shalata, Adel; Koifman, Arie; Segel, Reeval; Benyamini, Lilach; Rienstein, Shlomit; Kahyat, Morad; Sharony, Reuven; Maya, Idit; Ben Shachar, Shay

2018-05-29

To examine the risk for abnormal chromosomal microarray analysis (CMA) results among fetuses with an apparently isolated pelvic kidney. Data from all CMA analyses performed due to an isolated pelvic kidney reported to the Israeli Ministry of Health between January 2013 and September 2016 were retrospectively obtained. Risk estimation was performed comparing the rate of abnormal observed CMA findings to the general population risk, based on a systematic review encompassing 9272 cases and on local data of 5541 cases. Of 120 pregnancies with an isolated pelvic kidney, two gain-of-copy number variants suggesting microduplication syndromes were demonstrated (1.67%). In addition, three variants of unknown significance were detected (2.5%). The risk for clinically significant CMA findings among pregnancies with an isolated single pelvic kidney was not significantly different compared to both control populations. The results of our study question the practice of routine CMA analysis in fetuses with an isolated pelvic kidney.

Integrating population dynamics into mapping human exposure to seismic hazard

NASA Astrophysics Data System (ADS)

Freire, S.; Aubrecht, C.

2012-11-01

Disaster risk is not fully characterized without taking into account vulnerability and population exposure. Assessment of earthquake risk in urban areas would benefit from considering the variation of population distribution at more detailed spatial and temporal scales, and from a more explicit integration of this improved demographic data with existing seismic hazard maps. In the present work, "intelligent" dasymetric mapping is used to model population dynamics at high spatial resolution in order to benefit the analysis of spatio-temporal exposure to earthquake hazard in a metropolitan area. These night- and daytime-specific population densities are then classified and combined with seismic intensity levels to derive new spatially-explicit four-class-composite maps of human exposure. The presented approach enables a more thorough assessment of population exposure to earthquake hazard. Results show that there are significantly more people potentially at risk in the daytime period, demonstrating the shifting nature of population exposure in the daily cycle and the need to move beyond conventional residence-based demographic data sources to improve risk analyses. The proposed fine-scale maps of human exposure to seismic intensity are mainly aimed at benefiting visualization and communication of earthquake risk, but can be valuable in all phases of the disaster management process where knowledge of population densities is relevant for decision-making.

Maternal smoking during pregnancy and the risk of pediatric cardiovascular diseases of the offspring: A population-based cohort study with up to 18-years of follow up.

PubMed

Leybovitz-Haleluya, Noa; Wainstock, Tamar; Landau, Daniella; Sheiner, Eyal

2018-06-01

Cigarette smoke is a well-known reproductive toxicant. We aimed to study the long-term effect of cigarette smoking during pregnancy on the risk for childhood cardiovascular morbidity of the offspring. A population-based cohort analysis was performed comparing total and subtypes of cardiovascular related pediatric hospitalizations among offspring of smoking mothers versus offspring of non-smoking mothers. The analysis included all singletons born between the years 1999-2014.A Kaplan-Meier survival curve was used to compare the cumulative cardiovascular morbidity, and a Cox proportional hazards model was constructed to adjust for confounders. The study population included 242,342 newborns which met inclusion criteria; among them 2861 were born to smoking mothers. Offspring of smoking mothers had higher rates of cardiovascular-related hospitalizations (1.3% vs. 0.6%, OR 2.1, 95% CI 1.5-2.9; p < 0.001; Kaplan-Meier log-rank test p < 0.001). Smoking exposure during pregnancy is associated with an increased risk for long-term pediatric cardiovascular morbidity of the offspring. Copyright © 2018 Elsevier Inc. All rights reserved.

Heterogeneity in risk of prostate cancer: A Swedish population-based cohort study of competing risks and type 2 diabetes mellitus.

PubMed

Häggström, Christel; Van Hemelrijck, Mieke; Garmo, Hans; Robinson, David; Stattin, Pär; Rowley, Mark; Coolen, Anthony C C; Holmberg, Lars

2018-05-09

Most previous studies of prostate cancer have not taken into account that men in the studied populations are also at risk of competing event, and that these men may have different susceptibility to prostate cancer risk. The aim of this study was to investigate heterogeneity in risk of prostate cancer, using a recently developed latent class regression method for competing risks. We further aimed to elucidate the association between type 2 diabetes mellitus (T2DM) and prostate cancer risk, and to compare the results with conventional methods for survival analysis. We analysed the risk of prostate cancer in 126,482 men from the comparison cohort of the Prostate Cancer Data base Sweden (PCBaSe) 3.0. During a mean follow-up of 6 years 6,036 men were diagnosed with prostate cancer and 22,393 men died. We detected heterogeneity in risk of prostate cancer with two distinct latent classes in the study population. The smaller class included 9% of the study population in which men had a higher risk of prostate cancer and the risk was stronger associated with class membership than any of the covariates included in the study. Moreover, we found no association between T2DM and risk of prostate cancer after removal of the effect of informative censoring due to competing risks. The recently developed latent class for competing risks method could be used to provide new insights in precision medicine with the target to classify individuals regarding different susceptibility to a particular disease, reaction to a risk factor or response to treatment. This article is protected by copyright. All rights reserved. © 2018 UICC.

Time series analysis of demographic and temporal trends of tuberculosis in Singapore.

PubMed

Wah, Win; Das, Sourav; Earnest, Arul; Lim, Leo Kang Yang; Chee, Cynthia Bin Eng; Cook, Alex Richard; Wang, Yee Tang; Win, Khin Mar Kyi; Ong, Marcus Eng Hock; Hsu, Li Yang

2014-10-31

Singapore is an intermediate tuberculosis (TB) incidence country, with a recent rise in TB incidence from 2008, after a fall in incidence since 1998. This study identified population characteristics that were associated with the recent increase in TB cases, and built a predictive model of TB risk in Singapore. Retrospective time series analysis was used to study TB notification data collected from 1995 to 2011 from the Singapore Tuberculosis Elimination Program (STEP) registry. A predictive model was developed based on the data collected from 1995 to 2010 and validated using the data collected in 2011. There was a significant difference in demographic characteristics between resident and non-resident TB cases. TB risk was higher in non-residents than in residents throughout the period. We found no significant association between demographic and macro-economic factors and annual incidence of TB with or without adjusting for the population-at-risk. Despite growing non-resident population, there was a significant decrease in the non-resident TB risk (p < 0.0001). However, there was no evidence of trend in the resident TB risk over this time period, though differences between different demographic groups were apparent with ethnic minorities experiencing higher incidence rates. The study found that despite an increasing size of non-resident population, TB risk among non-residents was decreasing at a rate of about 3% per year. There was an apparent seasonality in the TB reporting.

Upper gastrointestinal cancer burden in Hebei Province, China: A population-based study.

PubMed

Li, Dao-Juan; Liang, Di; Song, Guo-Hui; Li, Yong-Wei; Wen, Deng-Gui; Jin, Jing; He, Yu-Tong

2017-04-14

To investigate the incidence and mortality rates of upper gastrointestinal cancer (UGIC) in Hebei Province, China, and to identify high-risk populations to improve UGIC prevention and control. Data for UGIC patients were collected from 21 population-based cancer registries covering 15.25% of the population in Hebei Province. Mortality data were extracted from three national retrospective death surveys (1973-1975, 1990-1992 and 2004-2005). The data were stratified by 5-year age groups, gender and area (high-risk/non-high-risk areas) for analysis. The age-period-cohort and grey system model were used. The crude incidence rate of UGIC was 55.47/100000, and the adjusted rate (Segi's population) was 44.90/100000. Males in rural areas had the highest incidence rate (world age-standardized rate = 87.89/100000). The crude mortality rate of UGIC displayed a decreasing trend in Hebei Province from the 1970s to 2013, and the adjusted rate decreased by 43.81% from the 1970s (58.07/100000) to 2013 (32.63/100000). The mortality rate declined more significantly in the high-risk areas (57.26%) than in the non-high-risk areas (55.02%) from the 1970s to 2013. The median age at diagnosis of UGIC was 65.06 years in 2013. There was a notable delay in the median age at death from the 1970s (66.15 years) to 2013 (70.39 years), especially in the high-risk areas. In Cixian, the total trend of the cohort effect declined, and people aged 65-69 years were a population at relatively high risk for UGIC. We predicted that the crude mortality rates of UGIC in Cixian and Shexian would decrease to 98.80 and 133.99 per 100000 in 2018, respectively. UGIC was the major cause of cancer death in Hebei Province, and males in rural areas were a high-risk population. We should strengthen early detection and treatment of UGIC in this population.

Investigating the sources and potential health risks of environmental contaminants in the soils and drinking waters from the rural clusters in Thiva area (Greece).

PubMed

Kelepertzis, Efstratios

2014-02-01

The present study investigates the possible influence of human activities on metal loadings of topsoil in a typical small rural city in central Greece and the chemical quality of tap water in surrounding villages. Furthermore, the study aimed to examine potential health risks of naturally enriched heavy metals to exposed population taking into account the soil and drinking water as exposure pathways. The mean concentrations of Ni, Cr, Co, Mn, Pb, Cu, Zn and Cd in the soil were 1777, 285, 99, 946, 30, 26, 78 and 0.67 mg/kg respectively. Combination of pollution indexes based on local reference background soils and statistical analyses (correlation analysis, cluster analysis and principal component analysis) revealed that anthropogenic activities have not modified the natural soil chemistry at least in a large scale. High Hazard Quotient (HQ) values for children were estimated for Ni, Cr and Co based on total metal concentrations for the soil ingestion route (9.26E-01, 9.75E-01 and 3.45E+00 respectively). However, evaluation of HQs based on published bioaccessible concentrations suggested that the population groups would not likely experience potential health risks as a result of exposure to contaminated soils. Concentrations of Cr(VI) in tap waters were within the allowable limits. However, the risk assessment model revealed that local residents (adults) of Eleonas and Neochori villages are at some carcinogenic risks considering lifetime ingestion of water (potential cancer risks 2.05E-04 and 1.29E-04 respectively). Despite the uncertainties accompanying these procedures and the great deal of debate regarding the human carcinogenicity of Cr(VI) by the oral route, results of this study drive attention to remediation measures that should include epidemiological studies for the local population. © 2013 Published by Elsevier Inc.

Association of an APOC3 promoter variant with type 2 diabetes risk and need for insulin treatment in lean persons.

PubMed

van Hoek, M; van Herpt, T W; Dehghan, A; Hofman, A; Lieverse, A G; van Duijn, C M; Witteman, J C M; Sijbrands, E J G

2011-06-01

An APOC3 promoter haplotype has been previously associated with type 1 diabetes. In this population-based study, we investigated whether APOC3 polymorphisms increase type 2 diabetes risk and need for insulin treatment in lean participants. In the Rotterdam Study, a population-based prospective cohort (n = 7,983), Cox and logistic regression models were used to analyse the associations and interactive effects of APOC3 promoter variants (-482C > T, -455T > C) and BMI on type 2 diabetes risk and insulin treatment. Analyses were followed by replication in an independent case-control sample (1,817 cases, 2,292 controls) and meta-analysis. In lean participants, the -482T allele was associated with increased risk of prevalent and incident type 2 diabetes: OR -482CT 1.47 (95% CI 1.13-1.92), -482TT 1.40 (95% CI 0.83-2.35), p = 0.009 for trend; HR -482CT 1.35 (95% CI 0.96-1.89), -482TT 1.68 (95% CI 0.91-3.1), p = 0.03 for trend, respectively. These results were confirmed by replication. Meta-analysis was highly significant (-482T meta-analysis p = 1.1 × 10(-4)). A borderline significant interaction was observed for insulin use among participants with type 2 diabetes (-482CT*BMI p = 0.06, -455TC*BMI p = 0.02). At a population-based level, the influence of APOC3 promoter variants on type 2 diabetes risk varies with the level of adiposity. Lean carriers of the -482T allele had increased type 2 diabetes risk, while such an effect was not observed in overweight participants. Conversely, in overweight participants the -455C allele seemed protective against type 2 diabetes. The interaction of the variants with need for insulin treatment may indicate beta cell involvement in lean participants. Our findings suggest overlap in the genetic backgrounds of type 1 diabetes and type 2 diabetes in lean patients.

Aneurismal subarachnoid hemorrhage in a Chilean population, with emphasis on risk factors

PubMed Central

2011-01-01

Background Subarachnoid Hemorrhage (SAH) is caused principally by the rupture of intracranial aneurisms. Important risk factors have been described such as age, sex, hypertension (HT) and season of the year, among others. The objective is to investigate the demographic characteristics and possible risk factors in a population of Chilean patients. Methods This retrospective study was based on the analysis of 244 clinical records of patients diagnosed with aneurismal SAH who were discharged from the Instituto de Neurocirugía ASENJO in Santiago, Chile. Results The mean age of patients was 49.85 years and the male:female ratio was 1:2.7. The signs and symptoms were not different between sexes; cephalea (85.7%) was predominant, followed by loss of consciousness, vomiting/nausea and meningeal signs. Risk factors included sex, age and HT. Concordant with other reports, the incidence of SAH was greatest in spring. Conclusions The demographic characteristics and risk factors observed in patients with aneurismal SAH treated in ASENJO were comparable to those of other populations. We were not able to conclude that tobacco and alcohol consumption were risk factors for this population. PMID:22035203

Calcium antagonists and deep gingival pockets in the population-based SHIP study

PubMed Central

Meisel, Peter; Schwahn, Christian; John, Ulrich; Kroemer, Heyo K; Kocher, Thomas

2005-01-01

Aim Gingival overgrowth is a common undesired side-effect in patients taking calcium channel blockers. Different reports have suggested that the drug-induced gingival hyperplasia may aggravate inflammatory periodontal disease. However, representative epidemiological data are lacking. We investigated the association between the intake of calcium antagonists and periodontitis in a population-based analysis including the most important risk factors of periodontitis. Methods In a cross-sectional epidemiological investigation involving 4290 subjects aged 20–80 years, we recorded periodontal risk factors and identified participants using calcium antagonists. Periodontal parameters, attachment loss, probing depth and number of teeth were assessed. In a subgroup analysis with matched pairs, 456 subjects using calcium antagonists and 456 without were compared for periodontal status. Results Subjects treated with calcium antagonistic drugs had significantly deeper gingival pockets than their drug-free counterparts. This was observed in the total population of 4290 and confirmed by logistic regression analyses (P < 0.001) controlled for the known risk factors of periodontitis (age, sex, smoking, education). In the matched-pair analysis only the probing depth was increased: extent probing depth ≥4 mm median 23.5 vs. 17.0% (P < 0.001); mean probing depth 3.0 ± 0.8 vs. 2.7 ± 0.9 mm (P < 0.001). No differences were found in extent and severity of clinical attachment loss and in the number of teeth. The risk of gingival overgrowth was aggravated in smokers. Conclusion In the general population, treatment with calcium antagonists leads to gingival overgrowth without an aggravation of periodontal disease. Interaction with smoking indicates the multifactorial background of the undesired effect of calcium antagonists. PMID:16236046

Online self-test identifies women at high familial breast cancer risk in population-based breast cancer screening without inducing anxiety or distress.

PubMed

van Erkelens, A; Sie, A S; Manders, P; Visser, A; Duijm, L E; Mann, R M; Ten Voorde, M; Kroeze, H; Prins, J B; Hoogerbrugge, N

2017-06-01

Identifying high familial breast cancer (FBC) risk improves detection of yet unknown BRCA1/2-mutation carriers, for whom BC risk is both highly likely and potentially preventable. We assessed whether a new online self-test could identify women at high FBC risk in population-based BC screening without inducing anxiety or distress. After their visit for screening mammography, women were invited by email to take an online self-test for identifying highly increased FBC risk-based on Dutch guidelines. Exclusion criteria were previously diagnosed as increased FBC risk or a personal history of BC. Anxiety (State-Trait Anxiety Inventory Dutch Version), distress (Hospital Anxiety Depression Scale) and BC risk perception were assessed using questionnaires, which were completed immediately before and after taking the online self-test and 2 weeks later. Of the 562 women invited by email, 406 (72%) completed the online self-test while 304 also completed questionnaires (response rate 54%). After exclusion criteria, 287 (51%) were included for data analysis. Median age was 56 years (range 50-74). A high or moderate FBC risk was identified in 12 (4%) and three (1%) women, respectively. After completion of the online self-test, anxiety and BC risk perception were decreased while distress scores remained unchanged. Levels were below clinical relevance. Most women (85%) would recommend the self-test; few (3%) would not. The online self-test identified previously unknown women at high FBC risk (4%), who may carry a BRCA1/2-mutation, without inducing anxiety or distress. We therefore recommend offering this self-test to women who attend population-based screening mammography for the first time. Copyright © 2017 Elsevier Ltd. All rights reserved.

Tuberculosis and poverty: why are the poor at greater risk in India?

PubMed

Oxlade, Olivia; Murray, Megan

2012-01-01

Although poverty is widely recognized as an important risk factor for tuberculosis (TB) disease, the specific proximal risk factors that mediate this association are less clear. The objective of our study was to investigate the mechanisms by which poverty increases the risk of TB. Using individual level data from 198,754 people from the 2006 Demographic Health Survey (DHS) for India, we assessed self-reported TB status, TB determinants and household socioeconomic status. We used these data to calculate the population attributable fractions (PAF) for each key TB risk factor based on the prevalence of determinants and estimates of the effect of these risk factors derived from published sources. We conducted a mediation analysis using principal components analysis (PCA) and regression to demonstrate how the association between poverty and TB prevalence is mediated. The prevalence of self-reported TB in the 2006 DHS for India was 545 per 100,000 and ranged from 201 in the highest quintile to 1100 in the lowest quintile. Among those in the poorest population, the PAFs for low body mass index (BMI) and indoor air pollution were 34.2% and 28.5% respectively. The PCA analysis also showed that low BMI had the strongest mediating effect on the association between poverty and prevalent TB (12%, p = 0.019). TB control strategies should be targeted to the poorest populations that are most at risk, and should address the most important determinants of disease--specifically low BMI and indoor air pollution.

Prevention of falls and fall-related injuries in community-dwelling seniors: an evidence-based analysis.

PubMed

2008-01-01

In early August 2007, the Medical Advisory Secretariat began work on the Aging in the Community project, an evidence-based review of the literature surrounding healthy aging in the community. The Health System Strategy Division at the Ministry of Health and Long-Term Care subsequently asked the secretariat to provide an evidentiary platform for the ministry's newly released Aging at Home Strategy.After a broad literature review and consultation with experts, the secretariat identified 4 key areas that strongly predict an elderly person's transition from independent community living to a long-term care home. Evidence-based analyses have been prepared for each of these 4 areas: falls and fall-related injuries, urinary incontinence, dementia, and social isolation. For the first area, falls and fall-related injuries, an economic model is described in a separate report.Please visit the Medical Advisory Secretariat Web site, http://www.health.gov.on.ca/english/providers/program/mas/mas_about.html, to review these titles within the Aging in the Community series.AGING IN THE COMMUNITY: Summary of Evidence-Based AnalysesPrevention of Falls and Fall-Related Injuries in Community-Dwelling Seniors: An Evidence-Based AnalysisBehavioural Interventions for Urinary Incontinence in Community-Dwelling Seniors: An Evidence-Based AnalysisCaregiver- and Patient-Directed Interventions for Dementia: An Evidence-Based AnalysisSocial Isolation in Community-Dwelling Seniors: An Evidence-Based AnalysisThe Falls/Fractures Economic Model in Ontario Residents Aged 65 Years and Over (FEMOR) OBJECTIVE: To identify interventions that may be effective in reducing the probability of an elderly person's falling and/or sustaining a fall-related injury. Although estimates of fall rates vary widely based on the location, age, and living arrangements of the elderly population, it is estimated that each year approximately 30% of community-dwelling individuals aged 65 and older, and 50% of those aged 85 and older will fall. Of those individuals who fall, 12% to 42% will have a fall-related injury. Several meta-analyses and cohort studies have identified falls and fall-related injuries as a strong predictor of admission to a long-term care (LTC) home. It has been shown that the risk of LTC home admission is over 5 times higher in seniors who experienced 2 or more falls without injury, and over 10 times higher in seniors who experienced a fall causing serious injury. Falls result from the interaction of a variety of risk factors that can be both intrinsic and extrinsic. Intrinsic factors are those that pertain to the physical, demographic, and health status of the individual, while extrinsic factors relate to the physical and socio-economic environment. Intrinsic risk factors can be further grouped into psychosocial/demographic risks, medical risks, risks associated with activity level and dependence, and medication risks. Commonly described extrinsic risks are tripping hazards, balance and slip hazards, and vision hazards. NOTE: It is recognized that the terms "senior" and "elderly" carry a range of meanings for different audiences; this report generally uses the former, but the terms are treated here as essentially interchangeable. EVIDENCE-BASED ANALYSIS OF EFFECTIVENESS: Since many risk factors for falls are modifiable, what interventions (devices, systems, programs) exist that reduce the risk of falls and/or fall-related injuries for community-dwelling seniors? English language;published between January 2000 and September 2007;population of community-dwelling seniors (majority aged 65+); andrandomized controlled trials (RCTs), quasi-experimental trials, systematic reviews, or meta-analyses. special populations (e.g., stroke or osteoporosis; however, studies restricted only to women were included);studies only reporting surrogate outcomes; orstudies whose outcome cannot be extracted for meta-analysis. number of fallers, andnumber of falls resulting in injury/fracture. A search was performed in OVID MEDLINE, MEDLINE In-Process and Other Non-Indexed Citations, EMBASE, the Cumulative Index to Nursing & Allied Health Literature (CINAHL), The Cochrane Library, and the International Agency for Health Technology Assessment (INAHTA) for studies published between January 2000 and September 2007. Furthermore, all studies included in a 2003 Cochrane review were considered for inclusion in this analysis. Abstracts were reviewed by a single author, and studies meeting the inclusion criteria outlined above were obtained. Studies were grouped based on intervention type, and data on population characteristics, fall outcomes, and study design were extracted. Reference lists were also checked for relevant studies. The quality of the evidence was assessed as high, moderate, low, or very low according to the GRADE methodology. The following 11 interventions were identified in the literature search: exercise programs, vision assessment and referral, cataract surgery, environmental modifications, vitamin D supplementation, vitamin D plus calcium supplementation, hormone replacement therapy (HRT), medication withdrawal, gait-stabilizing devices, hip protectors, and multifactorial interventions. Exercise programs were stratified into targeted programs where the exercise routine was tailored to the individuals' needs, and untargeted programs that were identical among subjects. Furthermore, analyses were stratified by exercise program duration (<6 months and ≥6 months) and fall risk of study participants. Similarly, the analyses on the environmental modification studies were stratified by risk. Low-risk study participants had had no fall in the year prior to study entry, while high-risk participants had had at least one fall in the previous year. A total of 17 studies investigating multifactorial interventions were identified in the literature search. Of these studies, 10 reported results for a high-risk population with previous falls, while 6 reported results for study participants representative of the general population. One study provided stratified results by fall risk, and therefore results from this study were included in each stratified analysis. Executive Summary Table 1:Summary of Meta-Analyses of Studies Investigating the Effectiveness of Interventions on the Risk of Falls in Community-Dwelling Seniors(*)InterventionRR [95% CI]GRADEExercise programs  1. Targeted programs        General population0.81 [0.67-0.98]Low      High-risk population0.93 [0.82-1.06]High      Short duration0.91 [0.73-1.13]High      Long duration0.89 [0.79-1.01]Moderate  2. Untargeted programs        General population0.78 [0.66-0.91]Moderate      High-risk population0.89 [0.72-1.10]Very low      Short duration0.85 [0.71-1.01]Low      Long duration0.76 [0.64-0.91]Moderate  3. Combined targeted vs. untargeted programs        General populationN/AN/A      High-risk population0.87 [0.57-1.34]Moderate      Short duration1.11 [0.73-1.70]High      Long duration0.73 [0.57-0.95]HighVision intervention      Assessment/referral1.12 [0.82-1.53]Moderate      Cataract surgery1.11 [0.92-1.35]ModerateEnvironmental modifications      Low-risk population1.03 [0.75-1.41]High      High-risk population0.66 [0.54-0.81]High      General population0.85 [0.75-0.97]HighDrugs/Nutritional supplements      Vitamin D (men and women)0.94 [0.77-1.14]High      Vitamin D (women only)0.55 [0.29-1.08]Moderate      Vitamin D and calcium (men and women)0.89 [0.74-1.07]Moderate      Vitamin D and calcium (women only)0.83 [0.73-0.95]Moderate      Hormone replacement therapy0.98 [0.80-1.20]Low      Medication withdrawal0.34 [0.16-0.74]†LowGait-stabilizing device0.43 [0.29-0.64]ModerateMultifactorial intervention      Geriatric screening (general population)0.87 [0.69-1.10]Very low      High-risk population0.86 [0.75-0.98]Low*CI refers to confidence interval; RR, relative risk.†Hazard ratio is reported, because RR was not available.Executive Summary Table 2:Summary of Meta-Analyses of Studies Investigating the Effectiveness of Interventions on the Risk of Fall-Related Injuries in Community-Dwelling Seniors*InterventionRR [95% CI]GRADEExercise programs      Targeted programs0.67 [0.51-0.89]Moderate    Untargeted programs0.57 [0.38-0.86]Low    Combined targeted vs untargeted programs0.31 [0.13-0.74]HighDrugs/nutritional supplements      Vitamin D plus calcium (women only)0.77 [0.49-1.21]ModerateGait-stabilizing device0.10 [0.01-0.74]ModerateHip protectors3.49 [0.68-17.97]†LowMultifactorial intervention      Geriatric screening (general population)0.90 [0.53-1.51]Low    High-risk population0.86 [0.66-1.11]Moderate*CI refers to confidence interval; RR, relative risk.†Odds ratio is reported, because RR was not available. High-quality evidence indicates that long-term exercise programs in mobile seniors and environmental modifications in the homes of frail elderly persons will effectively reduce falls and possibly fall-related injuries in Ontario's elderly population.A combination of vitamin D and calcium supplementation in elderly women will help reduce the risk of falls by more than 40%.The use of outdoor gait-stabilizing devices for mobile seniors during the winter in Ontario may reduce falls and fall-related injuries; however, evidence is limited and more research is required in this area.While psychotropic medication withdrawal may be an effective method for reducing falls, evidence is limited and long-term compliance has been demonstrated to be difficult to achieve.Multifactorial interventions in high-risk populations may be effective; however, the effect is only marginally significant, and the quality of evidence is low.

The Effect of Exposure to Ultraviolet Radiation in Infancy on Melanoma Risk.

PubMed

Gefeller, Olaf; Fiessler, Cornelia; Radespiel-Tröger, Martin; Uter, Wolfgang; Pfahlberg, Annette B

2016-01-01

Evidence on the effect of ultraviolet radiation (UVR) exposure in infancy on melanoma risk in later life is scarce. Three recent studies suffering from methodological shortcomings suggested that people born in spring carry a higher melanoma risk. Data from the Bavarian population-based cancer registry on 28374 incident melanoma cases between 2002 and 2012 were analyzed to reexamine this finding. Crude and adjusted analyses - using negative binomial regression models - were performed addressing the relationship. In the crude analysis, the birth months March - May were significantly overrepresented among melanoma cases. However, after additionally adjusting for the birth month distribution of the Bavarian population, the ostensible seasonal effect disappeared. Similar results emerged in all subgroup analyses. Our large registry-based study provides no evidence that people born in spring carry a higher risk for developing melanoma in later life and thus lends no support to the hypothesis of higher UVR-susceptibility during the first months of life.

A population-based validation study of the DCIS Score predicting recurrence risk in individuals treated by breast-conserving surgery alone.

PubMed

Rakovitch, Eileen; Nofech-Mozes, Sharon; Hanna, Wedad; Baehner, Frederick L; Saskin, Refik; Butler, Steven M; Tuck, Alan; Sengupta, Sandip; Elavathil, Leela; Jani, Prashant A; Bonin, Michel; Chang, Martin C; Robertson, Susan J; Slodkowska, Elzbieta; Fong, Cindy; Anderson, Joseph M; Jamshidian, Farid; Miller, Dave P; Cherbavaz, Diana B; Shak, Steven; Paszat, Lawrence

2015-07-01

Validated biomarkers are needed to improve risk assessment and treatment decision-making for women with ductal carcinoma in situ (DCIS) of the breast. The Oncotype DX DCIS Score (DS) was shown to predict the risk of local recurrence (LR) in individuals with low-risk DCIS treated by breast-conserving surgery (BCS) alone. Our objective was to confirm these results in a larger population-based cohort of individuals. We used an established population-based cohort of individuals diagnosed with DCIS treated with BCS alone from 1994 to 2003 with validation of treatment and outcomes. Central pathology assessment excluded cases with invasive cancer, DCIS < 2 mm or positive margins. Cox model was used to determine the relationship between independent covariates, the DS (hazard ratio (HR)/50 Cp units (U)) and LR. Tumor blocks were collected for 828 patients. Final evaluable population includes 718 cases, of whom 571 had negative margins. Median follow-up was 9.6 years. 100 cases developed LR following BCS alone (DCIS, N = 44; invasive, N = 57). In the primary pre-specified analysis, the DS was associated with any LR (DCIS or invasive) in ER+ patients (HR 2.26; P < 0.001) and in all patients regardless of ER status (HR 2.15; P < 0.001). DCIS Score provided independent information on LR risk beyond clinical and pathologic variables including size, age, grade, necrosis, multifocality, and subtype (adjusted HR 1.68; P = 0.02). DCIS was associated with invasive LR (HR 1.78; P = 0.04) and DCIS LR (HR 2.43; P = 0.005). The DCIS Score independently predicts and quantifies individualized recurrence risk in a population of patients with pure DCIS treated by BCS alone.

Socio-demographic Predictors for Urban Community Disaster Health Risk Perception and Household Based Preparedness in a Chinese Urban City

PubMed Central

Chan, Emily YY; Yue, Janice; Lee, Poyi; Wang, Susan Shuxin

2016-01-01

Objectives: There is limited evidence on urban Asian communities' disaster risk perceptions and household level preparedness. Hong Kong is characterized by high population density, and is susceptible to large-scale natural disasters and health crises such as typhoons, fires and infectious disease outbreaks. This research paper investigates the rates and predictors of urban community disaster risk perception, awareness and preparedness, at individual and household levels. Methods: A randomized cross-sectional, population-based telephone survey study was conducted among the Cantonese-speaking population aged over 15 years in Hong Kong. Descriptive statistics were reported. A stepwise multivariate logistic regression analysis was conducted to determine the independent associations between risk perceptions, socioeconomic factors, household characteristics, and personal background. Findings: Final study sample comprised of 1002 respondents with a 63% response rate. The majority of respondents (82.3%) did not perceive Hong Kong as a disaster-susceptible city. Half (54.6%) reported beliefs that the local population had lower disaster awareness than other global cities. Infectious disease outbreak (72.4%), typhoon (12.6%), and fire (7.1%) were ranked as the most-likely-to-occur population-based disasters. Although over 77% believed that basic first aid training was necessary for improving individual disaster preparedness, only a quarter (26.1%) of respondents reported participation in training. Conclusion: Despite Hong Kong’s high level of risk, general public perceptions of disaster in Hong Kong were low, and little preparedness has occurred at the individual or household levels. This report has potential to inform the development of related policies and risk communication strategies in Asian urban cities. PMID:28856059

Association of mRNA expression of TP53 and the TP53 codon 72 Arg/Pro gene polymorphism with colorectal cancer risk in Asian population: a bioinformatics analysis and meta-analysis.

PubMed

Dong, Zhiyong; Zheng, Longzhi; Liu, Weimin; Wang, Cunchuan

2018-01-01

The relationship between TP53 codon 72 Pro/Arg gene polymorphism and colorectal cancer risk in Asians is still controversial, and this bioinformatics analysis and meta-analysis was performed to assess the associations. The association studies were identified from PubMed, and eligible reports were included. RevMan 5.3.1 software, Oncolnc, cBioPortal, and Oncomine online tools were used for statistical analysis. A random/fixed effects model was used in meta-analysis. The data were reported as risk ratios or mean differences with corresponding 95% CI. We confirmed that TP53 was associated with colorectal cancer, the alteration frequency of TP53 was 53% mutation and 7% deep deletion, and TP53 mRNA expression was different in different types of colorectal cancer based on The Cancer Genome Atlas database. Then, 18 studies were included that examine the association of TP53 codon 72 gene polymorphism with colorectal cancer risk in Asians. The meta-analysis indicated that TP53 Pro allele and Pro/Pro genotype were associated with colorectal cancer risk in Asian population, but Arg/Arg genotype was not (Pro allele: odds ratios [OR]=1.20, 95% CI: 1.06 to 1.35, P =0.003; Pro/Pro genotype: OR=1.39, 95% CI: 1.15 to 1.69, P =0.0007; Arg/Arg genotype: OR=0.86, 95% CI: 0.74 to 1.00, P =0.05). Interestingly, in the meta-analysis of the controls from the population-based studies, we found that TP53 codon 72 Pro/Arg gene polymorphism was associated with colorectal cancer risk (Pro allele: OR=1.33, 95% CI: 1.15 to 1.55, P =0.0002; Pro/Pro genotype: OR=1.61, 95% CI: 1.28 to 2.02, P <0.0001; Arg/Arg genotype: OR=0.77, 95% CI: 0.63 to 0.93, P =0.009). TP53 was associated with colorectal cancer, but the different value levels of mRNA expression were not associated with survival rate of colon and rectal cancer. TP53 Pro allele and Pro/Pro genotype were associated with colorectal cancer risk in Asians.

Association of mRNA expression of TP53 and the TP53 codon 72 Arg/Pro gene polymorphism with colorectal cancer risk in Asian population: a bioinformatics analysis and meta-analysis

PubMed Central

Liu, Weimin; Wang, Cunchuan

2018-01-01

Background The relationship between TP53 codon 72 Pro/Arg gene polymorphism and colorectal cancer risk in Asians is still controversial, and this bioinformatics analysis and meta-analysis was performed to assess the associations. Methods The association studies were identified from PubMed, and eligible reports were included. RevMan 5.3.1 software, Oncolnc, cBioPortal, and Oncomine online tools were used for statistical analysis. A random/fixed effects model was used in meta-analysis. The data were reported as risk ratios or mean differences with corresponding 95% CI. Results We confirmed that TP53 was associated with colorectal cancer, the alteration frequency of TP53 was 53% mutation and 7% deep deletion, and TP53 mRNA expression was different in different types of colorectal cancer based on The Cancer Genome Atlas database. Then, 18 studies were included that examine the association of TP53 codon 72 gene polymorphism with colorectal cancer risk in Asians. The meta-analysis indicated that TP53 Pro allele and Pro/Pro genotype were associated with colorectal cancer risk in Asian population, but Arg/Arg genotype was not (Pro allele: odds ratios [OR]=1.20, 95% CI: 1.06 to 1.35, P=0.003; Pro/Pro genotype: OR=1.39, 95% CI: 1.15 to 1.69, P=0.0007; Arg/Arg genotype: OR=0.86, 95% CI: 0.74 to 1.00, P=0.05). Interestingly, in the meta-analysis of the controls from the population-based studies, we found that TP53 codon 72 Pro/Arg gene polymorphism was associated with colorectal cancer risk (Pro allele: OR=1.33, 95% CI: 1.15 to 1.55, P=0.0002; Pro/Pro genotype: OR=1.61, 95% CI: 1.28 to 2.02, P<0.0001; Arg/Arg genotype: OR=0.77, 95% CI: 0.63 to 0.93, P=0.009). Conclusion TP53 was associated with colorectal cancer, but the different value levels of mRNA expression were not associated with survival rate of colon and rectal cancer. TP53 Pro allele and Pro/Pro genotype were associated with colorectal cancer risk in Asians. PMID:29872345

Haloacetic acids in drinking water and risk for stillbirth

PubMed Central

King, W; Dodds, L; Allen, A; Armson, B; Fell, D; Nimrod, C

2005-01-01

Aims: To investigate the effects of haloacetic acid (HAA) compounds in drinking water on stillbirth risk. Methods: A population based case-control study was conducted in Nova Scotia and Eastern Ontario, Canada. Estimates of daily exposure to total and specific HAAs were based on household water samples and questionnaire information on water consumption at home and work. Results: The analysis included 112 stillbirth cases and 398 live birth controls. In analysis without adjustment for total THM exposure, a relative risk greater than 2 was observed for an intermediate exposure category for total HAA and dichloroacetic acid measures. After adjustment for total THM exposure, the risk estimates for intermediate exposure categories were diminished, the relative risk associated with the highest category was in the direction of a protective effect, and all confidence intervals included the null value. Conclusions: No association was observed between HAA exposures and stillbirth risk after controlling for THM exposures. PMID:15657195

Projected lifetime cancer risks from exposure to regional radioactive fallout in the Marshall Islands.

PubMed

Land, Charles E; Bouville, André; Apostoaei, Iulian; Simon, Steven L

2010-08-01

Radioactive fallout from nuclear test detonations during 1946-1958 at Bikini and Enewetak Atolls in the Marshall Islands (MI) exposed populations living elsewhere in the MI archipelago. A comprehensive analysis, presented in seven companion papers, has produced estimates of tissue-specific radiation absorbed dose to MI residents at all historically inhabited atolls from internal (ingested) and external irradiation resulting from exposure to radioactive fallout, by calendar year, and by age of the population at time of exposure. The present report deals, for the first time, with the implications of these doses for cancer risk among exposed members of the MI population. Radiation doses differed by geographic location and year of birth, and radiation-related cancer risk depends upon age at exposure and age at observation for risk. Using dose-response models based on committee reports published by the National Research Council and the National Institutes of Health, we project that, during the lifetimes of members of the MI population potentially exposed to ionizing radiation from weapons test fallout deposited during the testing period (1948-1958) and from residual radioactive sources during the subsequent 12 y (1959-1970), perhaps 1.6% (with 90% uncertainty range 0.4% to 3.4%) of all cancers might be attributable to fallout-related radiation exposures. By sub-population, the projected proportion of cancers attributable to radiation from fallout from all nuclear tests conducted in the Marshall Islands is 55% (28% to 69%) among 82 persons exposed in 1954 on Rongelap and Ailinginae, 10% (2.4% to 22%) for 157 persons exposed on Utrik, and 2.2% (0.5% to 4.8%) and 0.8% (0.2% to 1.8%), respectively, for the much larger populations exposed in mid-latitude locations including Kwajalein and in southern locations including Majuro. By cancer type, point estimates of attributable risk varied, by location, between 12% and 95% for thyroid cancer, between 2% and 78% for leukemia, and between 0.8% and 55% for all cancers combined. The largest projected risks pertain to the Rongelap Island community and the lowest risks pertain to the populations resident on the southern-most atolls. While the projected cancer risks are smaller than those estimated by the National Cancer Institute in a more simplistic analysis conducted in 2004, these estimates of cancer risk are the best available as they are based on the most detailed dose reconstruction to date and comprehensively include populations at all locations and dose contributions from all nuclear tests.

Higher risk for cervical herniated intervertebral disc in physicians: A retrospective nationwide population-based cohort study with claims analysis.

PubMed

Liu, Cheng; Huang, Chien-Cheng; Hsu, Chien-Chin; Lin, Hung-Jung; Guo, How-Ran; Su, Shih-Bin; Wang, Jhi-Joung; Weng, Shih-Feng

2016-10-01

There is no study about cervical herniated intervertebral disc (cervical HIVD) in physicians in the literature; therefore, we conceived a retrospective nationwide, population-based cohort study to elucidate the topic. We identified 26,038 physicians, 33,057 non-physician healthcare providers (HCPs), and identical numbers of non-HCP references (i.e., general population). All cohorts matched a 1:1 ratio with age and gender, and each were chosen from the Taiwan National Health Insurance Research Database (NHIRD). We compared cervical HIVD risk among physicians, nonphysician HCPs, and non-HCP references and performed a follow-up between 2007 and 2011. We also made comparisons among physician specialists. Both physicians and nonphysician HCPs had higher cervical HIVD risk than non-HCP references (odds ratio [OR]: 1.356; 95% confidence interval (CI): 1.162-1.582; OR: 1.383; 95% CI: 1.191-1.605, respectively). There was no significant difference of cervical HIVD risk between physicians and nonphysician HCPs. In the comparison among physician specialists, orthopedists had a higher cervical HIVD risk than other specialists, but the difference was not statistically significant (adjusted OR: 1.547; 95% CI: 0.782-3.061). Physicians are at higher cervical HIVD risk than the general population. Because unknown confounders could exist, further prospective studies are needed to identify possible causation.

Revisiting exposure: fatal and non-fatal traffic injury risk across different populations of travelers in Wisconsin, 2001-2009.

PubMed

McAndrews, Carolyn; Beyer, Kirsten; Guse, Clare E; Layde, Peter

2013-11-01

Comparing the injury risk of different travel modes requires using a travel-based measure of exposure. In this study we quantify injury risk by travel mode, age, race/ethnicity, sex, and injury severity using three different travel-based exposure measures (person-trips, person-minutes of travel, and person-miles of travel) to learn how these metrics affect the characterization of risk across populations. We used a linked database of hospital and police records to identify non-fatal injuries (2001-2009), the Fatality Analysis Reporting System for fatalities (2001-2009), and the 2001 Wisconsin Add-On to the National Household Travel Survey for exposure measures. In Wisconsin, bicyclists and pedestrians have a moderately higher injury risk compared to motor vehicle occupants (adjusting for demographic factors), but the risk is much higher when exposure is measured in distance. Although the analysis did not control for socio-economic status (a likely confounder) it showed that American Indian and Black travelers in Wisconsin face higher transportation injury risk than White travelers (adjusting for sex and travel mode), across all three measures of exposure. Working with multiple metrics to form comprehensive injury risk profiles such as this one can inform decision making about how to prioritize investments in transportation injury prevention. Copyright © 2013 Elsevier Ltd. All rights reserved.

Smoking paradox in the development of psoriatic arthritis among patients with psoriasis: a population-based study.

PubMed

Nguyen, Uyen-Sa D T; Zhang, Yuqing; Lu, Na; Louie-Gao, Qiong; Niu, Jingbo; Ogdie, Alexis; Gelfand, Joel M; LaValley, Michael P; Dubreuil, Maureen; Sparks, Jeffrey A; Karlson, Elizabeth W; Choi, Hyon K

2018-01-01

Smoking is associated with an increased risk of psoriatic arthritis (PsA) in the general population, but not among patients with psoriasis. We sought to clarify the possible methodological mechanisms behind this paradox. Using 1995-2015 data from The Health Improvement Network, we performed survival analysis to examine the association between smoking and incident PsA in the general population and among patients with psoriasis. We clarified the paradox using mediation analysis and conducted bias sensitivity analyses to evaluate the potential impact of index event bias and quantify its magnitude from uncontrolled/unmeasured confounders. Of 6.65 million subjects without PsA at baseline, 225 213 participants had psoriasis and 7057 developed incident PsA. Smoking was associated with an increased risk of PsA in the general population (HR 1.27; 95% CI 1.19 to 1.36), but with a decreased risk among patients with psoriasis (HR 0.91; 95% CI 0.84 to 0.99). Mediation analysis showed that the effect of smoking on the risk of PsA was mediated almost entirely through its effect on psoriasis. Bias-sensitivity analyses indicated that even when the relation of uncontrolled confounders to either smoking or PsA was modest (both HRs=~1.5), it could reverse the biased effect of smoking among patients with psoriasis (HR=0.9). In this large cohort representative of the UK general population, smoking was positively associated with PsA risk in the general population, but negatively associated among patients with psoriasis. Conditioning on a causal intermediate variable (psoriasis) may even reverse the association between smoking and PsA, potentially explaining the smoking paradox for the risk of PsA among patients with psoriasis. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Exposure to pesticides as risk factor for non-Hodgkin's lymphoma and hairy cell leukemia: pooled analysis of two Swedish case-control studies.

PubMed

Hardell, Lennart; Eriksson, Mikael; Nordstrom, Marie

2002-05-01

Increased risk for non-Hodgkin's lymphoma (NHL) following exposure to certain pesticides has previously been reported. To further elucidate the importance of phenoxyacetic acids and other pesticides in the etiology of NHL a pooled analysis was performed on two case-control studies, one on NHL and another on hairy cell leukemia (HCL), a rare subtype of NHL. The studies were population based with cases identified from cancer registry and controls from population registry. Data assessment was ascertained by questionnaires supplemented over the telephone by specially trained interviewers. The pooled analysis of NHL and HCL was based on 515 cases and 1141 controls. Increased risks in univariate analysis were found for subjects exposed to herbicides (OR 1.75, CI 95% 1.26-2.42), insecticides (OR 1.43, CI 95% 1.08-1.87), fungicides (OR 3.11, CI 95% 1.56-6.27) and impregnating agents (OR 1.48, CI 95% 1.11-1.96). Among herbicides, significant associations were found for glyphosate (OR 3.04, CI 95% 1.08-8.52) and 4-chloro-2-methyl phenoxyacetic acid (MCPA) (OR 2.62, CI 95% 1.40-4.88). For several categories of pesticides the highest risk was found for exposure during the latest decades before diagnosis. However, in multivariate analyses the only significantly increased risk was for a heterogeneous category of other herbicides than above.

Age-structured mark-recapture analysis: A virtual-population-analysis-based model for analyzing age-structured capture-recapture data

USGS Publications Warehouse

Coggins, L.G.; Pine, William E.; Walters, C.J.; Martell, S.J.D.

2006-01-01

We present a new model to estimate capture probabilities, survival, abundance, and recruitment using traditional Jolly-Seber capture-recapture methods within a standard fisheries virtual population analysis framework. This approach compares the numbers of marked and unmarked fish at age captured in each year of sampling with predictions based on estimated vulnerabilities and abundance in a likelihood function. Recruitment to the earliest age at which fish can be tagged is estimated by using a virtual population analysis method to back-calculate the expected numbers of unmarked fish at risk of capture. By using information from both marked and unmarked animals in a standard fisheries age structure framework, this approach is well suited to the sparse data situations common in long-term capture-recapture programs with variable sampling effort. ?? Copyright by the American Fisheries Society 2006.

Mapping the Risk of Snakebite in Sri Lanka - A National Survey with Geospatial Analysis.

PubMed

Ediriweera, Dileepa Senajith; Kasturiratne, Anuradhani; Pathmeswaran, Arunasalam; Gunawardena, Nipul Kithsiri; Wijayawickrama, Buddhika Asiri; Jayamanne, Shaluka Francis; Isbister, Geoffrey Kennedy; Dawson, Andrew; Giorgi, Emanuele; Diggle, Peter John; Lalloo, David Griffith; de Silva, Hithanadura Janaka

2016-07-01

There is a paucity of robust epidemiological data on snakebite, and data available from hospitals and localized or time-limited surveys have major limitations. No study has investigated the incidence of snakebite across a whole country. We undertook a community-based national survey and model based geostatistics to determine incidence, envenoming, mortality and geographical pattern of snakebite in Sri Lanka. The survey was designed to sample a population distributed equally among the nine provinces of the country. The number of data collection clusters was divided among districts in proportion to their population. Within districts clusters were randomly selected. Population based incidence of snakebite and significant envenoming were estimated. Model-based geostatistics was used to develop snakebite risk maps for Sri Lanka. 1118 of the total of 14022 GN divisions with a population of 165665 (0.8%of the country's population) were surveyed. The crude overall community incidence of snakebite, envenoming and mortality were 398 (95% CI: 356-441), 151 (130-173) and 2.3 (0.2-4.4) per 100000 population, respectively. Risk maps showed wide variation in incidence within the country, and snakebite hotspots and cold spots were determined by considering the probability of exceeding the national incidence. This study provides community based incidence rates of snakebite and envenoming for Sri Lanka. The within-country spatial variation of bites can inform healthcare decision making and highlights the limitations associated with estimates of incidence from hospital data or localized surveys. Our methods are replicable, and these models can be adapted to other geographic regions after re-estimating spatial covariance parameters for the particular region.

Meta-Analysis of the Association between Tea Intake and the Risk of Cognitive Disorders

PubMed Central

Ma, Qing-Ping; Huang, Chen; Cui, Qiao-Yun; Yang, Ding-Jun; Sun, Kang; Chen, Xuan; Li, Xing-Hui

2016-01-01

Background Alzheimer’s disease is a common neurodegenerative disorder in elderly. This study was aimed to systematically evaluate the association between tea intake and the risk of cognitive disorders by meta-analysis. Methods and Findings PubMed, Embase and Wanfang databases were systematically searched and a total of 26 observational studies were included in this study. Odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) were calculated and pooled by using fixed or random effects models according to the degree of heterogeneity. Results The overall pooled analysis indicated that tea intake could significantly reduce the risk of cognitive disorders (OR = 0.65, 95%CI = 0.58–0.73). Subgroup analyses were conducted based on study design, population, frequency of tea drinking and type of cognitive disorders. The results showed that tea drinking was significantly associated with the reduced incidence of cognitive disorders in all of subgroups based on study design and frequency of tea drinking. In particular, tea drinking was inversely associated with the risk of cognitive impairment (CoI), mild cognitive impairment (MCI), cognitive decline and ungrouped cognitive disorders. Moreover, for population subgroups, the significant association was only found in Chinese people. Conclusion Our study suggests that daily tea drinking is associated with decreased risk of CoI, MCI and cognitive decline in the elderly. However, the association between tea intake and Alzheimer’s disease remains elusive. PMID:27824892

Hepatitis C prevalence among the immigrant population in Spain: A systematic review and meta-analysis.

PubMed

Lazarus, Jeffrey V; Bromberg, Daniel J; Del Amo, Julia; Norgaard, Ole; García-Samaniego, Javier; Casellas, Aina; Calleja, José Luis; Requena-Méndez, Ana

2018-05-11

Spain, which has one of the largest immigrant populations in Europe, has committed to eliminating the hepatitis C virus (HCV). The aim of this study was to estimate the prevalence of HCV among migrant groups in Spain, a country of 46 million people, with an estimated HCV-antibody prevalence of 1.7%. Studies on HCV and migration in Spain were identified by systematically searching three databases from the first records to 30 November 2017, and consulting experts at the Ministry of Health and in the 17 Spanish autonomous communities. A meta-analysis was conducted to determine pooled HCV prevalence for the general migrant population. Prevalences were also calculated for high-risk migrant populations and populations who had undergone hospital screening, stratified by region of origin. Out of 243 studies identified, 26 met the eligibility criteria. The meta-analysis of the general migrant population found HCV antibody prevalence to be 1.6%. Migrants originating from European countries, including those at high or moderate risk for HCV, had the highest pooled prevalence (7.1%). In the general migrant population, prevalence was highest among sub-Saharan African migrants (3.1%) and lowest among Latin American migrants (0.2%). Based on the limited available data, the prevalence among the general migrant population was found to be the same as the general Spanish population. Further research is needed to more accurately determine HCV prevalence for the overall migrant population and specific migrant subpopulations with a higher risk in the country as a whole and in each of Spain's 17 autonomous communities. Copyright © 2018 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

The Effect of XPD Polymorphisms on Digestive Tract Cancers Risk: A Meta-Analysis

PubMed Central

Zhang, Qian; Chen, Zhipeng; Lu, Kai; Shu, Yongqian; Chen, Tao; Zhu, Lingjun

2014-01-01

Background The Xeroderma pigmento-sum group D gene (XPD) plays a key role in nucleotide excision repair. Single nucleotide polymorphisms (SNP) located in its functional region may alter DNA repair capacity phenotype and cancer risk. Many studies have demonstrated that XPD polymorphisms are significantly associated with digestive tract cancers risk, but the results are inconsistent. We conducted a comprehensive meta-analysis to assess the association between XPD Lys751Gln polymorphism and digestive tract cancers risk. The digestive tract cancers that our study referred to, includes oral cancer, esophageal cancer, gastric cancer and colorectal cancer. Methods We searched PubMed and EmBase up to December 31, 2012 to identify eligible studies. A total of 37 case-control studies including 9027 cases and 16072 controls were involved in this meta-analysis. Statistical analyses were performed with Stata software (version 11.0, USA). Odds ratios (ORs) with 95% confidence intervals (CIs) were used to assess the strength of the association. Results The results showed that XPD Lys751Gln polymorphism was associated with the increased risk of digestive tract cancers (homozygote comparison (GlnGln vs. LysLys): OR = 1.12, 95% CI = 1.01–1.24, P = 0.029, P heterogeneity = 0.133). We found no statistical evidence for a significantly increased digestive tract cancers risk in the other genetic models. In the subgroup analysis, we also found the homozygote comparison increased the susceptibility of Asian population (OR = 1.28, 95% CI = 1.01–1.63, P = 0.045, P heterogeneity = 0.287). Stratified by cancer type and source of control, no significantly increased cancer risk was found in these subgroups. Additionally, risk estimates from hospital-based studies and esophageal studies were heterogeneous. Conclusions Our meta-analysis suggested that the XPD 751Gln/Gln genotype was a low-penetrate risk factor for developing digestive tract cancers, especially in Asian populations. PMID:24787743

The effect of XPD polymorphisms on digestive tract cancers risk: a meta-analysis.

PubMed

Du, Haina; Guo, Nannan; Shi, Bin; Zhang, Qian; Chen, Zhipeng; Lu, Kai; Shu, Yongqian; Chen, Tao; Zhu, Lingjun

2014-01-01

The Xeroderma pigmento-sum group D gene (XPD) plays a key role in nucleotide excision repair. Single nucleotide polymorphisms (SNP) located in its functional region may alter DNA repair capacity phenotype and cancer risk. Many studies have demonstrated that XPD polymorphisms are significantly associated with digestive tract cancers risk, but the results are inconsistent. We conducted a comprehensive meta-analysis to assess the association between XPD Lys751Gln polymorphism and digestive tract cancers risk. The digestive tract cancers that our study referred to, includes oral cancer, esophageal cancer, gastric cancer and colorectal cancer. We searched PubMed and EmBase up to December 31, 2012 to identify eligible studies. A total of 37 case-control studies including 9027 cases and 16072 controls were involved in this meta-analysis. Statistical analyses were performed with Stata software (version 11.0, USA). Odds ratios (ORs) with 95% confidence intervals (CIs) were used to assess the strength of the association. The results showed that XPD Lys751Gln polymorphism was associated with the increased risk of digestive tract cancers (homozygote comparison (GlnGln vs. LysLys): OR = 1.12, 95% CI = 1.01-1.24, P = 0.029, P heterogeneity = 0.133). We found no statistical evidence for a significantly increased digestive tract cancers risk in the other genetic models. In the subgroup analysis, we also found the homozygote comparison increased the susceptibility of Asian population (OR = 1.28, 95% CI = 1.01-1.63, P = 0.045, P heterogeneity = 0.287). Stratified by cancer type and source of control, no significantly increased cancer risk was found in these subgroups. Additionally, risk estimates from hospital-based studies and esophageal studies were heterogeneous. Our meta-analysis suggested that the XPD 751Gln/Gln genotype was a low-penetrate risk factor for developing digestive tract cancers, especially in Asian populations.

Correlates of HIV infection among street-based and venue-based sex workers in Vietnam.

PubMed

Le, Thuy Tc; Nguyen, Quoc C; Tran, Ha Tt; Schwandt, Michael; Lim, Hyun J

2016-10-01

Commercial sex work is one of the driving forces of the HIV epidemic across the world. In Vietnam, although female sex workers (FSWs) carry a disproportionate burden of HIV, little is known about the risk profile and associated factors for HIV infection among this population. There is a need for large-scale research to obtain reliable and representative estimates of the measures of association. This study involved secondary data analysis of the 'HIV/STI Integrated Biological and Behavioral Surveillance' study in Vietnam in 2009-2010 to examine the correlates of HIV among FSWs. Data collected from 5298 FSWs, including 2530 street-based sex workers and 2768 venue-based sex workers from 10 provinces in Vietnam, were analyzed using descriptive statistics and bivariate and multivariate logistic regression analyses. HIV prevalence among the overall FSW population was 8.6% (n = 453). However, when stratified by FSW subpopulations, HIV prevalence was 10.6% (n = 267) for street-based sex workers and 6.7% (n = 186) for venue-based sex workers. Factors independently associated with HIV infection in the multivariate analysis, regardless of sex work types, were injecting drug use, high self-perceived HIV risk, and age ≥ 25 years. Additional factors independently associated with HIV risk within each FSW subpopulation included having ever been married among street-based sex workers and inconsistent condom use with clients and having sex partners who injected drugs among venue-based sex workers. Apart from strategies addressing modifiable risk behaviours among all FSWs, targeted strategies to address specific risk behaviours within each FSW subpopulation should be adopted. © The Author(s) 2016.

Groundwater chemistry and human health risk assessment in the mining region of East Singhbhum, Jharkhand, India.

PubMed

Singh, Umesh Kumar; Ramanathan, A L; Subramanian, V

2018-08-01

Groundwater chemistry of mining region of East Singhbhum district having complex contaminant sources were investigated based on heavy metals loads and other hydrochemical constituents. This study aimed to identify the degree of heavy metals exposure and their potential health risk to local population. The results of hydrochemical analysis showed that Na + , K + , and Ca 2+ ions are the dominant cations in the groundwater, while HCO 3 - , F - and Cl - ions dominate the anionic part of the groundwater. The weathering process was considered the dominant factor to determine the major ionic composition in the study area. Compositional analysis for heavy metal has identified that groundwater of the study area is contaminated by Cd, Pb and Cr elements. Source of these metals have been identified as an anthropogenic inputs from mining activities and mineral processing units. Health risk analysis of individual heavy metal for chronic daily intake (CDI) and hazard quotient (HQ) was found in the order of Cr > As > Cd > Pb which is indicating high health risk for the population. In addition, Hazard Index (HI) analysis for heavy metals was found significantly high (>1) which is considered as a threat for human population because they have the tendency to accumulate in the body and cause variety of diseases like kidney problem, dysfunction of liver and renal cortex as well as cancer. Copyright © 2018 Elsevier Ltd. All rights reserved.

Interdisciplinary modeling and analysis to reduce loss of life from tsunamis

NASA Astrophysics Data System (ADS)

Wood, N. J.

2016-12-01

Recent disasters have demonstrated the significant loss of life and community impacts that can occur from tsunamis. Minimizing future losses requires an integrated understanding of the range of potential tsunami threats, how individuals are specifically vulnerable to these threats, what is currently in place to improve their chances of survival, and what risk-reduction efforts could be implemented. This presentation will provide a holistic perspective of USGS research enabled by recent advances in geospatial modeling to assess and communicate population vulnerability to tsunamis and the range of possible interventions to reduce it. Integrated research includes efforts to characterize the magnitude and demography of at-risk individuals in tsunami-hazard zones, their evacuation potential based on landscape conditions, nature-based mitigation to improve evacuation potential, evacuation pathways and population demand at assembly areas, siting considerations for vertical-evacuation refuges, community implications of multiple evacuation zones, car-based evacuation modeling for distant tsunamis, and projected changes in population exposure to tsunamis over time. Collectively, this interdisciplinary research supports emergency managers in their efforts to implement targeted risk-reduction efforts based on local conditions and needs, instead of generic regional strategies that only focus on hazard attributes.

Accounting for rate instability and spatial patterns in the boundary analysis of cancer mortality maps

PubMed Central

Goovaerts, Pierre

2006-01-01

Boundary analysis of cancer maps may highlight areas where causative exposures change through geographic space, the presence of local populations with distinct cancer incidences, or the impact of different cancer control methods. Too often, such analysis ignores the spatial pattern of incidence or mortality rates and overlooks the fact that rates computed from sparsely populated geographic entities can be very unreliable. This paper proposes a new methodology that accounts for the uncertainty and spatial correlation of rate data in the detection of significant edges between adjacent entities or polygons. Poisson kriging is first used to estimate the risk value and the associated standard error within each polygon, accounting for the population size and the risk semivariogram computed from raw rates. The boundary statistic is then defined as half the absolute difference between kriged risks. Its reference distribution, under the null hypothesis of no boundary, is derived through the generation of multiple realizations of the spatial distribution of cancer risk values. This paper presents three types of neutral models generated using methods of increasing complexity: the common random shuffle of estimated risk values, a spatial re-ordering of these risks, or p-field simulation that accounts for the population size within each polygon. The approach is illustrated using age-adjusted pancreatic cancer mortality rates for white females in 295 US counties of the Northeast (1970–1994). Simulation studies demonstrate that Poisson kriging yields more accurate estimates of the cancer risk and how its value changes between polygons (i.e. boundary statistic), relatively to the use of raw rates or local empirical Bayes smoother. When used in conjunction with spatial neutral models generated by p-field simulation, the boundary analysis based on Poisson kriging estimates minimizes the proportion of type I errors (i.e. edges wrongly declared significant) while the frequency of these errors is predicted well by the p-value of the statistical test. PMID:19023455

Association between glutathione S-transferase P1 Ile (105) Val gene polymorphism and chronic obstructive pulmonary disease: A meta-analysis based on seventeen case-control studies.

PubMed

Yang, Lingjing; Li, Xixia; Tong, Xiang; Fan, Hong

2015-12-01

Previous studies have shown that glutathione S-transferase P1 (GSTP1) was associated with chronic obstructive pulmonary disease (COPD). However, the association between GSTP1 Ile (105) Val gene polymorphism and COPD remains controversial. To drive a more precise estimation, we performed a meta-analysis based on published case-control studies. An electronic search of PubMed, EMBASE, Cochrane library, Web of Science and China Knowledge Resource Integrated (CNKI) Database for papers on GSTP1 Ile (105) Val gene polymorphism and COPD risk was performed. The pooled odds ratios (ORs) with 95% confidence intervals (CIs) were used to assess the strength of association in the homozygote model, heterozygote model, dominant model, recessive model and an additive mode. Statistical heterogeneity, test of publication bias and sensitivity analysis was performed. The software STATA (Version 13.0) was used data analysis. Overall, seventeen studies with 1892 cases and 2012 controls were included in this meta-analysis. The GSTP1 Ile (105) Val polymorphism showed pooled odds ratios for the homozygote comparison (OR = 1.501, 95%CI [0.862, 2.614]), heterozygote comparison (OR = 0.924, 95%CI [0.733, 1.165]), dominant model (OR = 1.003, 95%CI [0.756, 1.331]), recessive model (OR = 1.510, 95%CI [0.934, 2.439]), and an additive model (OR = 1.072, 95%CI [0.822, 1.398]). In conclusion, the current meta-analysis, based on the most updated information, showed no significant association between GSTP1 Ile (105) Val gene polymorphism and COPD risk in any genetic models. The results of subgroup analysis also showed no significant association between GSTP1 Ile (105) Val gene polymorphism and COPD risk in Asian population and Caucasian population. Further studies involving large populations and careful control with age, sex, ethnicity, and cigarette smoking are greatly needed.

Association between glutathione S-transferase P1 Ile (105) Val gene polymorphism and chronic obstructive pulmonary disease: A meta-analysis based on seventeen case–control studies

PubMed Central

Yang, Lingjing; Li, Xixia; Tong, Xiang; Fan, Hong

2015-01-01

Introduction Previous studies have shown that glutathione S-transferase P1 (GSTP1) was associated with chronic obstructive pulmonary disease (COPD). However, the association between GSTP1 Ile (105) Val gene polymorphism and COPD remains controversial. To drive a more precise estimation, we performed a meta-analysis based on published case–control studies. Methods An electronic search of PubMed, EMBASE, Cochrane library, Web of Science and China Knowledge Resource Integrated (CNKI) Database for papers on GSTP1 Ile (105) Val gene polymorphism and COPD risk was performed. The pooled odds ratios (ORs) with 95% confidence intervals (CIs) were used to assess the strength of association in the homozygote model, heterozygote model, dominant model, recessive model and an additive mode. Statistical heterogeneity, test of publication bias and sensitivity analysis was performed. The software STATA (Version 13.0) was used data analysis. Results Overall, seventeen studies with 1892 cases and 2012 controls were included in this meta-analysis. The GSTP1 Ile (105) Val polymorphism showed pooled odds ratios for the homozygote comparison (OR = 1.501, 95%CI [0.862, 2.614]), heterozygote comparison (OR = 0.924, 95%CI [0.733, 1.165]), dominant model (OR = 1.003, 95%CI [0.756, 1.331]), recessive model (OR = 1.510, 95%CI [0.934, 2.439]), and an additive model (OR = 1.072, 95%CI [0.822, 1.398]). Conclusions In conclusion, the current meta-analysis, based on the most updated information, showed no significant association between GSTP1 Ile (105) Val gene polymorphism and COPD risk in any genetic models. The results of subgroup analysis also showed no significant association between GSTP1 Ile (105) Val gene polymorphism and COPD risk in Asian population and Caucasian population. Further studies involving large populations and careful control with age, sex, ethnicity, and cigarette smoking are greatly needed. PMID:26504746

Study of risk factors for gastric cancer by populational databases analysis

PubMed Central

Ferrari, Fangio; Reis, Marco Antonio Moura

2013-01-01

AIM: To study the association between the incidence of gastric cancer and populational exposure to risk/protective factors through an analysis of international databases. METHODS: Open-access global databases concerning the incidence of gastric cancer and its risk/protective factors were identified through an extensive search on the Web. As its distribution was neither normal nor symmetric, the cancer incidence of each country was categorized according to ranges of percentile distribution. The association of each risk/protective factor with exposure was measured between the extreme ranges of the incidence of gastric cancer (under the 25th percentile and above the 75th percentile) by the use of the Mann-Whitney test, considering a significance level of 0.05. RESULTS: A variable amount of data omission was observed among all of the factors under study. A weak or nonexistent correlation between the incidence of gastric cancer and the study variables was shown by a visual analysis of scatterplot dispersion. In contrast, an analysis of categorized incidence revealed that the countries with the highest human development index (HDI) values had the highest rates of obesity in males and the highest consumption of alcohol, tobacco, fruits, vegetables and meat, which were associated with higher incidences of gastric cancer. There was no significant difference for the risk factors of obesity in females and fish consumption. CONCLUSION: Higher HDI values, coupled with a higher prevalence of male obesity and a higher per capita consumption of alcohol, tobacco, fruits, vegetables and meat, are associated with a higher incidence of gastric cancer based on an analysis of populational global data. PMID:24409066

Association between risk factors and detection of cutaneous melanoma in the setting of a population-based skin cancer screening.

PubMed

Hübner, Joachim; Waldmann, Annika; Eisemann, Nora; Noftz, Maria; Geller, Alan C; Weinstock, Martin A; Volkmer, Beate; Greinert, Rüdiger; Breitbart, Eckhard W; Katalinic, Alexander

2017-07-07

Early detection is considered to improve the prognosis of cutaneous melanoma. The value of population-based screening for melanoma, however, is still controversial. The aim of this study was to evaluate the predictive power of established risk factors in the setting of a population-based screening and to provide empirical evidence for potential risk stratifications. We reanalyzed data (including age, sex, risk factors, and screening results) of 354 635 participants in the Skin Cancer Research to provide Evidence for Effectiveness of Screening in Northern Germany project conducted in the German state of Schleswig-Holstein (2003-2004). In multivariable analysis, atypical nevi [odds ratio (OR): 17.4; 95% confidence interval (CI): 14.4-20.1], personal history of melanoma (OR: 5.3; 95% CI: 3.6-7.6), and multiple (≥40) common nevi (OR: 1.3; 95% CI: 1.1-1.6) were associated with an increased risk of melanoma detection. Family history and congenital nevi were not significantly associated with melanoma detection in the Skin Cancer Research to provide Evidence for Effectiveness of Screening in Northern Germany population. The effects of several risk-adapted screening strategies were evaluated. Hypothesizing a screening of individuals aged more than or equal to 35 years, irrespective of risk factors (age approach), the number needed to screen is 559 (95% CI: 514-612), whereas a screening of adults (aged ≥20) with at least one risk factor (risk approach) leads to an number needed to screen of 178 (95% CI: 163-196). Converted into one screen-detected melanoma, the number of missed melanomas is 0.15 (95% CI: 0.12-0.18) with the age approach and 0.22 (95% CI: 0.19-0.26) with the risk approach. The results indicate that focusing on individuals at high risk for melanoma may improve the cost-effectiveness and the benefit-to-harm balance of melanoma screening programs.

Assessment of the influence of test characteristics on the clinical and cost impacts of methicillin-resistant Staphylococcus aureus screening programs in US hospitals.

PubMed

Olchanski, Natalia; Mathews, Charles; Fusfeld, Lauren; Jarvis, William

2011-03-01

To compare the impacts of different methicillin-resistant Staphylococcus aureus (MRSA) screening test options (eg, polymerase chain reaction [PCR], rapid culture) and program characteristics on the clinical outcomes and budget of a typical US hospital. We developed an Excel-based decision-analytic model, using published literature to calculate and compare hospital costs and MRSA infection rates for PCR- or culture-based MRSA screening and then used multivariate sensitivity analysis to evaluate key variables. Same-day PCR testing for a representative 370-bed teaching hospital in the United States was assessed in different populations (high-risk patients, intensive care unit [ICU] patients, or all patients) and compared with other test options. Different screening program populations (all patients, high-risk patients, ICU patients, or patients with previous MRSA colonization or infection only) represented a potential savings of $12,158-$76,624 per month over no program ($188,618). Analysis of multiple test options in high-risk population screening indicated that same-day PCR testing of high-risk patients resulted in fewer infections over 1,720 patient-days (2.9, compared with 3.5 for culture on selective media and 3.8 for culture on nonselective media) and the lowest total cost ($112,012). The costs of other testing approaches ranged from $113,742 to $123,065. Sensitivity analysis revealed that variations in transmission rate, conversion to infection, prevalence increases, and hospital size are important to determine program impact. Among test characteristics, turnaround time is highly influential. All screening options showed reductions in infection rates and cost impact improvement over no screening program. Among the options, same-day PCR testing for high-risk patients slightly edges out the others in terms of fewest infections and greatest potential cost savings.

Infective Endocarditis and Cancer Risk: A Population-Based Cohort Study.

PubMed

Sun, Li-Min; Wu, Jung-Nan; Lin, Cheng-Li; Day, Jen-Der; Liang, Ji-An; Liou, Li-Ren; Kao, Chia-Hung

2016-03-01

This study investigated the possible relationship between endocarditis and overall and individual cancer risk among study participants in Taiwan.We used data from the National Health Insurance program of Taiwan to conduct a population-based, observational, and retrospective cohort study. The case group consisted of 14,534 patients who were diagnosed with endocarditis between January 1, 2000 and December 31, 2010. For the control group, 4 patients without endocarditis were frequency matched to each endocarditis patient according to age, sex, and index year. Competing risks regression analysis was conducted to determine the effect of endocarditis on cancer risk.A large difference was noted in Charlson comorbidity index between endocarditis and nonendocarditis patients. In patients with endocarditis, the risk for developing overall cancer was significant and 119% higher than in patients without endocarditis (adjusted subhazard ratio = 2.19, 95% confidence interval = 1.98-2.42). Regarding individual cancers, in addition to head and neck, uterus, female breast and hematological malignancies, the risks of developing colorectal cancer, and some digestive tract cancers were significantly higher. Additional analyses determined that the association of cancer with endocarditis is stronger within the 1st 5 years after endocarditis diagnosis.This population-based cohort study found that patients with endocarditis are at a higher risk for colorectal cancer and other cancers in Taiwan. The risk was even higher within the 1st 5 years after endocarditis diagnosis. It suggested that endocarditis is an early marker of colorectal cancer and other cancers. The underlying mechanisms must still be explored and may account for a shared risk factor of infection in both endocarditis and malignancy.

Waist circumference cut-off points for identification of abdominal obesity among the tunisian adult population.

PubMed

Bouguerra, R; Alberti, H; Smida, H; Salem, L B; Rayana, C B; El Atti, J; Achour, A; Gaigi, S; Slama, C B; Zouari, B; Alberti, K G M M

2007-11-01

Waist circumference (WC) is a convenient measure of abdominal adipose tissue. It itself is a cardiovascular disease (CVD) and diabetes-risk factor and is strongly linked to other CVD risk factors. There are, however, ethnic differences in the relationship of WC to the other risk factors. The aim of this study was to determine the optimal cut-off points of WC and body mass index (BMI) at which cardiovascular risk factors can be identified with maximum sensitivity and specificity in a representative sample of the Tunisian adult population and to investigate any correlation between WC and BMI. We used a sample of the Tunisian National Nutrition Survey, a cross-sectional population-based survey, conducted in 1996 on a large nationally representative sample, which included 3435 adults (1244 men and 2191 women) of 20 years or older. WC, BMI, blood pressure and fasting blood measurements (plasma glucose, total cholesterol, triglycerides) were recorded. Receiver operating characteristic (ROC) curve analysis was used to identify optimal cut-off values of WC and BMI to identify with maximum sensitivity and specificity the detection of high blood pressure, hyperglycaemia, high blood cholesterol and hypertriglyceridaemia. ROC curve analysis suggested WC cut-off points of 85 cm in men and 85 cm in women for the optimum detection of high blood pressure, diabetes and dyslipidaemia. The optimum BMI cut-off points for predicting cardiovascular risk factors were 24 kg/m(2) in men and 27 kg/m(2) in women. The cut-off points recommended for the Caucasian population differ from those appropriate for the Tunisian population. The data show a continuous increase in odds ratios of each cardiovascular risk factor, with increasing level of WC and BMI. WC exceeding 85 cm in men and 79 cm in women correctly identified subjects with a BMI of >/=25 kg/m(2), sensitivity of >90% and specificity of >83%. Based on the ROC analysis, we suggest a WC of 85 cm for both men and women as appropriate cut-off points to identify central obesity for the purposes of CVD and diabetes-risk detection among Tunisians. WCs of 85 cm in men and 79 cm in women were the most sensitive and specific to identify most subjects with a BMI >/=25 kg/m(2).

Estimating population prevalence of psychiatric conditions by small area with applications to analysing outcome and referral variations.

PubMed

Congdon, Peter

2006-12-01

This paper considers the development of estimates of mental illness prevalence for small areas and applications in explaining psychiatric outcomes and in assessing service provision. Estimates of prevalence are based on a logistic regression analysis of two national studies that provides model based estimates of relative morbidity risk by demographic, socio-economic and ethnic group for major psychiatric conditions; household/marital and area status also figure in the regression. Relative risk estimates are used, along with suitably disaggregated census populations, to make prevalence estimates for 354 English local authorities (LAs). Two applications are considered: the first involves analysis of variations in schizophrenia referrals and suicide mortality over English LAs that takes account of prevalence differences, and the second involves assessing hospital referral and bed use in relation to prevalence (for ages 16-74) for a case study area, Waltham Forest in NE London.

Polypharmacy correlates with increased risk for hip fracture in the elderly: a population-based study.

PubMed

Lai, Shih-Wei; Liao, Kuan-Fu; Liao, Chien-Chang; Muo, Chih-Hsin; Liu, Chiu-Shong; Sung, Fung-Chang

2010-09-01

Few studies have addressed the association between polypharmacy and hip fracture using population data. We conducted a population-based case-control study to investigate whether polypharmacy increases the risk for hip fracture in the elderly. We used insurance claims data from the Taiwan Bureau of National Health Insurance, a universal insurance program with a coverage rate of more than 98% of the population in Taiwan. We identified 2328 elderly patients with newly diagnosed hip fracture during the period 2005-2007. We randomly selected 9312 individuals without hip fracture to serve as the control group. Patient characteristics, drugs prescribed by physicians, and all types of hip fracture were ascertained. The odds ratio (OR) of hip fracture in association with the number of medications used per day in previous years was assessed.We found that patients were older than controls, predominantly female, and more likely to use 5 or more drugs (22.2% vs. 9.3%, p < 0.0001). The OR of hip fracture increased with the number of medications used per day and with age. Multivariate logistic regression analysis revealed that the overall OR for patients using 10 or more drugs was 8.42 (95% confidence interval [CI], 4.73-15.0) compared with patients who used 0-1 drug per day. However, age-specific analysis revealed that the risk for hip fracture was 23 times greater for patients aged > or = 85 years who used 10 or more drugs than for those aged 65-74 years who used 0-1 drug after controlling for covariates (OR, 23.0; 95% CI, 3.77-140).We conclude that the risk of hip fracture in older people increases with the number of medications used, especially in women. Age interacts with the daily medications for the risk of hip fracture.

Additive Prognostic Value of Left Ventricular Systolic Dysfunction in a Population-Based Cohort.

PubMed

Kuznetsova, Tatiana; Cauwenberghs, Nicholas; Knez, Judita; Yang, Wen-Yi; Herbots, Lieven; D'hooge, Jan; Haddad, Francois; Thijs, Lutgarde; Voigt, Jens-Uwe; Staessen, Jan A

2016-07-01

Techniques of 2-dimensional speckle tracking enable the measurement of myocardial deformation (strain) during systole. Recent clinical studies explored the prognostic role of left ventricular global longitudinal strain (GLS). However, there are few data on the association between cardiovascular outcome and GLS in the community. Therefore, we hypothesized that GLS contains additive prognostic information over and beyond traditional cardiovascular risk factors in a large, population-based cohort. We measured GLS by 2-dimensional speckle tracking in the apical 4-chamber view in 791 participants (mean age 50.9 years). We calculated multivariable adjusted hazard ratios for midwall, endocardial, and epicardial GLS, while accounting for family cluster and cardiovascular risk factors. Median follow-up was 7.9 years (5th to 95th percentile, 3.7-9.6). In continuous analysis, with adjustments applied for covariables, midwall, endocardial, and epicardial GLS were significant predictors of fatal and nonfatal cardiovascular (n=96; P<0.0001) and cardiac events (n=68; P≤0.001). In the sex-specific low quartile of midwall GLS (<18.8% in women and <17.4% in men), the risk was significantly higher than the average population risk for cardiovascular (128%, P<0.0001) and cardiac (94%, P=0.0007) events. We also noticed that the risk for cardiovascular events increased with increasing number of left ventricular abnormalities, such as low GLS, diastolic dysfunction, and hypertrophy (log-rank P<0.0001). Low GLS measured by 2-dimensional speckle tracking predicts future cardiovascular events independent of conventional risk factors. Left ventricular midwall strain represents a simple echocardiographic measure, which might be used for assessing cardiovascular risk in a population-based cohort. © 2016 American Heart Association, Inc.

Autonomic dysfunction assessed by EZSCAN and subclinical atherosclerosis.

PubMed

Sun, Jichao; Zhang, Yinfei; Xu, Baihui; Lv, Xiaofei; Ding, Lin; Chen, Ying; Sun, Wanwan; Lu, Jieli; Xu, Min; Bi, Yufang; Ning, Guang

2014-09-01

The present study aimed to explore the association between autonomic dysfunction and measurements of atherosclerosis in a middle-aged and elderly Chinese population. A population-based cross-sectional study was performed in Shanghai, China, from March to August 2010, with 5076 participants included in the analysis. Autonomic function was assessed by a novel EZSCAN test based on sudomotor function analysis. Carotid intima-media thickness (CIMT) was measured using B-mode ultrasonography and brachial-ankle pulse wave velocity (ba-PWV) was measured using an autonomic device. Participants were divided into three groups based on EZSCAN values: Group 1: EZSCAN 0-24; Group 2, EZSCAN 25-49; and Group 3, EZSCAN 50-100. These groups denoted autonomic dysfunction risk groups as follows: no risk, moderate risk and high risk, respectively. The prevalence of elevated CIMT and ba-PWV increased markedly with increasing EZSCAN values (elevated CIMT 7.4%, 17.5%, and 29.7%, elevated ba-PWV 3.2%, 19.7%, and 36.5%, in Groups 1, 2, and 3, respectively; both Ptrend < 0.0001). Logistic regressions revealed that EZSCAN values ≥50 were associated with a non-significantly higher risk of elevated CIMT (odds ratio [OR] = 1.43; 95% confidence interval [CI] 0.98-2.07) and a significantly higher risk of elevated ba-PWV (OR = 2.16; 95% CI 1.25-3.71) compared with EZSCAN values <25, after controlling for conventional risk factors. A higher EZSCAN value (≥50), an index of high autonomic dysfunction risk, was associated with an increased risk of elevated ba-PWV and CIMT. Such associations were partially explained by traditional atherosclerotic risk factors. © 2014 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd.

Gene-by-Psychosocial Factor Interactions Influence Diastolic Blood Pressure in European and African Ancestry Populations: Meta-Analysis of Four Cohort Studies.

PubMed

Smith, Jennifer A; Zhao, Wei; Yasutake, Kalyn; August, Carmella; Ratliff, Scott M; Faul, Jessica D; Boerwinkle, Eric; Chakravarti, Aravinda; Diez Roux, Ana V; Gao, Yan; Griswold, Michael E; Heiss, Gerardo; Kardia, Sharon L R; Morrison, Alanna C; Musani, Solomon K; Mwasongwe, Stanford; North, Kari E; Rose, Kathryn M; Sims, Mario; Sun, Yan V; Weir, David R; Needham, Belinda L

2017-12-18

Inter-individual variability in blood pressure (BP) is influenced by both genetic and non-genetic factors including socioeconomic and psychosocial stressors. A deeper understanding of the gene-by-socioeconomic/psychosocial factor interactions on BP may help to identify individuals that are genetically susceptible to high BP in specific social contexts. In this study, we used a genomic region-based method for longitudinal analysis, Longitudinal Gene-Environment-Wide Interaction Studies (LGEWIS), to evaluate the effects of interactions between known socioeconomic/psychosocial and genetic risk factors on systolic and diastolic BP in four large epidemiologic cohorts of European and/or African ancestry. After correction for multiple testing, two interactions were significantly associated with diastolic BP. In European ancestry participants, outward/trait anger score had a significant interaction with the C10orf107 genomic region ( p = 0.0019). In African ancestry participants, depressive symptom score had a significant interaction with the HFE genomic region ( p = 0.0048). This study provides a foundation for using genomic region-based longitudinal analysis to identify subgroups of the population that may be at greater risk of elevated BP due to the combined influence of genetic and socioeconomic/psychosocial risk factors.

Green tea and liver cancer risk: A meta-analysis of prospective cohort studies in Asian populations.

PubMed

Huang, Ya-Qing; Lu, Xin; Min, Han; Wu, Qian-Qian; Shi, Xiao-Ting; Bian, Kang-Qi; Zou, Xiao-Ping

2016-01-01

The aim of this meta-analysis was to investigate whether an association existed between green tea consumption and the risk for liver cancer in prospective cohort studies in Asian populations. Relevant studies were identified by searching PubMed, EMBASE, ISI Web of Science, and the Chinese Bio-medicine Database published before April 2015. Study-specific risk estimates for the highest versus non- or lowest and increment of daily cup of green tea consumption levels were combined based on fixed- or random-effects models. STATA 11.0 (Stata Corporation, College Station, TX, USA) software was used for statistical analysis. Nine prospective cohort articles involving 465,274 participants and 3694 cases of liver cancer from China, Japan, and Singapore were included. The summary relative risk (RR) indicated a significant association between the highest green tea consumption and reduced risk for liver cancer (summary RR, 0.88; 95% confidence interval [CI], 0.81-0.97). However, no statistically significant association was observed when analyzing daily consumption of one cup (summary RR, 0.97; 95% CI, 0.95-1.00). When stratified by sex, the protective effect of green tea consumption on risk for liver cancer was observed only in the group of women (summary RR, 0.78; 95% CI, 0.64-0.96), but not in men (summary RR, 0.89; 95% CI, 0.79-1.00). The present analysis indicated the preventive effects of green tea intake on the risk for liver cancer in female Asian populations. However, additional studies are needed to make a convincing case for this association. Copyright © 2016 Elsevier Inc. All rights reserved.

High-risk population health management--achieving improved patient outcomes and near-term financial results.

PubMed

Lynch, J P; Forman, S A; Graff, S; Gunby, M C

2000-07-01

A managed care organization sought to achieve efficiencies in care delivery and cost savings by anticipating and better caring for its frail and least stable members. Time sequence case study of program intervention across an entire managed care population in its first year compared with the prior baseline year. Key attributes of the intervention included predictive registries of at-risk members based on existing data, relentless focus on the high-risk group, an integrated clinical and psychosocial approach to assessments and are planning, a reengineered care management process, secured Internet applications enabling rapid implementation and broad connectivity, and population-based outcomes metrics derived from widely used measures of resource utilization and functional status. Concentrating on the highest-risk group, which averaged just 1.1% prevalence in the total membership, yielded bottom line results. When the year before program implementation (July 1997 through June 1998) was compared with the subsequent year, the total population's annualized commercial admission rate was reduced 5.3%, and seniors' was reduced 3.0%. A claims-paid analysis exclusively of the highest-risk group revealed that their efficiencies and savings overwhelmingly contributed to the membershipwide effect. This subgroup's costs dropped 35.7% from preprogram levels of $2590 per member per month (excluding pharmaceuticals). During the same time, patient-derived cross-sectional functional status rose 12.5%. A sharply focused, Internet-deployed case management strategy achieved economic and functional status results on a population basis and produced systemwide savings in its first year of implementation.

Paternal exposure to medical-related radiation associated with low birthweight infants

PubMed Central

Chen, Shi; Yang, Yingying; QV, Yimin; Zou, Yun; ZHU, Huijuan; Gong, Fengying; Zou, Yongwei; Yang, Hongbo; WANG, Linjie; Lian, Bill Q.; Liu, Cynthia; Jiang, Yu; Yan, Chengsheng; LI, Jianqiang; Wang, Qing; Pan, Hui

2018-01-01

Abstract Low birthweight (LBW) is closely associated with fetal and perinatal mortality and morbidity. We identified the risk factors of LBW and geographical differences in LBW incidence in 30 Chinese provinces in the present study. This study was a population-based, retrospective cohort study performed in 30 Chinese provinces. We used data from the free National Pre-pregnancy Checkups Project, which is a countrywide population-based retrospective cohort study. To identify regional differences in LBW incidence, we used the Qinling-Huaihe climate line to divide China into northern and southern sections and the Heihe-Tengchong economic line to divide it into eastern and western sections. Multivariate unconditional logistic regression analysis with SAS 9.4 was used for data analysis. P < .05 was considered statistically significant. LBW incidence was 4.54% in rural China. Southern China had a significantly higher incidence (4.65%) than northern China (4.28%). Our main risk factor for LBW is paternal exposure to radiation (odds ratio = 1.537), which has never been studied before. This study identifies multiple risk factors of couples giving birth to LBW babies including paternal risk factors. PMID:29480847

Multi-hazard risk analysis using the FP7 RASOR Platform

NASA Astrophysics Data System (ADS)

Koudogbo, Fifamè N.; Duro, Javier; Rossi, Lauro; Rudari, Roberto; Eddy, Andrew

2014-10-01

Climate change challenges our understanding of risk by modifying hazards and their interactions. Sudden increases in population and rapid urbanization are changing exposure to risk around the globe, making impacts harder to predict. Despite the availability of operational mapping products, there is no single tool to integrate diverse data and products across hazards, update exposure data quickly and make scenario-based predictions to support both short and long-term risk-related decisions. RASOR (Rapid Analysis and Spatialization Of Risk) will develop a platform to perform multi-hazard risk analysis for the full cycle of disaster management, including targeted support to critical infrastructure monitoring and climate change impact assessment. A scenario-driven query system simulates future scenarios based on existing or assumed conditions and compares them with historical scenarios. RASOR will thus offer a single work environment that generates new risk information across hazards, across data types (satellite EO, in-situ), across user communities (global, local, climate, civil protection, insurance, etc.) and across the world. Five case study areas are considered within the project, located in Haiti, Indonesia, Netherlands, Italy and Greece. Initially available over those demonstration areas, RASOR will ultimately offer global services to support in-depth risk assessment and full-cycle risk management.

Spatial analysis of the tuberculosis treatment dropout, Buenos Aires, Argentina

PubMed Central

Herrero, María Belén; Arrossi, Silvina; Ramos, Silvina; Braga, Jose Ueleres

2015-01-01

OBJECTIVE Identify spatial distribution patterns of the proportion of nonadherence to tuberculosis treatment and its associated factors. METHODS We conducted an ecological study based on secondary and primary data from municipalities of the metropolitan area of Buenos Aires, Argentina. An exploratory analysis of the characteristics of the area and the distributions of the cases included in the sample (proportion of nonadherence) was also carried out along with a multifactor analysis by linear regression. The variables related to the characteristics of the population, residences and families were analyzed. RESULTS Areas with higher proportion of the population without social security benefits (p = 0.007) and of households with unsatisfied basic needs had a higher risk of nonadherence (p = 0.032). In addition, the proportion of nonadherence was higher in areas with the highest proportion of households with no public transportation within 300 meters (p = 0.070). CONCLUSIONS We found a risk area for the nonadherence to treatment characterized by a population living in poverty, with precarious jobs and difficult access to public transportation. PMID:26270011

Spatial analysis of the tuberculosis treatment dropout, Buenos Aires, Argentina.

PubMed

Herrero, María Belén; Arrossi, Silvina; Ramos, Silvina; Braga, Jose Ueleres

2015-01-01

OBJECTIVE Identify spatial distribution patterns of the proportion of nonadherence to tuberculosis treatment and its associated factors. METHODS We conducted an ecological study based on secondary and primary data from municipalities of the metropolitan area of Buenos Aires, Argentina. An exploratory analysis of the characteristics of the area and the distributions of the cases included in the sample (proportion of nonadherence) was also carried out along with a multifactor analysis by linear regression. The variables related to the characteristics of the population, residences and families were analyzed. RESULTS Areas with higher proportion of the population without social security benefits (p = 0.007) and of households with unsatisfied basic needs had a higher risk of nonadherence (p = 0.032). In addition, the proportion of nonadherence was higher in areas with the highest proportion of households with no public transportation within 300 meters (p = 0.070). CONCLUSIONS We found a risk area for the nonadherence to treatment characterized by a population living in poverty, with precarious jobs and difficult access to public transportation.

Risk Factors and Predictors for Candidemia in Pediatric Intensive Care Unit Patients: Implications for Prevention

PubMed Central

Zaoutis, Theoklis E.; Prasad, Priya A.; Localio, A. Russell; Coffin, Susan E.; Bell, Louis M.; Walsh, Thomas J.; Gross, Robert

2013-01-01

Summary Few data exist on risk factors for candidemia in pediatric intensive care unit (PICU) patients who are at high risk of mortality from infection. We conducted a population-based case-control study to determine risk factors and predictors for candidemia in the PICU. Background Candida species are the leading cause of invasive fungal infections in hospitalized children and are the third most common isolates recovered from pediatric healthcare-associated bloodstream infection in the US [1]. Few data exist on risk factors for candidemia in pediatric intensive care unit (PICU) patients. Methods We conducted a population-based case-control study of PICU patients at Children's Hospital of Philadelphia (CHOP) from 1997-2004. Cases were identified using laboratory records, controls were selected from PICU rosters. Controls were matched to cases by incidence density sampling, adjusting for time at risk. Following conditional multivariate analysis, we performed weighted multivariate analysis to determine predicted probabilities for candidemia given certain risk factor combinations. Results We identified 101 cases of candidemia(incidence,3.5/1,000 PICU admissions). Factors independently associated with candidemia included presence of a central venous catheter(OR 30.4;CI,7.7,119.5), malignancy(OR 4.0;CI,1.23,13.1), use of vancomycin for >3 days in the prior two weeks(OR 6.2;CI,2.4,16), and receipt of agents with activity against anaerobic organisms for >3 days in the prior two weeks(OR 3.5;CI, 1.5,8.4). Predicted probability of various combinations of the factors above ranged from 10.7%-46%. The 30-day mortality rate was 44% in cases compared to 14% in controls (OR 4.22;CI,2.35,7.60). Conclusions To our knowledge, this is the first study to evaluate independent risk factors and to determine a population of children in PICUs at high risk for developing candidemia. Future efforts should focus on validation of these risk factors identified in a different PICU population and development of interventions for prevention of candidemia in critically ill children. PMID:20636126

Potential for adult-based epidemiological studies to characterize overall cancer risks associated with a lifetime of CT scans.

PubMed

Shuryak, Igor; Lubin, Jay H; Brenner, David J

2014-06-01

Recent epidemiological studies have suggested that radiation exposure from pediatric CT scanning is associated with small excess cancer risks. However, the majority of CT scans are performed on adults, and most radiation-induced cancers appear during middle or old age, in the same age range as background cancers. Consequently, a logical next step is to investigate the effects of CT scanning in adulthood on lifetime cancer risks by conducting adult-based, appropriately designed epidemiological studies. Here we estimate the sample size required for such studies to detect CT-associated risks. This was achieved by incorporating different age-, sex-, time- and cancer type-dependent models of radiation carcinogenesis into an in silico simulation of a population-based cohort study. This approach simulated individual histories of chest and abdominal CT exposures, deaths and cancer diagnoses. The resultant sample sizes suggest that epidemiological studies of realistically sized cohorts can detect excess lifetime cancer risks from adult CT exposures. For example, retrospective analysis of CT exposure and cancer incidence data from a population-based cohort of 0.4 to 1.3 million (depending on the carcinogenic model) CT-exposed UK adults, aged 25-65 in 1980 and followed until 2015, provides 80% power for detecting cancer risks from chest and abdominal CT scans.

Association of Alzheimer's disease GWAS loci with MRI markers of brain aging.

PubMed

Chauhan, Ganesh; Adams, Hieab H H; Bis, Joshua C; Weinstein, Galit; Yu, Lei; Töglhofer, Anna Maria; Smith, Albert Vernon; van der Lee, Sven J; Gottesman, Rebecca F; Thomson, Russell; Wang, Jing; Yang, Qiong; Niessen, Wiro J; Lopez, Oscar L; Becker, James T; Phan, Thanh G; Beare, Richard J; Arfanakis, Konstantinos; Fleischman, Debra; Vernooij, Meike W; Mazoyer, Bernard; Schmidt, Helena; Srikanth, Velandai; Knopman, David S; Jack, Clifford R; Amouyel, Philippe; Hofman, Albert; DeCarli, Charles; Tzourio, Christophe; van Duijn, Cornelia M; Bennett, David A; Schmidt, Reinhold; Longstreth, William T; Mosley, Thomas H; Fornage, Myriam; Launer, Lenore J; Seshadri, Sudha; Ikram, M Arfan; Debette, Stephanie

2015-04-01

Whether novel risk variants of Alzheimer's disease (AD) identified through genome-wide association studies also influence magnetic resonance imaging-based intermediate phenotypes of AD in the general population is unclear. We studied association of 24 AD risk loci with intracranial volume, total brain volume, hippocampal volume (HV), white matter hyperintensity burden, and brain infarcts in a meta-analysis of genetic association studies from large population-based samples (N = 8175-11,550). In single-SNP based tests, AD risk allele of APOE (rs2075650) was associated with smaller HV (p = 0.0054) and CD33 (rs3865444) with smaller intracranial volume (p = 0.0058). In gene-based tests, there was associations of HLA-DRB1 with total brain volume (p = 0.0006) and BIN1 with HV (p = 0.00089). A weighted AD genetic risk score was associated with smaller HV (beta ± SE = -0.047 ± 0.013, p = 0.00041), even after excluding the APOE locus (p = 0.029). However, only association of AD genetic risk score with HV, including APOE, was significant after multiple testing correction (including number of independent phenotypes tested). These results suggest that novel AD genetic risk variants may contribute to structural brain aging in nondemented older community persons. Copyright © 2015 Elsevier Inc. All rights reserved.

Anterior cruciate ligament injury: Identifying information sources and risk factor awareness among the general population.

PubMed

Nagano, Yasuharu; Yako-Suketomo, Hiroko; Natsui, Hiroaki

2018-01-01

Raising awareness on a disorder is important for its prevention and for promoting public health. However, for sports injuries like the anterior cruciate ligament (ACL) injury no studies have investigated the awareness on risk factors for injury and possible preventative measures in the general population. The sources of information among the population are also unclear. The purpose of the present study was to identify these aspects of public awareness about the ACL injury. A questionnaire was randomly distributed among the general population registered with a web based questionnaire supplier, to recruit 900 participants who were aware about the ACL injury. The questionnaire consisted of two parts: Question 1 asked them about their sources of information regarding the ACL injury; Question 2 asked them about the risk factors for ACL injury. Multivariate logistic regression was used to determine the information sources that provide a good understanding of the risk factors. The leading source of information for ACL injury was television (57.0%). However, the results of logistic regression analysis revealed that television was not an effective medium to create awareness about the risk factors, among the general population. Instead "Lecture by a coach", "Classroom session on Health", and "Newspaper" were significantly more effective in creating a good awareness of the risk factors (p < 0.001).

Antidepressant Use After Aneurysmal Subarachnoid Hemorrhage: A Population-Based Case-Control Study.

PubMed

Huttunen, Jukka; Lindgren, Antti; Kurki, Mitja I; Huttunen, Terhi; Frösen, Juhana; von Und Zu Fraunberg, Mikael; Koivisto, Timo; Kälviäinen, Reetta; Räikkönen, Katri; Viinamäki, Heimo; Jääskeläinen, Juha E; Immonen, Arto

2016-09-01

To elucidate the predictors of antidepressant use after subarachnoid hemorrhage from saccular intracranial aneurysm (sIA-SAH) in a population-based cohort with matched controls. The Kuopio sIA database includes all unruptured and ruptured sIA cases admitted to the Kuopio University Hospital from its defined catchment population in Eastern Finland, with 3 matched controls for each patient. The use of all prescribed medicines has been fused from the Finnish national registry of prescribed medicines. In the present study, 2 or more purchases of antidepressant medication indicated antidepressant use. The risk factors of the antidepressant use were analyzed in 940 patients alive 12 months after sIA-SAH, and the classification tree analysis was used to create a predicting model for antidepressant use after sIA-SAH. The 940 12-month survivors of sIA-SAH had significantly more antidepressant use (odds ratio, 2.6; 95% confidence interval, 2.2-3.1) than their 2676 matched controls (29% versus 14%). Classification tree analysis, based on independent risk factors, was used for the best prediction model of antidepressant use after sIA-SAH. Modified Rankin Scale until 12 months was the most potent predictor, followed by condition (Hunt and Hess Scale) and age on admission for sIA-SAH. The sIA-SAH survivors use significantly more often antidepressants, indicative of depression, than their matched population controls. Even with a seemingly good recovery (modified Rankin Scale score, 0) at 12 months after sIA-SAH, there is a significant risk of depression requiring antidepressant medication. © 2016 American Heart Association, Inc.

Participatory Risk Mapping of Malaria Vector Exposure in Northern South America using Environmental and Population Data

PubMed Central

Fuller, D.O.; Troyo, A.; Alimi, T.O.; Beier, J.C.

2014-01-01

Malaria elimination remains a major public health challenge in many tropical regions, including large areas of northern South America. In this study, we present a new high spatial resolution (90 × 90 m) risk map for Colombia and surrounding areas based on environmental and human population data. The map was created through a participatory multi-criteria decision analysis in which expert opinion was solicited to determine key environmental and population risk factors, different fuzzy functions to standardize risk factor inputs, and variable factor weights to combine risk factors in a geographic information system. The new risk map was compared to a map of malaria cases in which cases were aggregated to the municipio (municipality) level. The relationship between mean municipio risk scores and total cases by muncípio showed a weak correlation. However, the relationship between pixel-level risk scores and vector occurrence points for two dominant vector species, Anopheles albimanus and An. darlingi, was significantly different (p < 0.05) from a random point distribution, as was a pooled point distribution for these two vector species and An. nuneztovari. Thus, we conclude that the new risk map derived based on expert opinion provides an accurate spatial representation of risk of potential vector exposure rather than malaria transmission as shown by the pattern of malaria cases, and therefore it may be used to inform public health authorities as to where vector control measures should be prioritized to limit human-vector contact in future malaria outbreaks. PMID:24976656

Identifying high-risk areas for sporadic measles outbreaks: lessons from South Africa.

PubMed

Sartorius, Benn; Cohen, C; Chirwa, T; Ntshoe, G; Puren, A; Hofman, K

2013-03-01

To develop a model for identifying areas at high risk for sporadic measles outbreaks based on an analysis of factors associated with a national outbreak in South Africa between 2009 and 2011. Data on cases occurring before and during the national outbreak were obtained from the South African measles surveillance programme, and data on measles immunization and population size, from the District Health Information System. A Bayesian hierarchical Poisson model was used to investigate the association between the risk of measles in infants in a district and first-dose vaccination coverage, population density, background prevalence of human immunodeficiency virus (HIV) infection and expected failure of seroconversion. Model projections were used to identify emerging high-risk areas in 2012. A clear spatial pattern of high-risk areas was noted, with many interconnected (i.e. neighbouring) areas. An increased risk of measles outbreak was significantly associated with both the preceding build-up of a susceptible population and population density. The risk was also elevated when more than 20% of infants in a populous area had missed a first vaccine dose. The model was able to identify areas at high risk of experiencing a measles outbreak in 2012 and where additional preventive measures could be undertaken. The South African measles outbreak was associated with the build-up of a susceptible population (owing to poor vaccine coverage), high prevalence of HIV infection and high population density. The predictive model developed could be applied to other settings susceptible to sporadic outbreaks of measles and other vaccine-preventable diseases.

Factors that affect risk for pancreatic disease in the general population: a systematic review and meta-analysis of prospective cohort studies.

PubMed

Alsamarrai, Ammar; Das, Stephanie L M; Windsor, John A; Petrov, Maxim S

2014-10-01

Pancreatic diseases place significant burdens on health care systems worldwide. However, there is lack of agreement about which factors increase or reduce risk for pancreatic disease. We reviewed high-quality studies of factors that affect risk for pancreatic diseases in the general population. We searched 3 databases (Medline, Embase, and Scopus) for prospective cohort studies of modifiable risk and/or protective factors for acute pancreatitis, chronic pancreatitis, and pancreatic cancer in adult populations. Factors that were investigated in 2 or more studies were assessed by meta-analysis if the required data were available. Subgroup analyses were performed when appropriate. Outcome measures were relative risk (RR) and 95% confidence interval (CI). Our analysis included 51 population-based studies with more than 3 million individuals and nearly 11,000 patients with pancreatic diseases. A total of 31 different factors were investigated. Current tobacco use was the single most important risk factor for pancreatic diseases (RR, 1.87; 95% CI, 1.54-2.27), followed by obesity (RR, 1.48; 95% CI, 1.15-1.92) and heavy use of alcohol (RR, 1.37; 95% CI, 1.19-1.58). Tobacco and heavy use of alcohol had bigger effects on risk of acute pancreatitis and chronic pancreatitis than pancreatic cancer. Vegetable consumption (RR, 0.71; 95% CI, 0.57-0.88) and fruit consumption (RR, 0.73; 95% CI, 0.60-0.90) provided the greatest degree of protection against pancreatic diseases on the basis of meta-analyses. Vegetable consumption had stronger association with protection against acute pancreatitis and fruit consumption with protection against pancreatic cancer. On the basis of systematic review and meta-analysis, current tobacco use, obesity, and heavy use of alcohol are associated with significant increases in risk for pancreatic diseases. Vegetables and fruit consumption are associated with reduced risk for pancreatic diseases. Prevention strategies for acute pancreatitis, chronic pancreatitis, and pancreatic cancer should consider these factors. Copyright © 2014 AGA Institute. Published by Elsevier Inc. All rights reserved.

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

PubMed Central

Sexton, Ken

2012-01-01

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

Prevention of Falls and Fall-Related Injuries in Community-Dwelling Seniors

PubMed Central

2008-01-01

Executive Summary In early August 2007, the Medical Advisory Secretariat began work on the Aging in the Community project, an evidence-based review of the literature surrounding healthy aging in the community. The Health System Strategy Division at the Ministry of Health and Long-Term Care subsequently asked the secretariat to provide an evidentiary platform for the ministry’s newly released Aging at Home Strategy. After a broad literature review and consultation with experts, the secretariat identified 4 key areas that strongly predict an elderly person’s transition from independent community living to a long-term care home. Evidence-based analyses have been prepared for each of these 4 areas: falls and fall-related injuries, urinary incontinence, dementia, and social isolation. For the first area, falls and fall-related injuries, an economic model is described in a separate report. Please visit the Medical Advisory Secretariat Web site, http://www.health.gov.on.ca/english/providers/program/mas/mas_about.html, to review these titles within the Aging in the Community series. Aging in the Community: Summary of Evidence-Based Analyses Prevention of Falls and Fall-Related Injuries in Community-Dwelling Seniors: An Evidence-Based Analysis Behavioural Interventions for Urinary Incontinence in Community-Dwelling Seniors: An Evidence-Based Analysis Caregiver- and Patient-Directed Interventions for Dementia: An Evidence-Based Analysis Social Isolation in Community-Dwelling Seniors: An Evidence-Based Analysis The Falls/Fractures Economic Model in Ontario Residents Aged 65 Years and Over (FEMOR) Objective To identify interventions that may be effective in reducing the probability of an elderly person’s falling and/or sustaining a fall-related injury. Background Although estimates of fall rates vary widely based on the location, age, and living arrangements of the elderly population, it is estimated that each year approximately 30% of community-dwelling individuals aged 65 and older, and 50% of those aged 85 and older will fall. Of those individuals who fall, 12% to 42% will have a fall-related injury. Several meta-analyses and cohort studies have identified falls and fall-related injuries as a strong predictor of admission to a long-term care (LTC) home. It has been shown that the risk of LTC home admission is over 5 times higher in seniors who experienced 2 or more falls without injury, and over 10 times higher in seniors who experienced a fall causing serious injury. Falls result from the interaction of a variety of risk factors that can be both intrinsic and extrinsic. Intrinsic factors are those that pertain to the physical, demographic, and health status of the individual, while extrinsic factors relate to the physical and socio-economic environment. Intrinsic risk factors can be further grouped into psychosocial/demographic risks, medical risks, risks associated with activity level and dependence, and medication risks. Commonly described extrinsic risks are tripping hazards, balance and slip hazards, and vision hazards. Note: It is recognized that the terms “senior” and “elderly” carry a range of meanings for different audiences; this report generally uses the former, but the terms are treated here as essentially interchangeable. Evidence-Based Analysis of Effectiveness Research Question Since many risk factors for falls are modifiable, what interventions (devices, systems, programs) exist that reduce the risk of falls and/or fall-related injuries for community-dwelling seniors? Inclusion and Exclusion Criteria Inclusion Criteria English language; published between January 2000 and September 2007; population of community-dwelling seniors (majority aged 65+); and randomized controlled trials (RCTs), quasi-experimental trials, systematic reviews, or meta-analyses. Exclusion Criteria special populations (e.g., stroke or osteoporosis; however, studies restricted only to women were included); studies only reporting surrogate outcomes; or studies whose outcome cannot be extracted for meta-analysis. Outcomes of Interest number of fallers, and number of falls resulting in injury/fracture. Search Strategy A search was performed in OVID MEDLINE, MEDLINE In-Process and Other Non-Indexed Citations, EMBASE, the Cumulative Index to Nursing & Allied Health Literature (CINAHL), The Cochrane Library, and the International Agency for Health Technology Assessment (INAHTA) for studies published between January 2000 and September 2007. Furthermore, all studies included in a 2003 Cochrane review were considered for inclusion in this analysis. Abstracts were reviewed by a single author, and studies meeting the inclusion criteria outlined above were obtained. Studies were grouped based on intervention type, and data on population characteristics, fall outcomes, and study design were extracted. Reference lists were also checked for relevant studies. The quality of the evidence was assessed as high, moderate, low, or very low according to the GRADE methodology. Summary of Findings The following 11 interventions were identified in the literature search: exercise programs, vision assessment and referral, cataract surgery, environmental modifications, vitamin D supplementation, vitamin D plus calcium supplementation, hormone replacement therapy (HRT), medication withdrawal, gait-stabilizing devices, hip protectors, and multifactorial interventions. Exercise programs were stratified into targeted programs where the exercise routine was tailored to the individuals’ needs, and untargeted programs that were identical among subjects. Furthermore, analyses were stratified by exercise program duration (<6 months and ≥6 months) and fall risk of study participants. Similarly, the analyses on the environmental modification studies were stratified by risk. Low-risk study participants had had no fall in the year prior to study entry, while high-risk participants had had at least one fall in the previous year. A total of 17 studies investigating multifactorial interventions were identified in the literature search. Of these studies, 10 reported results for a high-risk population with previous falls, while 6 reported results for study participants representative of the general population. One study provided stratified results by fall risk, and therefore results from this study were included in each stratified analysis. Executive Summary Table 1: Summary of Meta-Analyses of Studies Investigating the Effectiveness of Interventions on the Risk of Falls in Community-Dwelling Seniors* Intervention RR [95% CI] GRADE Exercise programs   1. Targeted programs           General population 0.81 [0.67–0.98] Low       High-risk population 0.93 [0.82–1.06] High       Short duration 0.91 [0.73–1.13] High       Long duration 0.89 [0.79–1.01] Moderate   2. Untargeted programs           General population 0.78 [0.66–0.91] Moderate       High-risk population 0.89 [0.72–1.10] Very low       Short duration 0.85 [0.71–1.01] Low       Long duration 0.76 [0.64–0.91] Moderate   3. Combined targeted vs. untargeted programs           General population N/A N/A       High-risk population 0.87 [0.57–1.34] Moderate       Short duration 1.11 [0.73–1.70] High       Long duration 0.73 [0.57–0.95] High Vision intervention       Assessment/referral 1.12 [0.82–1.53] Moderate       Cataract surgery 1.11 [0.92–1.35] Moderate Environmental modifications       Low-risk population 1.03 [0.75–1.41] High       High-risk population 0.66 [0.54–0.81] High       General population 0.85 [0.75–0.97] High Drugs/Nutritional supplements       Vitamin D (men and women) 0.94 [0.77–1.14] High       Vitamin D (women only) 0.55 [0.29–1.08] Moderate       Vitamin D and calcium (men and women) 0.89 [0.74–1.07] Moderate       Vitamin D and calcium (women only) 0.83 [0.73–0.95] Moderate       Hormone replacement therapy 0.98 [0.80–1.20] Low       Medication withdrawal 0.34 [0.16–0.74]† Low Gait-stabilizing device 0.43 [0.29–0.64] Moderate Multifactorial intervention       Geriatric screening (general population) 0.87 [0.69–1.10] Very low       High-risk population 0.86 [0.75–0.98] Low * CI refers to confidence interval; RR, relative risk. † Hazard ratio is reported, because RR was not available. Executive Summary Table 2: Summary of Meta-Analyses of Studies Investigating the Effectiveness of Interventions on the Risk of Fall-Related Injuries in Community-Dwelling Seniors* Intervention RR [95% CI] GRADE Exercise programs         Targeted programs 0.67 [0.51–0.89] Moderate     Untargeted programs 0.57 [0.38–0.86] Low     Combined targeted vs untargeted programs 0.31 [0.13–0.74] High Drugs/nutritional supplements         Vitamin D plus calcium (women only) 0.77 [0.49–1.21] Moderate Gait-stabilizing device 0.10 [0.01–0.74] Moderate Hip protectors 3.49 [0.68–17.97]† Low Multifactorial intervention         Geriatric screening (general population) 0.90 [0.53–1.51] Low     High-risk population 0.86 [0.66–1.11] Moderate * CI refers to confidence interval; RR, relative risk. † Odds ratio is reported, because RR was not available. Conclusions High-quality evidence indicates that long-term exercise programs in mobile seniors and environmental modifications in the homes of frail elderly persons will effectively reduce falls and possibly fall-related injuries in Ontario’s elderly population. A combination of vitamin D and calcium supplementation in elderly women will help reduce the risk of falls by more than 40%. The use of outdoor gait-stabilizing devices for mobile seniors during the winter in Ontario may reduce falls and fall-related injuries; however, evidence is limited and more research is required in this area. While psychotropic medication withdrawal may be an effective method for reducing falls, evidence is limited and long-term compliance has been demonstrated to be difficult to achieve. Multifactorial interventions in high-risk populations may be effective; however, the effect is only marginally significant, and the quality of evidence is low. PMID:23074507

Customized vs population-based growth charts to identify neonates at risk of adverse outcome: systematic review and Bayesian meta-analysis of observational studies.

PubMed

Chiossi, G; Pedroza, C; Costantine, M M; Truong, V T T; Gargano, G; Saade, G R

2017-08-01

To compare the effectiveness of customized vs population-based growth charts for the prediction of adverse pregnancy outcomes. MEDLINE, ClinicalTrials.gov and The Cochrane Library were searched up to 31 May 2016 to identify interventional and observational studies comparing adverse outcomes among large- (LGA) and small- (SGA) for-gestational-age neonates, when classified according to customized vs population-based growth charts. Perinatal mortality and admission to the neonatal intensive care unit (NICU) of both SGA and LGA neonates, intrauterine fetal demise (IUFD) and neonatal mortality of SGA neonates, and neonatal shoulder dystocia and hypoglycemia as well as maternal third- and fourth-degree perineal lacerations in LGA pregnancies were evaluated. The electronic search identified 237 records that were examined based on title and abstract, of which 27 full-text articles were examined for eligibility. After excluding seven articles, 20 observational studies were included in a Bayesian meta-analysis. Neonates classified as SGA according to customized growth charts had higher risks of IUFD (odds ratio (OR), 7.8 (95% CI, 4.2-12.3)), neonatal death (OR, 3.5 (95% CI, 1.1-8.0)), perinatal death (OR, 5.8 (95% CI, 3.8-7.8)) and NICU admission (OR, 3.6 (95% CI, 2.0-5.5)) than did non-SGA cases. Neonates classified as SGA according to population-based growth charts also had increased risk for adverse outcomes, albeit the point estimates of the pooled ORs were smaller: IUFD (OR, 3.3 (95% CI, 1.9-5.0)), neonatal death (OR, 2.9 (95% CI, 1.2-4.5)), perinatal death (OR, 4.0 (95% CI, 2.8-5.1)) and NICU admission (OR, 2.4 (95% CI, 1.7-3.2)). For LGA vs non-LGA, there were no differences in pooled ORs for perinatal death, NICU admission, hypoglycemia and maternal third- and fourth-degree perineal lacerations when classified according to either the customized or the population-based approach. In contrast, both approaches indicated that LGA neonates are at increased risk for shoulder dystocia than are non-LGA ones (OR, 7.4 (95% CI, 4.9-9.8) using customized charts; OR, 8.0 (95% CI, 5.3-10.1) using population-based charts). Both customized and population-based growth charts can identify SGA neonates at risk for adverse outcomes. Although the point estimates of the pooled ORs may differ for some outcomes, the overlapping CIs and lack of direct comparisons prevent conclusions from being drawn on the superiority of one method. Future clinical trials should compare directly the two approaches in the management of fetuses of abnormal size. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Extinction-effective population index: incorporating life-history variations in population viability analysis.

PubMed

Fujiwara, Masami

2007-09-01

Viability status of populations is a commonly used measure for decision-making in the management of populations. One of the challenges faced by managers is the need to consistently allocate management effort among populations. This allocation should in part be based on comparison of extinction risks among populations. Unfortunately, common criteria that use minimum viable population size or count-based population viability analysis (PVA) often do not provide results that are comparable among populations, primarily because they lack consistency in determining population size measures and threshold levels of population size (e.g., minimum viable population size and quasi-extinction threshold). Here I introduce a new index called the "extinction-effective population index," which accounts for differential effects of demographic stochasticity among organisms with different life-history strategies and among individuals in different life stages. This index is expected to become a new way of determining minimum viable population size criteria and also complement the count-based PVA. The index accounts for the difference in life-history strategies of organisms, which are modeled using matrix population models. The extinction-effective population index, sensitivity, and elasticity are demonstrated in three species of Pacific salmonids. The interpretation of the index is also provided by comparing them with existing demographic indices. Finally, a measure of life-history-specific effect of demographic stochasticity is derived.

Cancer Incidence in Physicians

PubMed Central

Lee, Yu-Sung; Hsu, Chien-Chin; Weng, Shih-Feng; Lin, Hung-Jung; Wang, Jhi-Joung; Su, Shih-Bin; Huang, Chien-Cheng; Guo, How-Ran

2015-01-01

Abstract Cancer has been the leading cause of death in Taiwan since 1982. Physicians have many health-related risk factors which may contribute to cancer, such as rotating night shift, radiation, poor lifestyle, and higher exposure risk to infection and potential carcinogenic drugs. However, the cancer risk in physicians is not clear. In Taiwan's National Health Insurance Research Database, we identified 14,889 physicians as the study cohort and randomly selected 29,778 nonmedical staff patients as the comparison cohort for this national population-based cohort study. Cox proportional-hazard regression was used to compare the cancer risk between physicians and comparisons. Physician subgroups were also analyzed. Physicians had a lower all-cancer risk than did the comparisons (hazard ratio [HR] 0.86, 95% confidence interval [CI] 0.76–0.97). In the sex-based analysis, male physicians had a lower all-cancer risk than did male comparisons (HR 0.82, 95% CI 0.73–0.94); and female physicians did not (HR 1.29, 95% CI 0.88–1.91). In the cancer-type analysis, male physicians had a higher risk of prostate cancer (HR 1.72, 95% CI 1.12–2.65) and female physicians had twice the risk of breast cancer (HR 2.00, 95% CI 1.11–3.62) than did comparisons. Cancer risk was not significantly associated with physician specialties. Physicians in Taiwan had a lower all-cancer risk but higher risks for prostate and breast cancer than did the general population. These new epidemiological findings require additional study to clarify possible mechanisms. PMID:26632715

Aligning population-based care management with chronic disease complexity.

PubMed

Hewner, Sharon; Seo, Jin Young; Gothard, Sandra E; Johnson, Barbara J

2014-01-01

Risk-stratified care management requires knowledge of the complexity of chronic disease and comorbidity, information that is often not readily available in the primary care setting. The purpose of this article was to describe a population-based approach to risk-stratified care management that could be applied in primary care. Three populations (Medicaid, Medicare, and privately insured) at a regional health plan were divided into risk-stratified cohorts based on chronic disease and complexity, and utilization was compared before and after the implementation of population-specific care management teams of nurses. Risk-stratified care management was associated with reductions in hospitalization rates in all three populations, but the opportunities to avoid admissions were different. Knowledge of population complexity is critical to the development of risk-stratified care management in primary care, and a complexity matrix can help nurses identify gaps in care and align interventions to cohort and population needs. Copyright © 2014 Elsevier Inc. All rights reserved.

The burden of road traffic injuries in Nigeria: results of a population-based survey.

PubMed

Labinjo, M; Juillard, C; Kobusingye, O C; Hyder, A A

2009-06-01

Mortality from road traffic injuries in sub-Saharan Africa is among the highest in the world, yet data from the region are sparse. To date, no multi-site population-based survey on road traffic injuries has been reported from Nigeria, the most populated country in Africa. To explore the epidemiology of road traffic injury in Nigeria and provide data on the populations affected and risk factors for road traffic injury. Data from a population-based survey using two-stage stratified cluster sampling. SUBJECTS/ SETTING: Road traffic injury status and demographic information were collected on 3082 respondents living in 553 households in seven of Nigeria's 37 states. Incidence rates were estimated with confidence intervals based on a Poisson distribution; Poisson regression analysis was used to calculate relative risks for associated factors. The overall road traffic injury rate was 41 per 1000 population (95% CI 34 to 49), and mortality from road traffic injuries was 1.6 per 1000 population (95% CI 0.5 to 3.8). Motorcycle crashes accounted for 54% of all road traffic injuries. The road traffic injury rates found for rural and urban respondents were not significantly different. Increased risk of injury was associated with male gender among those aged 18-44 years, with a relative risk of 2.96 when compared with women in the same age range (95% CI 1.72 to 5.09, p<0.001). The road traffic injury rates found in this survey highlight a neglected public health problem in Nigeria. Simple extrapolations from this survey suggest that over 4 million people may be injured and as many as 200 000 potentially killed as the result of road traffic crashes annually in Nigeria. Appropriate interventions in both the health and transport sectors are needed to address this significant cause of morbidity and mortality in Nigeria.

Exploring cardiovascular health: the Healthy Life in Suriname (HELISUR) study. A protocol of a cross-sectional study

PubMed Central

Diemer, Frederieke S; Aartman, Jet Q; Karamat, Fares A; Baldew, Sergio M; Jarbandhan, Ameerani V; van Montfrans, Gert A; Oehlers, Glenn P; Brewster, Lizzy M

2014-01-01

Introduction Obesity, hypertension and diabetes are on a dramatic rise in low-income and middle-income countries, and this foretells an overwhelming increase in chronic disease burden from cardiovascular disease. Therefore, rapid action should be taken through preventive population-based programmes. However, in these regions, data on the population distribution of cardiovascular risk factors, and of intermediate and final end points for cardiovascular disease are scarce. The Healthy Life in Suriname (HELISUR) study is a cardiovascular population study in Suriname, which is part of the Caribbean Community. The HELISUR study is dedicated to provide data on risk factors and prevalent cardiovascular disease in the multiethnic population, which is mainly of African and Asian descent. Methods and analysis In a cross-sectional, observational population-based setting, a random representative sample of 1800 citizens aged between 18 and 70 years will be selected using a cluster household sampling method. Self-reported demographic, socioeconomic and (cardiovascular) health-related data will be collected. Physical examination will include the assessment of cardiovascular risk factors and prevalent cardiovascular disease. In addition, we will study cardiovascular haemodynamics non-invasively, as a novel intermediate outcome. Finally, fasting blood and overnight urine samples will be collected to monitor cardiometabolic risk factors. The main outcome will be descriptive in reporting the prevalence of risk factors and measures of (sub) clinical end organ damage, stratified for ethnicity and sex-age groups. Ethics and dissemination Ethical approval has been obtained from the State Secretary of Health. Data analysis and manuscript submission are scheduled for 2016. Findings will be disseminated in peer-reviewed journals, and at national, regional and international scientific meetings. Importantly, data will be presented to Surinamese policymakers and healthcare workers, to develop preventive strategies to combat the rapid rise of cardiovascular disease. PMID:25537786

Living alone, obesity, and smoking increase risk for suicide independently of depressive mood findings from the population-based MONICA/KORA Augsburg cohort study.

PubMed

Schneider, Barbara; Lukaschek, Karoline; Baumert, Jens; Meisinger, Christa; Erazo, Natalia; Ladwig, Karl-Heinz

2014-01-01

Suicide is strongly associated with mental disorders, particularly with depression. There is insufficient knowledge to what extent sociodemographic and behavioral characteristics contribute to suicide risk. A population-based cohort study on three independent cross-sectional MONICA/KORA Augsburg surveys with 12,888 subjects (6456 men, 6432 women) was followed up on average for 12.0 years. Information on sociodemographic characteristics, chronic disease conditions, smoking habits, alcohol consumption, depressive symptoms, personality type, and other psychodiagnostic parameters was assessed by standardized interviews. Cox proportional hazards regression analyses were used to compute hazard ratios (HRs) as estimates of relative risks for suicide mortality. Additionally, population-attributable risks were calculated. Within the follow-up period, a total of 1449 persons had died, 38 of them by suicide. Although several variables were associated with increased risk in the basic analyses, only obesity (HR=2.73), smoking (HR=2.23), and living alone (HR=2.19) remained significantly associated with suicide additionally to male sex (HR=3.57) and depressed mood (HR=2.01) in a multivariate analysis. The generalization of our findings to countries with different social, economic or cultural conditions may be questioned. Our findings extend the knowledge about sociodemographic and behavioral risk factors for suicide in the general population: Suicide prevention measures should not consider only subjects with mental disorders but also address other adverse conditions. © 2013 Published by Elsevier B.V.

Large Scale Flood Risk Analysis using a New Hyper-resolution Population Dataset

NASA Astrophysics Data System (ADS)

Smith, A.; Neal, J. C.; Bates, P. D.; Quinn, N.; Wing, O.

2017-12-01

Here we present the first national scale flood risk analyses, using high resolution Facebook Connectivity Lab population data and data from a hyper resolution flood hazard model. In recent years the field of large scale hydraulic modelling has been transformed by new remotely sensed datasets, improved process representation, highly efficient flow algorithms and increases in computational power. These developments have allowed flood risk analysis to be undertaken in previously unmodeled territories and from continental to global scales. Flood risk analyses are typically conducted via the integration of modelled water depths with an exposure dataset. Over large scales and in data poor areas, these exposure data typically take the form of a gridded population dataset, estimating population density using remotely sensed data and/or locally available census data. The local nature of flooding dictates that for robust flood risk analysis to be undertaken both hazard and exposure data should sufficiently resolve local scale features. Global flood frameworks are enabling flood hazard data to produced at 90m resolution, resulting in a mis-match with available population datasets which are typically more coarsely resolved. Moreover, these exposure data are typically focused on urban areas and struggle to represent rural populations. In this study we integrate a new population dataset with a global flood hazard model. The population dataset was produced by the Connectivity Lab at Facebook, providing gridded population data at 5m resolution, representing a resolution increase over previous countrywide data sets of multiple orders of magnitude. Flood risk analysis undertaken over a number of developing countries are presented, along with a comparison of flood risk analyses undertaken using pre-existing population datasets.

[Multicriteria evaluation of environmental risk exposure using a geographic information system in Argentina].

PubMed

Pietri, Diana De; Dietrich, Patricia; Mayo, Patricia; Carcagno, Alejandro

2011-10-01

Develop a spatial model that includes environmental factors posing a health hazard, for application in the Matanza-Riachuelo River Basin (MRB) in Argentina. Multicriteria evaluation procedures were used with geographic information systems to obtain territorial zoning based on the degree of suitability for residence. Variables that characterize the habitability of housing and potential sources of basin pollution were geographically referenced. Health information was taken from the Risk Factor Survey (RFS) to measure the relative risk of living in unsuitable areas (exposed population) compared with suitable areas (unexposed population). Sixty percent of the MRB area is in suitable condition, a situation that affects 40% of residents. The rest of the population lives in unsuitable territory, and 6% live in the basin's most unsuitable conditions. Environmental conditions that are detrimental to health in the unsuitable areas became evident during the interviews through three of the pathologies considered: diarrheal diseases, respiratory diseases, and cancer. A regional analysis that provides valid information to support decisionmaking was obtained. Considering the basin as a unit of analysis allowed the use of a single protocol to undertake comprehensive measurement of the magnitude of risk and, thus, set priorities.

Mapping the Risk of Snakebite in Sri Lanka - A National Survey with Geospatial Analysis

PubMed Central

Ediriweera, Dileepa Senajith; Kasturiratne, Anuradhani; Pathmeswaran, Arunasalam; Gunawardena, Nipul Kithsiri; Wijayawickrama, Buddhika Asiri; Jayamanne, Shaluka Francis; Isbister, Geoffrey Kennedy; Dawson, Andrew; Giorgi, Emanuele; Diggle, Peter John; Lalloo, David Griffith; de Silva, Hithanadura Janaka

2016-01-01

Background There is a paucity of robust epidemiological data on snakebite, and data available from hospitals and localized or time-limited surveys have major limitations. No study has investigated the incidence of snakebite across a whole country. We undertook a community-based national survey and model based geostatistics to determine incidence, envenoming, mortality and geographical pattern of snakebite in Sri Lanka. Methodology/Principal Findings The survey was designed to sample a population distributed equally among the nine provinces of the country. The number of data collection clusters was divided among districts in proportion to their population. Within districts clusters were randomly selected. Population based incidence of snakebite and significant envenoming were estimated. Model-based geostatistics was used to develop snakebite risk maps for Sri Lanka. 1118 of the total of 14022 GN divisions with a population of 165665 (0.8%of the country’s population) were surveyed. The crude overall community incidence of snakebite, envenoming and mortality were 398 (95% CI: 356–441), 151 (130–173) and 2.3 (0.2–4.4) per 100000 population, respectively. Risk maps showed wide variation in incidence within the country, and snakebite hotspots and cold spots were determined by considering the probability of exceeding the national incidence. Conclusions/Significance This study provides community based incidence rates of snakebite and envenoming for Sri Lanka. The within-country spatial variation of bites can inform healthcare decision making and highlights the limitations associated with estimates of incidence from hospital data or localized surveys. Our methods are replicable, and these models can be adapted to other geographic regions after re-estimating spatial covariance parameters for the particular region. PMID:27391023

Inorganic arsenic in Chinese food and its cancer risk.

PubMed

Li, Gang; Sun, Guo-Xin; Williams, Paul N; Nunes, Luis; Zhu, Yong-Guan

2011-10-01

Even moderate arsenic exposure may lead to health problems, and thus quantifying inorganic arsenic (iAs) exposure from food for different population groups in China is essential. By analyzing the data from the China National Nutrition and Health Survey (CNNHS) and collecting reported values of iAs in major food groups, we developed a framework of calculating average iAs daily intake for different regions of China. Based on this framework, cancer risks from iAs in food was deterministically and probabilistically quantified. The article presents estimates for health risk due to the ingestion of food products contaminated with arsenic. Both per individual and for total population estimates were obtained. For the total population, daily iAs intake is around 42 μg day(-1), and rice is the largest contributor of total iAs intake accounting for about 60%. Incremental lifetime cancer risk from food iAs intake is 106 per 100,000 for adult individuals and the median population cancer risk is 177 per 100,000 varying between regions. Population in the Southern region has a higher cancer risk than that in the Northern region and the total population. Sensitive analysis indicated that cancer slope factor, ingestion rates of rice, aquatic products and iAs concentration in rice were the most relevant variables in the model, as indicated by their higher contribution to variance of the incremental lifetime cancer risk. We conclude that rice may be the largest contributor of iAs through food route for the Chinese people. The population from the South has greater cancer risk than that from the North and the whole population. Copyright © 2011 Elsevier Ltd. All rights reserved.

Integrated e-Health approach based on vascular ultrasound and pulse wave analysis for asymptomatic atherosclerosis detection and cardiovascular risk stratification in the community.

PubMed

Santana, Daniel Bia; Zócalo, Yanina A; Armentano, Ricardo L

2012-03-01

New strategies are urgently needed to identify subjects at increased risk of atherosclerotic cardiovascular disease (ACVD) development or complications. A National Public University Center (CUiiDARTE) was created in Uruguay, based on six main pillars: 1) integration of experts in different disciplines and creation of multidisciplinary teams, 2) incidence in public and professional education programs to give training in the use of new technologies and to shift the focus from ACVD treatment to disease prevention, 3) implementation of free vascular studies in the community (distributed rather than centralized healthcare), 4) innovation and application of e-Health and noninvasive technology and approaches, 5) design and development of a biomedical approach to determine the target population and patient workflow, and 6) improvement in individual risk estimation and differentiation between aging and ACVD-related arterial changes using population-based epidemiological and statistical patient-specific models. This work describes main features of CUiiDARTE project implementation, the scientific and technological steps and innovations done for individual risk stratification, and sub-clinical ACVD diagnosis. © 2012 IEEE

Incidence of Second Primary Malignancies Following Colorectal Cancer: A Distinct Pattern of Occurrence Between Colon and Rectal Cancers and Association of Co-Morbidity with Second Primary Malignancies in a Population-Based Cohort of 98,876 Patients in Taiwan

PubMed Central

Lee, Yu-Ting; Liu, Chia-Jen; Hu, Yu-Wen; Teng, Chung-Jen; Tzeng, Cheng-Hwai; Yeh, Chiu-Mei; Chen, Tzeng-Ji; Lin, Jen-Kou; Lin, Chun-Chi; Lan, Yuan-Tzu; Wang, Huann-Sheng; Yang, Shung-Haur; Jiang, Jeng-Kai; Chen, Wei-Shone; Lin, Tzu-Chen; Chang, Shih-Ching; Chen, Ming-Huang; Teng, Hao-Wei; Liu, Jin-Hwang; Yen, Chueh-Chuan

2015-01-01

Abstract The purpose of this study is to determine the features of second primary malignancies (SPMs) among patients with prior colorectal cancer (CRC) using a nationwide population-based dataset. Patients with CRC newly diagnosed between 1996 and 2011, and >1 year of follow-up were recruited from the Taiwan National Health Insurance database. Standardized incidence ratios (SIRs) of SPMs in patients with CRC were calculated. During the 16-year study period, 4259 SPMs developed among 98,876 CRC patients. The median duration of follow-up was 4.03 years. The SIR for all SPMs was 1.13 (95% confidence interval = 1.10–1.17). Compared with the general population, a higher incidence of thyroid, prostate, ovarian, and hematologic malignancies developed among patients with colon cancer, whereas the risk for bone and soft tissue cancers increased among patients with rectal cancer. The risk for breast, bladder, kidney, lung, and uterine cancers was significantly higher in patients with colon and rectal cancers than the general population. The risk for liver and biliary tract cancers declined in patients with rectal cancer. Based on multivariate analysis among patients with CRC, age ≥70 years, men, chronic obstructive pulmonary disease (COPD), cirrhosis, and dyslipidemia were independent predictors of an SPM. In conclusion, patients with CRC were at increased risk for a second cancer. The pattern of SPMs was distinct between patients with colon and rectal cancer. Age, men, COPD, cirrhosis, and dyslipidemia were independent risk factors for SPMs. Surveillance and education should be provided for survivors with respect to risk for SPMs. PMID:26131831

Soy isoflavone consumption and colorectal cancer risk: a systematic review and meta-analysis.

PubMed

Yu, Yi; Jing, Xiaoli; Li, Hui; Zhao, Xiang; Wang, Dongping

2016-05-12

Colorectal cancer (CRC) is one of the most predominant solid carcinomas in Western countries. However, there is conflicting information on the effects of soy isoflavone on CRC risk. Therefore, we performed a meta-analysis to assess the association between soy isoflavone consumption and CRC risk in humans using PubMed, Embase, Web of Science, and Cochrane Library databases. A total of 17 epidemiologic studies, which consisted of thirteen case-control and four prospective cohort studies, met the inclusion criteria. Our research findings revealed that soy isoflavone consumption reduced CRC risk (relative risk, RR: 0.78, 95% CI: 0.72-0.85; I(2) = 34.1%, P = 0.024). Based on subgroup analyses, a significant protective effect was observed with soy foods/products (RR: 0.79; 95% CI: 0.69-0.89), in Asian populations (RR: 0.79; 95% CI: 0.72-0.87), and in case-control studies (RR: 0.76; 95% CI: 0.68-0.84). Therefore, soy isoflavone consumption was significantly associated with a reduced risk of CRC risk, particularly with soy foods/products, in Asian populations, and in case-control studies. However, due to the limited number of studies, other factors may affect this association.

Genetic variation in the TNF/TRAF2/ASK1/p38 kinase signaling pathway as markers for postoperative pulmonary complications in lung cancer patients.

PubMed

Hildebrandt, Michelle A T; Roth, Jack A; Vaporciyan, Ara A; Pu, Xia; Ye, Yuanqing; Correa, Arlene M; Kim, Jae Y; Swisher, Stephen G; Wu, Xifeng

2015-07-13

Post-operative pulmonary complications are the most common morbidity associated with lung resection in non-small cell lung cancer (NSCLC) patients. The TNF/TRAF2/ASK1/p38 kinase pathway is activated by stress stimuli and inflammatory signals. We hypothesized that genetic polymorphisms within this pathway may contribute to risk of complications. In this case-only study, we genotyped 173 germline genetic variants in a discovery population of 264 NSCLC patients who underwent a lobectomy followed by genotyping of the top variants in a replication population of 264 patients. Complications data was obtained from a prospective database at MD Anderson. MAP2K4:rs12452497 was significantly associated with a decreased risk in both phases, resulting in a 40% reduction in the pooled population (95% CI:0.43-0.83, P = 0.0018). In total, seven variants were significant for risk in the pooled analysis. Gene-based analysis supported the involvement of TRAF2, MAP2K4, and MAP3K5 as mediating complications risk and a highly significant trend was identified between the number of risk genotypes and complications risk (P = 1.63 × 10(-8)). An inverse relationship was observed between association with clinical outcomes and complications for two variants. These results implicate the TNF/TRAF2/ASK1/p38 kinase pathway in modulating risk of pulmonary complications following lobectomy and may be useful biomarkers to identify patients at high risk.

Does genetic heterogeneity account for the divergent risk of type 2 diabetes in South Asian and white European populations?

PubMed

Sohani, Zahra N; Deng, Wei Q; Pare, Guillaume; Meyre, David; Gerstein, Hertzel C; Anand, Sonia S

2014-11-01

South Asians are up to four times more likely to develop type 2 diabetes than white Europeans. It is postulated that the higher prevalence results from greater genetic risk. To evaluate this hypothesis, we: (1) systematically reviewed the literature for single nucleotide polymorphisms (SNPs) predisposing to type 2 diabetes in South Asians; (2) compared risk estimates, risk alleles and risk allele frequencies of predisposing SNPs between South Asians and white Europeans; and (3) tested the association of novel SNPs discovered from South Asians in white Europeans. MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Cochrane registry were searched for studies of genetic variants associated with type 2 diabetes in South Asians. Meta-analysis estimates for common and novel bi-allelic SNPs in South Asians were compared with white Europeans from the DIAbetes Genetics Replication And Meta-analysis (DIAGRAM) consortium. The population burden from predisposing SNPs was assessed using a genotype score. Twenty-four SNPs from 21 loci were associated with type 2 diabetes in South Asians after meta-analysis. The majority of SNPs increase odds of the disorder by 15-35% per risk allele. No substantial differences appear to exist in risk estimates between South Asians and white Europeans from SNPs common to both groups, and the population burden also does not differ. Eight of the 24 are novel SNPs discovered from South Asian genome-wide association studies, some of which show nominal associations with type 2 diabetes in white Europeans. Based on current literature there is no strong evidence to indicate that South Asians possess a greater genetic risk of type 2 diabetes than white Europeans.

Cardiometabolic risk clustering in spinal cord injury: results of exploratory factor analysis.

PubMed

Libin, Alexander; Tinsley, Emily A; Nash, Mark S; Mendez, Armando J; Burns, Patricia; Elrod, Matt; Hamm, Larry F; Groah, Suzanne L

2013-01-01

Evidence suggests an elevated prevalence of cardiometabolic risks among persons with spinal cord injury (SCI); however, the unique clustering of risk factors in this population has not been fully explored. The purpose of this study was to describe unique clustering of cardiometabolic risk factors differentiated by level of injury. One hundred twenty-one subjects (mean 37 ± 12 years; range, 18-73) with chronic C5 to T12 motor complete SCI were studied. Assessments included medical histories, anthropometrics and blood pressure, and fasting serum lipids, glucose, insulin, and hemoglobin A1c (HbA1c). The most common cardiometabolic risk factors were overweight/obesity, high levels of low-density lipoprotein (LDL-C), and low levels of high-density lipoprotein (HDL-C). Risk clustering was found in 76.9% of the population. Exploratory principal component factor analysis using varimax rotation revealed a 3-factor model in persons with paraplegia (65.4% variance) and a 4-factor solution in persons with tetraplegia (73.3% variance). The differences between groups were emphasized by the varied composition of the extracted factors: Lipid Profile A (total cholesterol [TC] and LDL-C), Body Mass-Hypertension Profile (body mass index [BMI], systolic blood pressure [SBP], and fasting insulin [FI]); Glycemic Profile (fasting glucose and HbA1c), and Lipid Profile B (TG and HDL-C). BMI and SBP formed a separate factor only in persons with tetraplegia. Although the majority of the population with SCI has risk clustering, the composition of the risk clusters may be dependent on level of injury, based on a factor analysis group comparison. This is clinically plausible and relevant as tetraplegics tend to be hypo- to normotensive and more sedentary, resulting in lower HDL-C and a greater propensity toward impaired carbohydrate metabolism.

Peptic Ulcer Disease in Healthcare Workers: A Nationwide Population-Based Cohort Study.

PubMed

Lin, Hong-Yue; Weng, Shih-Feng; Lin, Hung-Jung; Hsu, Chien-Chin; Wang, Jhi-Joung; Su, Shih-Bin; Guo, How-Ran; Huang, Chien-Cheng

2015-01-01

Health care workers (HCWs) in Taiwan have heavy, stressful workloads, are on-call, and have rotating nightshifts, all of which might contribute to peptic ulcer disease (PUD). We wanted to evaluate the PUD risk in HCWs, which is not clear. Using Taiwan's National Health Insurance Research Database, we identified 50,226 physicians, 122,357 nurses, 20,677 pharmacists, and 25,059 other HCWs (dieticians, technicians, rehabilitation therapists, and social workers) as the study cohort, and randomly selected an identical number of non-HCW patients (i.e., general population) as the comparison cohort. Conditional logistical regression analysis was used to compare the PUD risk between them. Subgroup analysis for physician specialties was also done. Nurses and other HCWs had a significantly higher PUD risk than did the general population (odds ratio [OR]: 1.477; 95% confidence interval [CI]: 1.433-1.521 and OR: 1.328; 95% CI: 1.245-1.418, respectively); pharmacists had a lower risk (OR: 0.884; 95% CI: 0.828-0.945); physicians had a nonsignificantly different risk (OR: 1.029; 95% CI: 0.987-1.072). In the physician specialty subgroup analysis, internal medicine, surgery, Ob/Gyn, and family medicine specialists had a higher PUD risk than other physicians (OR: 1.579; 95% CI: 1.441-1.731, OR: 1.734; 95% CI: 1.565-1.922, OR: 1.336; 95% CI: 1.151-1.550, and OR: 1.615; 95% CI: 1.425-1.831, respectively). In contrast, emergency physicians had a lower risk (OR: 0.544; 95% CI: 0.359-0.822). Heavy workloads, long working hours, workplace stress, rotating nightshifts, and coping skills may explain our epidemiological findings of higher risks for PUD in some HCWs, which might help us improve our health policies for HCWs.

Methylenetetrahydrofolate reductase gene polymorphism and risk of chronic myelogenous leukemia: a meta-analysis.

PubMed

Li, Chen; Yichao, Jin; Jiaxin, Lin; Yueting, Zhang; Qin, Lu; Tonghua, Yang

2015-01-01

Reported evidence supports a role for methylenetetrahydrofolate reductase (MTHFR) in the risk of chronic myelogenous leykemia (CML). However, these reports arrived at non-conclusive and even conflicting results regarding the association between two common MTHFR polymorphisms (C677T and A1298C) and CML risk. Thus, a meta-analysis was carried out to clarify a more precise association between these two polymorphisms and the CML risk by updating the available publications. Pooled odds ratios (OR) with corresponding 95% confidence interval (95% CI) and stratification analysis were performed to estimate the relationship between MTHFR polymorphisms and the risk of CML under different genetic comparison models. Data from the meta-analysis showed no significant association between MTHFR C677T polymorphism and CML risk. However, significant associations were found between MTHFR A1298C variants and CML risk under homozygous comparison model (CC vs AA, OR=1.62, 95% CI=1.11-2.36, p=0.01) and dominant comparison model (CC+AC vs AA, OR=1.68, 95% CI=1.17-2.43, p=0.005) in overall population; especially more obvious impacts were noticed for Asian populations in subgroup analysis for homozygous model (CC vs AA, OR=2.00, 95% CI=1.25-3.21, p=0.004) and dominant model (CC+AC vs AA, OR=2.49, 95% CI=1.42-4.36, p=0.001), but this did not apply in Caucasian populations. The results of this meta-analysis suggested no significant association between MTHFR C677T polymorphism and CML risk, while an increased CML risk was noticed for 1298C variant carriers, especially in Asian populations but not in Caucasian populations, which suggested ethnicity differences between MTHFR A1298C polymorphisms and risk of CML.

Does daily vitamin D 800 IU and calcium 1000 mg supplementation decrease the risk of falling in ambulatory women aged 65-71 years? A 3-year randomized population-based trial (OSTPRE-FPS).

PubMed

Kärkkäinen, Matti K; Tuppurainen, Marjo; Salovaara, Kari; Sandini, Lorenzo; Rikkonen, Toni; Sirola, Joonas; Honkanen, Risto; Arokoski, Jari; Alhava, Esko; Kröger, Heikki

2010-04-01

The hypothesis was that the calcium and vitamin D supplementation prevents falls at the population level. The OSTPRE-FPS was a randomized population-based open-trial with 3-year follow-up. The supplementation group (n=1566) received daily cholecalciferol 800IU+calcium carbonate 1000mg, while the control group (n=1573) received no supplementation or placebo. A randomly selected subsample of 593 subjects underwent a detailed measurement program including serum 25(OH)D measurements. The occurrence of falls was the primary outcome of the study. The participants in the subsample were telephoned at 4 months intervals and the rest of the trial population was interviewed by phone once a year. In the entire trial population (ETP), there were 812 women with 1832 falls in the intervention group and 833 women with 1944 falls in the control group (risk ratio was 0.98, 95% CI 0.92-1.05, P=0.160). The supplementation was not associated with single or multiple falls in the ETP. However, in the subsample, multiple fall incidence decreased by 30% (odds ratio (OR) 0.70, 95% CI 0.50-0.97, P=0.034) in the supplementation group. Further, the supplementation decreased the incidence of multiple falls requiring medical attention (OR 0.72, 95% CI 0.53-0.97, P=0.031) in the ETP. The mean compliance in the entire trial population was 78% and in the subsample 79%. Overall, the primary analysis showed no association between calcium and vitamin D supplementation and risk of falls. However, the results of a post hoc analysis suggested that there was a decreased risk of multiple falls requiring medical attention: this finding requires confirmation. Copyright 2009 Elsevier Ireland Ltd. All rights reserved.

Interaction between nonsynonymous polymorphisms in PLA2G7 gene and smoking on the risk of coronary heart disease in a Chinese population.

PubMed

Chi, Yunpeng; Shi, Conghong; Zhang, Xiaojiang; Xi, Yang

2018-05-04

To investigate the impact of PLA2G7 polymorphism, and additional their interactions with smoking and drinking on coronary heart disease (CHD) risk based on Chinese population. GMDR model was used to screen the best gene-smoking and gene-drinking interaction combinations. Logistic regression was performed to investigate association between 4 SNPs and CHD, and the interaction effect between rs1805017 and smoking. For CHD patient-control haplotype analyses, the SHEsis online haplotype analysis software ( http://analysis.bio-x.cn/myAnalysis.php ) was employed. CHD risks were higher in carriers of homozygous mutant of rs1805017 and rs1805018 than those with wild-type homozygotes, OR (95% CI) were 1.45 (1.16-1.92) and 1.51 (1.23-1.97), respectively, but the other two SNPs, rs16874954 and rs1051931 were not significant associated with CHD risks. GMDR analysis indicated that there was a significant two-locus model (p = 0.0107) involving rs1805017 and smoking, indicating a potential gene-environment interaction between rs1805017 and smoking. But we did not found any gene-drinking and gene-gene interaction combinations in GMDR models. The haplotype R-I was observed most frequently in two groups, with 47.43 and 54.38% in the case and control group of the population, respectively. The results also indicated that the haplotype containing the rs1805017-H and rs1805018-T alleles were associated with a statistically increased CHD risk, OR (95% CI) 1.43 (1.10-1.86), p = 0.0021. Polymorphisms in rs1805017 and rs1805018, additional interaction between rs1805017 and smoking, and haplotype containing the rs1805017-H and rs1805018-T alleles were associated with increased CHD risk.

Pollen flow in the wildservice tree, Sorbus torminalis (L.) Crantz. I. Evaluating the paternity analysis procedure in continuous populations.

PubMed

Oddou-Muratorio, S; Houot, M-L; Demesure-Musch, B; Austerlitz, F

2003-12-01

The joint development of polymorphic molecular markers and paternity analysis methods provides new approaches to investigate ongoing patterns of pollen flow in natural plant populations. However, paternity studies are hindered by false paternity assignment and the nondetection of true fathers. To gauge the risk of these two types of errors, we performed a simulation study to investigate the impact on paternity analysis of: (i) the assumed values for the size of the breeding male population (NBMP), and (ii) the rate of scoring error in genotype assessment. Our simulations were based on microsatellite data obtained from a natural population of the entomophilous wild service tree, Sorbus torminalis (L.) Crantz. We show that an accurate estimate of NBMP is required to minimize both types of errors, and we assess the reliability of a technique used to estimate NBMP based on parent-offspring genetic data. We then show that scoring errors in genotype assessment only slightly affect the assessment of paternity relationships, and conclude that it is generally better to neglect the scoring error rate in paternity analyses within a nonisolated population.

A Probabilistic Model for Cushing's Syndrome Screening in At-Risk Populations: A Prospective Multicenter Study.

PubMed

León-Justel, Antonio; Madrazo-Atutxa, Ainara; Alvarez-Rios, Ana I; Infantes-Fontán, Rocio; Garcia-Arnés, Juan A; Lillo-Muñoz, Juan A; Aulinas, Anna; Urgell-Rull, Eulàlia; Boronat, Mauro; Sánchez-de-Abajo, Ana; Fajardo-Montañana, Carmen; Ortuño-Alonso, Mario; Salinas-Vert, Isabel; Granada, Maria L; Cano, David A; Leal-Cerro, Alfonso

2016-10-01

Cushing's syndrome (CS) is challenging to diagnose. Increased prevalence of CS in specific patient populations has been reported, but routine screening for CS remains questionable. To decrease the diagnostic delay and improve disease outcomes, simple new screening methods for CS in at-risk populations are needed. To develop and validate a simple scoring system to predict CS based on clinical signs and an easy-to-use biochemical test. Observational, prospective, multicenter. Referral hospital. A cohort of 353 patients attending endocrinology units for outpatient visits. All patients were evaluated with late-night salivary cortisol (LNSC) and a low-dose dexamethasone suppression test for CS. Diagnosis or exclusion of CS. Twenty-six cases of CS were diagnosed in the cohort. A risk scoring system was developed by logistic regression analysis, and cutoff values were derived from a receiver operating characteristic curve. This risk score included clinical signs and symptoms (muscular atrophy, osteoporosis, and dorsocervical fat pad) and LNSC levels. The estimated area under the receiver operating characteristic curve was 0.93, with a sensitivity of 96.2% and specificity of 82.9%. We developed a risk score to predict CS in an at-risk population. This score may help to identify at-risk patients in non-endocrinological settings such as primary care, but external validation is warranted.

Theory-Based Analysis of Interest in an HIV Vaccine for Reasons Indicative of Risk Compensation among African American Women

ERIC Educational Resources Information Center

Painter, Julia E.; Temple, Brandie S.; Woods, Laura A.; Cwiak, Carrie; Haddad, Lisa B.; Mulligan, Mark J.; DiClemente, Ralph J.

2018-01-01

Licensure of an HIV vaccine could reduce or eliminate HIV among vulnerable populations. However, vaccine effectiveness could be undermined by risk compensation (RC), defined by an increase in risky behavior due to a belief that the vaccine will confer protection. Interest in an HIV vaccine for reasons indicative of RC may serve as an indicator of…

Risk of Autism Associated with General Anesthesia during Cesarean Delivery: A Population-Based Birth-Cohort Analysis

ERIC Educational Resources Information Center

Chien, Li-Nien; Lin, Hsiu-Chen; Shao, Yu-Hsuan Joni; Chiou, Shu-Ti; Chiou, Hung-Yi

2015-01-01

The rates of Cesarean delivery (C-section) have risen to >30 % in numerous countries. Increased risk of autism has been shown in neonates delivered by C-section. This study examined the incidence of autism in neonates delivered vaginally, by C-section with regional anesthesia (RA), and by C-section with general anesthesia (GA) to evaluate the…

Gene-environment interaction in atopic diseases: a population-based twin study of early-life exposures.

PubMed

Kahr, Niklas; Naeser, Vibeke; Stensballe, Lone Graff; Kyvik, Kirsten Ohm; Skytthe, Axel; Backer, Vibeke; Bønnelykke, Klaus; Thomsen, Simon Francis

2015-01-01

The development of atopic diseases early in life suggests an important role of perinatal risk factors. To study whether early-life exposures modify the genetic influence on atopic diseases in a twin population. Questionnaire data on atopic diseases from 850 monozygotic and 2279 like-sex dizygotic twin pairs, 3-9 years of age, from the Danish Twin Registry were cross-linked with data on prematurity, Cesarean section, maternal age at birth, parental cohabitation, season of birth and maternal smoking during pregnancy, from the Danish National Birth Registry. Significant predictors of atopic diseases were identified with logistic regression and subsequently tested for genetic effect modification using variance components analysis. After multivariable adjustment, prematurity (gestational age below 32 weeks) [odds ratio (OR) = 1.93, confidence interval (CI) = 1.45-2.56], Cesarean section (OR = 1.25, CI = 1.05-1.49) and maternal smoking during pregnancy (OR = 1.70, CI = 1.42-2.04) significantly influenced the risk of asthma, whereas none of the factors were significantly associated with atopic dermatitis and hay fever. Variance components analysis stratified by exposure status showed no significant change in the heritability of asthma according to the identified risk factors. In this population-based study of children, there was no evidence of genetic effect modification of atopic diseases by several identified early-life risk factors. The causal relationship between these risk factors and atopic diseases may therefore be mediated via mechanisms different from gene-environment interaction. © 2014 John Wiley & Sons Ltd.

Cutaneous melanoma in situ: translational evidence from a large population-based study.

PubMed

Mocellin, Simone; Nitti, Donato

2011-01-01

Cutaneous melanoma in situ (CMIS) is a nosologic entity surrounded by health concerns and unsolved debates. We aimed to shed some light on CMIS by means of a large population-based study. Patients with histologic diagnosis of CMIS were identified from the Surveillance Epidemiology End Results (SEER) database. The records of 93,863 cases of CMIS were available for analysis. CMIS incidence has been steadily increasing over the past 3 decades at a rate higher than any other in situ or invasive tumor, including invasive skin melanoma (annual percentage change [APC]: 9.5% versus 3.6%, respectively). Despite its noninvasive nature, CMIS is treated with excision margins wider than 1 cm in more than one third of cases. CMIS is associated with an increased risk of invasive melanoma (standardized incidence ratio [SIR]: 8.08; 95% confidence interval [CI]: 7.66-8.57), with an estimated 3:5 invasive/in situ ratio; surprisingly, it is also associated with a reduced risk of gastrointestinal (SIR: 0.78, CI: 0.72-0.84) and lung (SIR: 0.65, CI: 0.59-0.71) cancers. Relative survival analysis shows that persons with CMIS have a life expectancy equal to that of the general population. CMIS is increasingly diagnosed and is often overtreated, although it does not affect the life expectancy of its carriers. Patients with CMIS have an increased risk of developing invasive melanoma (which warrants their enrollment in screening programs) but also a reduced risk of some epithelial cancers, which raises the intriguing hypothesis that genetic/environmental risk factors for some tumors may oppose the pathogenesis of others.

The Social-Emotional Well-Being of Children of Mothers with Intellectual Impairment: A Population-Based Analysis

ERIC Educational Resources Information Center

Hindmarsh, Gabrielle; Llewellyn, Gwynnyth; Emerson, Eric

2017-01-01

Background: Children of parents with intellectual impairment are thought to be at risk for poor social-emotional well-being. This study investigated the relationship between maternal intellectual impairment and poor child social-emotional well-being. Method: Secondary analysis of data from waves 2-4 of the Millennium Cohort Study (UK).…

Influence of diabetes on the risk of urothelial cancer according to body mass index: a 10-year nationwide population-based observational study.

PubMed

Bae, Woong Jin; Choi, Jin Bong; Moon, Hyong Woo; Park, Young Hyun; Cho, Hyuk Jin; Hong, Sung-Hoo; Lee, Ji Youl; Kim, Sae Woong; Han, Kyung-Do; Ha, U-Syn

2018-01-01

To examine the association between obesity and urothelial cancer, we used a representative data from the National Health Insurance System (NHIS). Participants included 826,170 men aged 20 years and older who experienced a health examination at least one time between 2004 and 2008. The study thus excluded people aged <20 years and women. We used a multivariate adjusted Cox regression analysis to examine the association between urothelial cancer and body mass index (BMI) via a hazard ratio (HR) and 95% confidence interval (CI). The age- or multivariable-adjusted HR for urothelial cancer was stratified by BMI. Men with a higher BMI were more likely to acquire urothelial cancer independent of variables. In the population with diabetes, there showed a considerable, increasing trend in the risk of urothelial cancer in the overweight and obesity group, compared to the group with the same BMI but without diabetes. This population-based study showed evidence of an association between obesity and the development of urothelial cancer, where the presence of diabetes increased the risk of urothelial cancer. Additionally, the higher the BMI, the higher the risk for urothelial cancer.

Communicating Pacific Rim Risk: A GIS Analysis of Hazard, Vulnerability, Population, and Infrastructure

NASA Astrophysics Data System (ADS)

Yurkovich, E. S.; Howell, D. G.

2002-12-01

Exploding population and unprecedented urban development within the last century helped fuel an increase in the severity of natural disasters. Not only has the world become more populated, but people, information and commodities now travel greater distances to service larger concentrations of people. While many of the earth's natural hazards remain relatively constant, understanding the risk to increasingly interconnected and large populations requires an expanded analysis. To improve mitigation planning we propose a model that is accessible to planners and implemented with public domain data and industry standard GIS software. The model comprises 1) the potential impact of five significant natural hazards: earthquake, flood, tropical storm, tsunami and volcanic eruption assessed by a comparative index of risk, 2) population density, 3) infrastructure distribution represented by a proxy, 4) the vulnerability of the elements at risk (population density and infrastructure distribution) and 5) the connections and dependencies of our increasingly 'globalized' world, portrayed by a relative linkage index. We depict this model with the equation, Risk = f(H, E, V, I) Where H is an index normalizing the impact of five major categories of natural hazards; E is one element at risk, population or infrastructure; V is a measure of the vulnerability for of the elements at risk; and I pertains to a measure of interconnectivity of the elements at risk as a result of economic and social globalization. We propose that future risk analysis include the variable I to better define and quantify risk. Each assessment reflects different repercussions from natural disasters: losses of life or economic activity. Because population and infrastructure are distributed heterogeneously across the Pacific region, two contrasting representations of risk emerge from this study.

Likelihood ratio-based integrated personal risk assessment of type 2 diabetes.

PubMed

Sato, Noriko; Htun, Nay Chi; Daimon, Makoto; Tamiya, Gen; Kato, Takeo; Kubota, Isao; Ueno, Yoshiyuki; Yamashita, Hidetoshi; Fukao, Akira; Kayama, Takamasa; Muramatsu, Masaaki

2014-01-01

To facilitate personalized health care for multifactorial diseases, risks of genetic and clinical/environmental factors should be assessed together for each individual in an integrated fashion. This approach is possible with the likelihood ratio (LR)-based risk assessment system, as this system can incorporate manifold tests. We examined the usefulness of this system for assessing type 2 diabetes (T2D). Our system employed 29 genetic susceptibility variants, body mass index (BMI), and hypertension as risk factors whose LRs can be estimated from openly available T2D association data for the Japanese population. The pretest probability was set at a sex- and age-appropriate population average of diabetes prevalence. The classification performance of our LR-based risk assessment was compared to that of a non-invasive screening test for diabetes called TOPICS (with score based on age, sex, family history, smoking, BMI, and hypertension) using receiver operating characteristic analysis with a community cohort (n = 1263). The area under the receiver operating characteristic curve (AUC) for the LR-based assessment and TOPICS was 0.707 (95% CI 0.665-0.750) and 0.719 (0.675-0.762), respectively. These AUCs were much higher than that of a genetic risk score constructed using the same genetic susceptibility variants, 0.624 (0.574-0.674). The use of ethnically matched LRs is necessary for proper personal risk assessment. In conclusion, although LR-based integrated risk assessment for T2D still requires additional tests that evaluate other factors, such as risks involved in missing heritability, our results indicate the potential usability of LR-based assessment system and stress the importance of stratified epidemiological investigations in personalized medicine.

Associations of Urinary Cotinine-Verified Active and Passive Smoking with Thyroid Function: Analysis of Population-Based Nationally Representative Data.

PubMed

Kang, Jihun; Kong, Eunhee; Choi, Jongsoon

2018-05-01

The effects of active and passive smoking on thyroid function in the Korean population have not been determined. Furthermore, related research is based on self-reported smoking status, which may be inaccurate, especially among women. The present study aimed at evaluating the association between biochemically verified smoking status and thyroid function in a nationally representative Korean population. This population-based cross-sectional study included 3404 subjects without thyroid disease who were not taking thyroid medication. Smoking status was identified using self-reported data and urinary cotinine levels. Kruskal-Wallis and Jonckheere-Terpstra trend tests were performed to evaluate the association between smoking exposure and thyroid function. Multivariate logistic regression analysis was used to estimate the effect of smoking on subclinical hypothyroidism (SCH). Biochemically verified active and passive smoking rates were 43.4% and 23.3% among men and 10.0% and 22.9% among women, respectively. Active smokers had significantly lower iodine levels than passive smokers and nonsmokers. Active smoking was associated with decreased serum thyrotropin (TSH) levels among both sexes, although only men exhibited a dose-response relationship between increasing smoking exposure and decreasing TSH levels. Passive smoking slightly decreased TSH levels, but the decrease was not statistically significant. The risk of SCH decreased with increasing smoking exposure in the multivariate-adjusted analysis (p for trend = 0.027 among men and 0.042 among women). Active and passive smoking were associated with decreasing serum TSH levels and a lower risk of SCH in a Korean population. These associations might be related to lower urinary iodine levels in active smokers.

A Markov chain model for studying suicide dynamics: an illustration of the Rose theorem

PubMed Central

2014-01-01

Background High-risk strategies would only have a modest effect on suicide prevention within a population. It is best to incorporate both high-risk and population-based strategies to prevent suicide. This study aims to compare the effectiveness of suicide prevention between high-risk and population-based strategies. Methods A Markov chain illness and death model is proposed to determine suicide dynamic in a population and examine its effectiveness for reducing the number of suicides by modifying certain parameters of the model. Assuming a population with replacement, the suicide risk of the population was estimated by determining the final state of the Markov model. Results The model shows that targeting the whole population for suicide prevention is more effective than reducing risk in the high-risk tail of the distribution of psychological distress (i.e. the mentally ill). Conclusions The results of this model reinforce the essence of the Rose theorem that lowering the suicidal risk in the population at large may be more effective than reducing the high risk in a small population. PMID:24948330

Latent Trajectories of Common Mental Health Disorder Risk Across 3 Decades of Adulthood in a Population-Based Cohort.

PubMed

Paksarian, Diana; Cui, Lihong; Angst, Jules; Ajdacic-Gross, Vladeta; Rössler, Wulf; Merikangas, Kathleen R

2016-10-01

Epidemiologic evidence indicates that most of the general population will experience a mental health disorder at some point in their lives. However, few prospective population-based studies have estimated trajectories of risk for mental disorders from young through middle adulthood to estimate the proportion of individuals who experience persistent mental disorder across this age period. To describe the proportion of the population who experience persistent mental disorder across adulthood and to estimate latent trajectories of disorder risk across this age period. A population-based, prospective cohort study was conducted between 1979 and 2008 in the canton of Zurich, Switzerland. A stratified random sample of 591 Swiss citizens was enrolled in 1978 at ages 19 years (men) and 20 years (women); 7 interviews were performed during a 29-year period. Men were sampled from military enrollment records and women from electoral records. From those initially enrolled, participants with high levels of psychiatric symptoms were oversampled for follow-up. Data analysis was performed from July 28, 2015, to June 8, 2016. Latent trajectories, estimated using growth mixture modeling, of past-year mood/anxiety disorder (ie, major depressive episode, phobias, panic, generalized anxiety disorder, and obsessive-compulsive disorder), substance use disorder (ie, drug abuse or dependence and alcohol abuse or dependence), and any mental disorder (ie, any of the above) assessed during in-person semistructured interviews at each wave. Diagnoses were based on DSM-III, DSM-III-R, and DSM-IV criteria. Of the 591 participants at baseline, 299 (50.6%) were female. Persistent mental health disorder across multiple study waves was rare. Among 252 individuals (42.6%) who participated in all 7 study waves, only 1.2% met criteria for disorder every time. Growth mixture modeling identified 3 classes of risk for any disorder across adulthood: low (estimated prevalence, 40.0%; 95% CI, -8.7% to 88.9%), increasing-decreasing (estimated prevalence, 15.3%; 95% CI, 1.0% to 29.6%), and increasing (estimated prevalence, 44.7%; 95% CI, -0.9% to 90.1%). Although no classes were characterized by persistently high disorder risk, for those in the increasing-decreasing class, risk was high from the late 20s to early 40s. Sex-specific models indicated 4 trajectory classes for women but only 3 for men. Persistently high mental health disorder risk across 3 decades of adulthood was rare in this population-based sample. Identifying early determinants of sex-specific risk trajectories would benefit prevention efforts.

Mapping genes underlying ethnic differences in disease risk by linkage disequilibrium in recently admixed populations.

PubMed Central

McKeigue, P M

1997-01-01

Where recent admixture has occurred between two populations that have different disease rates for genetic reasons, family-based association studies can be used to map the genes underlying these differences, if the ancestry of the alleles at each locus examined can be assigned to one of the two founding populations. This article explores the statistical power and design requirements of this approach. Markers suitable for assigning the ancestry of genomic regions could be defined by grouping alleles at closely spaced microsatellite loci into haplotypes, or generated by representational difference analysis. For a given relative risk between populations, the sample size required to detect a disease locus that accounts for this relative risk by linkage-disequilibrium mapping in an admixed population is not critically dependent on assumptions about genotype penetrances or allele frequencies. Using the transmission-disequilibrium test to search the genome for a locus that accounts for a relative risk of between 2 and 3 in a high-risk population, compared with a low-risk population, generally requires between 150 and 800 case-parent pairs of mixed descent. The optimal strategy is to conduct an initial study using markers spaced at < or = 10 cM with cases from the second and third generations of mixed descent, and then to map the disease loci more accurately in a subsequent study of a population with a longer history of admixture. This approach has greater statistical power than allele-sharing designs and has obvious applications to the genetics of hypertension, non-insulin-dependent diabetes, and obesity. PMID:8981962

Earthquake hazard and risk assessment based on Unified Scaling Law for Earthquakes: Greater Caucasus and Crimea

NASA Astrophysics Data System (ADS)

Kossobokov, Vladimir G.; Nekrasova, Anastasia K.

2018-05-01

We continue applying the general concept of seismic risk analysis in a number of seismic regions worldwide by constructing regional seismic hazard maps based on morphostructural analysis, pattern recognition, and the Unified Scaling Law for Earthquakes (USLE), which generalizes the Gutenberg-Richter relationship making use of naturally fractal distribution of earthquake sources of different size in a seismic region. The USLE stands for an empirical relationship log10 N(M, L) = A + B·(5 - M) + C·log10 L, where N(M, L) is the expected annual number of earthquakes of a certain magnitude M within a seismically prone area of linear dimension L. We use parameters A, B, and C of USLE to estimate, first, the expected maximum magnitude in a time interval at seismically prone nodes of the morphostructural scheme of the region under study, then map the corresponding expected ground shaking parameters (e.g., peak ground acceleration, PGA, or macro-seismic intensity). After a rigorous verification against the available seismic evidences in the past (usually, the observed instrumental PGA or the historically reported macro-seismic intensity), such a seismic hazard map is used to generate maps of specific earthquake risks for population, cities, and infrastructures (e.g., those based on census of population, buildings inventory). The methodology of seismic hazard and risk assessment is illustrated by application to the territory of Greater Caucasus and Crimea.

Small numbers, disclosure risk, security, and reliability issues in Web-based data query systems.

PubMed

Rudolph, Barbara A; Shah, Gulzar H; Love, Denise

2006-01-01

This article describes the process for developing consensus guidelines and tools for releasing public health data via the Web and highlights approaches leading agencies have taken to balance disclosure risk with public dissemination of reliable health statistics. An agency's choice of statistical methods for improving the reliability of released data for Web-based query systems is based upon a number of factors, including query system design (dynamic analysis vs preaggregated data and tables), population size, cell size, data use, and how data will be supplied to users. The article also describes those efforts that are necessary to reduce the risk of disclosure of an individual's protected health information.

The role of the RTEL1 rs2297440 polymorphism in the risk of glioma development: a meta-analysis.

PubMed

Zhang, Cuiping; Lu, Yu; Zhang, Xiaolian; Yang, Dongmei; Shang, Shuxin; Liu, Denghe; Jiang, Kongmei; Huang, Weiqiang

2016-07-01

The regulator of the telomere elongation helicase1 (RTEL1) gene plays a crucial role in the DNA double-stand break-repair pathway by maintaining genomic stability. Recent epidemiological studies showed that the rs2297440 polymorphism in the RTEL1 gene was a potential risk locus for glioma development, but the results were inconclusive. To clarify the association between this polymorphism and the risk of glioma, we performed a comprehensive meta-analysis. The PubMed, EMBASE, Web of Science, and China National Knowledge Infrastructure databases were systematically searched to identify all relevant published studies up to 30 August 2015. Four eligible studies were finally included. The pooled results indicated that the RTEL1 rs2297440 polymorphism moderately increased the risk of glioma in all genetic models. A comparison of the dominant model CT + CC versus TT (OR 1.40; 95 % CI 1.24-1.60; p < 0.001) indicated that having the C allele conferred a 40 % increased risk of developing glioma. In a subgroup analysis based on geographic location (Europe, Asia, and America), there was an association between the rs2297440 polymorphism and the risk of glioma in all three areas. The results of the subgroup analysis based on source of control indicated an elevated risk of glioma in population-based control studies. This meta-analysis demonstrates that the RTEL1 rs2297440 polymorphism plays a moderate, but significant role in the risk of glioma. Further studies with larger sample sizes are necessary to confirm this finding.

Earthquake Hazard and Risk Assessment based on Unified Scaling Law for Earthquakes: Altai-Sayan Region

NASA Astrophysics Data System (ADS)

Kossobokov, V. G.; Nekrasova, A.

2017-12-01

We continue applying the general concept of seismic risk analysis in a number of seismic regions worldwide by constructing regional seismic hazard maps based on morphostructural analysis, pattern recognition, and the Unified Scaling Law for Earthquakes, USLE, which generalizes the Gutenberg-Richter relationship making use of naturally fractal distribution of earthquake sources of different size in a seismic region. The USLE stands for an empirical relationship log10N(M, L) = A + B·(5 - M) + C·log10L, where N(M, L) is the expected annual number of earthquakes of a certain magnitude M within an seismically prone area of linear dimension L. We use parameters A, B, and C of USLE to estimate, first, the expected maximum credible magnitude in a time interval at seismically prone nodes of the morphostructural scheme of the region under study, then map the corresponding expected ground shaking parameters (e.g. peak ground acceleration, PGA, or macro-seismic intensity etc.). After a rigorous testing against the available seismic evidences in the past (usually, the observed instrumental PGA or the historically reported macro-seismic intensity), such a seismic hazard map is used to generate maps of specific earthquake risks for population, cities, and infrastructures (e.g., those based on census of population, buildings inventory, etc.). This, USLE based, methodology of seismic hazard and risks assessment is applied to the territory of Altai-Sayan Region, of Russia. The study supported by the Russian Science Foundation Grant No. 15-17-30020.

Clinical, demographic, and laboratory characteristics of children with nephrolithiasis.

PubMed

Sas, David J; Becton, Lauren J; Tutman, Jeffrey; Lindsay, Laura A; Wahlquist, Amy H

2016-06-01

While the incidence of pediatric kidney stones appears to be increasing, little is known about the demographic, clinical, laboratory, imaging, and management variables in this patient population. We sought to describe various characteristics of our stone-forming pediatric population. To that end, we retrospectively reviewed the charts of pediatric patients with nephrolithiasis confirmed by imaging. Data were collected on multiple variables from each patient and analyzed for trends. For body mass index (BMI) controls, data from the general pediatrics population similar to our nephrolithiasis population were used. Data on 155 pediatric nephrolithiasis patients were analyzed. Of the 54 calculi available for analysis, 98 % were calcium based. Low urine volume, elevated supersaturation of calcium phosphate, elevated supersaturation of calcium oxalate, and hypercalciuria were the most commonly identified abnormalities on analysis of 24-h urine collections. Our stone-forming population did not have a higher BMI than our general pediatrics population, making it unlikely that obesity is a risk factor for nephrolithiasis in children. More girls presented with their first stone during adolescence, suggesting a role for reproductive hormones contributing to stone risk, while boys tended to present more commonly at a younger age, though this did not reach statistical significance. These intriguing findings warrant further investigation.

Maternal gestational diabetes mellitus and the risk of subsequent pediatric cardiovascular diseases of the offspring: a population-based cohort study with up to 18 years of follow up.

PubMed

Leybovitz-Haleluya, Noa; Wainstock, Tamar; Landau, Daniella; Sheiner, Eyal

2018-06-23

The prevalence of gestational diabetes mellitus (GDM) has been increasing worldwide. We aimed to study the effect of GDM on the risk for childhood cardiovascular morbidity of the offspring. A population-based cohort analysis was performed comparing total and different subtypes of cardiovascular related pediatric diagnoses among offspring of mothers with GDM vs. offspring of mothers with no diabetes. The analysis included all singletons born between the years 1991-2014. Cardiovascular related morbidities included hospitalizations involving a pre-defined set of ICD-9 codes. Mothers with pregestational diabetes, Infants with congenital malformations, multiple gestations, and perinatal deaths were excluded from the analysis. A Cox proportional hazards model was constructed to adjust for confounders. The study population included 216197 newborns which met the inclusion criteria; among them 4.4% (9460) were born to mothers with GDM controlled by diet and exercise (GDM A1) and 0.3% (724) were born to mothers with GDM requiring oral treatment or insulin (GDM A2). A significant association was noted between GDM and the rate of cardiovascular related hospitalizations (0.97 for GDM A2 vs. 0.57 for GDM A1 vs. 0.33 for no GDM, respectively; p < 0.001). The association remained significant and independent for GDM A1 only while adjusting for relevant confounders [adjusted HR = 1.6 (1.2-2.2); p value 0.001]. A significant association is noted between the GDM and the rate of cardiovascular hospitalizations of the offspring. However, in our population GDM A1 is an independent risk factor for pediatric cardiovascular morbidity of the offspring.

Online Prediction of Health Care Utilization in the Next Six Months Based on Electronic Health Record Information: A Cohort and Validation Study.

PubMed

Hu, Zhongkai; Hao, Shiying; Jin, Bo; Shin, Andrew Young; Zhu, Chunqing; Huang, Min; Wang, Yue; Zheng, Le; Dai, Dorothy; Culver, Devore S; Alfreds, Shaun T; Rogow, Todd; Stearns, Frank; Sylvester, Karl G; Widen, Eric; Ling, Xuefeng

2015-09-22

The increasing rate of health care expenditures in the United States has placed a significant burden on the nation's economy. Predicting future health care utilization of patients can provide useful information to better understand and manage overall health care deliveries and clinical resource allocation. This study developed an electronic medical record (EMR)-based online risk model predictive of resource utilization for patients in Maine in the next 6 months across all payers, all diseases, and all demographic groups. In the HealthInfoNet, Maine's health information exchange (HIE), a retrospective cohort of 1,273,114 patients was constructed with the preceding 12-month EMR. Each patient's next 6-month (between January 1, 2013 and June 30, 2013) health care resource utilization was retrospectively scored ranging from 0 to 100 and a decision tree-based predictive model was developed. Our model was later integrated in the Maine HIE population exploration system to allow a prospective validation analysis of 1,358,153 patients by forecasting their next 6-month risk of resource utilization between July 1, 2013 and December 31, 2013. Prospectively predicted risks, on either an individual level or a population (per 1000 patients) level, were consistent with the next 6-month resource utilization distributions and the clinical patterns at the population level. Results demonstrated the strong correlation between its care resource utilization and our risk scores, supporting the effectiveness of our model. With the online population risk monitoring enterprise dashboards, the effectiveness of the predictive algorithm has been validated by clinicians and caregivers in the State of Maine. The model and associated online applications were designed for tracking the evolving nature of total population risk, in a longitudinal manner, for health care resource utilization. It will enable more effective care management strategies driving improved patient outcomes.

Online Prediction of Health Care Utilization in the Next Six Months Based on Electronic Health Record Information: A Cohort and Validation Study

PubMed Central

Hu, Zhongkai; Hao, Shiying; Jin, Bo; Shin, Andrew Young; Zhu, Chunqing; Huang, Min; Wang, Yue; Zheng, Le; Dai, Dorothy; Culver, Devore S; Alfreds, Shaun T; Rogow, Todd; Stearns, Frank

2015-01-01

Background The increasing rate of health care expenditures in the United States has placed a significant burden on the nation’s economy. Predicting future health care utilization of patients can provide useful information to better understand and manage overall health care deliveries and clinical resource allocation. Objective This study developed an electronic medical record (EMR)-based online risk model predictive of resource utilization for patients in Maine in the next 6 months across all payers, all diseases, and all demographic groups. Methods In the HealthInfoNet, Maine’s health information exchange (HIE), a retrospective cohort of 1,273,114 patients was constructed with the preceding 12-month EMR. Each patient’s next 6-month (between January 1, 2013 and June 30, 2013) health care resource utilization was retrospectively scored ranging from 0 to 100 and a decision tree–based predictive model was developed. Our model was later integrated in the Maine HIE population exploration system to allow a prospective validation analysis of 1,358,153 patients by forecasting their next 6-month risk of resource utilization between July 1, 2013 and December 31, 2013. Results Prospectively predicted risks, on either an individual level or a population (per 1000 patients) level, were consistent with the next 6-month resource utilization distributions and the clinical patterns at the population level. Results demonstrated the strong correlation between its care resource utilization and our risk scores, supporting the effectiveness of our model. With the online population risk monitoring enterprise dashboards, the effectiveness of the predictive algorithm has been validated by clinicians and caregivers in the State of Maine. Conclusions The model and associated online applications were designed for tracking the evolving nature of total population risk, in a longitudinal manner, for health care resource utilization. It will enable more effective care management strategies driving improved patient outcomes. PMID:26395541

Associations between behavioural risk factors and overweight and obesity among adults in population-based samples from 31 countries.

PubMed

Pengpid, Supa; Peltzer, Karl

Concern about overweight and obesity is growing worldwide, and more research to examine behaviours associated with the risk for increased weight in adult populations is needed. The aim of this study was to estimate associations between behavioural risk factors and overweight and obesity among adults in nationally representative population samples from 20 countries in Europe, 8 countries in Asia, Australia, Chile and USA. This secondary analysis is based on the International Social Survey Program (ISSP), 2011-2013, Health and Health Care Module. In a cross-sectional population-based survey (N=48,741) (mean age 46.6 years, SD=17.4, age range 15-102 years) simple or multi-stage stratified random sampling was used, yielding representative samples of the adult population of respective countries. Body Mass Index was assessed by self-reported height and weight. Correlates were risk behaviours for chronic disease (smoking status, alcohol intake, consumption of fruits and vegetable (=FV), and physical activity). Overall, for all 31 countries the prevalence of overweight or obesity was 44.1%, 31.7% overweight and 12.4% obese. In adjusted logistic regression models, among men and among women ex-smoking was positively associated with both overweight and obesity, while light or moderate smoking overall and among men were inversely related with obesity. Moderate alcohol use was positively associated with both overweight and obesity, while heavy alcohol use was negatively associated with overweight. The daily consumption of FV was found to be protective from both overweight and obesity, overall and for men but not for women. Physical activity was positively associated with overweight but not obesity. Some risk behaviours for chronic disease appear to be associated with overweight and obesity among adults. Interventions targeting these risk behaviours may have the potential to reduce weight. Copyright © 2016 Asia Oceania Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.

Malaria Disease Mapping in Malaysia based on Besag-York-Mollie (BYM) Model

NASA Astrophysics Data System (ADS)

Azah Samat, Nor; Mey, Liew Wan

2017-09-01

Disease mapping is the visual representation of the geographical distribution which give an overview info about the incidence of disease within a population through spatial epidemiology data. Based on the result of map, it helps in monitoring and planning resource needs at all levels of health care and designing appropriate interventions, tailored towards areas that deserve closer scrutiny or communities that lead to further investigations to identify important risk factors. Therefore, the choice of statistical model used for relative risk estimation is important because production of disease risk map relies on the model used. This paper proposes Besag-York-Mollie (BYM) model to estimate the relative risk for Malaria in Malaysia. The analysis involved using the number of Malaria cases that obtained from the Ministry of Health Malaysia. The outcomes of analysis are displayed through graph and map, including Malaria disease risk map that constructed according to the estimation of relative risk. The distribution of high and low risk areas of Malaria disease occurrences for all states in Malaysia can be identified in the risk map.

Predictors of short-term mortality, cognitive and physical decline in older adults in northwest Russia: a population-based prospective cohort study.

PubMed

Turusheva, Anna; Frolova, Elena; Hegendoerfer, Eralda; Degryse, Jean-Marie

2017-08-01

The classical phenotype, accumulated deficit model and self-report approach of frailty were found not useful in older adults in northwest Russia. More research is needed to identify predictors of adverse outcomes in this population. The aim of this study is to identify predictors of mortality, autonomy and cognitive decline in a population that is characterized by a high cardiovascular morbidity and mortality rate. A population-based prospective cohort study of 611 community-dwelling individuals 65+. Anthropometry, medical history nutritional status were recorded. An evaluation of cognitive, physical and autonomy function, spirometry, and laboratory tests were performed. The total follow-up was 5 years. Multiple imputation, backward stepwise Cox regression analysis, C-statistic, risk reclassification analysis and the bootstrapping techniques were used to analyze the data. We found that the combination of increasing age, male sex, low physical function, low mid-arm muscle area, low forced expiratory volume in 1 s and anemia was associated with mortality for people 65+. The substitution of anemia with anemia + high level of C-reactive protein (hCRP) and the addition of high brain natriuretic peptide (hBNP) levels improved the classification of older persons at risk for mortality. The combination of low physical function, low mid-arm muscle area, low forced expiratory volume in 1 s, anemia with hCRP levels and hBNP identified older persons at a higher risk for mortality. These predictors may be used for the development of a prediction model to detect older people who are at risk for adverse health outcomes in northwest Russia.

Comparative assessment of absolute cardiovascular disease risk characterization from non-laboratory-based risk assessment in South African populations

PubMed Central

2013-01-01

Background All rigorous primary cardiovascular disease (CVD) prevention guidelines recommend absolute CVD risk scores to identify high- and low-risk patients, but laboratory testing can be impractical in low- and middle-income countries. The purpose of this study was to compare the ranking performance of a simple, non-laboratory-based risk score to laboratory-based scores in various South African populations. Methods We calculated and compared 10-year CVD (or coronary heart disease (CHD)) risk for 14,772 adults from thirteen cross-sectional South African populations (data collected from 1987 to 2009). Risk characterization performance for the non-laboratory-based score was assessed by comparing rankings of risk with six laboratory-based scores (three versions of Framingham risk, SCORE for high- and low-risk countries, and CUORE) using Spearman rank correlation and percent of population equivalently characterized as ‘high’ or ‘low’ risk. Total 10-year non-laboratory-based risk of CVD death was also calculated for a representative cross-section from the 1998 South African Demographic Health Survey (DHS, n = 9,379) to estimate the national burden of CVD mortality risk. Results Spearman correlation coefficients for the non-laboratory-based score with the laboratory-based scores ranged from 0.88 to 0.986. Using conventional thresholds for CVD risk (10% to 20% 10-year CVD risk), 90% to 92% of men and 94% to 97% of women were equivalently characterized as ‘high’ or ‘low’ risk using the non-laboratory-based and Framingham (2008) CVD risk score. These results were robust across the six risk scores evaluated and the thirteen cross-sectional datasets, with few exceptions (lower agreement between the non-laboratory-based and Framingham (1991) CHD risk scores). Approximately 18% of adults in the DHS population were characterized as ‘high CVD risk’ (10-year CVD death risk >20%) using the non-laboratory-based score. Conclusions We found a high level of correlation between a simple, non-laboratory-based CVD risk score and commonly-used laboratory-based risk scores. The burden of CVD mortality risk was high for men and women in South Africa. The policy and clinical implications are that fast, low-cost screening tools can lead to similar risk assessment results compared to time- and resource-intensive approaches. Until setting-specific cohort studies can derive and validate country-specific risk scores, non-laboratory-based CVD risk assessment could be an effective and efficient primary CVD screening approach in South Africa. PMID:23880010

Seroepidemiology of HBV infection in South-East of iran; a population based study.

PubMed

Salehi, M; Alavian, S M; Tabatabaei, S V; Izadi, Sh; Sanei Moghaddam, E; Amini Kafi-Abad, S; Gharehbaghian, A; Khosravi, S; Abolghasemi, H

2012-05-01

Hepatitis B virus (HBV) infection is a major risk factor of cirrhosis and hepatocellular carcinoma affecting billions of people globally. Since information on its prevalence in general population is mandatory for formulating effective policies, this population based serological survey was conducted in Sistan and Baluchistan, where no previous epidemiological data were available. Using random cluster sampling 3989 healthy subjects were selected from 9 districts of Sistan and Baluchistan Province in southeastern Iran. The subjects' age ranged from 6 to 65 years old. Serum samples were tested for HBcAb, HBsAg. Screening tests were carried out by the third generation of ELISA. Various risk factors were recorded and multivariate analysis was performed. The prevalence of HBsAg and HBcAb in Sistan and Baluchistan was 3.38% (95% CI 2.85; 3.98) and 23.58% (95% CI 22.29; 24.93) respectively. We found 8 cases of positive anti-HDV antibody. Predictors of HBsAg or HBcAb in multivariate analysis were age, marital status and addiction. The rate of HBV infection in Sistan and Baluchistan was higher than other parts of Iran. Approximately 25% of general population in this province had previous exposure to HBV and 3% were HBsAg carriers. Intrafamilial and addiction were major routes of HBV transmission in this province.

Neonatal vitamin D status and risk of schizophrenia: a population-based case-control study.

PubMed

McGrath, John J; Eyles, Darryl W; Pedersen, Carsten B; Anderson, Cameron; Ko, Pauline; Burne, Thomas H; Norgaard-Pedersen, Bent; Hougaard, David M; Mortensen, Preben B

2010-09-01

Clues from the epidemiology of schizophrenia suggest that low levels of developmental vitamin D may be associated with increased risk of schizophrenia. To directly examine the association between neonatal vitamin D status and risk of schizophrenia. Individually matched case-control study drawn from a population-based cohort. Danish national health registers and neonatal biobank. A total of 424 individuals with schizophrenia and 424 controls matched for sex and date of birth. The concentration of 25 hydroxyvitamin D(3) (25[OH]D3) was assessed from neonatal dried blood samples using a highly sensitive liquid chromatography tandem mass spectroscopy method. Relative risks were calculated for the matched pairs when examined for quintiles of 25(OH)D3. Compared with neonates in the fourth quintile (with 25[OH]D3 concentrations between 40.5 and 50.9 nmol/L), those in each of the lower 3 quintiles had a significantly increased risk of schizophrenia (2-fold elevated risk). Unexpectedly, those in the highest quintile also had a significantly increased risk of schizophrenia. Based on this analysis, the population-attributable fraction associated with neonatal vitamin D status was 44%. The relationship was not explained by a wide range of potential confounding or interacting variables. Both low and high concentrations of neonatal vitamin D are associated with increased risk of schizophrenia, and it is feasible that this exposure could contribute to a sizeable proportion of cases in Denmark. In light of the substantial public health implications of this finding, there is an urgent need to further explore the effect of vitamin D status on brain development and later mental health.

Population-based studies of antithyroid drugs and sudden cardiac death

PubMed Central

van Noord, Charlotte; Sturkenboom, Miriam C J M; Straus, Sabine M J M; Hofman, Albert; Witteman, Jacqueline C M; Stricker, Bruno H Ch

2009-01-01

AIM Thyroid free T4 is associated with QTc-interval prolongation, which is a risk factor for sudden cardiac death (SCD). Hyperthyroidism has been associated with SCD in case reports, but there are no population-based studies confirming this. The aim was to investigate whether use of antithyroid drugs (as a direct cause or as an indicator of poorly controlled hyperthyroidism) is associated with an increased risk of SCD. METHODS We studied the occurrence of SCD in a two-step procedure in two different Dutch populations. First, the prospective population-based Rotterdam Study including 7898 participants (≥55 years old). Second, we used the Integrated Primary Care Information (IPCI) database, which is a longitudinal general practice research database to see whether we could replicate results from the first study. Drug use at the index date was assessed with prescription information from automated pharmacies (Rotterdam Study) or drug prescriptions from general practices (IPCI). We used a Cox proportional hazards model in a cohort analysis, adjusted for age, gender and use of QTc prolonging drugs (Rotterdam Study) and conditional logistic regression analysis in a case–control analysis, matched for age, gender, practice and calendar time and adjusted for arrhythmia and cerebrovascular ischaemia (IPCI). RESULTS In the Rotterdam Study, 375 participants developed SCD during follow-up. Current use of antithyroid drugs was associated with SCD [adjusted hazard ratio 3.9; 95% confidence interval (CI) 1.7, 8.7]. IPCI included 1424 cases with SCD and 14 443 controls. Also in IPCI, current use of antithyroid drugs was associated with SCD (adjusted odds ratio 2.9; 95% CI 1.1, 7.4). CONCLUSIONS Use of antithyroid drugs was associated with a threefold increased risk of SCD. Although this might be directly caused by antithyroid drug use, it might be more readily explained by underlying poorly controlled hyperthyroidism, since treated patients who developed SCD still had low thyroid-stimulating hormone levels shortly before death. PMID:19740403

A novel risk assessment method for landfill slope failure: Case study application for Bhalswa Dumpsite, India.

PubMed

Jahanfar, Ali; Amirmojahedi, Mohsen; Gharabaghi, Bahram; Dubey, Brajesh; McBean, Edward; Kumar, Dinesh

2017-03-01

Rapid population growth of major urban centres in many developing countries has created massive landfills with extraordinary heights and steep side-slopes, which are frequently surrounded by illegal low-income residential settlements developed too close to landfills. These extraordinary landfills are facing high risks of catastrophic failure with potentially large numbers of fatalities. This study presents a novel method for risk assessment of landfill slope failure, using probabilistic analysis of potential failure scenarios and associated fatalities. The conceptual framework of the method includes selecting appropriate statistical distributions for the municipal solid waste (MSW) material shear strength and rheological properties for potential failure scenario analysis. The MSW material properties for a given scenario is then used to analyse the probability of slope failure and the resulting run-out length to calculate the potential risk of fatalities. In comparison with existing methods, which are solely based on the probability of slope failure, this method provides a more accurate estimate of the risk of fatalities associated with a given landfill slope failure. The application of the new risk assessment method is demonstrated with a case study for a landfill located within a heavily populated area of New Delhi, India.

Commonality of Risk Factors for Mothers' Poor Oral Health and General Health: Baseline Analysis of a Population-Based Birth Cohort Study.

PubMed

Ha, Diep H; Spencer, A John; Thomson, W Murray; Scott, Jane A; Do, Loc G

2018-04-01

Objective The association between and commonality of risk factors for poor self-rated oral health (SROH) and general health (SRGH) among new mothers has not been reported. The purpose of this paper is to assess the commonality of risk factors for poor SROH and SRGH, and self-reported obesity and dental pain, among a population-based sample of new mothers in Australia. It also investigated health conditions affecting new mothers' general health. Methods Data collected at baseline of a population-based birth cohort was used. Mothers of newborns in Adelaide were approached to participate. Mothers completed a questionnaire collecting data on socioeconomic status (SES), health behaviours, dental pain, SROH, self-reported height and weight and SRGH. Analysis was conducted sequentially from bivariate to multivariable regression to estimate prevalence rate (PR) of reporting poor/fair SROH and SRGH. Results of the 1895 new mothers, some 21 and 6% rated their SROH and SRGH as poor/fair respectively. Dental pain was associated with low income and smoking status, while being obese was associated with low SES, low education and infrequent tooth brushing. SROH and SRGH was associated with low SES, smoking, and dental pain. SROH was also associated with SRGH [PR: 3.06 (2.42-3.88)]. Conclusion for practice There was a commonality of factors associated with self-rated oral health and general health. Strong associations between OH and GH were also observed. Given the importance of maternal health for future generations, there would be long-term societal benefit from addressing common risk factors for OH and GH in integrated programs.

Contrasting results from molecular and pedigree-based population diversity measures in captive zebra highlight challenges facing genetic management of zoo populations.

PubMed

Ito, Hideyuki; Ogden, Rob; Langenhorst, Tanya; Inoue-Murayama, Miho

2017-01-01

Zoo conservation breeding programs manage the retention of population genetic diversity through analysis of pedigree records. The range of demographic and genetic indices determined through pedigree analysis programs allows the conservation of diversity to be monitored relative to the particular founder population for a species. Such approaches are based on a number of well-documented founder assumptions, however without knowledge of actual molecular genetic diversity there is a risk that pedigree-based measures will be misinterpreted and population genetic diversity misunderstood. We examined the genetic diversity of the captive populations of Grevy's zebra, Hartmann's mountain zebra and plains zebra in Japan and the United Kingdom through analysis of mitochondrial DNA sequences. Very low nucleotide variability was observed in Grevy's zebra. The results were evaluated with respect to current and historic diversity in the wild, and indicate that low genetic diversity in the captive population is likely a result of low founder diversity, which in turn suggests relatively low wild genetic diversity prior to recent population declines. Comparison of molecular genetic diversity measures with analogous diversity indices generated from the studbook data for Grevy's zebra and Hartmann's mountain zebra show contrasting patterns, with Grevy's zebra displaying markedly less molecular diversity than mountain zebra, despite studbook analysis indicating that the Grevy's zebra population has substantially more founders, greater effective population size, lower mean kinship, and has suffered less loss of gene diversity. These findings emphasize the need to validate theoretical estimates of genetic diversity in captive breeding programs with empirical molecular genetic data. Zoo Biol. 36:87-94, 2017. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

The TRIAGE-ProADM Score for an Early Risk Stratification of Medical Patients in the Emergency Department - Development Based on a Multi-National, Prospective, Observational Study

PubMed Central

Hausfater, Pierre; Amin, Devendra; Amin, Adina; Canavaggio, Pauline; Sauvin, Gabrielle; Bernard, Maguy; Conca, Antoinette; Haubitz, Sebastian; Struja, Tristan; Huber, Andreas; Mueller, Beat; Schuetz, Philipp

2016-01-01

Introduction The inflammatory biomarker pro-adrenomedullin (ProADM) provides additional prognostic information for the risk stratification of general medical emergency department (ED) patients. The aim of this analysis was to develop a triage algorithm for improved prognostication and later use in an interventional trial. Methods We used data from the multi-national, prospective, observational TRIAGE trial including consecutive medical ED patients from Switzerland, France and the United States. We investigated triage effects when adding ProADM at two established cut-offs to a five-level ED triage score with respect to adverse clinical outcome. Results Mortality in the 6586 ED patients showed a step-wise, 25-fold increase from 0.6% to 4.5% and 15.4%, respectively, at the two ProADM cut-offs (≤0.75nmol/L, >0.75–1.5nmol/L, >1.5nmol/L, p ANOVA <0.0001). Risk stratification by combining ProADM within cut-off groups and the triage score resulted in the identification of 1662 patients (25.2% of the population) at a very low risk of mortality (0.3%, n = 5) and 425 patients (6.5% of the population) at very high risk of mortality (19.3%, n = 82). Risk estimation by using ProADM and the triage score from a logistic regression model allowed for a more accurate risk estimation in the whole population with a classification of 3255 patients (49.4% of the population) in the low risk group (0.3% mortality, n = 9) and 1673 (25.4% of the population) in the high-risk group (15.1% mortality, n = 252). Conclusions Within this large international multicenter study, a combined triage score based on ProADM and established triage scores allowed a more accurate mortality risk discrimination. The TRIAGE-ProADM score improved identification of both patients at the highest risk of mortality who may benefit from early therapeutic interventions (rule in), and low risk patients where deferred treatment without negatively affecting outcome may be possible (rule out). PMID:28005916

How effective are risk assessments/measures for predicting future aggressive behaviour in adults with intellectual disabilities (ID): A systematic review and meta-analysis.

PubMed

Lofthouse, Rachael; Golding, Laura; Totsika, Vasiliki; Hastings, Richard; Lindsay, William

2017-12-01

Risk assessments assist professionals in the identification and management of risk of aggression. The present study aimed to systematically review evidence on the efficacy of assessments for managing the risk of physical aggression in adults with intellectual disabilities (ID). A literature search was conducted using the databases PsycINFO, EMBASE, MEDLINE, Web of Science, and Google Scholar. Electronic and hand searches identified 14 studies that met the inclusion criteria. Standardised mean difference effect sizes Area Under Curve (AUC) were calculated for studies. Random effects subgroup analysis was used to compare different types of risk measures (Actuarial, Structured Professional Judgment and dynamic), and prospective vs. catch-up longitudinal study designs. Overall, evidence of predictive validity was found for risk measures with ID populations: (AUC)=0.724, 95% CI [0.681, 0.768]. There was no variation in the performance of different types of risk measures, or different study design. Risk assessment measures predict the likelihood of aggression in ID population and are comparable to those in mainstream populations. Further meta-analysis is necessary when risk measures are more established in this population. Copyright © 2017 Elsevier Ltd. All rights reserved.

Risk of placenta previa in second birth after first birth cesarean section: a population-based study and meta-analysis

PubMed Central

2011-01-01

Background Objective: To compare the risk of placenta previa at second birth among women who had a cesarean section (CS) at first birth with women who delivered vaginally. Methods Retrospective cohort study of 399,674 women who gave birth to a singleton first and second baby between April 2000 and February 2009 in England. Multiple logistic regression was used to adjust the estimates for maternal age, ethnicity, deprivation, placenta previa at first birth, inter-birth interval and pregnancy complications. In addition, we conducted a meta-analysis of the reported results in peer-reviewed articles since 1980. Results The rate of placenta previa at second birth for women with vaginal first births was 4.4 per 1000 births, compared to 8.7 per 1000 births for women with CS at first birth. After adjustment, CS at first birth remained associated with an increased risk of placenta previa (odds ratio = 1.60; 95% CI 1.44 to 1.76). In the meta-analysis of 37 previously published studies from 21 countries, the overall pooled random effects odds ratio was 2.20 (95% CI 1.96-2.46). Our results from the current study is consistent with those of the meta-analysis as the pooled odds ratio for the six population-based cohort studies that analyzed second births only was 1.51 (95% CI 1.39-1.65). Conclusions There is an increased risk of placenta previa in the subsequent pregnancy after CS delivery at first birth, but the risk is lower than previously estimated. Given the placenta previa rate in England and the adjusted effect of previous CS, 359 deliveries by CS at first birth would result in one additional case of placenta previa in the next pregnancy. PMID:22103697

The TSH levels and risk of hypothyroidism: Results from a population based prospective cohort study in an Iranian adult's population.

PubMed

Aminorroaya, Ashraf; Meamar, Rokhsareh; Amini, Massoud; Feizi, Awat; Nasri, Maryam; Tabatabaei, Azamosadat; Faghihimani, Elham

2017-06-01

The aim of current study was to assess the relationship between serum TSH levels and hypothyroidism risk in the euthyroid population. In a population-based cohort study, a total of 615 individuals with a normal baseline TSH, from of total population (n=2254) in 2006, were followed up for 6years. TSH, total T4, thyroid peroxidase antibody (TPOAb), and thyroglobulin antibody (TgAb) were measured. The relative risk (RR) and 95% confidence interval (95%CI) were calculated based on logistic regression. The Receiver Operating Characteristic (ROC) analysis along with area under the curve (AUC) was used to prediction of future hypothyroidism. TSH level in 2006 was a significant predictor for overt hypothyroidism, in the total population (RR=3.5) and female (RR=1.37) (all, P value<0.05). A cutoff value of TSH at 2.05mIU/L [AUC: (CI95 %), 0.68 (0.44-0.92; P=0.05)] was obtained for differentiating the patients with overt hypothyroidism from euthyroid. However, this cut off was not observed when we included only negative TPO and TgAbs people in 2006. The RR of hypothyroidism increased gradually when TSH level increased from 2.06-3.6mIU/L to >3.6mIU/L in the total population and both sexes. In women, the risk of overt hypothyroidism was significantly higher in subjects with TSH above 3.6 than those subject with THS levels≤2.05 [RR: (CI95 %), 20.57(2.-207.04), P value<0.05]. A cutoff value of TSH at 2.05mIU/L could predict the development of overt hypothyroidism in future. However, it was not applicable for people with negative TPOAb and negative TgAb. Copyright © 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

Gonorrhea infection increases the risk of prostate cancer in Asian population: a nationwide population-based cohort study.

PubMed

Wang, Y-C; Chung, C-H; Chen, J-H; Chiang, M-H; Ti-Yin; Tsao, C-H; Lin, F-H; Chien, W-C; Shang, S-T; Chang, F-Y

2017-05-01

This nationwide population-based retrospective cohort study evaluated the risk of developing prostate cancer among patients with gonorrhea. We identified cases of newly diagnosed gonorrhea in men between 2000 and 2010 from the Taiwan National Health Insurance Research Database. Each patient with gonorrhea was matched to four controls, based on age and index year. All subjects were followed up from the index date to December 31, 2010. The Cox proportional hazards regression model was used to assess the risk of prostate cancer. A total of 355 men were included in the study group, and 1,420 age-matched subjects without gonorrhea were included in the control group. After adjusting for age, comorbidities, urbanization level, hospital level, and monthly income, gonorrhea was significantly associated with an increased risk of prostate cancer (adjusted hazard ratio = 5.66, 95% confidence interval = 1.36-23.52). Men aged 45-70 years and those with lower monthly income were more strongly associated with prostate cancer in the study group than the control group. The higher risk for developing prostate cancer were also found in those without syphilis, without genital warts, without diabetes mellitus, without chronic obstructive pulmonary disease, without benign prostatic hypertrophy, without chronic prostatitis, and without alcoholism. The Kaplan-Meier analysis showed the risk of prostate cancer was significantly higher in the study group than in the control group. Gonorrhea may be involved in the development of prostate cancer. More intensive screening and prevention interventions for prostate cancer should be recommended in men with gonorrhea.

Probabilistic framework for the estimation of the adult and child toxicokinetic intraspecies uncertainty factors.

PubMed

Pelekis, Michael; Nicolich, Mark J; Gauthier, Joseph S

2003-12-01

Human health risk assessments use point values to develop risk estimates and thus impart a deterministic character to risk, which, by definition, is a probability phenomenon. The risk estimates are calculated based on individuals and then, using uncertainty factors (UFs), are extrapolated to the population that is characterized by variability. Regulatory agencies have recommended the quantification of the impact of variability in risk assessments through the application of probabilistic methods. In the present study, a framework that deals with the quantitative analysis of uncertainty (U) and variability (V) in target tissue dose in the population was developed by applying probabilistic analysis to physiologically-based toxicokinetic models. The mechanistic parameters that determine kinetics were described with probability density functions (PDFs). Since each PDF depicts the frequency of occurrence of all expected values of each parameter in the population, the combined effects of multiple sources of U/V were accounted for in the estimated distribution of tissue dose in the population, and a unified (adult and child) intraspecies toxicokinetic uncertainty factor UFH-TK was determined. The results show that the proposed framework accounts effectively for U/V in population toxicokinetics. The ratio of the 95th percentile to the 50th percentile of the annual average concentration of the chemical at the target tissue organ (i.e., the UFH-TK) varies with age. The ratio is equivalent to a unified intraspecies toxicokinetic UF, and it is one of the UFs by which the NOAEL can be divided to obtain the RfC/RfD. The 10-fold intraspecies UF is intended to account for uncertainty and variability in toxicokinetics (3.2x) and toxicodynamics (3.2x). This article deals exclusively with toxicokinetic component of UF. The framework provides an alternative to the default methodology and is advantageous in that the evaluation of toxicokinetic variability is based on the distribution of the effective target tissue dose, rather than applied dose. It allows for the replacement of the default adult and children intraspecies UF with toxicokinetic data-derived values and provides accurate chemical-specific estimates for their magnitude. It shows that proper application of probability and toxicokinetic theories can reduce uncertainties when establishing exposure limits for specific compounds and provide better assurance that established limits are adequately protective. It contributes to the development of a probabilistic noncancer risk assessment framework and will ultimately lead to the unification of cancer and noncancer risk assessment methodologies.

Baseline assessment of prevalence and geographical distribution of HPV types in Chile using self-collected vaginal samples

PubMed Central

Ferreccio, Catterina; Corvalán, Alejandro; Margozzini, Paula; Viviani, Paola; González, Claudia; Aguilera, Ximena; Gravitt, Patti E

2008-01-01

Background Chile has broad variations in weather, economics and population from the far desert north (Region 1) to the cold, icy south (Region 12). A home-based self-collected vaginal sampling was nested in the 2003 Chilean population-based health survey in order to explore the possibility of a type-specific geographical variation for human papillomavirus Methods The population was a national probability sample of people 17 years of age and over. Consenting women provided self-collected cervicovaginal swabs in universal collection media (UCM). DNA was extracted and typed to 37 HPV genotypes using PGMY consensus PCR and line blot assay. Weighted prevalence rates and adjusted OR were calculated. Results Of the 1,883 women participating in the health survey, 1,219 (64.7%) provided a cervicovaginal sample and in 1,110 (56.2% of participants and 66.5% of those eligible) the samples were adequate for analysis. Refusal rate was 16.9%. HPV prevalence was 29.2% (15.1% high-risk HPV and 14.1% low-risk HPV). Predominant high-risk types were HPV 16, 52, 51, 56 and 58. Predominant low-risk HPVs were HPV 84, CP6108, 62, 53 and 61. High-risk and low-risk HPV rates were inversely correlated between the regions. High-risk HPV prevalence was highest among the youngest women, whereas low-risk HPV increased slightly with age. Conclusion Self-obtained vaginal sampling is adequate for monitoring HPV in the community, for identifying high-risk areas, and for surveying the long term impact of interventions. PMID:18304362

Feasibility of nonselective testing for hemoglobinopathies in early pregnancy in The Netherlands.

PubMed

Kaufmann, Judith O; Demirel-Güngör, Gönül; Selles, Anke; Hudig, Cisca; Steen, Gerard; Ponjee, Gabrielle; Holleboom, Cas; Freeman, Liv M; Hendiks, Joris; Wijermans, Pierre; Giordano, Piero C; Kerkhoffs, Jean-Louis

2011-12-01

To examine the feasibility of standardized hemoglobinopathy (HBP) carrier testing for pregnant women in The Netherlands in addition to the standard anemia screening. We assessed the prevalence of HBP in women at the time of the first pregnancy visit using both a prospective cohort (N = 703) and a retrospective series of women selected at random (N = 588). For the purpose of analysis, the population was divided into a high risk and a low risk group for HBP based on maternal ethnicity. Screening for HBP utilized standard screening tests for anemia, with additional high performance liquid chromatography (Variant II); molecular analysis was performed by Gap-polymerase chain reaction (Gap-PCR) and if necessary, direct sequencing and multiplex ligation-dependent probe amplification (MLPA). Family history was reported or collected from the medical records. β-Globin defects were found in 3.9% of the total population (50/1291). The frequency in the high risk population was 5.6% (37/656), compared with 1.2% (6/501) in the low risk group. In the prospective study we found 30 HBP carriers, leading to testing of 16 partners and identification of two couples at risk. One affected child was born. Mean gestational age at the screening was 11.3 weeks with a standard deviation (SD) of 5.8. We found that the prevalence of HBP carriers is high enough in our population to warrant HBP testing for the entire multiethnic population in early pregnancy at the time of anemia screening. This is feasible as most women had their booking early in their first trimester. Copyright © 2011 John Wiley & Sons, Ltd.

Maternal and perinatal mortality by place of delivery in sub-Saharan Africa: a meta-analysis of population-based cohort studies.

PubMed

Chinkhumba, Jobiba; De Allegri, Manuela; Muula, Adamson S; Robberstad, Bjarne

2014-09-28

Facility-based delivery has gained traction as a key strategy for reducing maternal and perinatal mortality in developing countries. However, robust evidence of impact of place of delivery on maternal and perinatal mortality is lacking. We aimed to estimate the risk of maternal and perinatal mortality by place of delivery in sub-Saharan Africa. We conducted a systematic review of population-based cohort studies reporting on risk of maternal or perinatal mortality at the individual level by place of delivery in sub-Saharan Africa. Newcastle-Ottawa Scale was used to assess study quality. Outcomes were summarized in pooled analyses using fixed and random effects models. We calculated attributable risk percentage reduction in mortality to estimate exposure effect. We report mortality ratios, crude odds ratios and associated 95% confidence intervals. We found 9 population-based cohort studies: 6 reporting on perinatal and 3 on maternal mortality. The mean study quality score was 10 out of 15 points. Control for confounders varied between the studies. A total of 36,772 pregnancy episodes were included in the analyses. Overall, perinatal mortality is 21% higher for home compared to facility-based deliveries, but the difference is only significant when produced with a fixed effects model (OR 1.21, 95% CI: 1.02-1.46) and not when produced by a random effects model (OR 1.21, 95% CI: 0.79-1.84). Under best settings, up to 14 perinatal deaths might be averted per 1000 births if the women delivered at facilities instead of homes. We found significantly increased risk of maternal mortality for facility-based compared to home deliveries (OR 2.29, 95% CI: 1.58-3.31), precluding estimates of attributable risk fraction. Evaluating the impact of facility-based delivery strategy on maternal and perinatal mortality using population-based studies is complicated by selection bias and poor control of confounders. Studies that pool data at an individual level may overcome some of these problems and provide better estimates of relative effectiveness of place of delivery in the region.

Disease mapping based on stochastic SIR-SI model for Dengue and Chikungunya in Malaysia

NASA Astrophysics Data System (ADS)

Samat, N. A.; Ma'arof, S. H. Mohd Imam

2014-12-01

This paper describes and demonstrates a method for relative risk estimation which is based on the stochastic SIR-SI vector-borne infectious disease transmission model specifically for Dengue and Chikungunya diseases in Malaysia. Firstly, the common compartmental model for vector-borne infectious disease transmission called the SIR-SI model (susceptible-infective-recovered for human populations; susceptible-infective for vector populations) is presented. This is followed by the explanations on the stochastic SIR-SI model which involve the Bayesian description. This stochastic model then is used in the relative risk formulation in order to obtain the posterior relative risk estimation. Then, this relative estimation model is demonstrated using Dengue and Chikungunya data of Malaysia. The viruses of these diseases are transmitted by the same type of female vector mosquito named Aedes Aegypti and Aedes Albopictus. Finally, the findings of the analysis of relative risk estimation for both Dengue and Chikungunya diseases are presented, compared and displayed in graphs and maps. The distribution from risk maps show the high and low risk area of Dengue and Chikungunya diseases occurrence. This map can be used as a tool for the prevention and control strategies for both diseases.

Disease mapping based on stochastic SIR-SI model for Dengue and Chikungunya in Malaysia

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

Samat, N. A.; Ma'arof, S. H. Mohd Imam

This paper describes and demonstrates a method for relative risk estimation which is based on the stochastic SIR-SI vector-borne infectious disease transmission model specifically for Dengue and Chikungunya diseases in Malaysia. Firstly, the common compartmental model for vector-borne infectious disease transmission called the SIR-SI model (susceptible-infective-recovered for human populations; susceptible-infective for vector populations) is presented. This is followed by the explanations on the stochastic SIR-SI model which involve the Bayesian description. This stochastic model then is used in the relative risk formulation in order to obtain the posterior relative risk estimation. Then, this relative estimation model is demonstrated using Denguemore » and Chikungunya data of Malaysia. The viruses of these diseases are transmitted by the same type of female vector mosquito named Aedes Aegypti and Aedes Albopictus. Finally, the findings of the analysis of relative risk estimation for both Dengue and Chikungunya diseases are presented, compared and displayed in graphs and maps. The distribution from risk maps show the high and low risk area of Dengue and Chikungunya diseases occurrence. This map can be used as a tool for the prevention and control strategies for both diseases.« less

Population-based estimate of trauma-related deaths for law enforcement personnel: Risks for death are higher and increasing over time.

PubMed

Eastman, Alexander L; Cripps, Michael W; Abdelfattah, Kareem R; Inaba, Kenji; Weiser, Thomas G; Spain, David A; Staudenmayer, Kristan L

2017-08-01

Trauma-related deaths remain an important public health problem. One group susceptible to death due to traumatic mechanisms is US law enforcement (LE). We hypothesized that LE officers experienced a higher chance of violent death compared with the general US population and that risks have increased over time. The National Institute on Occupational Safety and Health National Occupational Mortality Surveillance is a population-based survey of occupational deaths. It includes data for workers who died during 1985 to 1998 in one of 30 US states (EARLY period). Additional deaths were added from 23 US states in 1999, 2003 to 2004, 2007 to 2010 (LATE period). Mortality rates are estimated by calculating proportionate mortality ratios (PMR). A PMR above 100 is considered to exceed the average background risk for all occupations. All adults older than 18 years whose primary occupation was listed as "law enforcement worker" were included in the analysis. Law enforcement personnel were more likely to die from an injury compared with the general population (Fig. 1). The overall PMR for injury in EARLY was 111 (95% confidence interval [CI], 108-114; p < 0.01), and for LATE was 118 (95% CI, 110-127; p < 0.01). Four mechanisms of death reached statistical significance: motor vehicle traffic (MVT)-driver, MVT-other, intentional self-harm, and assault/homicide. The highest PMR in EARLY was associated with firearms (PMR, 272; 95% CI, 207-350; p < 0.01). The highest PMR in LATE was associated with death due to being a driver in an MVT (PMR, 194; 95% CI, 169-222; p < 0.01). There were differences in risk of death by race and sex. White females had the highest PMR due to assault and homicide (PMR, 317; 95% CI, 164-554; p < 0.01). All groups had similar risks of death due to intentional self-harm (PMR, 130-171). The risk of death for US LE officers is high and increasing over time, suggesting an at-risk population that requires further interventions. Targeted efforts based on risk factors, such as sex and race, may assist with the development of prevention programs for this population. Epidemiologic study, level II.

All-Cause Mortality in Patients With Diabetes Under Treatment With Dapagliflozin: A Population-Based, Open-Cohort Study in The Health Improvement Network Database.

PubMed

Toulis, Konstantinos A; Willis, Brian H; Marshall, Tom; Kumarendran, Balachadran; Gokhale, Krishna; Ghosh, Sandip; Thomas, G Neil; Cheng, Kar Keung; Narendran, Parth; Hanif, Wasim; Nirantharakumar, Krishnarajah

2017-05-01

Empagliflozin was found to decrease mortality in patients with type 2 diabetes mellitus (T2DM) and a prior cardiovascular disease (CVD) event. To establish whether these benefits can be replicated in a real-world setting, should be expected with the use of dapagliflozin, and apply to T2DM patients at low risk of CVD. General practice, population-based, retrospective cohort study (January 2013 to September 2015). The Health Improvement Network database. A total of 22,124 T2DM patients (4444 exposed to dapagliflozin; 17,680 unexposed T2DM patients) matched for age, sex, body mass index, T2DM duration, and smoking. The primary outcome was all-cause mortality (high and low risk for CVD) in the total study population, expressed as the adjusted incidence rate ratio (aIRR) with 95% confidence intervals (CIs). As a secondary analysis in the low-risk population, all-cause mortality and incident CVD were considered. Patients with T2DM exposed to dapagliflozin were significantly less likely to die of any cause (aIRR: 0.50; 95% CI: 0.33 to 0.75; P = 0.001). Similarly, in low-risk patients, death from any cause was significantly lower in the cohort exposed to dapagliflozin (aIRR: 0.44; 95% CI: 0.25 to 0.78; P = 0.002). The difference in the risk of incident CVD did not reach statistical significance between groups in low-risk patients (aIRR: 0.89; 95% CI: 0.61 to 1.31; P = 0.546). Patients with T2DM who were exposed to dapagliflozin had a lower risk of death from any cause irrespective of baseline CVD status. Copyright © 2017 Endocrine Society

Quantitative assessment of the relationship between Fas/FasL genes polymorphisms and head and neck cancer risk.

PubMed

Zhang, Dan-Feng; Jiang, Guang-Bin; Qin, Chuan-Qi; Liu, De-Xi; Hu, Ya-Jun; Zhou, Juan; Niu, Yu-Ming

2018-02-01

Molecular epidemiological studies have demonstrated a closer association between Fas/FasL polymorphisms and head and neck cancer (HNC) risk, and the results of these published studies were inconsistent. We therefore performed this meta-analysis to explore the associations between Fas/FasL polymorphisms and HNC risk. Four online databases (PubMed, Embase, CNKI, and Wanfang) were searched. Odds ratios (ORs) with 95% confidence interval (95% CIs) were calculated to assess the association between Fas -670A>G, Fas -1377G>A, and FasL -844C>T polymorphisms and HNC risk. In addition, heterogeneity, accumulative/sensitivity analysis, and publication bias were conducted to check the statistical power. Overall, 9 related publications (20 independent case-control studies) involving 3179 patients and 4217 controls were identified. Significant association of protective effects was observed between FasL -844C>T polymorphism and HNC risk in codominant and dominant model models (CT vs CC: OR = 0.89, 95% CI = 0.79-1.00, P = .05, I = 38.3%, CT+TT vs CC: OR = 0.88, 95% CI = 0.79-0.98, P = .02, I = 35.8%). Furthermore, the similar protective effects were observed the subgroup analysis of in Asian population and population-based controls group. Our meta-analysis indicated that FasL -844C>T polymorphism plays a protective role against HNC development, but the Fas -670A>G and Fas -1377G>A polymorphisms maybe not associated with HNC risk.

Relationship between blood manganese and blood pressure in the Korean general population according to KNHANES 2008

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

Lee, Byung-Kook; Kim, Yangho, E-mail: yanghokm@nuri.net

Introduction: We present data on the association of manganese (Mn) level with hypertension in a representative sample of the adult Korean population who participated in the Korean National Health and Nutrition Examination Survey (KNHANES) 2008. Methods: This study was based on the data obtained by KNHANES 2008, which was conducted for three years (2007-2009) using a rolling sampling design involving a complex, stratified, multistage, probability-cluster survey of a representative sample of the noninstitutionalized civilian population of South Korea. Results: Multiple regression analysis after controlling for covariates, including gender, age, regional area, education level, smoking, drinking status, hemoglobin, and serum creatinine,more » showed that the beta coefficients of log blood Mn were 3.514, 1.878, and 2.517 for diastolic blood pressure, and 3.593, 2.449, and 2.440 for systolic blood pressure in female, male, and all participants, respectively. Multiple regression analysis including three other blood metals, lead, mercury, and cadmium, revealed no significant effects of the three metals on blood pressure and showed no effect on the association between blood Mn and blood pressure. In addition, doubling the blood Mn increased the risk of hypertension 1.828, 1.573, and 1.567 fold in women, men, and all participants, respectively, after adjustment for covariates. The addition of blood lead, mercury, and cadmium as covariates did not affect the association between blood Mn and the prevalence of hypertension. Conclusion: Blood Mn level was associated with an increased risk of hypertension in a representative sample of the Korean adult population. - Highlights: {yields} We showed the association of manganese with hypertension in Korean population. {yields} This study was based on the data obtained by KNHANES 2008. {yields} Blood manganese level was associated with an increased risk of hypertension.« less

Dietary patterns and the risk of esophageal squamous cell carcinoma: A population-based case-control study in a rural population.

PubMed

Liu, Xudong; Wang, Xiaorong; Lin, Sihao; Lao, Xiangqian; Zhao, Jin; Song, Qingkun; Su, Xuefen; Tak-Sun Yu, Ignatius

2017-02-01

Few studies were available in exploring the roles of dietary patterns in the development of esophageal cancer, especially in China. This study aimed to investigate the roles of dietary patterns in the risk of esophageal squamous cell carcinoma (ESCC) in a Chinese rural population. A population-based cases-control study was designed and conducted in Yanting County, Sichuan Province of China during two years (between June 2011 and May 2013). A total of 942 pairs of ESCC cases and controls were recruited. A food frequency questionnaire was adopted to collect information of dietary consumption. Dietary patterns were extracted by using principle component and factor analysis based on 24 dietary groups. Odds ratios (ORs) with 95% confidence intervals (95% CI) were calculated by using logistic regression model, with adjustment for possible confounding variables. Four major dietary patterns were identified, which were labeled as "prudent", "vegetable and fruits", "processed food" and "alcohol drinking". In comparison of the highest with the lowest quartiles of pattern scores, the processed food pattern (OR: 2.84, 95% CI: 2.13-3.80) and alcohol drinking pattern (OR: 2.69, 95% CI: 1.95-3.71) were significantly associated with an increased risk of ESCC, while the vegetable and fruit pattern (OR: 0.70, 95% CI: 0.53-0.92) was associated with reduced risk by 30%. The prudent pattern was associated with a reduced risk by 33% (OR: 0.67, 95% CI: 0.50-0.88) in a multivariate logistic regression model, but no statistical significance was reached in a composite model. The results suggest an important role of dietary patterns in ESCC. Diets rich in vegetables and fruits may decrease the risk of ESCC, whereas diets rich in processed food and drinking alcohol may increase the risk. Copyright © 2015 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

[Health risks in different living circumstances of mothers. Analyses based on a population study].

PubMed

Sperlich, Stefanie

2014-12-01

The objective of this study was to determine the living circumstances ('Lebenslagen') in mothers which are associated with elevated health risks. Data were derived from a cross-sectional population based sample of German women (n = 3129) with underage children. By means of a two-step cluster analysis ten different maternal living circumstances were assessed which proved to be distinct with respect to indicators of socioeconomic position, employment status and family-related factors. Out of the ten living circumstances, one could be attributed to higher socioeconomic status (SES), while five were assigned to a middle SES and four to a lower SES. In line with previous findings, mothers with a high SES predominantly showed the best health while mothers with a low SES tended to be at higher health risk with respect to subjective health, mental health (anxiety and depression), obesity and smoking. However, there were important health differences between the different living circumstances within the middle and lower SES. In addition, varying health risks were found among different living circumstances of single mothers, pointing to the significance of family and job-related living conditions in establishing health risks. With this exploratory analysis strategy small-scale living conditions could be detected which were associated with specific health risks. This approach seemed particularly suitable to provide a more precise definition of target groups for health promotion. The findings encourage a more exrensive application of the concept of living conditions in medical sociology research as well as health monitoring.

Expanding HIV testing efforts in concentrated epidemic settings: a population-based survey from rural Vietnam.

PubMed

Pharris, Anastasia; Nguyen, Thi Kim Chuc; Tishelman, Carol; Brugha, Ruairí; Nguyen, Phuong Hoa; Thorson, Anna

2011-01-11

To improve HIV prevention and care programs, it is important to understand the uptake of HIV testing and to identify population segments in need of increased HIV testing. This is particularly crucial in countries with concentrated HIV epidemics, where HIV prevalence continues to rise in the general population. This study analyzes determinants of HIV testing in a rural Vietnamese population in order to identify potential access barriers and areas for promoting HIV testing services. A population-based cross-sectional survey of 1874 randomly sampled adults was linked to pregnancy, migration and economic cohort data from a demographic surveillance site (DSS). Multivariate logistic regression analysis was used to determine which factors were associated with having tested for HIV. The age-adjusted prevalence of ever-testing for HIV was 7.6%; however 79% of those who reported feeling at-risk of contracting HIV had never tested. In multivariate analysis, younger age (aOR 1.85, 95% CI 1.14-3.01), higher economic status (aOR 3.4, 95% CI 2.21-5.22), and semi-urban residence (aOR 2.37, 95% CI 1.53-3.66) were associated with having been tested for HIV. HIV testing rates did not differ between women of reproductive age who had recently been pregnant and those who had not. We found low testing uptake (6%) among pregnant women despite an existing prevention of mother-to-child HIV testing policy, and lower-than-expected testing among persons who felt that they were at-risk of HIV. Poverty and residence in a more geographically remote location were associated with less HIV testing. In addition to current HIV testing strategies focusing on high-risk groups, we recommend targeting HIV testing in concentrated HIV epidemic settings to focus on a scaled-up provision of antenatal testing. Additional recommendations include removing financial and geographic access barriers to client-initiated testing, and encouraging provider-initiated testing of those who believe that they are at-risk of HIV.

Using Integrated Earth and Social Science Data for Disaster Risk Assessment

NASA Astrophysics Data System (ADS)

Downs, R. R.; Chen, R. S.; Yetman, G.

2016-12-01

Society faces many different risks from both natural and technological hazards. In some cases, disaster risk managers focus on only a few risks, e.g., in regions where a single hazard such as earthquakes dominate. More often, however, disaster risk managers deal with multiple hazards that pose diverse threats to life, infrastructure, and livelihoods. From the viewpoint of scientists, hazards are often studied based on traditional disciplines such as seismology, hydrology, climatology, and epidemiology. But from the viewpoint of disaster risk managers, data are needed on all hazards in a specific region and on the exposure and vulnerability of population, infrastructure, and economic resources and activity. Such managers also need to understand how hazards, exposures, and vulnerabilities may interact, and human and environmental systems respond, to hazard events, as in the case of the Fukushima nuclear disaster that followed from the Sendai earthquake and tsunami. In this regard, geospatial tools that enable visualization and analysis of both Earth and social science data can support the use case of disaster risk managers who need to quickly assess where specific hazard events occur relative to population and critical infrastructure. Such information can help them assess the potential severity of actual or predicted hazard events, identify population centers or key infrastructure at risk, and visualize hazard dynamics, e.g., earthquakes and their aftershocks or the paths of severe storms. This can then inform efforts to mitigate risks across multiple hazards, including reducing exposure and vulnerability, strengthening system resiliency, improving disaster response mechanisms, and targeting mitigation resources to the highest or most critical risks. We report here on initial efforts to develop hazard mapping tools that draw on open web services and support simple spatial queries about population exposure. The NASA Socioeconomic Data and Applications Center (SEDAC) Hazards Mapper, a web-based mapping tool, enables users to estimate population living in areas subject to flood or tornado warnings, near recent earthquakes, or around critical infrastructure. The HazPop mobile app, implemented for iOS devices, utilizes location services to support disaster risk managers working in field conditions.

Physiologically Based Pharmacokinetic (PBPK) Modeling of ...

EPA Pesticide Factsheets

Background: Quantitative estimation of toxicokinetic variability in the human population is a persistent challenge in risk assessment of environmental chemicals. Traditionally, inter-individual differences in the population are accounted for by default assumptions or, in rare cases, are based on human toxicokinetic data.Objectives: To evaluate the utility of genetically diverse mouse strains for estimating toxicokinetic population variability for risk assessment, using trichloroethylene (TCE) metabolism as a case study. Methods: We used data on oxidative and glutathione conjugation metabolism of TCE in 16 inbred and one hybrid mouse strains to calibrate and extend existing physiologically-based pharmacokinetic (PBPK) models. We added one-compartment models for glutathione metabolites and a two-compartment model for dichloroacetic acid (DCA). A Bayesian population analysis of inter-strain variability was used to quantify variability in TCE metabolism. Results: Concentration-time profiles for TCE metabolism to oxidative and glutathione conjugation metabolites varied across strains. Median predictions for the metabolic flux through oxidation was less variable (5-fold range) than that through glutathione conjugation (10-fold range). For oxidative metabolites, median predictions of trichloroacetic acid production was less variable (2-fold range) than DCA production (5-fold range), although uncertainty bounds for DCA exceeded the predicted variability. Conclusions:

Association of Ring Finger Protein 213 Gene P.R4810k Polymorphism with Intracranial Major Artery Stenosis/Occlusion.

PubMed

Zhang, Qian; Yu, Lebao; Ge, Peicong; Ma, Yonggang; Zhang, Dong; Zhang, Yan; Wang, Rong; Wang, Shuo; Zhao, Yuanli; Cao, Yong; Liu, Xingju; Deng, Xiaofeng; Zhao, Jizong

2018-06-01

Intracranial major artery stenosis/occlusion (ICASO) is a common cause of ischemic stroke worldwide. A number of studies have assessed the association of the p.R4810K polymorphism in the ring finger protein 213 (RNF213) gene with ICASO, but the results have not been entirely consistent. We conducted a case-control study to estimate the association between the p.R4810K polymorphism and the risk of ICASO in a Chinese population. A total of 124 patients and 230 controls were enrolled. Moreover, a meta-analysis was performed to evaluate this association in the East Asian populations. In our case-control study, the frequencies of the G/A genotype of p.R4810K were significantly higher in the ICASO patients than in the control group (4.03% versus .43%, P = .021, respectively). Moreover, in the meta-analysis, we assessed 7 case-control studies that included 1239 patients and 1377 controls. The pooled odds ratios (ORs) indicated significant association between the p.R4810K polymorphism and the ICASO risk in the dominant model (OR = 9.37, 95% confidence interval: 4.61-19.02, P = .000), the heterozygote comparison (OR = 8.97, 95% CI: 4.41-18.25, P = .000), and the allele comparison (OR = 9.50, 95% confidence interval: 4.71-19.19, P = .000) in the East Asian populations. Subgroup analysis based on ethnicity revealed that the risks in the Japanese and the Korean populations were higher than that in the Chinese population. The p.R4810K polymorphism was associated with an increased risk of ICASO in the East Asian populations. Further studies on the function of the RNF213 protein and the clinical features of this subtype of ICASO are needed. Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Population-based risk for complications after transthoracic needle lung biopsy of a pulmonary nodule: an analysis of discharge records.

PubMed

Wiener, Renda Soylemez; Schwartz, Lisa M; Woloshin, Steven; Welch, H Gilbert

2011-08-02

Because pulmonary nodules are found in up to 25% of patients undergoing computed tomography of the chest, the question of whether to perform biopsy is becoming increasingly common. Data on complications after transthoracic needle lung biopsy are limited to case series from selected institutions. To determine population-based estimates of risks for complications after transthoracic needle biopsy of a pulmonary nodule. Cross-sectional analysis. The 2006 State Ambulatory Surgery Databases and State Inpatient Databases for California, Florida, Michigan, and New York from the Healthcare Cost and Utilization Project. 15 865 adults who had transthoracic needle biopsy of a pulmonary nodule. Percentage of biopsies complicated by hemorrhage, any pneumothorax, or pneumothorax requiring a chest tube, and adjusted odds ratios for these complications associated with various biopsy characteristics, calculated by using multivariate, population-averaged generalized estimating equations. Although hemorrhage was rare, complicating 1.0% (95% CI, 0.9% to 1.2%) of biopsies, 17.8% (CI, 11.8% to 23.8%) of patients with hemorrhage required a blood transfusion. In contrast, the risk for any pneumothorax was 15.0% (CI, 14.0% to 16.0%), and 6.6% (CI, 6.0% to 7.2%) of all biopsies resulted in pneumothorax requiring a chest tube. Compared with patients without complications, those who experienced hemorrhage or pneumothorax requiring a chest tube had longer lengths of stay (P < 0.001) and were more likely to develop respiratory failure requiring mechanical ventilation (P = 0.020). Patients aged 60 to 69 years (as opposed to younger or older patients), smokers, and those with chronic obstructive pulmonary disease had higher risk for complications. Estimated risks may be inaccurate if coding of complications is incomplete. The analyzed databases contain little clinical detail (such as information on nodule characteristics or biopsy pathology) and cannot indicate whether performing the biopsy produced useful information. Whereas hemorrhage is an infrequent complication of transthoracic needle lung biopsy, pneumothorax is common and often necessitates chest tube placement. These population-based data should help patients and physicians make more informed choices about whether to perform biopsy of a pulmonary nodule. Department of Veterans Affairs and National Cancer Institute.

Population-based contracting (population health): part II.

PubMed

Jacofsky, D J

2017-11-01

Modern healthcare contracting is shifting the responsibility for improving quality, enhancing community health and controlling the total cost of care for patient populations from payers to providers. Population-based contracting involves capitated risk taken across an entire population, such that any included services within the contract are paid for by the risk-bearing entity throughout the term of the agreement. Under such contracts, a risk-bearing entity, which may be a provider group, a hospital or another payer, administers the contract and assumes risk for contractually defined services. These contracts can be structured in various ways, from professional fee capitation to full global per member per month diagnosis-based risk. The entity contracting with the payer must have downstream network contracts to provide the care and facilities that it has agreed to provide. Population health is a very powerful model to reduce waste and costs. It requires a deep understanding of the nuances of such contracting and the appropriate infrastructure to manage both networks and risk. Cite this article: Bone Joint J 2017;99-B:1431-4. ©2017 The British Editorial Society of Bone & Joint Surgery.

Cutaneous Melanoma In Situ: Translational Evidence from a Large Population-Based Study

PubMed Central

Nitti, Donato

2011-01-01

Background. Cutaneous melanoma in situ (CMIS) is a nosologic entity surrounded by health concerns and unsolved debates. We aimed to shed some light on CMIS by means of a large population-based study. Methods. Patients with histologic diagnosis of CMIS were identified from the Surveillance Epidemiology End Results (SEER) database. Results. The records of 93,863 cases of CMIS were available for analysis. CMIS incidence has been steadily increasing over the past 3 decades at a rate higher than any other in situ or invasive tumor, including invasive skin melanoma (annual percentage change [APC]: 9.5% versus 3.6%, respectively). Despite its noninvasive nature, CMIS is treated with excision margins wider than 1 cm in more than one third of cases. CMIS is associated with an increased risk of invasive melanoma (standardized incidence ratio [SIR]: 8.08; 95% confidence interval [CI]: 7.66–8.57), with an estimated 3:5 invasive/in situ ratio; surprisingly, it is also associated with a reduced risk of gastrointestinal (SIR: 0.78, CI: 0.72–0.84) and lung (SIR: 0.65, CI: 0.59–0.71) cancers. Relative survival analysis shows that persons with CMIS have a life expectancy equal to that of the general population. Conclusions. CMIS is increasingly diagnosed and is often overtreated, although it does not affect the life expectancy of its carriers. Patients with CMIS have an increased risk of developing invasive melanoma (which warrants their enrollment in screening programs) but also a reduced risk of some epithelial cancers, which raises the intriguing hypothesis that genetic/environmental risk factors for some tumors may oppose the pathogenesis of others. PMID:21632457

Social activity, cognitive decline and dementia risk: a 20-year prospective cohort study.

PubMed

Marioni, Riccardo E; Proust-Lima, Cecile; Amieva, Helene; Brayne, Carol; Matthews, Fiona E; Dartigues, Jean-Francois; Jacqmin-Gadda, Helene

2015-10-24

Identifying modifiable lifestyle correlates of cognitive decline and risk of dementia is complex, particularly as few population-based longitudinal studies jointly model these interlinked processes. Recent methodological developments allow us to examine statistically defined sub-populations with separate cognitive trajectories and dementia risks. Engagement in social, physical, or intellectual pursuits, social network size, self-perception of feeling well understood, and degree of satisfaction with social relationships were assessed in 2854 participants from the Paquid cohort (mean baseline age 77 years) and related to incident dementia and cognitive change over 20-years of follow-up. Multivariate repeated cognitive information was exploited by defining the global cognitive functioning as the latent common factor underlying the tests. In addition, three latent homogeneous sub-populations of cognitive change and dementia were identified and contrasted according to social environment variables. In the whole population, we found associations between increased engagement in social, physical, or intellectual pursuits and increased cognitive ability (but not decline) and decreased risk of incident dementia, and between feeling understood and slower cognitive decline. There was evidence for three sub-populations of cognitive aging: fast, medium, and no cognitive decline. The social-environment measures at baseline did not help explain the heterogeneity of cognitive decline and incident dementia diagnosis between these sub-populations. We observed a complex series of relationships between social-environment variables and cognitive decline and dementia. In the whole population, factors such as increased engagement in social, physical, or intellectual pursuits were related to a decreased risk of dementia. However, in a sub-population analysis, the social-environment variables were not linked to the heterogeneous patterns of cognitive decline and dementia risk that defined the sub-groups.

Night shift work, chronotype and prostate cancer risk in the MCC-Spain case-control study.

PubMed

Papantoniou, Kyriaki; Castaño-Vinyals, Gemma; Espinosa, Ana; Aragonés, Nuria; Pérez-Gómez, Beatriz; Burgos, Javier; Gómez-Acebo, Inés; Llorca, Javier; Peiró, Rosana; Jimenez-Moleón, Jose Juan; Arredondo, Francisco; Tardón, Adonina; Pollan, Marina; Kogevinas, Manolis

2015-09-01

Night shift work has been classified as a probable human carcinogen based on experimental studies and limited human evidence on breast cancer. Evidence on other common cancers, such as prostate cancer, is scarce. Chronotype is an individual characteristic that may relate to night work adaptation. We evaluated night shift work with relation to prostate cancer, taking into account chronotype and disease severity in a population based case-control study in Spain. We included 1,095 prostate cancer cases and 1,388 randomly selected population controls. We collected detailed information on shift schedules (permanent vs. rotating, time schedules, duration, frequency), using lifetime occupational history. Sociodemographic and lifestyle factors were assessed by face-to-face interviews and chronotype through a validated questionnaire. We used unconditional logistic regression analysis adjusting for potential confounders. Subjects who had worked at least for one year in night shift work had a slightly higher prostate cancer risk [Odds Ratio (OR) 1.14; 95%CI 0.94, 1.37] compared with never night workers; this risk increased with longer duration of exposure (≥ 28 years: OR 1.37; 95%CI 1.05, 1.81; p-trend = 0.047). Risks were more pronounced for high risk tumors [D'Amico classification, Relative Risk Ratio (RRR) 1.40; 95%CI 1.05, 1.86], particularly among subjects with longer duration of exposure (≥28 years: RRR 1.63; 95%CI 1.08, 2.45; p-trend = 0.027). Overall risk was higher among subjects with an evening chronotype, but also increased in morning chronotypes after long-term night work. In this large population based study, we found an association between night shift work and prostate cancer particularly for tumors with worse prognosis. © 2014 UICC.

The Relative Importance of the Vadose Zone in Multimedia Risk Assessment Modeling Applied at a National Scale: An Analysis of Benzene Using 3MRA

NASA Astrophysics Data System (ADS)

Babendreier, J. E.

2002-05-01

Evaluating uncertainty and parameter sensitivity in environmental models can be a difficult task, even for low-order, single-media constructs driven by a unique set of site-specific data. The challenge of examining ever more complex, integrated, higher-order models is a formidable one, particularly in regulatory settings applied on a national scale. Quantitative assessment of uncertainty and sensitivity within integrated, multimedia models that simulate hundreds of sites, spanning multiple geographical and ecological regions, will ultimately require a systematic, comparative approach coupled with sufficient computational power. The Multimedia, Multipathway, and Multireceptor Risk Assessment Model (3MRA) is an important code being developed by the United States Environmental Protection Agency for use in site-scale risk assessment (e.g. hazardous waste management facilities). The model currently entails over 700 variables, 185 of which are explicitly stochastic. The 3MRA can start with a chemical concentration in a waste management unit (WMU). It estimates the release and transport of the chemical throughout the environment, and predicts associated exposure and risk. The 3MRA simulates multimedia (air, water, soil, sediments), pollutant fate and transport, multipathway exposure routes (food ingestion, water ingestion, soil ingestion, air inhalation, etc.), multireceptor exposures (resident, gardener, farmer, fisher, ecological habitats and populations), and resulting risk (human cancer and non-cancer effects, ecological population and community effects). The 3MRA collates the output for an overall national risk assessment, offering a probabilistic strategy as a basis for regulatory decisions. To facilitate model execution of 3MRA for purposes of conducting uncertainty and sensitivity analysis, a PC-based supercomputer cluster was constructed. Design of SuperMUSE, a 125 GHz Windows-based Supercomputer for Model Uncertainty and Sensitivity Evaluation is described, along with the conceptual layout of an accompanying java-based paralleling software toolset. Preliminary work is also reported for a scenario involving Benzene disposal that describes the relative importance of the vadose zone in driving risk levels for ecological receptors and human health. Incorporating landfills, waste piles, aerated tanks, surface impoundments, and land application units, the site-based data used in the analysis included 201 national facilities representing 419 site-WMU combinations.

A Serological Biopsy Using Five Stomach-Specific Circulating Biomarkers for Gastric Cancer Risk Assessment: A Multi-Phase Study.

PubMed

Tu, Huakang; Sun, Liping; Dong, Xiao; Gong, Yuehua; Xu, Qian; Jing, Jingjing; Bostick, Roberd M; Wu, Xifeng; Yuan, Yuan

2017-05-01

We aimed to assess a serological biopsy using five stomach-specific circulating biomarkers-pepsinogen I (PGI), PGII, PGI/II ratio, anti-Helicobacter pylori (H. pylori) antibody, and gastrin-17 (G-17)-for identifying high-risk individuals and predicting risk of developing gastric cancer (GC). Among 12,112 participants with prospective follow-up from an ongoing population-based screening program using both serology and gastroscopy in China, we conducted a multi-phase study involving a cross-sectional analysis, a follow-up analysis, and an integrative risk prediction modeling analysis. In the cross-sectional analysis, the five biomarkers (especially PGII, the PGI/II ratio, and H. pylori sero-positivity) were associated with the presence of precancerous gastric lesions or GC at enrollment. In the follow-up analysis, low PGI levels and PGI/II ratios were associated with higher risk of developing GC, and both low (<0.5 pmol/l) and high (>4.7 pmol/l) G-17 levels were associated with higher risk of developing GC, suggesting a J-shaped association. In the risk prediction modeling analysis, the five biomarkers combined yielded a C statistic of 0.803 (95% confidence interval (CI)=0.789-0.816) and improved prediction beyond traditional risk factors (C statistic from 0.580 to 0.811, P<0.001) for identifying precancerous lesions at enrollment, and higher serological biopsy scores based on the five biomarkers at enrollment were associated with higher risk of developing GC during follow-up (P for trend <0.001). A serological biopsy composed of the five stomach-specific circulating biomarkers could be used to identify high-risk individuals for further diagnostic gastroscopy, and to stratify individuals' risk of developing GC and thus to guide targeted screening and precision prevention.

Artificial neural network models for prediction of cardiovascular autonomic dysfunction in general Chinese population

PubMed Central

2013-01-01

Background The present study aimed to develop an artificial neural network (ANN) based prediction model for cardiovascular autonomic (CA) dysfunction in the general population. Methods We analyzed a previous dataset based on a population sample consisted of 2,092 individuals aged 30–80 years. The prediction models were derived from an exploratory set using ANN analysis. Performances of these prediction models were evaluated in the validation set. Results Univariate analysis indicated that 14 risk factors showed statistically significant association with CA dysfunction (P < 0.05). The mean area under the receiver-operating curve was 0.762 (95% CI 0.732–0.793) for prediction model developed using ANN analysis. The mean sensitivity, specificity, positive and negative predictive values were similar in the prediction models was 0.751, 0.665, 0.330 and 0.924, respectively. All HL statistics were less than 15.0. Conclusion ANN is an effective tool for developing prediction models with high value for predicting CA dysfunction among the general population. PMID:23902963

A DOSIMETRIC ANALYSIS OF THE ACUTE BEHAVIORAL EFFECTS OF INHALED TOLUENE IN RATS

EPA Science Inventory

Knowledge of the appropriate metric of dose for a toxic chemical facilitates quantitative extrapolation of toxicity observed in the laboratory to the risk of adverse effects in the human population. Here we utilize a physiologically-based toxicokinetic (PBTK) model for toluene, a...

A Cost Analysis of a Pancreatic Cancer Screening Protocol in High-Risk Populations

PubMed Central

Bruenderman, Elizabeth; Martin, Robert CG

2016-01-01

Background Pancreatic cancer is the 4th leading cause of cancer death in the U.S. A screening protocol is needed to catch early stage, resectable disease. This study suggests a protocol for high-risk individuals and assesses the cost in the context of the Affordable Care Act. Methods Medicare and national average pricing were used for cost analysis of a protocol using MRI/MRCP biannually in high-risk groups. Results: ‘ Costs per year of life added’ based on Medicare and national average costs, respectively, are: $638.62 and $2542.37 for Peutz-Jehgers Syndrome, $945.33 and $3763.44 for Hereditary Pancreatitis, $1141.77 and $4545.45 for Familial Pancreatic Cancer and p16-Leiden mutations, and $356.42 and $1418.92 for new-onset diabetes over age 50 with weight loss or smoking. Conclusion A screening program using MRI/MRCP is affordable in high-risk populations. The U.S. Preventive Services Task Force must reevaluate its pancreatic cancer screening guidelines to make screening more cost-effective for the individual. PMID:26003200

Soy isoflavone consumption and colorectal cancer risk: a systematic review and meta-analysis

PubMed Central

Yu, Yi; Jing, Xiaoli; Li, Hui; Zhao, Xiang; Wang, Dongping

2016-01-01

Colorectal cancer (CRC) is one of the most predominant solid carcinomas in Western countries. However, there is conflicting information on the effects of soy isoflavone on CRC risk. Therefore, we performed a meta-analysis to assess the association between soy isoflavone consumption and CRC risk in humans using PubMed, Embase, Web of Science, and Cochrane Library databases. A total of 17 epidemiologic studies, which consisted of thirteen case-control and four prospective cohort studies, met the inclusion criteria. Our research findings revealed that soy isoflavone consumption reduced CRC risk (relative risk, RR: 0.78, 95% CI: 0.72–0.85; I2 = 34.1%, P = 0.024). Based on subgroup analyses, a significant protective effect was observed with soy foods/products (RR: 0.79; 95% CI: 0.69–0.89), in Asian populations (RR: 0.79; 95% CI: 0.72–0.87), and in case-control studies (RR: 0.76; 95% CI: 0.68–0.84). Therefore, soy isoflavone consumption was significantly associated with a reduced risk of CRC risk, particularly with soy foods/products, in Asian populations, and in case-control studies. However, due to the limited number of studies, other factors may affect this association. PMID:27170217

Social deprivation and population density are not associated with small area risk of amyotrophic lateral sclerosis.

PubMed

Rooney, James P K; Tobin, Katy; Crampsie, Arlene; Vajda, Alice; Heverin, Mark; McLaughlin, Russell; Staines, Anthony; Hardiman, Orla

2015-10-01

Evidence of an association between areal ALS risk and population density has been previously reported. We aim to examine ALS spatial incidence in Ireland using small areas, to compare this analysis with our previous analysis of larger areas and to examine the associations between population density, social deprivation and ALS incidence. Residential area social deprivation has not been previously investigated as a risk factor for ALS. Using the Irish ALS register, we included all cases of ALS diagnosed in Ireland from 1995-2013. 2006 census data was used to calculate age and sex standardised expected cases per small area. Social deprivation was assessed using the pobalHP deprivation index. Bayesian smoothing was used to calculate small area relative risk for ALS, whilst cluster analysis was performed using SaTScan. The effects of population density and social deprivation were tested in two ways: (1) as covariates in the Bayesian spatial model; (2) via post-Bayesian regression. 1701 cases were included. Bayesian smoothed maps of relative risk at small area resolution matched closely to our previous analysis at a larger area resolution. Cluster analysis identified two areas of significant low risk. These areas did not correlate with population density or social deprivation indices. Two areas showing low frequency of ALS have been identified in the Republic of Ireland. These areas do not correlate with population density or residential area social deprivation, indicating that other reasons, such as genetic admixture may account for the observed findings. Copyright © 2015 Elsevier Inc. All rights reserved.

A Balanced Risk-Benefit Analysis to Determine Human Risks Associated with Pyrrolizidine Alkaloids (PA)-The Case of Tea and Herbal Infusions.

PubMed

Habs, Michael; Binder, Karin; Krauss, Stefan; Müller, Karolina; Ernst, Brigitte; Valentini, Luzia; Koller, Michael

2017-07-07

Humans are exposed to pyrrolizidine alkaloids (PA) through different sources, mainly from contaminated foodstuff. Teas and herbal infusions (T&HI) can be contaminated by PA producing weed. PA can possess toxic, mutagenic, genotoxic, and carcinogenic properties. Thus, possible health risks for the general population are under debate. There is a strong safety record for T&HI and additionally epidemiological evidence for the preventive effects of regular tea consumption on cardiovascular events and certain types of cancer. There is no epidemiological evidence, however, for human risks of regular low dose PA exposure. Recommended regulatory PA-threshold values are based on experimental data only, accepting big uncertainties. If a general risk exists through PA contaminated T&HI, it must be small compared to other frequently accepted risks of daily living and the proven health effects of T&HI. Decision making should be based on a balanced riskbenefit analysis. Based on analyses of the scientific data currently available, it is concluded that the benefits of drinking T&HI clearly outweigh the negligible health risk of possible PA contamination. At the same time, manufacturers must continue their efforts to secure good product quality and to be transparent on their measures of quality control and risk communication.

A comparative study of the risk profile of hemodialysis patients in a for profit network and in two regional registries of the Italian Society of Nephrology.

PubMed

Postorino, Maurizio; Amato, Claudia; Mancini, Elena; Carioni, Paola; D'Arrigo, Graziella; Di Benedetto, Attilio; Cerino, Fabrizio; Marino, Carmela; Vilasi, Antonio; Tripepi, Giovanni; Stuard, Stefano; Capasso, Giovanbattista; Santoro, Antonio; Zoccali, Carmine

2018-02-01

In 2013, the Italian Society of Nephrology joined forces with Nephrocare-Italy to create a clinical research cohort of patients on file in the data-rich clinical management system (EUCLID) of this organization for the performance of observational studies in the hemodialysis (HD) population. To see whether patients in EUCLID are representative of the HD population in Italy, we set out to compare the whole EUCLID population with patients included in the regional HD registries in Emilia-Romagna (Northern Italy) and in Calabria (Southern Italy), the sole regions in Italy which have systematically collected an enlarged clinical data set allowing comparison with the data-rich EUCLID system. An analysis of prevalent and incident patients in 2010 and 2011 showed that EUCLID patients had a lower prevalence of coronary heart disease, peripheral vascular disease, heart failure, valvular heart disease, liver disease, peptic ulcer and other comorbidities and risk factors and a higher fractional urea clearance (Kt/V) than those in the Emilia Romagna and Calabria registries. Accordingly, survival analysis showed a lower mortality risk in the EUCLID 2010 and 2011 cohorts than in the combined two regional registries in the corresponding years: for 2010, hazard ratio (HR) EUCLID vs. Regional registries: 0.80 [95% confidence interval: 0.71-0.90]; for 2011, HR: 0.76 [0.65-0.90]. However, this difference was nullified by statistical adjustment for the difference in comorbidities and risk factors, indicating that the longer survival in the EUCLID database was attributable to the lower risk profile of patients included in that database. This preliminary analysis sets the stage for future observational studies and indicates that appropriate adjustment for difference in comorbidities and risk factors is needed to generalize to the Italian HD population analyses based on the data-rich EUCLID database.

Assessing privacy risks in population health publications using a checklist-based approach.

PubMed

O'Keefe, Christine M; Ickowicz, Adrien; Churches, Tim; Westcott, Mark; O'Sullivan, Maree; Khan, Atikur

2017-11-10

Recent growth in the number of population health researchers accessing detailed datasets, either on their own computers or through virtual data centers, has the potential to increase privacy risks. In response, a checklist for identifying and reducing privacy risks in population health analysis outputs has been proposed for use by researchers themselves. In this study we explore the usability and reliability of such an approach by investigating whether different users identify the same privacy risks on applying the checklist to a sample of publications. The checklist was applied to a sample of 100 academic population health publications distributed among 5 readers. Cohen's κ was used to measure interrater agreement. Of the 566 instances of statistical output types found in the 100 publications, the most frequently occurring were counts, summary statistics, plots, and model outputs. Application of the checklist identified 128 outputs (22.6%) with potential privacy concerns. Most of these were associated with the reporting of small counts. Among these identified outputs, the readers found no substantial actual privacy concerns when context was taken into account. Interrater agreement for identifying potential privacy concerns was generally good. This study has demonstrated that a checklist can be a reliable tool to assist researchers with anonymizing analysis outputs in population health research. This further suggests that such an approach may have the potential to be developed into a broadly applicable standard providing consistent confidentiality protection across multiple analyses of the same data. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Significant association between asthma risk and the GSTM1 and GSTT1 deletion polymorphisms: an updated meta-analysis of case-control studies.

PubMed

Liang, Siqiao; Wei, Xuan; Gong, Chen; Wei, Jinmei; Chen, Zhangrong; Chen, Xiaoli; Wang, Zhibo; Deng, Jingmin

2013-07-01

Polymorphisms in GSTM1 and GSTT1 may be associated with asthma risk, yet several studies and meta-analyses have reported inconclusive results. Therefore, an updated meta-analysis was conducted. Literature searches were performed using the Pubmed, Embase and Web of Science databases until October 2012. Variant 'null' genotype was compared with wild-type 'present' in the pooled data. All statistical analyses were performed using STATA 11.0. A total of 26 case-control studies were suitable for inclusion in the meta-analysis. In the overall population, a significant association was found for both the GSTM1 (odds ratio (OR) = 1.452; 95% confidence interval (CI): 1.192-1.770) and GSTT1 polymorphism (OR = 1.792; 95% CI:1.293-2.483). For subgroup analysis by age, GSTM1 significantly increased risk for both children (OR = 1.368; 95% CI: 1.051-1.781) and adults (OR = 1.859; 95% CI: 1.183-2.921). For GSTT1, a significant association was only found in the adult population (OR = 2.312; 95%CI: 1.204-4.439). Based on subgroup analysis by ethnicity, a significant association for GSTM1 was found in Europe (OR = 1.303; 95% CI: 1.018-1.667), Africa (OR = 2.175; 95%CI: 1.560-3.031) and Latin America (OR = 2.265; 95%CI: 1.375-3.729). For GSTT1, significantly increased risk was found only for Asian (OR = 2.105; 95% CI: 1.101-4.025) and Russian (OR = 2.747; 95% CI: 1.071-7.046) populations. This meta-analysis provides evidence that GSTM1 and GSTT1 polymorphisms may be risk factors for asthma. © 2013 The Authors. Respirology © 2013 Asian Pacific Society of Respirology.

Gender Differences in HIV Risk Behaviors Among Persons Involved in the U.S. Criminal Justice System and Living with HIV or at Risk for HIV: A "Seek, Test, Treat, and Retain" Harmonization Consortium.

PubMed

Loeliger, Kelsey B; Biggs, Mary L; Young, Rebekah; Seal, David W; Beckwith, Curt G; Kuo, Irene; Gordon, Michael S; Altice, Frederick L; Ouellet, Lawrence J; Cunningham, William E; Young, Jeremy D; Springer, Sandra A

2017-10-01

The U.S. female criminal justice (CJ) population is rapidly growing, yet large-scale studies exploring gender-specific HIV risk behaviors in the CJ population are lacking. This analysis uses baseline data on adults with a CJ history from eight U.S. studies in an NIH-funded "Seek, Test, Treat, Retain" harmonization consortium. Data were collected using a standardized HIV risk behavior assessment tool and pooled across studies to describe participants' characteristics and risk behaviors. Multilevel mixed-effects logistic regression models were used to test for gender-based behavior differences. Among 784 HIV-positive (21.4% female) and 5521 HIV-negative (8.5% female) participants, HIV-positive women had higher odds than HIV-positive men of engaging in condomless sexual intercourse (AOR 1.84 [1.16-2.95]) with potentially sero-discordant partners (AOR 2.40 [1.41-4.09]) and of sharing injection equipment (AOR 3.36 [1.31-8.63]). HIV risk reduction interventions targeting CJ-involved women with HIV are urgently needed as this population may represent an under-recognized potential source of HIV transmission.

Estimating the Effect of Targeted Screening Strategies: An Application to Colonoscopy and Colorectal Cancer.

PubMed

Thomas, Duncan C

2017-07-01

Screening behavior depends on previous screening history and family members' behaviors, which can act as both confounders and intermediate variables on a causal pathway from screening to disease risk. Conventional analyses that adjust for these variables can lead to incorrect inferences about the causal effect of screening if high-risk individuals are more likely to be screened. Analyzing the data in a manner that treats screening as randomized conditional on covariates allows causal parameters to be estimated; inverse probability weighting based on propensity of exposure scores is one such method considered here. I simulated family data under plausible models for the underlying disease process and for screening behavior to assess the performance of alternative methods of analysis and whether a targeted screening approach based on individuals' risk factors would lead to a greater reduction in cancer incidence in the population than a uniform screening policy. Simulation results indicate that there can be a substantial underestimation of the effect of screening on subsequent cancer risk when using conventional analysis approaches, which is avoided by using inverse probability weighting. A large case-control study of colonoscopy and colorectal cancer from Germany shows a strong protective effect of screening, but inverse probability weighting makes this effect even stronger. Targeted screening approaches based on either fixed risk factors or family history yield somewhat greater reductions in cancer incidence with fewer screens needed to prevent one cancer than population-wide approaches, but the differences may not be large enough to justify the additional effort required. See video abstract at, http://links.lww.com/EDE/B207.

Genome-wide association study in discordant sibships identifies multiple inherited susceptibility alleles linked to lung cancer.

PubMed

Galvan, Antonella; Falvella, Felicia S; Frullanti, Elisa; Spinola, Monica; Incarbone, Matteo; Nosotti, Mario; Santambrogio, Luigi; Conti, Barbara; Pastorino, Ugo; Gonzalez-Neira, Anna; Dragani, Tommaso A

2010-03-01

We analyzed a series of young (median age = 52 years) non-smoker lung cancer patients and their unaffected siblings as controls, using a genome-wide 620 901 single-nucleotide polymorphism (SNP) array analysis and a case-control DNA pooling approach. We identified 82 putatively associated SNPs that were retested by individual genotyping followed by use of the sib transmission disequilibrium test, pointing to 36 SNPs associated with lung cancer risk in the discordant sibs series. Analysis of these 36 SNPs in a polygenic model characterized by additive and interchangeable effects of rare alleles revealed a highly statistically significant dosage-dependent association between risk allele carrier status and proportion of cancer cases. Replication of the same 36 SNPs in a population-based series confirmed the association with lung cancer for three SNPs, suggesting that phenocopies and genetic heterogeneity can play a major role in the complex genetics of lung cancer risk in the general population.

Prevalence of and risk factors for pterygia in a rural Northern Chinese population.

PubMed

Li, Zhijian; Wu, Shubin; Mai, Jieying; Xu, Keke; Sun, Ying; Song, Zhen; Jin, Di; Wang, Haijing; Liu, Ping

2014-12-01

To determine the prevalence of and associated risk factors for pterygia development in a high-latitude-dwelling Northern Chinese population. A prospective population-based survey was conducted between November 2008 and July 2009. A stratified, clustered, randomized sampling procedure was used to select 8445 subjects, aged ≥18 years, all with diagnosed, graded pterygia. Risk factors associated with the occurrence of pterygia were evaluated according to logistic regression models. A total of 8445 residents (aged 18-94 years) from the Heilongjiang Province, China, participated in the study. Of these, 208 (2.5%) had at least one diagnosed pterygium. The prevalence of bilateral pterygia was 1.2% (95% confidence interval, CI, 1.0-1.4%). According to multivariable analysis, pterygia were significantly more likely to occur in persons aged 70-94 years than in those aged 18-39 years (odds ratio, OR, 29.0, 95% CI 13.6-61.6, p < 0.01). Pterygia were significantly associated with male sex (OR 1.9, 95% CI 1.4-2.6, p < 0.01) and outdoor work (OR 1.8, 95% CI 1.2-2.6, p < 0.01). Multivariable analysis indicated that pterygia were not associated with smoking status (OR 1.0, 95% CI 0.8-1.4) or alcohol intake (OR 1.0, 95% CI 0.7-1.4, p > 0.05). This study details the occurrence of and risk factors for pterygia in a Chinese population residing in a rural, high-latitude, cold-climate area of Northern China. The primary risk factors for pterygia were age, male sex, and outdoor work.

Association of the oxytocin receptor (OXTR) gene polymorphisms with autism spectrum disorder (ASD) in the Japanese population.

PubMed

Liu, Xiaoxi; Kawamura, Yoshiya; Shimada, Takafumi; Otowa, Takeshi; Koishi, Shinko; Sugiyama, Toshiro; Nishida, Hisami; Hashimoto, Ohiko; Nakagami, Ryoichi; Tochigi, Mamoru; Umekage, Tadashi; Kano, Yukiko; Miyagawa, Taku; Kato, Nobumasa; Tokunaga, Katsushi; Sasaki, Tsukasa

2010-03-01

The oxytocin receptor (OXTR) gene, which is located on chromosome 3p25.3, has been implicated as a candidate gene for susceptibility of autism spectrum disorder (ASD). Positive associations between OXTR and ASD have been reported in earlier studies. However, the results were inconsistent and demand further studies. In this study, we investigated the associations between OXTR and ASD in a Japanese population by analyzing 11 single-nucleotide polymorphisms (SNPs) using both family-based association test (FBAT) and population-based case-control test. No significant signal was detected in the FBAT test. However, significant differences were observed in allelic frequencies of four SNPs, including rs2254298 between patients and controls. The risk allele of rs2254298 was 'A', which was consistent with the previous study in Chinese, and not with the observations in Caucasian. The difference in the risk allele of this SNP in previous studies might be attributable to an ethnic difference in the linkage disequilibrium structure between the Asians and Caucasians. In addition, haplotype analysis exhibits a significant association between a five-SNP haplotype and ASD, including rs22542898. In conclusion, our study might support that OXTR has a significant role in conferring the risk of ASD in the Japanese population.

Diabetes mellitus increases the risk of rotator cuff tear repair surgery: A population-based cohort study.

PubMed

Huang, Shih-Wei; Wang, Wei-Te; Chou, Lin-Chuan; Liou, Tsan-Hon; Chen, Yi-Wen; Lin, Hui-Wen

Rotator cuff tears are the most common cause of shoulder disability in people older than 50years, and surgical intervention is usually required for restoring functioning. However, in patients undergoing rotator cuff repair surgery, patients with DM had poorer functional outcomes than those without DM, and hence, DM is one of the possible risks factor for rotator cut off tear. The aim of this population-based study was to investigate the relationship between DM and the risk of rotator cuff tear in patients receiving rotator cuff repair surgery. In this retrospective longitudinal population-based 7-year cohort study, we investigated the risk of rotator cuff repair surgery in patients with DM. We performed a case-control matched analysis by using data from the Taiwan Longitudinal Health Insurance Database 2005. Patients were enrolled on the basis of the International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic codes for DM between January 1, 2004, and December 31, 2007. The prevalence and the adjusted hazard ratios (HRs) of a rotator cuff repair surgery in patients with and without DM were estimated according to the Cox proportional hazard regression analysis using the frailty model. The DM and non-DM cohorts comprised 58,652 patients with DM and 117,304 (1:2) patients without DM after matching for age and sex. The incidence of rotator cuff repair surgery was 41 per 100,000 and 26 per 100,000 person-years in the DM and non-DM cohorts, respectively. The HR of rotator cuff repair surgery during the follow-up period was 1.56 (95% confidence interval [CI] 1.25-1.93, p<0.001) for patients with DM. After adjustment for covariates, the adjusted HR of rotator cuff repair surgery was 1.33 (95% CI, 1.05-1.68, p<0.001) in the DM cohort. DM is an independent risk factor for rotator cuff tear repair surgery. Copyright © 2016 Elsevier Inc. All rights reserved.

Dose-response relationship between dietary magnesium intake and cardiovascular mortality: A systematic review and dose-based meta-regression analysis of prospective studies.

PubMed

Fang, Xin; Liang, Chun; Li, Mei; Montgomery, Scott; Fall, Katja; Aaseth, Jan; Cao, Yang

2016-12-01

Although epidemiology studies have reported the relationship, including a dose-response relationship, between dietary magnesium intake and risk of cardiovascular disease (CVD), the risk for CVD mortality is inconclusive and the evidence for a dose-response relationship has not been summarized. We conducted a systematic review and meta-analysis of prospective studies to summarize the evidence regarding the association of dietary magnesium intake with risk of CVD mortality and describe their dose-response relationship. We identified relevant studies by searching major scientific literature databases and grey literature resources from their inception to August 2015, and reviewed references lists of retrieved articles. We included population-based studies that reported mortality risks, i.e. relative risks (RRs), odds ratios (ORs) or hazard ratios (HRs) of CVD mortality or cause-specific CVD death. Linear dose-response relationships were assessed using random-effects meta-regression. Potential nonlinear associations were evaluated using restricted cubic splines. Out of 3002 articles, 9 articles from 8 independent studies met the eligibility criteria. These studies comprised 449,748 individuals and 10,313 CVD deaths. Compared with the lowest dietary magnesium consumption group in the population, the risk of CVD mortality was reduced by 16% in women and 8% in men. No significant linear dose-response relationship was found between increment in dietary magnesium intake and CVD mortality across all the studies. After adjusting for age and BMI, the risk of CVD mortality was reduced by 24-25% per 100mg/d increment in dietary magnesium intake in women of all the participants and in all the US participants. Although the combined data confirm the role of dietary magnesium intake in reducing CVD mortality, the dose-response relationship was only found among women and in US population. Copyright © 2016 Elsevier GmbH. All rights reserved.

Estimation of risk of cancers before occurrence of acquired immunodeficiency syndrome in persons infected with human immunodeficiency virus.

PubMed

Li, Yueming; Law, Matthew; McDonald, Ann; Correll, Patty; Kaldor, John M; Grulich, Andrew E

2002-01-15

There is methodological debate as to whether cohorts defined by acquired immunodeficiency syndrome (AIDS) diagnosis can be used to estimate risks of cancer in persons with human immunodeficiency virus (HIV) before AIDS. The authors compared risks of non-AIDS-defining cancers before AIDS in persons with HIV using a cohort based on AIDS diagnosis and a second cohort based on HIV diagnosis. National population-based registries of AIDS and HIV diagnoses to August 1999 were matched separately with the National Cancer Registry in Australia. Four analyses were performed. In analysis 1, follow-up was from 5 years before AIDS registration in 8,118 persons with AIDS. Analysis 2 was similar but adjusted expected numbers of cancers for decreased survival. Analysis 3 was based on 7,061 persons registered with HIV, with follow-up from the reported date of diagnosis. Analysis 4 was based on 2,112 AIDS cases previously reported with HIV, with follow-up from 5 years before AIDS diagnosis. In all analyses, follow-up ended at cancer diagnosis, death, 6 months before AIDS, or the end of available cancer data, whichever occurred first. For 10 types of cancer there were at least three cases in any one of the analyses. For these cancers there was no systematic pattern such that one analysis produced consistently higher or lower estimates than the others. These analyses suggest that cancer risk in persons with HIV before AIDS diagnosis may be estimated reliably based on cancer experience 5 years before AIDS.

The utility of diabetes risk score items as predictors of incident type 2 diabetes in Asian populations: An evidence-based review.

PubMed

Hu, Pei Lin; Koh, Yi Ling Eileen; Tan, Ngiap Chuan

2016-12-01

The prevalence of type 2 diabetes mellitus is rising, with many Asian countries featured in the top 10 countries with the highest numbers of persons with diabetes. Reliable diabetes risk scores enable the identification of individuals at risk of developing diabetes for early intervention. This article aims to identify common risk factors in the risk scores with the highest discrimination; factors with the most influence on the risk score in Asian populations, and to propose a set of factors translatable to the multi-ethnic Singapore population. A systematic search of PubMed and EMBASE databases was conducted to identify studies published before August 2016 that developed risk prediction models for incident diabetes. 12 studies were identified. Risk scores that included laboratory measurements had better discrimination. Coefficient analysis showed fasting glucose and HbA1c having the greatest impact on the risk score. A proposed Asian risk score would include: family history of diabetes, age, gender, smoking status, body mass index, waist circumference, hypertension, fasting plasma glucose, HbA1c, HDL-cholesterol and triglycerides. Future research is required on the influence of ethnicity in Singapore. The risk score may potentially be used to stratify individuals for enrolment into diabetes prevention programmes. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Retracted: Association of ACE I/D gene polymorphism with T2DN susceptibility and the risk of T2DM developing into T2DN in a Caucasian population.

PubMed

Liu, Guohui; Zhou, Tian-Biao; Jiang, Zongpei; Zheng, Dongwen

2015-03-01

The association of the angiotensin-converting enzyme (ACE) insertion/deletion (I/D) gene polymorphism with type-2 diabetic nephropathy (T2DN) susceptibility and the risk of type-2 diabetes mellitus (T2DM) developing into T2DN in Caucasian populations is still controversial. A meta-analysis was performed to evaluate the association of ACE I/D gene polymorphism with T2DN susceptibility and the risk of T2DM developing into T2DN in Caucasian populations. A predefined literature search and selection of eligible relevant studies were performed to collect data from electronic databases. Sixteen articles were identified for the analysis of the association of ACE I/D gene polymorphism with T2DN susceptibility and the risk of T2DM developing into T2DN in Caucasian populations. ACE I/D gene polymorphism was not associated with T2DN susceptibility and the risk of patients with T2DM developing T2DN in Caucasian populations. Sensitivity analysis according to sample size of case (<100 vs. ≥100) was also performed, and the results were similar to the non-sensitivity analysis. ACE I/D gene polymorphism was not associated with T2DN susceptibility and the risk of patients with T2DM developing T2DN in Caucasian populations. However, more studies should be performed in the future. © The Author(s) 2014.

Whole exome sequencing in 75 high-risk families with validation and replication in independent case-control studies identifies TANGO2, OR5H14, and CHAD as new prostate cancer susceptibility genes.

PubMed

Karyadi, Danielle M; Geybels, Milan S; Karlins, Eric; Decker, Brennan; McIntosh, Laura; Hutchinson, Amy; Kolb, Suzanne; McDonnell, Shannon K; Hicks, Belynda; Middha, Sumit; FitzGerald, Liesel M; DeRycke, Melissa S; Yeager, Meredith; Schaid, Daniel J; Chanock, Stephen J; Thibodeau, Stephen N; Berndt, Sonja I; Stanford, Janet L; Ostrander, Elaine A

2017-01-03

Prostate cancer (PCa) susceptibility is defined by a continuum from rare, high-penetrance to common, low-penetrance alleles. Research to date has concentrated on identification of variants at the ends of that continuum. Taking an alternate approach, we focused on the important but elusive class of low-frequency, moderately penetrant variants by performing disease model-based variant filtering of whole exome sequence data from 75 hereditary PCa families. Analysis of 341 candidate risk variants identified nine variants significantly associated with increased PCa risk in a population-based, case-control study of 2,495 men. In an independent nested case-control study of 7,121 men, there was risk association evidence for TANGO2 p.Ser17Ter and the established HOXB13 p.Gly84Glu variant. Meta-analysis combining the case-control studies identified two additional variants suggestively associated with risk, OR5H14 p.Met59Val and CHAD p.Ala342Asp. The TANGO2 and HOXB13 variants co-occurred in cases more often than expected by chance and never in controls. Finally, TANGO2 p.Ser17Ter was associated with aggressive disease in both case-control studies separately. Our analyses identified three new PCa susceptibility alleles in the TANGO2, OR5H14 and CHAD genes that not only segregate in multiple high-risk families but are also of importance in altering disease risk for men from the general population. This is the first successful study to utilize sequencing in high-risk families for the express purpose of identifying low-frequency, moderately penetrant PCa risk mutations.

[Study of population profiles in relation to the level of suicide risk in France: Study "Mental health in the general population"].

PubMed

Chabaud, Francis; Debarre, Julie; Serazin, Céline; Bouet, Roland; Vaïva, Guillaume; Roelandt, Jean Luc

2010-01-01

Suicidal behaviour is a very important public health issue. The French study of mental health in the general population casts a whole new insight on this issue thanks to the size of the sample used, to its representative nature and to the variety of the collected data. This study aims at defining better the relationships between the factors of suicide risk within a noninstitutionalized adult population and more specifically between the socioeconomic and the psychopathological factors. The final aim is to help define the intervention strategies which should be developed in the context of prevention programs. The method used consists in estimating the suicide risk for each person included in the study by developing a standardized indicator. Six questions taken from the MINI (Mini International Neuropsychiatric Interview) were used to define the four levels of suicide risks which compose this indicator. Next, this indicator was matched for the socioeconomic variables of the study as well as for the main psychopathological categories. A factor analysis of the numerous relations was then carried out. Its principle consisted in synthesizing the information contained in a great number of variables and individuals thanks to the mathematical projection of these features onto a graph. The variables which were retained for the analysis were those which presented the richest relationship with the main variable.(that is to say the level of suicide risk). The estimated prevalence rate of suicidal risk in the general population (with at least one positive answer) is 13.7% which can be divided into 9.7% of low risk, 2.1% of medium risk and 1.9% of high risk. The relationship between the presence of a psychopathology and a medium or high risk of suicide is quite significant. What is more, the presence of associated pathologies (comorbidities) increases the risk. The highest prevalence of risk is observed in psychotic and depressive disorders. However, suicide risk exists in some people who do not present any detected psychopathology : the statistical analysis reveals an excessive medium and high suicide risk in relation to a low family income, unemployment, separation and the 18 to 24 age group. The multidimensional analysis brings to light several specific aspects : the principal explanation shows a relationship between unfavourable socio economic status and the presence of suicide risk at a level which is not equal to zero. The second explanatory line defines the level of risk according to the principal psychopathological characteristics. These two lines define a plane which enables to differentiate low risk groups from medium risk groups and high risk groups. The latter consists mainly in isolated pathological factors or associated factors (comorbidities). The medium and high risk groups are composed mainly of the combination of the two variables. To conclude, these results - which are necessarily flimsy since they are based on epidemiological and statistical analysis - do however match up with the data of the epidemiologic literature in an interesting way and raise the question of an intervention and prevention strategy that would integrate better the medical factors and the socio economic aspects into its program. They should be completed by targeted forward clinical studies as well as by more precise epidemiological patterns. Copyright 2010 L’Encéphale. Published by Elsevier Masson SAS.. All rights reserved.

Mesalamine, but Not Sulfasalazine, Reduces the Risk of Colorectal Neoplasia in Patients with Inflammatory Bowel Disease: An Agent-specific Systematic Review and Meta-analysis.

PubMed

OʼConnor, Anthony; Packey, Christopher D; Akbari, Mona; Moss, Alan C

2015-11-01

In some studies, 5-aminosalicylates as a class have been associated with protective effects against colorectal cancer in inflammatory bowel disease. In practice, only mesalamine at doses greater than 1.2 g per day is currently widely in this setting. The specific impact of mesalamine at these doses has not has not previously been determined. We performed a systematic review and meta-analysis of the effect of mesalamine on risk of colorectal neoplasia (CRN) from prior cohort and case-control studies. Sensitivity analyses for study setting and case definition were performed. A quality assessment was made of all included studies. Mesalamine was associated with a modest reduction in the odds ratio (OR) of CRN (OR = 0.6, 95% confidence interval, 0.4-0.9, P = 0.04). This effect was only noted in hospital-based studies and only in the reduction of all CRN (not cancers alone). Patients prescribed doses >1.2 g per day had a lower risk of CRN (OR = 0.5, 95% confidence interval, 0.3-0.9, P = 0.02) than lower doses. This effect was also only present in the hospital-based studies. In contrast, there was no reduction in the risk of CRN in patients prescribed sulfasalazine (OR = 0.8, 95% confidence interval, 0.5-1.2, P = 0.3), regardless of study setting. Mesalamine, particularly at doses >1.2 g per day, produces a modest reduction in the risk of CRN in inflammatory bowel disease patient populations from referral centers. Sulfasalazine does not seem to reduce the risk. No benefit was noted in population-based studies.

Dementia and Traffic Accidents: A Danish Register-Based Cohort Study.

PubMed

Petersen, Jindong Ding; Siersma, Volkert; Nielsen, Connie Thurøe; Vass, Mikkel; Waldorff, Frans Boch

2016-09-27

As a consequence of a rapid growth of an ageing population, more people with dementia are expected on the roads. Little is known about whether these people are at increased risk of road traffic-related accidents. Our study aims to investigate the risk of road traffic-related accidents for people aged 65 years or older with a diagnosis of dementia in Denmark. We will conduct a nationwide population-based cohort study consisting of Danish people aged 65 or older living in Denmark as of January 1, 2008. The cohort is followed for 7 years (2008-2014). Individual's personal data are available in Danish registers and can be linked using a unique personal identification number. A person is identified with dementia if the person meets at least one of the following criteria: (1) a diagnosis of the disease in the Danish National Patient Register or in the Danish Psychiatric Central Research Register, and/or (2) at least one dementia diagnosis-related drug prescription registration in the Danish National Prescription Registry. Police-, hospital-, and emergency room-reported road traffic-related accidents occurred within the study follow-up are defined as the study outcome. Cox proportional hazard regression models are used for the main analysis. Our study protocol has 3 phases including data collection, data analysis, and reporting. The first phase of register-based data collection of 853,228 individual's personal information was completed in August, 2016. The next phase is data analysis, which is expected to be finished before December 2016, and thereafter writing publications based on the findings. The study started in January 2016 and will end in December 2018. This study covers the entire elderly population of Denmark, and thereby will avoid selection bias due to nonparticipation and loss to follow-up. Furthermore, this ensures that the study results are reliable and generalizable. However, underreporting of traffic-related accidents may occur, which will limit estimation of absolute risks.

Dementia and Traffic Accidents: A Danish Register-Based Cohort Study

PubMed Central

Siersma, Volkert; Nielsen, Connie Thurøe; Vass, Mikkel; Waldorff, Frans Boch

2016-01-01

Background As a consequence of a rapid growth of an ageing population, more people with dementia are expected on the roads. Little is known about whether these people are at increased risk of road traffic-related accidents. Objective Our study aims to investigate the risk of road traffic-related accidents for people aged 65 years or older with a diagnosis of dementia in Denmark. Methods We will conduct a nationwide population-based cohort study consisting of Danish people aged 65 or older living in Denmark as of January 1, 2008. The cohort is followed for 7 years (2008-2014). Individual’s personal data are available in Danish registers and can be linked using a unique personal identification number. A person is identified with dementia if the person meets at least one of the following criteria: (1) a diagnosis of the disease in the Danish National Patient Register or in the Danish Psychiatric Central Research Register, and/or (2) at least one dementia diagnosis-related drug prescription registration in the Danish National Prescription Registry. Police-, hospital-, and emergency room-reported road traffic-related accidents occurred within the study follow-up are defined as the study outcome. Cox proportional hazard regression models are used for the main analysis. Results Our study protocol has 3 phases including data collection, data analysis, and reporting. The first phase of register-based data collection of 853,228 individual’s personal information was completed in August, 2016. The next phase is data analysis, which is expected to be finished before December 2016, and thereafter writing publications based on the findings. The study started in January 2016 and will end in December 2018. Discussion This study covers the entire elderly population of Denmark, and thereby will avoid selection bias due to nonparticipation and loss to follow-up. Furthermore, this ensures that the study results are reliable and generalizable. However, underreporting of traffic-related accidents may occur, which will limit estimation of absolute risks. PMID:27678553

Primary Sjogren's syndrome and the risk of acute pancreatitis: a nationwide cohort study.

PubMed

Chang, Chi-Ching; Chang, Yu-Sheng; Wang, Shu-Hung; Lin, Shyr-Yi; Chen, Yi-Hsuan; Chen, Jin Hua

2017-08-11

Studies on the risk of acute pancreatitis in patients with primary Sjogren's syndrome (pSS) are limited. We evaluated the effects of pSS on the risk of acute pancreatitis in a nationwide, population-based cohort in Taiwan. Population-based retrospective cohort study. We studied the claims data of the >97% Taiwan population from 2002 to 2012. We identified 9468 patients with pSS by using the catastrophic illness registry of the National Health Insurance Database in Taiwan. We also selected 37 872 controls that were randomly frequency matched by age (in 5 year bands), sex and index year from the general population. We analysed the risk of acute pancreatitis by using Cox proportional hazards regression models including sex, age and comorbidities. From 23.74 million people in the cohort, 9468 patients with pSS (87% women, mean age=55.6 years) and 37 872 controls were followed-up for 4.64 and 4.74 years, respectively. A total of 44 cases of acute pancreatitis were identified in the pSS cohort versus 105 cases in the non-pSS cohort. Multivariate Cox regression analysis indicated that the incidence rate of acute pancreatitis was significantly higher in the pSS cohort than in the non-pSS cohort (adjusted HR (aHR) 1.48, 95% CI 1.03 to 2.12). Cyclophosphamide use increased the risk of acute pancreatitis (aHR 5.27, 95% CI 1.16 to 23.86). By contrast, hydroxychloroquine reduced the risk of acute pancreatitis (aHR 0.23, 95% CI 0.09 to 0.55). This nationwide, retrospective cohort study demonstrated that the risk of acute pancreatitis was significantly higher in patients with pSS than in the general population. © 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.

Hyperthyroidism is a Risk Factor for Developing Adhesive Capsulitis of the Shoulder: A Nationwide Longitudinal Population-Based Study

PubMed Central

Huang, Shih-Wei; Lin, Jia-Wei; Wang, Wei-Te; Wu, Chin-Wen; Liou, Tsan-Hon; Lin, Hui-Wen

2014-01-01

The purpose of this study was to investigate the prevalence and risk of adhesive capsulitis among hyperthyroidism patients. The data were obtained from the Longitudinal Health Insurance Database 2005 (LHID 2005) in Taiwan, using 1 million participants and a prospective population-based 7-year cohort study of survival analysis. The ambulatory-care claim records of patients diagnosed according to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes relating to hyperthyroidism between January 1, 2004 and December 31, 2007, were obtained. The prevalence and the adjusted hazard ratio (HR) of adhesive capsulitis among hyperthyroid patients and the control group were estimated. Of 4472 hyperthyroid patients, 162 (671/100 000 person-years) experienced adhesive capsulitis during the 24 122 person-year follow-up period. The crude HR of stroke was 1.26 (95% confidence interval [CI], 1.06 to 1.49), which was larger than that of the control group. The adjusted HR of developing adhesive capsulitis was 1.22 (95% CI, 1.03 to 1.45) for hyperthyroid patients during the 7-year follow-up period, which achieved statistical significance. The results of our large-scale longitudinal population-based study indicated that hyperthyroidism is an independent risk factor of developing adhesive capsulitis. PMID:24567049

Hyperthyroidism is a risk factor for developing adhesive capsulitis of the shoulder: a nationwide longitudinal population-based study.

PubMed

Huang, Shih-Wei; Lin, Jia-Wei; Wang, Wei-Te; Wu, Chin-Wen; Liou, Tsan-Hon; Lin, Hui-Wen

2014-02-25

The purpose of this study was to investigate the prevalence and risk of adhesive capsulitis among hyperthyroidism patients. The data were obtained from the Longitudinal Health Insurance Database 2005 (LHID 2005) in Taiwan, using 1 million participants and a prospective population-based 7-year cohort study of survival analysis. The ambulatory-care claim records of patients diagnosed according to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes relating to hyperthyroidism between January 1, 2004 and December 31, 2007, were obtained. The prevalence and the adjusted hazard ratio (HR) of adhesive capsulitis among hyperthyroid patients and the control group were estimated. Of 4472 hyperthyroid patients, 162 (671/100,000 person-years) experienced adhesive capsulitis during the 24,122 person-year follow-up period. The crude HR of stroke was 1.26 (95% confidence interval [CI], 1.06 to 1.49), which was larger than that of the control group. The adjusted HR of developing adhesive capsulitis was 1.22 (95% CI, 1.03 to 1.45) for hyperthyroid patients during the 7-year follow-up period, which achieved statistical significance. The results of our large-scale longitudinal population-based study indicated that hyperthyroidism is an independent risk factor of developing adhesive capsulitis.

Methylenetetrahydrofolate reductase gene polymorphisms and acute lymphoblastic leukemia risk: a meta-analysis based on 28 case-control studies.

PubMed

Tong, Na; Sheng, Xiaojing; Wang, Meilin; Fang, Yongjun; Shi, Danni; Zhang, Zhizhong; Zhang, Zhengdong

2011-10-01

Methylenetetrahydrofolate reductase (MTHFR) is involved in DNA methylation and nucleotide synthesis. Accumulated evidence has demonstrated that C677T and A1298C polymorphisms of the MTHFR gene are associated with acute lymphoblastic leukemia (ALL) risk, but the results have been inconclusive. To determine a more precise estimation, we performed a meta-analysis of 28 studies with 4240 cases and 9289 controls. We found that the 677TT genotype showed a reduced risk of ALL compared with the 677CC genotype in the overall population (odds ratio [OR] 0.76, 95% confidence interval [CI] 0.61-0.92). The reduced risk was pronounced only among the Caucasian population (OR 0.68, 95% CI 0.51-0.90), not the Asian (OR 0.89, 95% CI 0.75-1.05). For the MTHFR A1298C polymorphism, no significant association with ALL susceptibility was observed in the pooled analyses. However, significantly increased ALL risk was found in childhood in the comparison of 1298CA versus AA genotype. This study provides evidence that MTHFR polymorphisms may play an important role in the development of ALL.

Fleeing to Fault Zones: Incorporating Syrian Refugees into Earthquake Risk Analysis along the East Anatolian and Dead Sea Rift Fault Zones

NASA Astrophysics Data System (ADS)

Wilson, B.; Paradise, T. R.

2016-12-01

The influx of millions of Syrian refugees into Turkey has rapidly changed the population distribution along the Dead Sea Rift and East Anatolian Fault zones. In contrast to other countries in the Middle East where refugees are accommodated in camp environments, the majority of displaced individuals in Turkey are integrated into cities, towns, and villages—placing stress on urban settings and increasing potential exposure to strong shaking. Yet, displaced populations are not traditionally captured in data sources used in earthquake risk analysis or loss estimations. Accordingly, we present a district-level analysis assessing the spatial overlap of earthquake hazards and refugee locations in southeastern Turkey to determine how migration patterns are altering seismic risk in the region. Using migration estimates from the U.S. Humanitarian Information Unit, we create three district-level population scenarios that combine official population statistics, refugee camp populations, and low, median, and high bounds for integrated refugee populations. We perform probabilistic seismic hazard analysis alongside these population scenarios to map spatial variations in seismic risk between 2011 and late 2015. Our results show a significant relative southward increase of seismic risk for this period due to refugee migration. Additionally, we calculate earthquake fatalities for simulated earthquakes using a semi-empirical loss estimation technique to determine degree of under-estimation resulting from forgoing migration data in loss modeling. We find that including refugee populations increased casualties by 11-12% using median population estimates, and upwards of 20% using high population estimates. These results communicate the ongoing importance of placing environmental hazards in their appropriate regional and temporal context which unites physical, political, cultural, and socio-economic landscapes. Keywords: Earthquakes, Hazards, Loss-Estimation, Syrian Crisis, Migration, Refugees

Detection of canine distemper virus serum neutralizing antibodies in captive U.S. phocids.

PubMed

Clancy, Meredith M; Gamble, Kathryn C; Travis, Dominic A

2013-03-01

Antibodies to morbilliviruses have been documented in free-ranging pinnipeds throughout populations in the Atlantic and Arctic Oceans, but not from the Pacific Ocean. As a symbolic geographic barrier between the exposed Atlantic and naive Pacific populations, the captive phocid population in North America had undocumented serologic status. In this study, canine distemper virus (CDV) serum neutralization assays were used to assess the prevalence of antibodies in this population with participation of 25 U.S. institutions from grey seals (Halichoerus grypus, n = 6) and harbor seals (Phoca vitulina, n = 108). Historic and environmental risk factors associated with the epidemiology of distemper virus were collected by survey. Based on antibodies to canine distemper virus, the prevalence of exposure in this population was 25.5%, with 28 seals (grey, n = 2; harbor, n = 26) demonstrating antibody titers > or = 1:16, and positive titers ranged from 1:4 to 1:1,536. By survey analysis, strong associations with seropositive status were identified for captive origin (P = 0.013) and movement among institutions (P = 0.024). Size of population has positive correlation with likelihood of seropositive seals at an institution (P = 0.020). However, no major husbandry or enclosure-based risk factors were identified in institutions with seropositive seals, and no interaction between individual or institutional risk factors was identified. Previously undocumented prior to this study, CDV antibodies were measured in harbor seals (n = 2) recently stranded from the Pacific coast.

Performance of diagnosis-based risk adjustment measures in a population of sick Australians.

PubMed

Duckett, S J; Agius, P A

2002-12-01

Australia is beginning to explore 'managed competition' as an organising framework for the health care system. This requires setting fair capitation rates, i.e. rates that adjust for the risk profile of covered lives. This paper tests two US-developed risk adjustment approaches using Australian data. Data from the 'co-ordinated care' dataset (which incorporates all service costs of 16,538 participants in a large health service research project conducted in 1996-99) were grouped into homogenous risk categories using risk adjustment 'grouper software'. The grouper products yielded three sets of homogenous categories: Diagnostic Groups and Diagnostic cost Groups. A two-stage analysis of predictive power was used: probability of any service use in the concurrent year, next year and the year after (logistic regression) and, for service users, a regression of logged cost of service use. The independent variables were diagnosis gender, a SES variable and the Age, gender and diagnosis-based risk adjustment measures explain around 40-45% of variation in costs of service use in the current year for untrimmed data (compared with around 15% for age and gender alone). Prediction of subsequent use is much poorer (around 20%). Using more information to assign people to risk categories generally improves prediction. Predictive power of diagnosis-base risk adjusters on this Australian dataset is similar to that found in Low predictive power carries policy risks of cream skimming rather than managing population health and care. Competitive funding models with risk adjustment on prior year experience could reduce system efficiency if implemented with current risk adjustment technology.

Population-based screening program for reducing oral cancer mortality in 2,334,299 Taiwanese cigarette smokers and/or betel quid chewers.

PubMed

Chuang, Shu-Lin; Su, William Wang-Yu; Chen, Sam Li-Sheng; Yen, Amy Ming-Fang; Wang, Cheng-Ping; Fann, Jean Ching-Yuan; Chiu, Sherry Yueh-Hsia; Lee, Yi-Chia; Chiu, Han-Mo; Chang, Dun-Cheng; Jou, Yann-Yuh; Wu, Chien-Yuan; Chen, Hsiu-Hsi; Chen, Mu-Kuan; Chiou, Shu-Ti

2017-05-01

To reduce oral cancer mortality, an organized, population-based screening program for the early detection of oral premalignancy and oral cancer was designed for high-risk individuals with habits of betel quid chewing, cigarette smoking, or both. The objective of this report was to evaluate the long-term effectiveness of this program in reducing the incidence of advanced disease and deaths from oral cancer. A nationwide, population-based screening program for oral cancer has been conducted in Taiwan since 2004. Residents aged ≥ 18 years with oral habits of cigarette smoking and/or betel quid chewing were invited. The standardized mortality ratio method was used to compare the observed numbers of advanced oral cancers and deaths from oral cancer among screening attendees with the expected numbers derived from mortality among nonattendees. An intention-to-treat analysis of the relative rate of reductions in advanced-stage oral cancers and oral cancer mortality also was conducted. The overall screening rate was 55.1%. The relative risk of death from oral cancer was 0.53 (95% confidence interval [CI], 0.51-0.56) as a result of screening compared with the expected risk of oral cancer deaths in the absence of screening. The corresponding relative risk was 0.74 (95% CI, 0.72-0.77) after adjusting for self-selection bias. The relative risk of advanced oral cancer for the screened group versus the nonscreened group was 0.62 (95% CI, 0.59-0.64), which increased to 0.79 (95% CI, 0.76-0.82) after adjustment for self-selection bias. An organized, population-based oral cancer screening program targeting more than 2 million Taiwanese cigarette smokers and/or betel quid chewers demonstrated the effectiveness of reducing stage III or IV oral cancers and oral cancer mortality. These evidence-based findings corroborate and support the screening strategy of oral visual inspection for the prevention of oral cancer among high-risk individuals in areas with a high incidence of oral cancer. Cancer 2017;123:1597-1609. © 2017 American Cancer Society. © 2017 American Cancer Society.

Fasting insulin, insulin resistance and risk of hypertension in the general population: A meta-analysis.

PubMed

Wang, Feng; Han, Lili; Hu, Dayi

2017-01-01

Studies on the association of fasting insulin concentrations or insulin resistance with subsequent risk of hypertension have yielded conflicting results. To quantitatively assess the association of fasting insulin concentrations or homeostasis model assessment insulin resistance (HOMA-IR) with incident hypertension in a general population by performing a meta-analysis. We searched the PubMed and Embase databases until August 31, 2016 for prospective observational studies investigating the elevated fasting insulin concentrations or HOMA-IR with subsequent risk of hypertension in the general population. Pooled risk ratio (RR) and 95% confidence interval (CI) of hypertension was calculated for the highest versus the lowest category of fasting insulin or HOMA-IR. Eleven studies involving 10,230 hypertension cases were identified from 55,059 participants. Meta-analysis showed that the pooled adjusted RR of hypertension was 1.54 (95% CI 1.34-1.76) for fasting insulin concentrations and 1.43 (95% CI 1.27-1.62) for HOMA-IR comparing the highest to the lowest category. Subgroup analysis results showed that the association of fasting insulin concentrations with subsequent risk of hypertension seemed more pronounced in women (RR 2.07; 95% CI 1.19-3.60) than in men (RR 1.48; 95% CI 1.17-1.88). This meta-analysis suggests that elevated fasting insulin concentrations or insulin resistance as estimated by homeostasis model assessment is independently associated with an exacerbated risk of hypertension in the general population. Early intervention of hyperinsulinemia or insulin resistance may help clinicians to identify the high risk of hypertensive population. Copyright © 2016 Elsevier B.V. All rights reserved.

Haloacetic acids in drinking water and risk for stillbirth.

PubMed

King, W D; Dodds, L; Allen, A C; Armson, B A; Fell, D; Nimrod, C

2005-02-01

Trihalomethanes (THMs) occurring in public drinking water sources have been investigated in several epidemiological studies of fetal death and results support a modest association. Other classes of disinfection by-products found in drinking water have not been investigated. To investigate the effects of haloacetic acid (HAA) compounds in drinking water on stillbirth risk. A population based case-control study was conducted in Nova Scotia and Eastern Ontario, Canada. Estimates of daily exposure to total and specific HAAs were based on household water samples and questionnaire information on water consumption at home and work. The analysis included 112 stillbirth cases and 398 live birth controls. In analysis without adjustment for total THM exposure, a relative risk greater than 2 was observed for an intermediate exposure category for total HAA and dichloroacetic acid measures. After adjustment for total THM exposure, the risk estimates for intermediate exposure categories were diminished, the relative risk associated with the highest category was in the direction of a protective effect, and all confidence intervals included the null value. No association was observed between HAA exposures and stillbirth risk after controlling for THM exposures.

Duration of second stage of labor and instrumental delivery as risk factors for severe perineal lacerations: population-based study.

PubMed

Simic, Marija; Cnattingius, Sven; Petersson, Gunnar; Sandström, Anna; Stephansson, Olof

2017-02-21

We sought to investigate the impact of the duration of second stage of labor on risk of severe perineal lacerations (third and fourth degree). This population based cohort study was conducted in the Stockholm/Gotland region, Sweden, 2008-2014. Study population included 52 211 primiparous women undergoing vaginal delivery with cephalic presentation at term. Unconditional logistic regression analysis was used to calculate crude and adjusted odds ratios (OR), using 95% confidence intervals (CI). Main exposure was duration of second stage of labor, and main outcome was risks of severe perineal lacerations (third and fourth degree). Risk of severe perineal lacerations increased with duration of second stage of labor. Compared with a second stage of labor of 1 h or less, women with a second stage of more than 2 h had an increased risk (aOR 1.42; 95% CI 1.28-1.58). Compared with non-instrumental vaginal deliveries, the risk was elevated among instrumental vaginal deliveries (aOR 2.24; 95% CI 2.07-2.42). The risk of perineal laceration increased with duration of second stage of labor until less than 3 h in both instrumental and non-instrumental vaginal deliveries, but after 3 h, the ORs did not further increase. After adjustments for potential confounders, macrosomia (birth weight > 4 500 g) and occiput posterior fetal position were risk factors of severe perineal lacerations. The risk of severe perineal laceration increases with duration until the third hour of second stage of labor. Instrumental delivery is the most significant risk factor for severe lacerations, followed by duration of second stage of labor, fetal size and occiput posterior fetal position.

Secondary Primary Malignancy Risk in Patients With Cervical Cancer in Taiwan: A Nationwide Population-Based Study.

PubMed

Teng, Chung-Jen; Huon, Leh-Kiong; Hu, Yu-Wen; Yeh, Chiu-Mei; Chao, Yee; Yang, Muh-Hwa; Chen, Tzeng-Ji; Hung, Yi-Ping; Liu, Chia-Jen

2015-10-01

To evaluate the risk of secondary primary malignancy (SPM) in patients with cervical cancer using a nationwide population-based dataset.Patients newly diagnosed with cervical cancer between 1997 and 2011 were identified using Taiwan's National Health Insurance database. Patients with antecedent malignancies were excluded. Standardized incidence ratios (SIRs) for SPM were calculated by comparing with the cancer incidence in the general population. Risk factors for cancer development were analyzed using Cox proportional hazard models.During the 14-year study period (follow-up of 223,062 person-years), 2004 cancers developed in 35,175 patients with cervical cancer. The SIR for all cancers was 1.56 (95% confidence interval, 1.50-1.63, P < 0.001). SIRs for follow-up periods of >10, 5 to 10, 1 to 5, and <1 year were 1.37, 1.51, 1.34, and 2.59, respectively. After the exclusion of SPM occurring within 1 year of cervical cancer diagnosis, SIRs were significantly higher for cancers of the esophagus (2.05), stomach (1.38), colon, rectum, and anus (1.36); lung and mediastinum (2.28), bone and soft tissue (2.23), uterus (3.76), bladder (2.26), and kidneys (1.41). Multivariate analysis showed that age ≥60 was a significant SPM risk factor (hazard ratio [HR] 1.59). Different treatments for cervical cancer, including radiotherapy (HR 1.41) and chemotherapy (HR 1.27), had different impacts on SPM risk. Carboplatin and fluorouracil independently increased SPM risk in cervical cancer patients.Patients with cervical cancer are at increased risk of SPM development. Age ≥60 years, chemotherapy, and radiotherapy are independent risk factors. Carboplatin and fluorouracil also increased SPM risk independently. Close surveillance of patients at high risk should be considered for the early detection of SPMs.

Urinary bladder cancer treated with radical cystectomy: perioperative parameters and early complications prospectively registered in a national population-based database.

PubMed

Jerlström, Tomas; Gårdmark, Truls; Carringer, Malcolm; Holmäng, Sten; Liedberg, Fredrik; Hosseini, Abolfazl; Malmström, Per-Uno; Ljungberg, Börje; Hagberg, Oskar; Jahnson, Staffan

2014-08-01

Cystectomy combined with pelvic lymph-node dissection and urinary diversion entails high morbidity and mortality. Improvements are needed, and a first step is to collect information on the current situation. In 2011, this group took the initiative to start a population-based database in Sweden (population 9.5 million in 2011) with prospective registration of patients and complications until 90 days after cystectomy. This article reports findings from the first year of registration. Participation was voluntary, and data were reported by local urologists or research nurses. Perioperative parameters and early complications classified according to the modified Clavien system were registered, and selected variables of possible importance for complications were analysed by univariate and multivariate logistic regression. During 2011, 285 (65%) of 435 cystectomies performed in Sweden were registered in the database, the majority reported by the seven academic centres. Median blood loss was 1000 ml, operating time 318 min, and length of hospital stay 15 days. Any complications were registered for 103 patients (36%). Clavien grades 1-2 and 3-5 were noted in 19% and 15%, respectively. Thirty-seven patients (13%) were reoperated on at least once. In logistic regression analysis elevated risk of complications was significantly associated with operating time exceeding 318 min in both univariate and multivariate analysis, and with age 76-89 years only in multivariate analysis. It was feasible to start a national population-based registry of radical cystectomies for bladder cancer. The evaluation of the first year shows an increased risk of complications in patients with longer operating time and higher age. The results agree with some previously published series but should be interpreted with caution considering the relatively low coverage, which is expected to be higher in the future.

Geographic Variation of Amyotrophic Lateral Sclerosis Incidence in New Jersey, 2009–2011

PubMed Central

Henry, Kevin A.; Fagliano, Jerald; Jordan, Heather M.; Rechtman, Lindsay; Kaye, Wendy E.

2015-01-01

Few analyses in the United States have examined geographic variation and socioeconomic disparities in amyotrophic lateral sclerosis (ALS) incidence, because of lack of population-based incidence data. In this analysis, we used population-based ALS data to identify whether ALS incidence clusters geographically and to determine whether ALS risk varies by area-based socioeconomic status (SES). This study included 493 incident ALS cases diagnosed (via El Escorial criteria) in New Jersey between 2009 and 2011. Geographic variation and clustering of ALS incidence was assessed using a spatial scan statistic and Bayesian geoadditive models. Poisson regression was used to estimate the associations between ALS risk and SES based on census-tract median income while controlling for age, sex, and race. ALS incidence varied across and within counties, but there were no statistically significant geographic clusters. SES was associated with ALS incidence. After adjustment for age, sex, and race, the relative risk of ALS was significantly higher (relative risk (RR) = 1.37, 95% confidence interval (CI): 1.02, 1.82) in the highest income quartile than in the lowest. The relative risk of ALS was significantly lower among blacks (RR = 0.57, 95% CI: 0.39, 0.83) and Asians (RR = 0.63, 95% CI: 0.41, 0.97) than among whites. Our findings suggest that ALS incidence in New Jersey appears to be associated with SES and race. PMID:26041711

Spatial Analysis of Geohazards using ArcGIS--A web-based Course.

NASA Astrophysics Data System (ADS)

Harbert, W.; Davis, D.

2003-12-01

As part of the Environmental Systems Research Incorporated (ESRI) Virtual Campus program, a course was designed to present the benefits of Geographical Information Systems (GIS) based spatial analysis as applied towards a variety of geohazards. We created this on-line ArcGIS 8.x-based course to aid the motivated student or professional in his or her efforts to use GIS in determining where geohazards are likely to occur and for assessing their potential impact on the human community. Our course is broadly designed for earth scientists, public sector professionals, students, and others who want to apply GIS to the study of geohazards. Participants work with ArcGIS software and diverse datasets to display, visualize and analyze a wide variety of data sets and map a variety of geohazards including earthquakes, volcanoes, landslides, tsunamis, and floods. Following the GIS-based methodology of posing a question, decomposing the question into specific criteria, applying the criteria to spatial or tabular geodatasets and then analyzing feature relationships, from the beginning the course content was designed in order to enable the motivated student to answer questions. For example, to explain the relationship between earth quake location, earthquake depth, and plate boundaries; use a seismic hazard map to identify population and features at risk from an earthquake; import data from an earthquake catalog and visualize these data in 3D; explain the relationship between earthquake damage and local geology; use a flood scenario map to identify features at risk for forecast river discharges; use a tsunami inundation map to identify population and features at risk from tsunami; use a hurricane inundation map to identify the population at risk for any given category hurricane; estimate accumulated precipitation by integrating time-series Doppler radar data; and model a real-life landslide event. The six on-line modules for our course are Earthquakes I, Earthquakes II, Volcanoes, Floods, Coastal Geohazards and Landslides. Earthquake I can be viewed and accessed for no cost at http://campus.esri.com.

Using reference values to define disease based on the lower limit of normal biased the population attributable fraction, but not the population excess risk: the example of chronic airflow obstruction.

PubMed

Burney, Peter; Minelli, Cosetta

2018-01-01

The impact of disease on population health is most commonly estimated by the population attributable fraction (PAF), or less commonly by the excess risk, an alternative measure that estimates the absolute risk of disease in the population that can be ascribed to the exposure. Using chronic airflow obstruction as an example, we examined the impact on these estimates of defining disease based on different "normal" values. We estimated PAF and the excess risk in scenarios in which the true rate of disease was 10% in the exposed and 5% in the unexposed, and where either 50% or 20% of the population was exposed. Disease definition was based on a "lower limit of normal", using the 5th, 1st and 0.2nd centile of values in a "normal" population as thresholds to define normality. Where normality is defined by centiles of values in a "normal" population, PAF is strongly influenced by which centile is selected to define normality. This is not true for the population excess risk. Care should be taken when interpreting estimates of PAF when disease is defined from a centile of a normal population. Copyright © 2017 Elsevier Inc. All rights reserved.

Project Recon

DTIC Science & Technology

2012-06-14

Management tool • Current Risk Recon functionality • Issues Recon & Opportunity Recon – Launching Fall 2012 • FMEA and Lessons Learned – Planned Future...Lessons learned UNCLASSIFIED Integrated Risk Management FMEA Failure Mode and Effects Analysis Risk Recon Fields from FMEA software pre...populate Risk Info sheet. Risk Mitigation from Risk Recon trace back and populate FMEA , new RPN numbers. Issues Recon When a risk becomes an issue

Male suicide rates in German prisons and the role of citizenship.

PubMed

Radeloff, Daniel; Lempp, Thomas; Kettner, Mattias; Rauf, Amna; Bennefeld-Kersten, Katharina; Freitag, Christine M

2017-01-01

Prisoners are at a particularly high risk of suicide. In contrast to other psychosocial risk factors it remains unclear to what degree the risk of suicide differs between prisoners with local citizenship and foreigners. In order to provide more detailed information for suicide prevention in prisons, this study aims to compare suicide rates (SR) between these populations in German criminal custody. Based on a German national database of completed suicide in custody, suicides by prisoners were analysed and compared with epidemiological data of the prison population and the general population, stratified for German and foreign citizenship. Data analysis was adjusted for differences in the age distribution of both populations by calculating standard mortality ratios (SMR) for suicide. SR were higher in prisoners with German citizenship than those with foreign citizenship (SR = 76.5 vs. SR = 42.8, P<0.01). This association was not specific to the prison population, as the higher SR in citizens compared to non-citizens (SR = 19.3 vs. SR = 9.0, P<0.01) were also found in the general population. The association between prison suicide and citizenship was comparable in juvenile and adult prisoners, indicating its relevance to both the juvenile and adult detention systems. Imprisonment is associated with a substantially increased risk of suicide in both German and non-German citizens, a finding which needs to be taken into consideration by the justice system. The lower suicide risk in non-German citizens is independent of whether or not they are in custody.

Risk factors for deep vein thrombosis and pulmonary embolism during pregnancy or post partum: a population-based, case-control study.

PubMed

Danilenko-Dixon, D R; Heit, J A; Silverstein, M D; Yawn, B P; Petterson, T M; Lohse, C M; Melton, L J

2001-01-01

We sought to determine risk factors for deep vein thrombosis and pulmonary embolism during pregnancy or post partum. We performed a population-based case-control study. All Olmsted County, Minnesota, residents with a first lifetime deep vein thrombosis or pulmonary embolism during pregnancy or post partum from 1966 to 1990 were identified (N = 90). Where possible, a resident without deep vein thrombosis or pulmonary embolism was matched to each patient by date of the first live birth after the patient's child. The medical records of all remaining patients and all control subjects were reviewed for >25 baseline characteristics, which were tested as risk factors for deep vein thrombosis or pulmonary embolism. In multivariate analysis smoking (odds ratio, 2.4) and prior superficial vein thrombosis (odds ratio, 9.4) were independent risk factors for deep vein thrombosis or pulmonary thrombosis during pregnancy or post partum. Venous thromboembolism prophylaxis may be warranted for pregnant women with prior superficial vein thrombosis. Smoking cessation should be recommended, especially during pregnancy and the postpartum period.

Occupational exposures and non-Hodgkin's lymphoma: Canadian case-control study.

PubMed

Karunanayake, Chandima P; McDuffie, Helen H; Dosman, James A; Spinelli, John J; Pahwa, Punam

2008-08-07

The objective was to study the association between Non-Hodgkin's Lymphoma (NHL) and occupational exposures related to long held occupations among males in six provinces of Canada. A population based case-control study was conducted from 1991 to 1994. Males with newly diagnosed NHL (ICD-10) were stratified by province of residence and age group. A total of 513 incident cases and 1506 population based controls were included in the analysis. Conditional logistic regression was conducted to fit statistical models. Based on conditional logistic regression modeling, the following factors independently increased the risk of NHL: farmer and machinist as long held occupations; constant exposure to diesel exhaust fumes; constant exposure to ionizing radiation (radium); and personal history of another cancer. Men who had worked for 20 years or more as farmer and machinist were the most likely to develop NHL. An increased risk of developing NHL is associated with the following: long held occupations of faer and machinist; exposure to diesel fumes; and exposure to ionizing radiation (radium). The risk of NHL increased with the duration of employment as a farmer or machinist.

Case-control study of urinary bladder cancer in metropolitan Nagoya.

PubMed

Ohno, Y; Aoki, K; Obata, K; Morrison, A S

1985-12-01

We conducted a population-based case-control study of patients with bladder cancer and of controls drawn randomly from the general population of Metropolitan Nagoya and interviewed both groups. The incidence rates of bladder cancer were 2.42 and 7.05/100,000 for females and males, respectively. The analysis, based on 293 patients and 589 controls who were frequency matched for age, sex, and residence, provided the following major findings. Age-adjusted relative risks of 1.89 (1.15-3.10) and 3.53 (1.71-7.27) were found in male and female cigarette smokers, respectively. Significant relative risk was also found in males who drank cocoa. Elevated risk with a dose-response relationship was observed among women who used hair dye and who smoke, but this risk was insignificant, with the disappearance of a dose-response relationship, when it was adjusted for smoking. Age- and smoking-adjusted relative risk of coffee drinking was insignificant with no dose-response relationship. Relative risk of artificial sweetener use was below 1 with adjustment for age and smoking. Intake of alcoholic beverages and cola was insignificantly associated. Reduced risk of significance was suggested for the intake of black tea and matcha (powdered green tea) in females and of fruit juice in males.

Evaluation of Biomonitoring Data from the CDC National ...

EPA Pesticide Factsheets

BACKGROUND: Biomonitoring data reported in the National Report on Human Exposure to Environmental Chemicals (NER) provide information on the presence and concentrations of more than 400 chemicals in human blood and urine. Biomonitoring Equivalents (BEs) and other risk assessment-based values now allow interpretation of these biomonitoring data in a public health risk context. OBJECTIVES: Compare the measured biomarker concentrations in the NER with BEs and similar risk assessment values to provide an across-chemical risk assessment perspective on the measured levels for approximately 130 analytes in the NER. METHODS: Available risk assessment-based biomarker screening values, including BEs and Human Biomonitoring-I (HBM-I) values from the German Human Biomonitoring Commission, were identified. Geometric mean and 95th percentile population biomarker concentrations from the NER were compared to the available screening values to generate chemical-specific hazard quotients (HQ) or cancer risk estimates. CONCLUSIONS: Several analytes in the NER approach or exceed HQ values of 1 or cancer risks greater than 1x 10-4 at the geometric mean or 95th percentile, suggesting exposure levels exceed what is considered safe in a large fraction of the population. Analytes of concern include acrylamide, dioxin-like chemicals, benzene, xylene, several metals, di-2(ethylhexyl)phthalate, and some legacy organochlorine pesticides. This analysis provides for the first time a mean

The value of survival analyses for evidence-based rural medical workforce planning.

PubMed

Russell, Deborah J; Humphreys, John S; McGrail, Matthew R; Cameron, W Ian; Williams, Peter J

2013-12-11

Globally, abundant opportunities exist for policymakers to improve the accessibility of rural and remote populations to primary health care through improving workforce retention. This paper aims to identify and quantify the most important factors associated with rural and remote Australian family physician turnover, and to demonstrate how evidence generated by survival analysis of health workforce data can inform rural workforce policy making. A secondary analysis of longitudinal data collected by the New South Wales (NSW) Rural Doctors Network for all family physicians working in rural or remote NSW between January 1(st) 2003 and December 31(st) 2012 was performed. The Prentice, Williams and Peterson statistical model for survival analysis was used to identify and quantify risk factors for rural NSW family physician turnover. Multivariate modelling revealed a higher (2.65-fold) risk of family physician turnover in small, remote locations compared to that in small closely settled locations. Family physicians who graduated from countries other than Australia, United Kingdom, United States of America, New Zealand, Ireland, and Canada also had a higher (1.45-fold) risk of turnover compared to Australian trained family physicians. This was after adjusting for the effects of conditional registration. Procedural skills and public hospital admitting rights were associated with a lower risk of turnover. These risks translate to a predicted median survival of 11 years for Australian-trained family physician non-proceduralists with hospital admitting rights working in small coastal closely settled locations compared to 3 years for family physicians in remote locations. This study provides rigorous empirical evidence of the strong association between population size and geographical location and the retention of family physicians in rural and remote NSW. This has important policy ramifications since retention grants for rural and remote family physicians in Australia are currently based on a geographical 'remoteness' classification rather than population size. In addition, this study demonstrates how survival analysis assists health workforce planning, such as through generating evidence to assist in benchmarking 'reasonable' lengths of practice in different geographic settings that might guide service obligation requirements.

The value of survival analyses for evidence-based rural medical workforce planning

PubMed Central

2013-01-01

Background Globally, abundant opportunities exist for policymakers to improve the accessibility of rural and remote populations to primary health care through improving workforce retention. This paper aims to identify and quantify the most important factors associated with rural and remote Australian family physician turnover, and to demonstrate how evidence generated by survival analysis of health workforce data can inform rural workforce policy making. Methods A secondary analysis of longitudinal data collected by the New South Wales (NSW) Rural Doctors Network for all family physicians working in rural or remote NSW between January 1st 2003 and December 31st 2012 was performed. The Prentice, Williams and Peterson statistical model for survival analysis was used to identify and quantify risk factors for rural NSW family physician turnover. Results Multivariate modelling revealed a higher (2.65-fold) risk of family physician turnover in small, remote locations compared to that in small closely settled locations. Family physicians who graduated from countries other than Australia, United Kingdom, United States of America, New Zealand, Ireland, and Canada also had a higher (1.45-fold) risk of turnover compared to Australian trained family physicians. This was after adjusting for the effects of conditional registration. Procedural skills and public hospital admitting rights were associated with a lower risk of turnover. These risks translate to a predicted median survival of 11 years for Australian-trained family physician non-proceduralists with hospital admitting rights working in small coastal closely settled locations compared to 3 years for family physicians in remote locations. Conclusions This study provides rigorous empirical evidence of the strong association between population size and geographical location and the retention of family physicians in rural and remote NSW. This has important policy ramifications since retention grants for rural and remote family physicians in Australia are currently based on a geographical ‘remoteness’ classification rather than population size. In addition, this study demonstrates how survival analysis assists health workforce planning, such as through generating evidence to assist in benchmarking ‘reasonable’ lengths of practice in different geographic settings that might guide service obligation requirements. PMID:24330603

Risk factors for age-related macular degeneration: findings from the Andhra Pradesh eye disease study in South India.

PubMed

Krishnaiah, Sannapaneni; Das, Taraprasad; Nirmalan, Praveen K; Nutheti, Rishita; Shamanna, Bindiganavale R; Rao, Gullapalli N; Thomas, Ravi

2005-12-01

To assess prevalence, potential risk factors, and population attributable risk percentage (PAR%) for age-related macular degeneration (AMD) in the Indian state of Andhra Pradesh. A population-based study, using a stratified, random, cluster, systematic sampling strategy, was conducted in the state of Andhra Pradesh in India from 1996 to 2000. Participants from 94 clusters in one urban and three rural areas representative of the population of Andhra Pradesh underwent a detailed interview and a detailed dilated ocular evaluation by trained professionals. In this report, the authors present the prevalence estimates of AMD and examine the association of AMD with potential risk factors in persons aged 40 to 102 years (n = 3723). AMD was defined according to the international classification and grading system. Standard bivariate and multivariate analyses were performed to identify the potential risk factors for AMD. PAR% was calculated by Levin's formula. AMD was present in 71 subjects--an age-gender-area-adjusted prevalence of 1.82% (95% confidence interval [CI], 1.39%-2.25%). Risk factors that were significant in bivariate analyses were considered for multivariate logistic regression analysis. Multivariate analysis showed that the adjusted prevalence of AMD was significantly higher in those 60 years of age or older (odds ratio [OR], 3.55; 95% CI, 1.61-7.82) and history of prior cigar smoking (OR, 3.29; 95%CI, 1.42-7.57). Presence of cortical cataract and prior cataract surgery were significantly associated with increased prevalence of AMD (adjusted OR, 2.87; 95% CI, 1.57-5.26 and 3.79; 95% CI, 2.1-6.78), respectively. The prevalence of AMD was significantly lower in light alcohol drinkers (adjusted OR, 0.38; 95% CI, 0.19-0.76) compared with nondrinkers. The PAR% for hypertension and heavy cigar smoking was 10% and 14%, respectively, in this population. The prevalence of AMD in this south Indian population is similar to those reported in other developed countries. Abstinence from smoking may reduce the risk of AMD in this population.

Family history assessment for colorectal cancer (CRC) risk analysis - comparison of diagram- and questionnaire-based web interfaces.

PubMed

Schultz, Michael; Seo, Steven Bohwan; Holt, Alec; Regenbrecht, Holger

2015-11-18

Colorectal cancer (CRC) has a high incidence, especially in New Zealand. The reasons for this are unknown. While most cancers develop sporadically, a positive family history, determined by the number and age at diagnosis of affected first and second degree relatives with CRC is one of the major factors, which may increase an individual's lifetime risk. Before a patient can be enrolled in a surveillance program a detailed assessment and documentation of the family history is important but time consuming and often inaccurate. The documentation is usually paper-based. Our aim was therefore to develop and validate the usability and efficacy of a web-based family history assessment tool for CRC suitable for the general population. The tool was also to calculate the risk and make a recommendation for surveillance. Two versions of an electronic assessment tool, diagram-based and questionnaire-based, were developed with the risk analysis and recommendations for surveillance based on the New Zealand Guidelines Group recommendations. Accuracy of our tool was tested prior to the study by comparing risk calculations based on family history by experienced gastroenterologists with the electronic assessment. The general public, visiting a local science fair were asked to use and comment on the usability of the two interfaces. Ninety people assessed and commented on the two interfaces. Both interfaces were effective in assessing the risk to develop CRC through their familial history for CRC. However, the questionnaire-based interface performed with significantly better satisfaction (p = 0.001) than the diagram-based interface. There was no difference in efficacy though. We conclude that a web-based questionnaire tool can assist in the accurate documentation and analysis of the family history relevant to determine the individual risk of CRC based on local guidelines. The calculator is now implemented and assessable through the web-page of a local charity for colorectal cancer awareness and integral part of the local general practitioners' e-referral system for colonic imaging.

Development and validation of a generic finite element vehicle buck model for the analysis of driver rib fractures in real life nearside oblique frontal crashes.

PubMed

Iraeus, Johan; Lindquist, Mats

2016-10-01

Frontal crashes still account for approximately half of all fatalities in passenger cars, despite several decades of crash-related research. For serious injuries in this crash mode, several authors have listed the thorax as the most important. Computer simulation provides an effective tool to study crashes and evaluate injury mechanisms, and using stochastic input data, whole populations of crashes can be studied. The aim of this study was to develop a generic buck model and to validate this model on a population of real-life frontal crashes in terms of the risk of rib fracture. The study was conducted in four phases. In the first phase, real-life validation data were derived by analyzing NASS/CDS data to find the relationship between injury risk and crash parameters. In addition, available statistical distributions for the parameters were collected. In the second phase, a generic parameterized finite element (FE) model of a vehicle interior was developed based on laser scans from the A2MAC1 database. In the third phase, model parameters that could not be found in the literature were estimated using reverse engineering based on NCAP tests. Finally, in the fourth phase, the stochastic FE model was used to simulate a population of real-life crashes, and the result was compared to the validation data from phase one. The stochastic FE simulation model overestimates the risk of rib fracture, more for young occupants and less for senior occupants. However, if the effect of underestimation of rib fractures in the NASS/CDS material is accounted for using statistical simulations, the risk of rib fracture based on the stochastic FE model matches the risk based on the NASS/CDS data for senior occupants. The current version of the stochastic model can be used to evaluate new safety measures using a population of frontal crashes for senior occupants. Copyright © 2016 Elsevier Ltd. All rights reserved.

New arrows in the quiver for targeting care management: high-risk versus high-opportunity case identification.

PubMed

Bernstein, Richard H

2007-01-01

"Care management" purposefully obscures the distinctions between disease and case management and stresses their common features: action in the present to prevent adverse future outcomes and costs. It includes identifying a high-need population by referrals, screening, or data analysis, assessing those likely to benefit from interventions, intervening, evaluating the intervention, and adjusting interventions when needed. High-risk individuals can be identified using at least 9 techniques, from referrals and questionnaires to retrospective claims analysis and predictive models. Other than referrals, software based on the risk-adjustment methodology that we have adapted can incorporate all these methodologies. Because the risk adjustment employs extensive case mix and severity adjustment, it provides care managers with 3 innovative ways to identify not only high-risk individuals but also high-opportunity cases.

An individual-based model of zebrafish population dynamics accounting for energy dynamics.

PubMed

Beaudouin, Rémy; Goussen, Benoit; Piccini, Benjamin; Augustine, Starrlight; Devillers, James; Brion, François; Péry, Alexandre R R

2015-01-01

Developing population dynamics models for zebrafish is crucial in order to extrapolate from toxicity data measured at the organism level to biological levels relevant to support and enhance ecological risk assessment. To achieve this, a dynamic energy budget for individual zebrafish (DEB model) was coupled to an individual based model of zebrafish population dynamics (IBM model). Next, we fitted the DEB model to new experimental data on zebrafish growth and reproduction thus improving existing models. We further analysed the DEB-model and DEB-IBM using a sensitivity analysis. Finally, the predictions of the DEB-IBM were compared to existing observations on natural zebrafish populations and the predicted population dynamics are realistic. While our zebrafish DEB-IBM model can still be improved by acquiring new experimental data on the most uncertain processes (e.g. survival or feeding), it can already serve to predict the impact of compounds at the population level.

An Individual-Based Model of Zebrafish Population Dynamics Accounting for Energy Dynamics

PubMed Central

Beaudouin, Rémy; Goussen, Benoit; Piccini, Benjamin; Augustine, Starrlight; Devillers, James; Brion, François; Péry, Alexandre R. R.

2015-01-01

Developing population dynamics models for zebrafish is crucial in order to extrapolate from toxicity data measured at the organism level to biological levels relevant to support and enhance ecological risk assessment. To achieve this, a dynamic energy budget for individual zebrafish (DEB model) was coupled to an individual based model of zebrafish population dynamics (IBM model). Next, we fitted the DEB model to new experimental data on zebrafish growth and reproduction thus improving existing models. We further analysed the DEB-model and DEB-IBM using a sensitivity analysis. Finally, the predictions of the DEB-IBM were compared to existing observations on natural zebrafish populations and the predicted population dynamics are realistic. While our zebrafish DEB-IBM model can still be improved by acquiring new experimental data on the most uncertain processes (e.g. survival or feeding), it can already serve to predict the impact of compounds at the population level. PMID:25938409

A population health approach to reducing observational intensity bias in health risk adjustment: cross sectional analysis of insurance claims.

PubMed

Wennberg, David E; Sharp, Sandra M; Bevan, Gwyn; Skinner, Jonathan S; Gottlieb, Daniel J; Wennberg, John E

2014-04-10

To compare the performance of two new approaches to risk adjustment that are free of the influence of observational intensity with methods that depend on diagnoses listed in administrative databases. Administrative data from the US Medicare program for services provided in 2007 among 306 US hospital referral regions. Cross sectional analysis. 20% sample of fee for service Medicare beneficiaries residing in one of 306 hospital referral regions in the United States in 2007 (n = 5,153,877). The effect of health risk adjustment on age, sex, and race adjusted mortality and spending rates among hospital referral regions using four indices: the standard Centers for Medicare and Medicaid Services--Hierarchical Condition Categories (HCC) index used by the US Medicare program (calculated from diagnoses listed in Medicare's administrative database); a visit corrected HCC index (to reduce the effects of observational intensity on frequency of diagnoses); a poverty index (based on US census); and a population health index (calculated using data on incidence of hip fractures and strokes, and responses from a population based annual survey of health from the Centers for Disease Control and Prevention). Estimated variation in age, sex, and race adjusted mortality rates across hospital referral regions was reduced using the indices based on population health, poverty, and visit corrected HCC, but increased using the standard HCC index. Most of the residual variation in age, sex, and race adjusted mortality was explained (in terms of weighted R2) by the population health index: R2=0.65. The other indices explained less: R2=0.20 for the visit corrected HCC index; 0.19 for the poverty index, and 0.02 for the standard HCC index. The residual variation in age, sex, race, and price adjusted spending per capita across the 306 hospital referral regions explained by the indices (in terms of weighted R2) were 0.50 for the standard HCC index, 0.21 for the population health index, 0.12 for the poverty index, and 0.07 for the visit corrected HCC index, implying that only a modest amount of the variation in spending can be explained by factors most closely related to mortality. Further, once the HCC index is visit corrected it accounts for almost none of the residual variation in age, sex, and race adjusted spending. Health risk adjustment using either the poverty index or the population health index performed substantially better in terms of explaining actual mortality than the indices that relied on diagnoses from administrative databases; the population health index explained the majority of residual variation in age, sex, and race adjusted mortality. Owing to the influence of observational intensity on diagnoses from administrative databases, the standard HCC index over-adjusts for regional differences in spending. Research to improve health risk adjustment methods should focus on developing measures of risk that do not depend on observation influenced diagnoses recorded in administrative databases.

Society of Behavioral Medicine supports implementation of high quality lung cancer screening in high-risk populations.

PubMed

Watson, Karriem S; Blok, Amanda C; Buscemi, Joanna; Molina, Yamile; Fitzgibbon, Marian; Simon, Melissa A; Williams, Lance; Matthews, Kameron; Studts, Jamie L; Lillie, Sarah E; Ostroff, Jamie S; Carter-Harris, Lisa; Winn, Robert A

2016-12-01

The Society of Behavioral Medicine (SBM) supports the United States Preventive Services Task Force (USPSTF) recommendation of low-dose computed tomography (LDCT) screening of the chest for eligible populations to reduce lung cancer mortality. Consistent with efforts to translate research findings into real-world settings, SBM encourages health-care providers and health-care systems to (1) integrate evidence-based tobacco treatment as an essential component of LDCT-based lung cancer screening, (2) examine the structural barriers that may impact screening uptake, and (3) incorporate shared decision-making as a clinical platform to facilitate consultations and engagement with individuals at high risk for lung cancer about the potential benefits and harms associated with participation in a lung cancer screening program. We advise policy makers and legislators to support screening in high-risk populations by continuing to (1) expand access to high quality LDCT-based screening among underserved high-risk populations, (2) enhance cost-effectiveness by integrating evidence-based tobacco treatments into screening in high-risk populations, and (3) increase funding for research that explores implementation science and increased public awareness and access of diverse populations to participate in clinical and translational research.

Risk of colorectal cancer in Asian patients with ulcerative colitis: a systematic review and meta-analysis.

PubMed

Bopanna, Sawan; Ananthakrishnan, Ashwin N; Kedia, Saurabh; Yajnik, Vijay; Ahuja, Vineet

2017-04-01

The increased risk of colorectal cancer in ulcerative colitis is well known. The risk of sporadic colorectal cancer in Asian populations is considered low and risk estimates of colorectal cancer related to ulcerative colitis from Asia vary. This meta-analysis is an Asian perspective on the risk of colorectal cancer related to ulcerative colitis. We searched PubMed and Embase for terms related to colorectal cancer in ulcerative colitis from inception to July 1, 2016. The search for published articles was done by country for all countries in Asia. We included studies with information on the prevalence and cumulative risk of colorectal cancer at various timepoints. A random-effects meta-analysis was done to calculate the pooled prevalence as well as a cumulative risk at 10 years, 20 years, and 30 years of disease. Our search identified 2575 articles; of which 44 were eligible for inclusion. Our analysis included a total of 31 287 patients with ulcerative colitis with a total of 293 reported colorectal cancers. Using pooled prevalence estimates from various studies, the overall prevalence was 0·85% (95% CI 0·65-1·04). The risks for colorectal cancer were 0·02% (95% CI 0·00-0·04) at 10 years, 4·81% (3·26-6·36) at 20 years, and 13·91% (7·09-20·72) at 30 years. Subgroup analysis by stratifying the studies according to region or period of the study did not reveal any significant differences. We found the risk of colorectal cancer in Asian patients with ulcerative colitis was similar to recent estimates in Europe and North America. Adherence to screening is therefore necessary. Larger population-based, prospective studies are required for better estimates of the risk. Indo-US Science and Technology Forum. Copyright © 2017 Elsevier Ltd. All rights reserved.

Risk of colorectal cancer in Asian patients with ulcerative colitis: a systematic review and meta-analysis

PubMed Central

Bopanna, Sawan; Ananthakrishnan, Ashwin N; Kedia, Saurabh; Yajnik, Vijay; Ahuja, Vineet

2017-01-01

Summary Background The increased risk of colorectal cancer in ulcerative colitis is well known. The risk of sporadic colorectal cancer in Asian populations is considered low and risk estimates of colorectal cancer related to ulcerative colitis from Asia vary. This meta-analysis is an Asian perspective on the risk of colorectal cancer related to ulcerative colitis. Methods We searched PubMed and Embase for terms related to colorectal cancer in ulcerative colitis from inception to July 1, 2016. The search for published articles was done by country for all countries in Asia. We included studies with information on the prevalence and cumulative risk of colorectal cancer at various timepoints. A random-effects meta-analysis was done to calculate the pooled prevalence as well as a cumulative risk at 10 years, 20 years, and 30 years of disease. Findings Our search identified 2575 articles; of which 44 were eligible for inclusion. Our analysis included a total of 31 287 patients with ulcerative colitis with a total of 293 reported colorectal cancers. Using pooled prevalence estimates from various studies, the overall prevalence was 0·85% (95% CI 0·65–1·04). The risks for colorectal cancer were 0·02% (95% CI 0·00–0·04) at 10 years, 4·81% (3·26–6·36) at 20 years, and 13·91% (7·09–20·72) at 30 years. Subgroup analysis by stratifying the studies according to region or period of the study did not reveal any significant differences. Interpretation We found the risk of colorectal cancer in Asian patients with ulcerative colitis was similar to recent estimates in Europe and North America. Adherence to screening is therefore necessary. Larger population-based, prospective studies are required for better estimates of the risk. PMID:28404156

Smoking as a risk factor for stroke in women compared with men: a systematic review and meta-analysis of 81 cohorts, including 3,980,359 individuals and 42,401 strokes.

PubMed

Peters, Sanne A E; Huxley, Rachel R; Woodward, Mark

2013-10-01

It is currently unknown whether the excess risk of stroke by smoking is the same for women and men. We performed a systematic review and meta-analysis to estimate the effect of smoking on stroke in women compared with men. PubMed MEDLINE was systematically searched for prospective population-based cohort studies published between January 1, 1966, and January 26, 2013. Studies that presented sex-specific estimates of the relative risk of stroke comparing current smoking with nonsmoking and its associated variability were selected. The sex-specific relative risks and their ratio (RRR), comparing women with men, were pooled using random-effects meta-analysis with inverse variance weighting. Similarly, the RRR for former versus never smoking was pooled. Data from 81 prospective cohort studies that included 3,980,359 individuals and 42,401 strokes were available. Smoking was an independent risk factor for stroke in both sexes. Overall, the pooled multiple-adjusted RRR indicated a similar risk of stroke associated with smoking in women compared with men (RRR, 1.06 [95% confidence interval, 0.99-1.13]). In a regional analysis, there was evidence of a more harmful effect of smoking in women than in men in Western (RRR, 1.10 [1.02-1.18)] but not in Asian (RRR, 0.97 [0.87-1.09]) populations. Compared with never-smokers, the beneficial effects of quitting smoking among former smokers on stroke risk were similar between the sexes (RRR, 1.10 [0.99-1.22]). Compared with nonsmokers, the excess risk of stroke is at least as great among women who smoke compared with men who smoke.

Genome-wide association study of ancestry-specific TB risk in the South African Coloured population

PubMed Central

Chimusa, Emile R.; Zaitlen, Noah; Daya, Michelle; Möller, Marlo; van Helden, Paul D.; Mulder, Nicola J.; Price, Alkes L.; Hoal, Eileen G.

2014-01-01

The worldwide burden of tuberculosis (TB) remains an enormous problem, and is particularly severe in the admixed South African Coloured (SAC) population residing in the Western Cape. Despite evidence from twin studies suggesting a strong genetic component to TB resistance, only a few loci have been identified to date. In this work, we conduct a genome-wide association study (GWAS), meta-analysis and trans-ethnic fine mapping to attempt the replication of previously identified TB susceptibility loci. Our GWAS results confirm the WT1 chr11 susceptibility locus (rs2057178: odds ratio = 0.62, P = 2.71e−06) previously identified by Thye et al., but fail to replicate previously identified polymorphisms in the TLR8 gene and locus 18q11.2. Our study demonstrates that the genetic contribution to TB risk varies between continental populations, and illustrates the value of including admixed populations in studies of TB risk and other complex phenotypes. Our evaluation of local ancestry based on the real and simulated data demonstrates that case-only admixture mapping is currently impractical in multi-way admixed populations, such as the SAC, due to spurious deviations in average local ancestry generated by current local ancestry inference methods. This study provides insights into identifying disease genes and ancestry-specific disease risk in multi-way admixed populations. PMID:24057671

Prevalence of sexually transmitted infections and bacterial vaginosis among women in sub-Saharan Africa: An individual participant data meta-analysis of 18 HIV prevention studies

PubMed Central

Morrison, Charles S.; Chen, Pai-Lien; Kwok, Cynthia; McCormack, Sheena; McGrath, Nuala; Watson-Jones, Deborah; Gottlieb, Sami L.

2018-01-01

Background Estimates of sexually transmitted infection (STI) prevalence are essential for efforts to prevent and control STIs. Few large STI prevalence studies exist, especially for low- and middle-income countries (LMICs). Our primary objective was to estimate the prevalence of chlamydia, gonorrhea, trichomoniasis, syphilis, herpes simplex virus type 2 (HSV-2), and bacterial vaginosis (BV) among women in sub-Saharan Africa by age, region, and population type. Methods and findings We analyzed individual-level data from 18 HIV prevention studies (cohort studies and randomized controlled trials; conducted during 1993–2011), representing >37,000 women, that tested participants for ≥1 selected STIs or BV at baseline. We used a 2-stage meta-analysis to combine data. After calculating the proportion of participants with each infection and standard error by study, we used a random-effects model to obtain a summary mean prevalence of each infection and 95% confidence interval (CI) across ages, regions, and population types. Despite substantial study heterogeneity for some STIs/populations, several patterns emerged. Across the three primary region/population groups (South Africa community-based, Southern/Eastern Africa community-based, and Eastern Africa higher-risk), prevalence was higher among 15–24-year-old than 25–49-year-old women for all STIs except HSV-2. In general, higher-risk populations had greater prevalence of gonorrhea and syphilis than clinic/community-based populations. For chlamydia, prevalence among 15–24-year-olds was 10.3% (95% CI: 7.4%, 14.1%; I2 = 75.7%) among women specifically recruited from higher-risk settings for HIV in Eastern Africa and was 15.1% (95% CI: 12.7%, 17.8%; I2 = 82.3%) in South African clinic/community-based populations. Among clinic/community-based populations, prevalence was generally greater in South Africa than in Southern/Eastern Africa for most STIs; for gonorrhea, prevalence among 15–24-year-olds was 4.6% (95% CI: 3.3%, 6.4%; I2 = 82.8%) in South Africa and was 1.7% (95% CI: 1.2%, 2.6%; I2 = 55.2%) in Southern/Eastern Africa. Across the three primary region/population groups, HSV-2 and BV prevalence was high among 25–49-year-olds (ranging from 70% to 83% and 33% to 44%, respectively). The main study limitation is that the data are not from random samples of the target populations. Conclusions Combining data from 18 HIV prevention studies, our findings highlight important features of STI/BV epidemiology among sub-Saharan African women. This methodology can be used where routine STI surveillance is limited and offers a new approach to obtaining critical information on STI and BV prevalence in LMICs. PMID:29485986

Introduction of a guide to enhance risk communication among low-income and minority populations: a grassroots community engagement approach.

PubMed

Rowel, Randy; Sheikhattari, Payam; Barber, Tanyka M; Evans-Holland, Myrtle

2012-01-01

Low-income populations, especially those belonging to minority groups, are among the most vulnerable groups before, during, and after a natural disaster. One of the factors that can be attributed to their vulnerability is the ineffectiveness of traditional risk communication systems in reaching this population. Many low-income populations are distrustful of government agencies and those who typically communicate risk messages. Consequently, traditional systems are not as effective in reaching these communities. Furthermore, traditional systems have been based on the social media that the general population uses and not based on social networks of disadvantaged populations which are more important than formal channels in these communities for dissemination of information. To bridge the gap, an approach is needed that relies on trusted agencies and leaders to educate and warn low-income communities about possible public health threats. A grassroots approach can enhance the capacity of the risk communication systems to more effectively reach vulnerable populations by engaging grassroots organizations in risk communication activities. The Guide to Enhance Grassroots Risk Communication Among Low-Income Populations provides strategies and guidance that can assist agencies in upgrading their systems for risk communication by building partnerships with local community stakeholders.

Urinary incontinence, fecal incontinence and pelvic organ prolapse in a population-based, racially diverse cohort. Prevalence and risk factors

PubMed Central

RORTVEIT, Guri; SUBAK, Leslee L.; THOM, David H.; CREASMAN, Jennifer M.; VITTINGHOFF, Eric; VAN DEN EEDEN, Stephen K.; BROWN, Jeanette S.

2016-01-01

Objectives We investigated the prevalence of and risk factors for combinations of urinary incontinence (UI), fecal incontinence (FI) and pelvic organ prolapse (POP) in racially diverse women over age 40. Methods The Reproductive Risks for Incontinence Study at Kaiser (RRISK) is a population-based study with data from 2106 women > 40 years. Pelvic floor conditions were determined by self-report. Risk factors were assessed by self-report, interview and record review. Independent risk factors were identified by multinomial logistic regression analysis. Results At least one pelvic floor condition was reported by 714 (34%) women. Of these, 494 (69%) had UI only, 60 (8%) POP only, and 46 (6%) had FI only. Both UI and FI were reported by 64 (9%), both UI and POP by 51 (7%). Among women with FI, 60% reported more than one condition. Corresponding figures for POP and UI were 49% and 18%. Estrogen use and constipation were shared risk factors for UI, FI and POP. BMI was a unique risk factor for UI only, diabetes for FI only and parity for POP only. No clear pattern could be found to support the hypothesis that risk factors for single conditions are more strongly associated with combined conditions. Conclusions Patients with FI or POP often have concomitant UI. These diseases both share and have unique risk factors in a complex pattern. PMID:22453506

Possible association between ocular chloramphenicol and aplastic anaemia—the absolute risk is very low

PubMed Central

Laporte, Joan-Ramon; Vidal, Xavier; Ballarín, Elena; Ibáñez, Luisa

1998-01-01

Aims To determine whether topical ocular chloramphenicol increases the risk of aplastic anaemia and to estimate the magnitude of this risk, if any. Methods Population-based prospective case-control surveillance of aplastic anaemia in a community of 4.2 million inhabitants from 1980 to 1995 (67.2 million person-years) plus case-population estimate of the risk, based on sales figures of ocular chloramphenicol in the study area during the study period. Results One hundred and forty-five patients with aplastic anaemia and 1,226 controls were included in the analysis. Three cases (2.1%) and 5 controls (0.4%) had been exposed to ocular chloramphenicol during the relevant etiological period. The adjusted odds ratio was 3.77 (95% confidence interval, 0.84–16.90). Two cases had also been exposed to other known causes of aplastic anaemia. The incidence of aplastic anaemia among users of ocular chloramphenicol was 0.36 cases per million weeks of treatment. The incidence among non users was 0.04 cases per million weeks. Conclusions An association between ocular chloramphenicol and aplastic anaemia cannot be excluded. However, the risk is less than one per million treatment courses. PMID:9723830

Cardiometabolic Risk Clustering in Spinal Cord Injury: Results of Exploratory Factor Analysis

PubMed Central

2013-01-01

Background: Evidence suggests an elevated prevalence of cardiometabolic risks among persons with spinal cord injury (SCI); however, the unique clustering of risk factors in this population has not been fully explored. Objective: The purpose of this study was to describe unique clustering of cardiometabolic risk factors differentiated by level of injury. Methods: One hundred twenty-one subjects (mean 37 ± 12 years; range, 18–73) with chronic C5 to T12 motor complete SCI were studied. Assessments included medical histories, anthropometrics and blood pressure, and fasting serum lipids, glucose, insulin, and hemoglobin A1c (HbA1c). Results: The most common cardiometabolic risk factors were overweight/obesity, high levels of low-density lipoprotein (LDL-C), and low levels of high-density lipoprotein (HDL-C). Risk clustering was found in 76.9% of the population. Exploratory principal component factor analysis using varimax rotation revealed a 3–factor model in persons with paraplegia (65.4% variance) and a 4–factor solution in persons with tetraplegia (73.3% variance). The differences between groups were emphasized by the varied composition of the extracted factors: Lipid Profile A (total cholesterol [TC] and LDL-C), Body Mass-Hypertension Profile (body mass index [BMI], systolic blood pressure [SBP], and fasting insulin [FI]); Glycemic Profile (fasting glucose and HbA1c), and Lipid Profile B (TG and HDL-C). BMI and SBP formed a separate factor only in persons with tetraplegia. Conclusions: Although the majority of the population with SCI has risk clustering, the composition of the risk clusters may be dependent on level of injury, based on a factor analysis group comparison. This is clinically plausible and relevant as tetraplegics tend to be hypo- to normotensive and more sedentary, resulting in lower HDL-C and a greater propensity toward impaired carbohydrate metabolism. PMID:23960702

Peptic Ulcer Disease in Healthcare Workers: A Nationwide Population-Based Cohort Study

PubMed Central

Lin, Hong-Yue; Weng, Shih-Feng; Lin, Hung-Jung; Hsu, Chien-Chin; Wang, Jhi-Joung; Su, Shih-Bin; Guo, How-Ran; Huang, Chien-Cheng

2015-01-01

Health care workers (HCWs) in Taiwan have heavy, stressful workloads, are on-call, and have rotating nightshifts, all of which might contribute to peptic ulcer disease (PUD). We wanted to evaluate the PUD risk in HCWs, which is not clear. Using Taiwan’s National Health Insurance Research Database, we identified 50,226 physicians, 122,357 nurses, 20,677 pharmacists, and 25,059 other HCWs (dieticians, technicians, rehabilitation therapists, and social workers) as the study cohort, and randomly selected an identical number of non-HCW patients (i.e., general population) as the comparison cohort. Conditional logistical regression analysis was used to compare the PUD risk between them. Subgroup analysis for physician specialties was also done. Nurses and other HCWs had a significantly higher PUD risk than did the general population (odds ratio [OR]: 1.477; 95% confidence interval [CI]: 1.433–1.521 and OR: 1.328; 95% CI: 1.245–1.418, respectively); pharmacists had a lower risk (OR: 0.884; 95% CI: 0.828–0.945); physicians had a nonsignificantly different risk (OR: 1.029; 95% CI: 0.987–1.072). In the physician specialty subgroup analysis, internal medicine, surgery, Ob/Gyn, and family medicine specialists had a higher PUD risk than other physicians (OR: 1.579; 95% CI: 1.441–1.731, OR: 1.734; 95% CI: 1.565–1.922, OR: 1.336; 95% CI: 1.151–1.550, and OR: 1.615; 95% CI: 1.425–1.831, respectively). In contrast, emergency physicians had a lower risk (OR: 0.544; 95% CI: 0.359–0.822). Heavy workloads, long working hours, workplace stress, rotating nightshifts, and coping skills may explain our epidemiological findings of higher risks for PUD in some HCWs, which might help us improve our health policies for HCWs. PMID:26301861

Heterogeneity in Risk of Pelvic Inflammatory Diseases After Chlamydia Infection: A Population-Based Study in Manitoba, Canada

PubMed Central

Davies, Bethan; Ward, Helen; Leung, Stella; Turner, Katy M. E.; Garnett, Geoff P.; Blanchard, James F.; Yu, B. Nancy

2014-01-01

Background. The association between chlamydia infection and pelvic inflammatory disease (PID) is a key parameter for models evaluating the impact of chlamydia control programs. We quantified this association using a retrospective population-based cohort. Methods. We used administrative health data sets to construct a retrospective population-based cohort of women and girls aged 12–24 years who were resident in Manitoba, Canada, between 1992 and 1996. We performed survival analysis on a subcohort of individuals who were tested for chlamydia to estimate the risk of PID diagnosed in a primary care, outpatient, or inpatient setting after ≥1 positive chlamydia test. Results. A total of 73 883 individuals contributed 625 621 person years of follow-up. Those with a diagnosis of chlamydia had an increased risk of PID over their reproductive lifetime compared with those who tested negative (adjusted hazard ratio [AHR], 1.55; 95% confidence interval [CI], 1.43–1.70). This risk increased with each subsequent infection: the AHR was 1.17 for first reinfection (95% CI, 1.06–1.30) and 1.35 for the second (95% CI, 1.04–1.75). The increased risk of PID from reinfection was highest in younger individuals (AHR, 4.55 (95% CI, 3.59–5.78) in individuals aged 12–15 years at the time of their second reinfection, compared with individuals older than 30 years). Conclusions. There is heterogeneity in the risk of PID after a chlamydia infection. Describing the progression to PID in mathematical models as an average rate may be an oversimplification; more accurate estimates of the cost-effectiveness of screening may be obtained by using an individual-based measure of risk. Health inequalities may be reduced by targeting health promotion interventions at sexually active girls younger than 16 years and those with a history of chlamydia. PMID:25381374

Heterogeneity in risk of pelvic inflammatory diseases after chlamydia infection: a population-based study in Manitoba, Canada.

PubMed

Davies, Bethan; Ward, Helen; Leung, Stella; Turner, Katy M E; Garnett, Geoff P; Blanchard, James F; Yu, B Nancy

2014-12-01

The association between chlamydia infection and pelvic inflammatory disease (PID) is a key parameter for models evaluating the impact of chlamydia control programs. We quantified this association using a retrospective population-based cohort. We used administrative health data sets to construct a retrospective population-based cohort of women and girls aged 12-24 years who were resident in Manitoba, Canada, between 1992 and 1996. We performed survival analysis on a subcohort of individuals who were tested for chlamydia to estimate the risk of PID diagnosed in a primary care, outpatient, or inpatient setting after ≥ 1 positive chlamydia test. A total of 73 883 individuals contributed 625 621 person years of follow-up. Those with a diagnosis of chlamydia had an increased risk of PID over their reproductive lifetime compared with those who tested negative (adjusted hazard ratio [AHR], 1.55; 95% confidence interval [CI], 1.43-1.70). This risk increased with each subsequent infection: the AHR was 1.17 for first reinfection (95% CI, 1.06-1.30) and 1.35 for the second (95% CI, 1.04-1.75). The increased risk of PID from reinfection was highest in younger individuals (AHR, 4.55 (95% CI, 3.59-5.78) in individuals aged 12-15 years at the time of their second reinfection, compared with individuals older than 30 years). There is heterogeneity in the risk of PID after a chlamydia infection. Describing the progression to PID in mathematical models as an average rate may be an oversimplification; more accurate estimates of the cost-effectiveness of screening may be obtained by using an individual-based measure of risk. Health inequalities may be reduced by targeting health promotion interventions at sexually active girls younger than 16 years and those with a history of chlamydia. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America.

Fibromyalgia and Risk of Dementia-A Nationwide, Population-Based, Cohort Study.

PubMed

Tzeng, Nian-Sheng; Chung, Chi-Hsiang; Liu, Feng-Cheng; Chiu, Yu-Hsiang; Chang, Hsin-An; Yeh, Chin-Bin; Huang, San-Yuan; Lu, Ru-Band; Yeh, Hui-Wen; Kao, Yu-Chen; Chiang, Wei-Shan; Tsao, Chang-Hui; Wu, Yung-Fu; Chou, Yu-Ching; Lin, Fu-Huang; Chien, Wu-Chien

2018-02-01

Fibromyalgia is a syndrome of chronic pain and other symptoms and is associated with patient discomfort and other diseases. This nationwide matched-cohort population-based study aimed to investigate the association between fibromyalgia and the risk of developing dementia, and to clarify the association between fibromyalgia and dementia. A total of 41,612 patients of age ≥50 years with newly diagnosed fibromyalgia between January 1, and December 31, 2000 were selected from the National Health Insurance Research Database of Taiwan, along with 124,836 controls matched for sex and age. After adjusting for any confounding factors, Fine and Gray competing risk analysis was used to compare the risk of developing dementia during the 10 years of follow-up. Of the study subjects, 1,704 from 41,612 fibromyalgia patients (21.23 per 1,000 person-years) developed dementia when compared to 4,419 from 124,836 controls (18.94 per 1,000 person-years). Fine and Gray competing risk analysis revealed that the study subjects were more likely to develop dementia (hazard ratio: 2.29, 95% CI: 2.16-2.42; P < 0.001). After adjusting for sex, age, monthly income, urbanization level, geographic region of residence and comorbidities the hazard ratio was 2.77 (95% CI: 2.61-2.95, P < 0.001). Fibromyalgia was associated with increased risk of all types of dementia in this study. The study subjects with fibromyalgia had a 2.77-fold risk of dementia in comparison to the control group. Therefore, further studies are needed to elucidate the underlying mechanisms of the association between fibromyalgia and the risk of dementia. Copyright © 2018 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.

Prevalence and risk factors for primary open-angle glaucoma in a rural northeast China population: a population-based survey in Bin County, Harbin

PubMed Central

Sun, J; Zhou, X; Kang, Y; Yan, L; Sun, X; Sui, H; Qin, D; Yuan, H

2012-01-01

Purpose To estimate the prevalence and associated risk factors of primary open-angle glaucoma (POAG) in a rural population in northeast China. Methods A population-based survey was conducted within Bin County, Harbin of northeast China. Glaucoma was diagnosed using International Society of Geographical and Epidemiological Ophthalmology criteria. All the subjects underwent a complete ophthalmic examination. Results A total of 4956 (86.0%) of 5762 subjects aged 40 years or older were examined. The mean intraocular pressure (IOP) of right eyes was 14.0 (95% confidence interval (CI), 13.9 to 14.1) mm Hg. The prevalence of POAG was 0.71% (35/4956, 95% CI, 0.47 to 0.93). In these POAG subjects, 17 (48.6%) had elevated IOP >21 mm Hg in either eye, 3 (8.8%) participants had been treated by laser trabeculoplasty or trabeculectomy and were known to have POAG. Vision impairment to varying degrees was present in 20 subjects (58.8%) with 1 subject blind in both eyes and 8 subjects blind in one eye. On multivariate analysis, age, family history of glaucoma, systemic hypertension, and IOP were regarded as significant independent risk factors. Conclusions POAG is a disease of serious consequence and of low diagnosis and treatment rates in rural northeast China. Age, family history of glaucoma, systemic hypertension, and IOP remain as significant independent risk factors for POAG. PMID:22157917

Cardiovascular Disease Risk in a Large, Population-Based Cohort of Breast Cancer Survivors.

PubMed

Boekel, Naomi B; Schaapveld, Michael; Gietema, Jourik A; Russell, Nicola S; Poortmans, Philip; Theuws, Jacqueline C M; Schinagl, Dominic A X; Rietveld, Derek H F; Versteegh, Michel I M; Visser, Otto; Rutgers, Emiel J T; Aleman, Berthe M P; van Leeuwen, Flora E

2016-04-01

To conduct a large, population-based study on cardiovascular disease (CVD) in breast cancer (BC) survivors treated in 1989 or later. A large, population-based cohort comprising 70,230 surgically treated stage I to III BC patients diagnosed before age 75 years between 1989 and 2005 was linked with population-based registries for CVD. Cardiovascular disease risks were compared with the general population, and within the cohort using competing risk analyses. Compared with the general Dutch population, BC patients had a slightly lower CVD mortality risk (standardized mortality ratio 0.92, 95% confidence interval [CI] 0.88-0.97). Only death due to valvular heart disease was more frequent (standardized mortality ratio 1.28, 95% CI 1.08-1.52). Left-sided radiation therapy after mastectomy increased the risk of any cardiovascular event compared with both surgery alone (subdistribution hazard ratio (sHR) 1.23, 95% CI 1.11-1.36) and right-sided radiation therapy (sHR 1.19, 95% CI 1.04-1.36). Radiation-associated risks were found for not only ischemic heart disease, but also for valvular heart disease and congestive heart failure (CHF). Risks were more pronounced in patients aged <50 years at BC diagnosis (sHR 1.48, 95% CI 1.07-2.04 for left- vs right-sided radiation therapy after mastectomy). Left- versus right-sided radiation therapy after wide local excision did not increase the risk of all CVD combined, yet an increased ischemic heart disease risk was found (sHR 1.14, 95% CI 1.01-1.28). Analyses including detailed radiation therapy information showed an increased CVD risk for left-sided chest wall irradiation alone, left-sided breast irradiation alone, and internal mammary chain field irradiation, all compared with right-sided breast irradiation alone. Compared with patients not treated with chemotherapy, chemotherapy used ≥1997 (ie, anthracyline-based chemotherapy) increased the risk of CHF (sHR 1.35, 95% CI 1.00-1.83). Radiation therapy regimens used in BC treatment between 1989 and 2005 increased the risk of CVD, and anthracycline-based chemotherapy regimens increased the risk of CHF. Copyright © 2016 Elsevier Inc. All rights reserved.

Coincident Alcohol Dependence and Depression Increases Risk of Suicidal Ideation among Army National Guard Soldiers

PubMed Central

Fink, David; Sampson, Laura; Tamburrino, Marijo; Liberzon, Israel; Calabrese, Joseph R.; Galea, Sandro

2017-01-01

Purpose Suicide rates among military service members have risen dramatically, while drivers remain poorly understood. We aimed to examine the relationship between coincident alcohol dependence and depression in shaping subsequent risk of suicidal ideation among National Guard forces. Methods We performed a longitudinal analysis using a randomly selected, population-based sample of Ohio Army National Guard soldiers. Telephone-based surveys of 1582 soldiers who participated in both wave 1 (data collected 2008–2009) and wave 2 (data collected 2009– 2010) were analyzed. Results Incident suicidal ideation was present among 2.47% of soldiers at follow-up. Odds ratios (ORs) for suicidal ideation among those with vs. without alcohol dependence were similar among non-depressed [OR=3.85 (95% Confidence Intervals(CI) = 1.18–12.52)] and depressed individuals [OR = 3.13 (95% CI = 0.88–11.14)]; a logistic model cross-product term confirmed an absence of multiplicative interaction (beta coefficient=−0.21, p=0.82). In contrast, the risk differences (RD) for suicidal ideation among those with vs. without alcohol dependence diverged for those without depression [RD = 0.04 (95% CI = 0.02–0.07)] compared to those with depression [RD 0.11(95% CI=0.06–0.18)]; strong evidence of additive interaction was observed - [Relative Excess Risk of Interaction (RERI) = 5.978(95% CI=0.364–11.591)]. Conclusions We found that alcohol dependence and depression worked together to shape risk for incident suicidal ideation among Army National Guard service members. Because coincident alcohol dependence and depression is relatively rare, a high-risk prevention approach is recommended. Population-based screening for suicidality among patients with alcohol dependence, depression, and particularly those with both conditions is warranted in military populations. PMID:28139369

Implications of Supermarket Access, Neighborhood Walkability, and Poverty Rates for Diabetes Risk in an Employee Population

PubMed Central

Herrick, Cynthia J.; Yount, Byron W.; Eyler, Amy A.

2016-01-01

Objective Diabetes is a growing public health problem, and the environment in which people live and work may affect diabetes risk. The goal of this study was to examine the association between multiple aspects of environment and diabetes risk in an employee population. Design This was a retrospective cross-sectional analysis. Home environment variables were derived using employee zip code. Descriptive statistics were run on all individual and zip code level variables, stratified by diabetes risk and worksite. A multivariable logistic regression analysis was then conducted to determine the strongest associations with diabetes risk. Setting Data was collected from employee health fairs in a Midwestern health system 2009–2012. Subjects The dataset contains 25,227 unique individuals across four years of data. From this group, using an individual’s first entry into the database, 15,522 individuals had complete data for analysis. Results The prevalence of high diabetes risk in this population was 2.3%. There was significant variability in individual and zip code level variables across worksites. From the multivariable analysis, living in a zip code with higher percent poverty and higher walk score was positively associated with high diabetes risk, while living in a zip code with higher supermarket density was associated with a reduction in high diabetes risk. Conclusions Our study underscores the important relationship between poverty, home neighborhood environment, and diabetes risk, even in a relatively healthy employed population, and suggests a role for the employer in promoting health. PMID:26638995

Implications of supermarket access, neighbourhood walkability and poverty rates for diabetes risk in an employee population.

PubMed

Herrick, Cynthia J; Yount, Byron W; Eyler, Amy A

2016-08-01

Diabetes is a growing public health problem, and the environment in which people live and work may affect diabetes risk. The goal of the present study was to examine the association between multiple aspects of environment and diabetes risk in an employee population. This was a retrospective cross-sectional analysis. Home environment variables were derived using employees' zip code. Descriptive statistics were run on all individual- and zip-code-level variables, stratified by diabetes risk and worksite. A multivariable logistic regression analysis was then conducted to determine the strongest associations with diabetes risk. Data were collected from employee health fairs in a Midwestern health system, 2009-2012. The data set contains 25 227 unique individuals across four years of data. From this group, using an individual's first entry into the database, 15 522 individuals had complete data for analysis. The prevalence of high diabetes risk in this population was 2·3 %. There was significant variability in individual- and zip-code-level variables across worksites. From the multivariable analysis, living in a zip code with higher percentage of poverty and higher walk score was positively associated with high diabetes risk, while living in a zip code with higher supermarket density was associated with a reduction in high diabetes risk. Our study underscores the important relationship between poverty, home neighbourhood environment and diabetes risk, even in a relatively healthy employed population, and suggests a role for the employer in promoting health.

Association between month of birth and melanoma risk: fact or fiction?

PubMed

Fiessler, Cornelia; Pfahlberg, Annette B; Keller, Andrea K; Radespiel-Tröger, Martin; Uter, Wolfgang; Gefeller, Olaf

2017-04-01

Evidence on the effect of ultraviolet radiation (UVR) exposure in infancy on melanoma risk in later life is scarce. Three recent studies suggest that people born in spring carry a higher melanoma risk. Our study aimed at verifying whether such a seasonal pattern of melanoma risk actually exists. Data from the population-based Cancer Registry Bavaria (CRB) on the birth months of 28 374 incident melanoma cases between 2002 and 2012 were analysed and compared with data from the Bavarian State Office for Statistics and Data Processing on the birth month distribution in the Bavarian population. Crude and adjusted analyses using negative binomial regression models were performed in the total study group and supplemented by several subgroup analyses. In the crude analysis, the birth months March-May were over-represented among melanoma cases. Negative binomial regression models adjusted only for sex and birth year revealed a seasonal association between melanoma risk and birth month with 13-21% higher relative incidence rates for March, April and May compared with the reference December. However, after additionally adjusting for the birth month distribution of the Bavarian population, these risk estimates decreased markedly and no association with the birth month was observed any more. Similar results emerged in all subgroup analyses. Our large registry-based study provides no evidence that people born in spring carry a higher risk for developing melanoma in later life and thus lends no support to the hypothesis of higher UVR susceptibility during the first months of life. © The Author 2016; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association

What Is the Risk of Progressive Multifocal Leukoencephalopathy in Patients With Ulcerative Colitis or Crohn's Disease Treated With Vedolizumab?

PubMed

Card, Timothy; Xu, Jing; Liang, Huifang; Bhayat, Fatima

2018-04-23

Progressive multifocal leukoencephalopathy is a serious condition linked to certain diseases and immunosuppressant therapies, including the α4 integrin antagonist natalizumab. No cases have been reported to date with vedolizumab, a selective antagonist of the α4β7 integrin expressed on gut-homing lymphocytes. This analysis aimed to describe the current and future expected occurrence of progressive multifocal leukoencephalopathy with vedolizumab use, were the risk the same as in other populations in which this disease has been studied. The expected number of vedolizumab-associated progressive multifocal leukoencephalopathy cases was estimated up to May 19, 2016, and modeled up to 2034. These estimates were based on the cumulative exposure to the drug, assuming an equivalent risk to that of patients treated with natalizumab or those from other reference populations where progressive multifocal leukoencephalopathy has been examined. Future cases were modeled based on similar risks and projected sales. The cumulative vedolizumab exposure was estimated at 54,619 patient-years, with a 95% confidence interval of 0.0 to 6.75 cases per 100,000 patient-years. An estimated 30.2 (95% confidence interval, 19.4-40.9) cases of progressive multifocal leukoencephalopathy would have occurred if vedolizumab had the same risk as that of natalizumab. There would be a 50% chance of the first case occurring by 2018, assuming an equivalent risk to the general population. These analyses indicate that the risk of progressive multifocal leukoencephalopathy with vedolizumab is small, and unlikely to be above 6.75 cases per 100,000 patient-years.

A cohort study of cervical screening using partial HPV typing and cytology triage.

PubMed

Schiffman, Mark; Hyun, Noorie; Raine-Bennett, Tina R; Katki, Hormuzd; Fetterman, Barbara; Gage, Julia C; Cheung, Li C; Befano, Brian; Poitras, Nancy; Lorey, Thomas; Castle, Philip E; Wentzensen, Nicolas

2016-12-01

HPV testing is more sensitive than cytology for cervical screening. However, to incorporate HPV tests into screening, risk-stratification ("triage") of HPV-positive women is needed to avoid excessive colposcopy and overtreatment. We prospectively evaluated combinations of partial HPV typing (Onclarity, BD) and cytology triage, and explored whether management could be simplified, based on grouping combinations yielding similar 3-year or 18-month CIN3+ risks. We typed ∼9,000 archived specimens, taken at enrollment (2007-2011) into the NCI-Kaiser Permanente Northern California (KPNC) HPV Persistence and Progression (PaP) cohort. Stratified sampling, with reweighting in the statistical analysis, permitted risk estimation of HPV/cytology combinations for the 700,000+-woman KPNC screening population. Based on 3-year CIN3+ risks, Onclarity results could be combined into five groups (HPV16, else HPV18/45, else HPV31/33/58/52, else HPV51/35/39/68/56/66/68, else HPV negative); cytology results fell into three risk groups ("high-grade," ASC-US/LSIL, NILM). For the resultant 15 HPV group-cytology combinations, 3-year CIN3+ risks ranged 1,000-fold from 60.6% to 0.06%. To guide management, we compared the risks to established "benchmark" risk/management thresholds in this same population (e.g., LSIL predicted 3-year CIN3+ risk of 5.8% in the screening population, providing the benchmark for colposcopic referral). By benchmarking to 3-year risk thresholds (supplemented by 18-month estimates), the widely varying risk strata could be condensed into four action bands (very high risk of CIN3+ mandating consideration of cone biopsy if colposcopy did not find precancer; moderate risk justifying colposcopy; low risk managed by intensified follow-up to permit HPV "clearance"; and very low risk permitting routine screening.) Overall, the results support primary HPV testing, with management of HPV-positive women using partial HPV typing and cytology. © 2016 UICC.

Association between Polymorphisms in MicroRNAs and Risk of Urological Cancer: A Meta-Analysis Based on 17,019 Subjects

PubMed Central

Wang, Yu-Hui; Hu, Han-Ning; Weng, Hong; Chen, Hao; Luo, Chang-Liang; Ji, Jia; Yin, Chang-Qing; Yuan, Chun-Hui; Wang, Fu-Bing

2017-01-01

Accumulating evidence has demonstrated that some single nucleotide polymorphisms (SNPs) existing in miRNAs correlate with the susceptibility to urological cancers. However, a clear consensus still not reached due to the limited statistical power in individual study. Thus, we concluded a meta-analysis to systematically evaluate the association between microRNA SNPs and urological cancer risk. Eligible studies were collected from PubMed, Embase, Web of Science, and CNKI databases. Pooled odds ratio (OR) and corresponding 95% confidence interval (95% CI) were calculated to assess the strength of the relationships between three SNPs (miR-196a2, C>T rs11614913; miR-146a, G>C rs2910164; and miR-499, A>G rs3746444) and the risk of urological cancers. In addition, the stability of our analysis was evaluated by publication bias, sensitivity and heterogeneity analysis. Overall, a total of 17,019 subjects from 14 studies were included in this meta-analysis. We found that CT (miR-196a2, C>T rs11614913) was a risk factor for renal cell carcinoma (CT vs. CC: OR = 1.72, 95%CI = 1.05–2.80, P = 0.03, I2 = 66%), especially in Asian population (CT vs. CC: OR = 1.17, 95%CI = 1.04–1.32, P < 0.01, I2 = 0%). miR-146a G>C rs2910164 was a protective factor of urological cancers (C vs. G: OR = 0.87, 95%CI = 0.81–0.93, P < 0.01, I2 = 0%), especially for bladder cancer. miR-499 A>G rs3746444 was correlated with an increased risk of urological cancers, specifically in Asian population. In conclusion, our meta-analysis suggests that polymorphisms in microRNAs, miR-196a2, C>T rs11614913, miR-146a G>C rs2910164 and miR-499 A>G rs3746444, may be associated with the development of urological cancers and the risks mainly exist in Asian populations. PMID:28579964

Tsunami evacuation analysis, modelling and planning: application to the coastal area of El Salvador

NASA Astrophysics Data System (ADS)

Gonzalez-Riancho, Pino; Aguirre-Ayerbe, Ignacio; Aniel-Quiroga, Iñigo; Abad Herrero, Sheila; González Rodriguez, Mauricio; Larreynaga, Jeniffer; Gavidia, Francisco; Quetzalcoalt Gutiérrez, Omar; Álvarez-Gómez, Jose Antonio; Medina Santamaría, Raúl

2014-05-01

Advances in the understanding and prediction of tsunami impacts allow the development of risk reduction strategies for tsunami-prone areas. Conducting adequate tsunami risk assessments is essential, as the hazard, vulnerability and risk assessment results allow the identification of adequate, site-specific and vulnerability-oriented risk management options, with the formulation of a tsunami evacuation plan being one of the main expected results. An evacuation plan requires the analysis of the territory and an evaluation of the relevant elements (hazard, population, evacuation routes, and shelters), the modelling of the evacuation, and the proposal of alternatives for those communities located in areas with limited opportunities for evacuation. Evacuation plans, which are developed by the responsible authorities and decision makers, would benefit from a clear and straightforward connection between the scientific and technical information from tsunami risk assessments and the subsequent risk reduction options. Scientifically-based evacuation plans would translate into benefits for the society in terms of mortality reduction. This work presents a comprehensive framework for the formulation of tsunami evacuation plans based on tsunami vulnerability assessment and evacuation modelling. This framework considers (i) the hazard aspects (tsunami flooding characteristics and arrival time), (ii) the characteristics of the exposed area (people, shelters and road network), (iii) the current tsunami warning procedures and timing, (iv) the time needed to evacuate the population, and (v) the identification of measures to improve the evacuation process, such as the potential location for vertical evacuation shelters and alternative routes. The proposed methodological framework aims to bridge the gap between risk assessment and risk management in terms of tsunami evacuation, as it allows for an estimation of the degree of evacuation success of specific management options, as well as for the classification and prioritization of the gathered information, in order to formulate an optimal evacuation plan. The framework has been applied to the El Salvador case study through the project "Tsunami Hazard and Risk Assessment in El Salvador", funded by AECID during the period 2009-12, demonstrating its applicability to site-specific response times and population characteristics.

Prevalence and burden of chronic kidney disease among the general population and high-risk groups in Africa: a systematic review

PubMed Central

Abd ElHafeez, Samar; Bolignano, Davide; D’Arrigo, Graziella; Dounousi, Evangelia; Tripepi, Giovanni; Zoccali, Carmine

2018-01-01

Objectives While increasing attention is paid to the rising prevalence of chronic diseases in Africa, there is little focus on chronic kidney disease (CKD). This systematic review assesses CKD burden among the general population and high-risk groups on the entire African continent. Design, setting and participants We searched Medline and PubMed databases for articles published between 1 January 1995 and 7 April 2017 by sensitive search strategies focusing on CKD surveys at the community level and high-risk groups. In total, 7918 references were evaluated, of which 7766 articles were excluded because they did not meet the inclusion criteria. Thus, 152 studies were included in the final analysis. Outcome measurement The prevalence of CKD in each study group was expressed as a range and pooled prevalence rate of CKD was calculated as a point estimate and 95% CI. No meta-analysis was done. Data were presented for different populations. Results In the community-level studies, based on available medium-quality and high-quality studies, the prevalence of CKD ranged from 2% to 41% (pooled prevalence: 10.1%; 95% CI 9.8% to 10.5%). The prevalence of CKD in the high-risk groups ranged from 1% to 46% (pooled prevalence: 5.6%; 95% CI 5.4% to 5.8%) in patients with HIV (based on available medium-quality and high-quality studies), 11%–90% (pooled prevalence: 24.7%; 95% CI 23.6% to 25.7%) in patients with diabetes (based on all available studies which are of low quality except four of medium quality) and 13%–51% (pooled prevalence: 34.5%; 95 % CI 34.04% to 36%) in patients with hypertension (based on all available studies which are of low quality except two of medium quality). Conclusion In Africa, CKD is a public health problem, mainly attributed to high-risk conditions as hypertension and diabetes. The poor data quality restricts the validity of the findings and draws the attention to the importance of designing future robust studies. PMID:29326180

Image Based Biomarker of Breast Cancer Risk: Analysis of Risk Disparity Among Minority Populations

DTIC Science & Technology

2014-03-01

attenuation coefficient of calcium hydroxyapatite ; is a parameter controlling the contrast of MCs in synthetic images (0< ə); and is the linear...effect of acquisition parameters and quantum noise," Med Phys, 37, 1591-600 (2010). [13] M. J. Yaffe, J. M. Boone, N. Packard, O. Alonzo-Proulx, S. Y...the acquisition of individual mammograms, the use of linear transformations does not seem appropriate for mammogram registration. Non-linear

Does Helicobacter pylori infection increase incidence of dementia? The Personnes Agées QUID Study.

PubMed

Roubaud Baudron, Claire; Letenneur, Luc; Langlais, Anthony; Buissonnière, Alice; Mégraud, Francis; Dartigues, Jean-François; Salles, Nathalie

2013-01-01

To determine whether Helicobacter pylori infection was associated with dementia and risk of developing dementia in a longitudinal population-based cohort of elderly adults living in the community. Prospective community-based cohort study. The population-based Personnes Agées QUID (PAQUID) Study. Six hundred three noninstitutionalized individuals aged 65 and older living in the southwest of France followed from 1989 to 2008. A descriptive and comparative analysis including dementia prevalence, according to H. pylori status (serology), was made at baseline. Cox proportional hazard models were used to study the risk of developing dementia according to H. pylori status assessed on sera samples from elderly adults initially free of dementia and followed for 20 years. A neurologist diagnosed dementia according to Diagnostic and Statistical Manual of Mental Disorders Third Edition criteria. At baseline, 391 (64.8%) subjects (348 women, mean age 73.9 ± 6.5) were seropositive for H. pylori. Dementia prevalence was higher in the infected group (5.4% vs 1.4%, P = .02). After 20 years of follow-up, 148 incident cases of dementia were diagnosed. After controlling for age, sex, educational level, apolipoprotein E4 status, cardiovascular risk factors, and Mini-Mental State Examination score, H. pylori infection was determined to be a risk factor for developing dementia (hazard ratio = 1.46, P = .04). This longitudinal population-based study provides additional epidemiological support to the hypothesis of an association between dementia and H. pylori infection, which may enhance neurodegeneration. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.

HIV-Risk Index: Development and Validation of a Brief Risk Index for Hispanic Young People.

PubMed

Ballester-Arnal, Rafael; Gil-Llario, María Dolores; Castro-Calvo, Jesús; Giménez-García, Cristina

2016-08-01

The prevalence of HIV risk behaviors among young people facilitates the spread of HIV, in particular regarding unsafe sex behavior, although this trend is different within this population. For this reason, identifying the riskier young population is required to prevent HIV infection. The main purpose of this study was to develop and validate a risk index to assess the different sexual HIV risk exposure among Hispanic Young people. For this purpose, 9861 Spanish young people were randomly distributed into two groups (derivation and validation group). According to the results, the factor analyses grouped the nine items of the HIV- risk index into two factors (factor 1, direct sexual risk indicators and factor 2, indirect sexual risk indicators) with an equal structure for men and women by a multi-group confirmatory factor analysis. The variance explained was 54.26 %. Moreover, the Cronbach's alpha coefficient revealed high internal reliability (α = .79) and the convergent validity supported its evidence based on different HIV risk indexes. Therefore, the HIV-risk index seem to be a rigorous and valid measure to estimate HIV risk exposure among young people.

Developing and validating risk prediction models in an individual participant data meta-analysis

PubMed Central

2014-01-01

Background Risk prediction models estimate the risk of developing future outcomes for individuals based on one or more underlying characteristics (predictors). We review how researchers develop and validate risk prediction models within an individual participant data (IPD) meta-analysis, in order to assess the feasibility and conduct of the approach. Methods A qualitative review of the aims, methodology, and reporting in 15 articles that developed a risk prediction model using IPD from multiple studies. Results The IPD approach offers many opportunities but methodological challenges exist, including: unavailability of requested IPD, missing patient data and predictors, and between-study heterogeneity in methods of measurement, outcome definitions and predictor effects. Most articles develop their model using IPD from all available studies and perform only an internal validation (on the same set of data). Ten of the 15 articles did not allow for any study differences in baseline risk (intercepts), potentially limiting their model’s applicability and performance in some populations. Only two articles used external validation (on different data), including a novel method which develops the model on all but one of the IPD studies, tests performance in the excluded study, and repeats by rotating the omitted study. Conclusions An IPD meta-analysis offers unique opportunities for risk prediction research. Researchers can make more of this by allowing separate model intercept terms for each study (population) to improve generalisability, and by using ‘internal-external cross-validation’ to simultaneously develop and validate their model. Methodological challenges can be reduced by prospectively planned collaborations that share IPD for risk prediction. PMID:24397587

Parsing Social Network Survey Data from Hidden Populations Using Stochastic Context-Free Grammars

PubMed Central

Poon, Art F. Y.; Brouwer, Kimberly C.; Strathdee, Steffanie A.; Firestone-Cruz, Michelle; Lozada, Remedios M.; Kosakovsky Pond, Sergei L.; Heckathorn, Douglas D.; Frost, Simon D. W.

2009-01-01

Background Human populations are structured by social networks, in which individuals tend to form relationships based on shared attributes. Certain attributes that are ambiguous, stigmatized or illegal can create a ÔhiddenÕ population, so-called because its members are difficult to identify. Many hidden populations are also at an elevated risk of exposure to infectious diseases. Consequently, public health agencies are presently adopting modern survey techniques that traverse social networks in hidden populations by soliciting individuals to recruit their peers, e.g., respondent-driven sampling (RDS). The concomitant accumulation of network-based epidemiological data, however, is rapidly outpacing the development of computational methods for analysis. Moreover, current analytical models rely on unrealistic assumptions, e.g., that the traversal of social networks can be modeled by a Markov chain rather than a branching process. Methodology/Principal Findings Here, we develop a new methodology based on stochastic context-free grammars (SCFGs), which are well-suited to modeling tree-like structure of the RDS recruitment process. We apply this methodology to an RDS case study of injection drug users (IDUs) in Tijuana, México, a hidden population at high risk of blood-borne and sexually-transmitted infections (i.e., HIV, hepatitis C virus, syphilis). Survey data were encoded as text strings that were parsed using our custom implementation of the inside-outside algorithm in a publicly-available software package (HyPhy), which uses either expectation maximization or direct optimization methods and permits constraints on model parameters for hypothesis testing. We identified significant latent variability in the recruitment process that violates assumptions of Markov chain-based methods for RDS analysis: firstly, IDUs tended to emulate the recruitment behavior of their own recruiter; and secondly, the recruitment of like peers (homophily) was dependent on the number of recruits. Conclusions SCFGs provide a rich probabilistic language that can articulate complex latent structure in survey data derived from the traversal of social networks. Such structure that has no representation in Markov chain-based models can interfere with the estimation of the composition of hidden populations if left unaccounted for, raising critical implications for the prevention and control of infectious disease epidemics. PMID:19738904

Active epilepsy prevalence, the treatment gap, and treatment gap risk profile in eastern China: A population-based study.

PubMed

Ding, Xiaoyan; Zheng, Yang; Guo, Yi; Shen, Chunhong; Wang, Shan; Chen, Feng; Yan, Shengqiang; Ding, Meiping

2018-01-01

We measured the prevalence of active epilepsy and investigated the treatment gap and treatment gap risk profile in eastern China. This was a cross-sectional population-based survey conducted in Zhejiang, China, from October 2013 to March 2014. A total 54,976 people were selected using multi-stage cluster sampling. A two-stage questionnaire-based process was used to identify patients with active epilepsy and to record their demographic, socioeconomic, and epilepsy-related features. Logistic regression analysis was used to analyze risk factors of the treatment gap in eastern China, as adjusted for age and sex. We interviewed 50,035 people; 118 had active epilepsy (2.4‰), among which the treatment gap was 58.5%. In multivariate analysis, failure to receive appropriate antiepileptic treatment was associated with higher seizure frequency of 12-23 times per year (adjusted odds ratio=6.874; 95% confidence interval [CI]=2.372-19.918), >24 times per year (adjusted odds ratio=19.623; 95% CI=4.999-77.024), and a lack of health insurance (adjusted odds ratio=7.284; 95% CI=1.321-40.154). Eastern China has relatively lower prevalence of active epilepsy and smaller treatment gap. Interventions aimed at reducing seizure frequency, improving the health insurance system should be investigated as potential targets to further bridge the treatment gap. Copyright © 2017 Elsevier Inc. All rights reserved.

Quantitative assessment of the relationship between Fas/FasL genes polymorphisms and head and neck cancer risk

PubMed Central

Zhang, Dan-Feng; Jiang, Guang-Bin; Qin, Chuan-Qi; Liu, De-Xi; Hu, Ya-Jun; Zhou, Juan; Niu, Yu-Ming

2018-01-01

Abstract Background: Molecular epidemiological studies have demonstrated a closer association between Fas/FasL polymorphisms and head and neck cancer (HNC) risk, and the results of these published studies were inconsistent. We therefore performed this meta-analysis to explore the associations between Fas/FasL polymorphisms and HNC risk. Methods: Four online databases (PubMed, Embase, CNKI, and Wanfang) were searched. Odds ratios (ORs) with 95% confidence interval (95% CIs) were calculated to assess the association between Fas -670A>G, Fas -1377G>A, and FasL -844C>T polymorphisms and HNC risk. In addition, heterogeneity, accumulative/sensitivity analysis, and publication bias were conducted to check the statistical power. Results: Overall, 9 related publications (20 independent case–control studies) involving 3179 patients and 4217 controls were identified. Significant association of protective effects was observed between FasL -844C>T polymorphism and HNC risk in codominant and dominant model models (CT vs CC: OR = 0.89, 95% CI = 0.79–1.00, P = .05, I2 = 38.3%, CT+TT vs CC: OR = 0.88, 95% CI = 0.79–0.98, P = .02, I2 = 35.8%). Furthermore, the similar protective effects were observed the subgroup analysis of in Asian population and population-based controls group. Conclusion: Our meta-analysis indicated that FasL -844C>T polymorphism plays a protective role against HNC development, but the Fas -670A>G and Fas -1377G>A polymorphisms maybe not associated with HNC risk. PMID:29419701

Most common single-nucleotide polymorphisms associated with rheumatoid arthritis in persons of European ancestry confer risk of rheumatoid arthritis in African Americans.

PubMed

Hughes, Laura B; Reynolds, Richard J; Brown, Elizabeth E; Kelley, James M; Thomson, Brian; Conn, Doyt L; Jonas, Beth L; Westfall, Andrew O; Padilla, Miguel A; Callahan, Leigh F; Smith, Edwin A; Brasington, Richard D; Edberg, Jeffrey C; Kimberly, Robert P; Moreland, Larry W; Plenge, Robert M; Bridges, S Louis

2010-12-01

Large-scale genetic association studies have identified >20 rheumatoid arthritis (RA) risk alleles among individuals of European ancestry. The influence of these risk alleles has not been comprehensively studied in African Americans. We therefore sought to examine whether these validated RA risk alleles are associated with RA risk in an African American population. Twenty-seven candidate single-nucleotide polymorphisms (SNPs) were genotyped in 556 autoantibody-positive African Americans with RA and 791 healthy African American control subjects. Odds ratios (ORs) and 95% confidence intervals (95% CIs) for each SNP were compared with previously published ORs for RA patients of European ancestry. We then calculated a composite genetic risk score (GRS) for each individual based on the sum of all risk alleles. Overlap of the ORs and 95% CIs between the European and African American populations was observed for 24 of the 27 candidate SNPs. Conversely, 3 of the 27 SNPs (CCR6 rs3093023, TAGAP rs394581, and TNFAIP3 rs6920220) demonstrated ORs in the opposite direction from those reported for RA patients of European ancestry. The GRS analysis indicated a small but highly significant probability that African American patients relative to control subjects were enriched for the risk alleles validated in European RA patients (P = 0.00005). The majority of RA risk alleles previously validated for RA patients of European ancestry showed similar ORs in our population of African Americans with RA. Furthermore, the aggregate GRS supports the hypothesis that these SNPs are risk alleles for RA in the African American population. Future large-scale genetic studies are needed to validate these risk alleles and identify novel RA risk alleles in African Americans. Copyright © 2010 by the American College of Rheumatology.

Assessing Breast Cancer Risk Estimates Based on the Gail Model and Its Predictors in Qatari Women.

PubMed

Bener, Abdulbari; Çatan, Funda; El Ayoubi, Hanadi R; Acar, Ahmet; Ibrahim, Wanis H

2017-07-01

The Gail model is the most widely used breast cancer risk assessment tool. An accurate assessment of individual's breast cancer risk is very important for prevention of the disease and for the health care providers to make decision on taking chemoprevention for high-risk women in clinical practice in Qatar. To assess the breast cancer risk among Arab women population in Qatar using the Gail model and provide a global comparison of risk assessment. In this cross-sectional study of 1488 women (aged 35 years and older), we used the Gail Risk Assessment Tool to assess the risk of developing breast cancer. Sociodemographic features such as age, lifestyle habits, body mass index, breast-feeding duration, consanguinity among parents, and family history of breast cancer were considered as possible risks. The mean age of the study population was 47.8 ± 10.8 years. Qatari women and Arab women constituted 64.7% and 35.3% of the study population, respectively. The mean 5-year and lifetime breast cancer risks were 1.12 ± 0.52 and 10.57 ± 3.1, respectively. Consanguineous marriage among parents was seen in 30.6% of participants. We found a relationship between the 5-year and lifetime risks of breast cancer and variables such as age, age at menarche, gravidity, parity, body mass index, family history of cancer, menopause age, occupation, and level of education. The linear regression analysis identified the predictors for breast cancer in women such as age, age at menarche, age of first birth, family history and age of menopausal were considered the strong predictors and significant contributing risk factors for breast cancer after adjusting for ethnicity, parity and other variables. The current study is the first to evaluate the performance of the Gail model for Arab women population in the Gulf Cooperation Council. Gail model is an appropriate breast cancer risk assessment tool for female population in Qatar.

Texting for Health: An Evaluation of a Population Approach to Type 2 Diabetes Risk Reduction With a Personalized Message.

PubMed

Khurshid, Anjum; Brown, Lisanne; Mukherjee, Snigdha; Abebe, Nebeyou; Kulick, David

2015-11-01

txt4health is an innovative, 14-week, interactive, population-based mobile health program for individuals at risk of type 2 diabetes, developed under the Beacon Community Program in the Greater New Orleans, La., area. A comprehensive social marketing campaign sought to enroll hard-to-reach, at-risk populations using a combination of mass media and face-to-face engagement in faith-based and retail environments. Little is known about the effectiveness of social marketing for mobile technology application in the general population. A systematic evaluation of the campaign identified successes and barriers to implementing a population-based mobile health program. Face-to-face engagement helped increase program enrollment after the initial launch; otherwise, enrollment leveled off over time. Results show positive trends in reaching target populations and in the use of mobile phones to record personal health information and set goals for reducing the risk of type 2 diabetes. The lessons from the txt4health campaign can help inform the development and programmatic strategies to provide a person-level intervention using a population-level approach for individuals at risk for diabetes as well as aid in chronic disease management.

Finding Groups Using Model-based Cluster Analysis: Heterogeneous Emotional Self-regulatory Processes and Heavy Alcohol Use Risk

PubMed Central

Mun, Eun-Young; von Eye, Alexander; Bates, Marsha E.; Vaschillo, Evgeny G.

2010-01-01

Model-based cluster analysis is a new clustering procedure to investigate population heterogeneity utilizing finite mixture multivariate normal densities. It is an inferentially based, statistically principled procedure that allows comparison of non-nested models using the Bayesian Information Criterion (BIC) to compare multiple models and identify the optimum number of clusters. The current study clustered 36 young men and women based on their baseline heart rate (HR) and HR variability (HRV), chronic alcohol use, and reasons for drinking. Two cluster groups were identified and labeled High Alcohol Risk and Normative groups. Compared to the Normative group, individuals in the High Alcohol Risk group had higher levels of alcohol use and more strongly endorsed disinhibition and suppression reasons for use. The High Alcohol Risk group showed significant HRV changes in response to positive and negative emotional and appetitive picture cues, compared to neutral cues. In contrast, the Normative group showed a significant HRV change only to negative cues. Findings suggest that the individuals with autonomic self-regulatory difficulties may be more susceptible to heavy alcohol use and use alcohol for emotional regulation. PMID:18331138

Can an Internet-based health risk assessment highlight problems of heart disease risk factor awareness? A cross-sectional analysis.

PubMed

Dickerson, Justin B; McNeal, Catherine J; Tsai, Ginger; Rivera, Cathleen M; Smith, Matthew Lee; Ohsfeldt, Robert L; Ory, Marcia G

2014-04-18

Health risk assessments are becoming more popular as a tool to conveniently and effectively reach community-dwelling adults who may be at risk for serious chronic conditions such as coronary heart disease (CHD). The use of such instruments to improve adults' risk factor awareness and concordance with clinically measured risk factor values could be an opportunity to advance public health knowledge and build effective interventions. The objective of this study was to determine if an Internet-based health risk assessment can highlight important aspects of agreement between respondents' self-reported and clinically measured CHD risk factors for community-dwelling adults who may be at risk for CHD. Data from an Internet-based cardiovascular health risk assessment (Heart Aware) administered to community-dwelling adults at 127 clinical sites were analyzed. Respondents were recruited through individual hospital marketing campaigns, such as media advertising and print media, found throughout inpatient and outpatient facilities. CHD risk factors from the Framingham Heart Study were examined. Weighted kappa statistics were calculated to measure interrater agreement between respondents' self-reported and clinically measured CHD risk factors. Weighted kappa statistics were then calculated for each sample by strata of overall 10-year CHD risk. Three samples were drawn based on strategies for treating missing data: a listwise deleted sample, a pairwise deleted sample, and a multiple imputation (MI) sample. The MI sample (n=16,879) was most appropriate for addressing missing data. No CHD risk factor had better than marginal interrater agreement (κ>.60). High-density lipoprotein cholesterol (HDL-C) exhibited suboptimal interrater agreement that deteriorated (eg, κ<.30) as overall CHD risk increased. Conversely, low-density lipoprotein cholesterol (LDL-C) interrater agreement improved (eg, up to κ=.25) as overall CHD risk increased. Overall CHD risk of the sample was lower than comparative population-based CHD risk (ie, no more than 15% risk of CHD for the sample vs up to a 30% chance of CHD for the population). Interventions are needed to improve knowledge of CHD risk factors. Specific interventions should address perceptions of HDL-C and LCL-C. Internet-based health risk assessments such as Heart Aware may contribute to public health surveillance, but they must address selection bias of Internet-based recruitment methods.

A new model for care population management.

PubMed

Williams, Jeni

2013-03-01

Steps toward building a population management model of care should include: Identifying the population that would be cared for through a population management initiative. Conducting an actuarial analysis for this population, reviewing historical utilization and cost data and projecting changes in utilization. Investing in data infrastructure that supports the exchange of data among providers and with payers. Determining potential exposure to downside risk and organizational capacity to assume this risk. Experimenting with payment models and care delivery approaches Hiring care coordinators to manage care for high-risk patients.

Colorectal cancer screening in high-risk groups is increasing, although current smokers fall behind.

PubMed

Oluyemi, Aminat O; Welch, Amy R; Yoo, Lisa J; Lehman, Erik B; McGarrity, Thomas J; Chuang, Cynthia H

2014-07-15

There is limited information about colorectal cancer (CRC) screening trends in high-risk groups, including the black, obese, diabetic, and smoking populations. For this study, the authors evaluated national CRC screening trends in these high-risk groups to provide insights into whether screening resources are being appropriately used. This was a nationally representative, population-based study using the Behavioral Risk Factor Surveillance System from the Centers for Disease Control. Data analysis was performed using bivariate analyses with weighted logistic regression. In the general population, CRC screening increased significantly from 59% to 65% during the years 2006 to 2010. The screening prevalence in non-Hispanic blacks was 58% in 2006 and 65% in 2010. Among obese individuals, the prevalence of up-to-date CRC screening increased significantly from 59% in 2006 to 66% in 2010. Screening prevalence in individuals with diabetes was 63% in 2006 and 69% in 2010. The CRC screening prevalence in current smokers was 45% in 2006 and 50% in 2010. The odds of CRC screening in the non-Hispanic black population, the obese population, and the diabetic population were higher than in non-Hispanic whites, normal weight individuals, and the population without diabetes, respectively. Current smokers had significantly lower odds of CRC screening than never-smokers in the years studied (2006: odds ratio [OR], 0.71; 95% confidence interval [CI], 0.66-0.76; 2008: OR, 0.67; 95% CI, 0.63-0.71; 2010: OR, 0.69; 95% CI, 0.66-0.73). The prevalence of CRC screening in high-risk groups is trending upward. Despite this, current smokers have significantly lower odds of CRC screening compared with the general population. © 2014 American Cancer Society.

Defining Survivorship Trajectories Across Patients With Solid Tumors: An Evidence-Based Approach.

PubMed

Dood, Robert L; Zhao, Yang; Armbruster, Shannon D; Coleman, Robert L; Tworoger, Shelley; Sood, Anil K; Baggerly, Keith A

2018-06-02

Survivorship involves a multidisciplinary approach to surveillance and management of comorbidities and secondary cancers, overseen by oncologists, surgeons, and primary care physicians. Optimal timing and coordination of care, however, is unclear and often based on arbitrary 5-year cutoffs. To determine high- and low-risk periods for all tumor types that could define when survivorship care might best be overseen by oncologists and when to transition to primary care physicians. In this pan-cancer, longitudinal, observational study, excess mortality hazard, calculated as an annualized mortality risk above a baseline population, was plotted over time. The time this hazard took to stabilize defined a high-risk period. The percent morality elevation above age- and sex-matched controls in the latter low-risk period was reported as a mortality gap. The US population-based Surveillance, Epidemiology, and End Results database defined the cancer population, and the US Census life tables defined controls. Incident cases of patients with cancer were separated into tumor types based on International Classification of Diseases for Oncology definitions. Population-level data on incident cancer cases was compared with the general US population. Overall mortality and cause of death were reported on observed cancer cases. A total of 2 317 185 patients (median age, 63 years; 49.8% female) with 66 primary tumor types were evaluated. High-risk surveillance period durations ranged from less than 1 year (breast, prostate, lip, ocular, and parathyroid cancers) up to 19 years (unspecified gastrointestinal cancers). The annualized mortality gap, representing the excess mortality in the stable period, ranged from a median 0.26% to 9.33% excess annual mortality (thyroid and hypopharyngeal cancer populations, respectively). Cluster analysis produced 6 risk cluster groups: group 1, with median survival of 16.2 (5th to 95th percentile range [PR], 10.7-40.2) years and median high-risk period of 2.5 (PR, 0-5.0) years; group 2, 8.3 (PR, 5.1-23.3) and 2.5 (PR, 4.0-8.0) years; group 3, 2.8 (PR, 1.4-3.7) and 7.0 (PR, 6.0-11.1) years; group 4, 1.6 (PR, 1.5-1.8) and 6.0 (PR, 5.1-11.4) years; group 5, 0.8 (PR, 0.5-1.2) and 0.8 (PR, 0.5-1.2) years; and group 6, 0.5 (PR, 0.4-0.8) and 12.0 (PR, 9.3-12.9) years, respectively. Subanalyses of selected tumor types in these groups revealed that stratifying on stage and histologic type can change the risk cluster and guidance for care. These findings indicate that a standardized 5-year surveillance period is inadequate for some cancers while excessive for others. High-risk cancers require the most resources with the longest high-risk period, highest persistent baseline mortality risk, and longest period of primary cancer mortality, all arguing for longer follow-up with an oncologist in these cancers.

Analysis of metabolic syndrome components in >15 000 african americans identifies pleiotropic variants: results from the population architecture using genomics and epidemiology study.

PubMed

Carty, Cara L; Bhattacharjee, Samsiddhi; Haessler, Jeff; Cheng, Iona; Hindorff, Lucia A; Aroda, Vanita; Carlson, Christopher S; Hsu, Chun-Nan; Wilkens, Lynne; Liu, Simin; Selvin, Elizabeth; Jackson, Rebecca; North, Kari E; Peters, Ulrike; Pankow, James S; Chatterjee, Nilanjan; Kooperberg, Charles

2014-08-01

Metabolic syndrome (MetS) refers to the clustering of cardiometabolic risk factors, including dyslipidemia, central adiposity, hypertension, and hyperglycemia, in individuals. Identification of pleiotropic genetic factors associated with MetS traits may shed light on key pathways or mediators underlying MetS. Using the Metabochip array in 15 148 African Americans from the Population Architecture using Genomics and Epidemiology (PAGE) study, we identify susceptibility loci and investigate pleiotropy among genetic variants using a subset-based meta-analysis method, ASsociation-analysis-based-on-subSETs (ASSET). Unlike conventional models that lack power when associations for MetS components are null or have opposite effects, Association-analysis-based-on-subsets uses 1-sided tests to detect positive and negative associations for components separately and combines tests accounting for correlations among components. With Association-analysis-based-on-subsets, we identify 27 single nucleotide polymorphisms in 1 glucose and 4 lipids loci (TCF7L2, LPL, APOA5, CETP, and APOC1/APOE/TOMM40) significantly associated with MetS components overall, all P<2.5e-7, the Bonferroni adjusted P value. Three loci replicate in a Hispanic population, n=5172. A novel African American-specific variant, rs12721054/APOC1, and rs10096633/LPL are associated with ≥3 MetS components. We find additional evidence of pleiotropy for APOE, TOMM40, TCF7L2, and CETP variants, many with opposing effects (eg, the same rs7901695/TCF7L2 allele is associated with increased odds of high glucose and decreased odds of central adiposity). We highlight a method to increase power in large-scale genomic association analyses and report a novel variant associated with all MetS components in African Americans. We also identify pleiotropic associations that may be clinically useful in patient risk profiling and for informing translational research of potential gene targets and medications. © 2014 American Heart Association, Inc.

Association between the interleukin-1β C-511T polymorphism and periodontitis: a meta-analysis in the Chinese population.

PubMed

Wang, H F; He, F Q; Xu, C J; Li, D M; Sun, X J; Chi, Y T; Guo, W

2017-02-23

The association between the interleukin-1 beta (IL-1β) C-511T (or rs16944) polymorphism and periodontitis remains inconclusive, even though there have been previous studies on this association. To assess the effects of IL-1β C-511T variants on the risk of development of periodontitis, a meta-analysis was performed in a single ethnic population. Studies, published up to December 2015, were selected for the meta-analysis from PubMed and Chinese databases. The associations were assessed with pooled OR and 95%CI. This meta-analysis identified 8 studies, including 1276 periodontitis cases and 1558 controls. Overall, a significant association between the IL-1β C-511T polymorphism and periodontitis was found in the Chinese population (TT vs CC: OR = 1.48, 95%CI = 1.19-1.85; TT + CT vs CC: OR = 1.50, 95%CI = 1.25-1.81; T vs C: OR = 1.33, 95%CI = 1.06-1.68). In the subgroup analyses based on geographical area(s), source of controls, and type of periodontitis, significant results were obtained for the association between IL-1β C-511T variants and periodontitis. Our meta-analysis indicated that the IL-1β C-511T polymorphism may be a genetic susceptibility factor for periodontitis in the Chinese population. This marker could be used to identify Chinese individuals at a high risk for periodontitis.

Heart failure disease management programs: a cost-effectiveness analysis.

PubMed

Chan, David C; Heidenreich, Paul A; Weinstein, Milton C; Fonarow, Gregg C

2008-02-01

Heart failure (HF) disease management programs have shown impressive reductions in hospitalizations and mortality, but in studies limited to short time frames and high-risk patient populations. Current guidelines thus only recommend disease management targeted to high-risk patients with HF. This study applied a new technique to infer the degree to which clinical trials have targeted patients by risk based on observed rates of hospitalization and death. A Markov model was used to assess the incremental life expectancy and cost of providing disease management for high-risk to low-risk patients. Sensitivity analyses of various long-term scenarios and of reduced effectiveness in low-risk patients were also considered. The incremental cost-effectiveness ratio of extending coverage to all patients was $9700 per life-year gained in the base case. In aggregate, universal coverage almost quadrupled life-years saved as compared to coverage of only the highest quintile of risk. A worst case analysis with simultaneous conservative assumptions yielded an incremental cost-effectiveness ratio of $110,000 per life-year gained. In a probabilistic sensitivity analysis, 99.74% of possible incremental cost-effectiveness ratios were <$50,000 per life-year gained. Heart failure disease management programs are likely cost-effective in the long-term along the whole spectrum of patient risk. Health gains could be extended by enrolling a broader group of patients with HF in disease management.

Baseline characteristics predict risk of progression and response to combined medical therapy for benign prostatic hyperplasia (BPH).

PubMed

Kozminski, Michael A; Wei, John T; Nelson, Jason; Kent, David M

2015-02-01

To better risk stratify patients, using baseline characteristics, to help optimise decision-making for men with moderate-to-severe lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) through a secondary analysis of the Medical Therapy of Prostatic Symptoms (MTOPS) trial. After review of the literature, we identified potential baseline risk factors for BPH progression. Using bivariate tests in a secondary analysis of MTOPS data, we determined which variables retained prognostic significance. We then used these factors in Cox proportional hazard modelling to: i) more comprehensively risk stratify the study population based on pre-treatment parameters and ii) to determine which risk strata stood to benefit most from medical intervention. In all, 3047 men were followed in MTOPS for a mean of 4.5 years. We found varying risks of progression across quartiles. Baseline BPH Impact Index score, post-void residual urine volume, serum prostate-specific antigen (PSA) level, age, American Urological Association Symptom Index score, and maximum urinary flow rate were found to significantly correlate with overall BPH progression in multivariable analysis. Using baseline factors permits estimation of individual patient risk for clinical progression and the benefits of medical therapy. A novel clinical decision tool based on these analyses will allow clinicians to weigh patient-specific benefits against possible risks of adverse effects for a given patient. © 2014 The Authors. BJU International © 2014 BJU International.

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.

Is a HIV vaccine a viable option and at what price? An economic evaluation of adding HIV vaccination into existing prevention programs in Thailand.

PubMed

Leelahavarong, Pattara; Teerawattananon, Yot; Werayingyong, Pitsaphun; Akaleephan, Chutima; Premsri, Nakorn; Namwat, Chawetsan; Peerapatanapokin, Wiwat; Tangcharoensathien, Viroj

2011-07-05

This study aims to determine the maximum price at which HIV vaccination is cost-effective in the Thai healthcare setting. It also aims to identify the relative importance of vaccine characteristics and risk behavior changes among vaccine recipients to determine how they affect this cost-effectiveness. A semi-Markov model was developed to estimate the costs and health outcomes of HIV prevention programs combined with HIV vaccination in comparison to the existing HIV prevention programs without vaccination. The estimation was based on a lifetime horizon period (99 years) and used the government perspective. The analysis focused on both the general population and specific high-risk population groups. The maximum price of cost-effective vaccination was defined by using threshold analysis; one-way and probabilistic sensitivity analyses were performed. The study employed an expected value of perfect information (EVPI) analysis to determine the relative importance of parameters and to prioritize future studies. The most expensive HIV vaccination which is cost-effective when given to the general population was 12,000 Thai baht (US$1 = 34 Thai baht in 2009). This vaccination came with 70% vaccine efficacy and lifetime protection as long as risk behavior was unchanged post-vaccination. The vaccine would be considered cost-ineffective at any price if it demonstrated low efficacy (30%) and if post-vaccination risk behavior increased by 10% or more, especially among the high-risk population groups. The incremental cost-effectiveness ratios were the most sensitive to change in post-vaccination risk behavior, followed by vaccine efficacy and duration of protection. The EVPI indicated the need to quantify vaccine efficacy, changed post-vaccination risk behavior, and the costs of vaccination programs. The approach used in this study differentiated it from other economic evaluations and can be applied for the economic evaluation of other health interventions not available in healthcare systems. This study is important not only for researchers conducting future HIV vaccine research but also for policy decision makers who, in the future, will consider vaccine adoption.

Genotype-Based Association Mapping of Complex Diseases: Gene-Environment Interactions with Multiple Genetic Markers and Measurement Error in Environmental Exposures

PubMed Central

Lobach, Irvna; Fan, Ruzone; Carroll, Raymond T.

2011-01-01

With the advent of dense single nucleotide polymorphism genotyping, population-based association studies have become the major tools for identifying human disease genes and for fine gene mapping of complex traits. We develop a genotype-based approach for association analysis of case-control studies of gene-environment interactions in the case when environmental factors are measured with error and genotype data are available on multiple genetic markers. To directly use the observed genotype data, we propose two genotype-based models: genotype effect and additive effect models. Our approach offers several advantages. First, the proposed risk functions can directly incorporate the observed genotype data while modeling the linkage disequihbrium information in the regression coefficients, thus eliminating the need to infer haplotype phase. Compared with the haplotype-based approach, an estimating procedure based on the proposed methods can be much simpler and significantly faster. In addition, there is no potential risk due to haplotype phase estimation. Further, by fitting the proposed models, it is possible to analyze the risk alleles/variants of complex diseases, including their dominant or additive effects. To model measurement error, we adopt the pseudo-likelihood method by Lobach et al. [2008]. Performance of the proposed method is examined using simulation experiments. An application of our method is illustrated using a population-based case-control study of association between calcium intake with the risk of colorectal adenoma development. PMID:21031455

Comparison of the risk factors effects between two populations: two alternative approaches illustrated by the analysis of first and second kidney transplant recipients

PubMed Central

2013-01-01

Background Whereas the prognosis of second kidney transplant recipients (STR) compared to the first ones has been frequently analyzed, no study has addressed the issue of comparing the risk factor effects on graft failure between both groups. Methods Here, we propose two alternative strategies to study the heterogeneity of risk factors between two groups of patients: (i) a multiplicative-regression model for relative survival (MRS) and (ii) a stratified Cox model (SCM) specifying the graft rank as strata and assuming subvectors of the explicatives variables. These developments were motivated by the analysis of factors associated with time to graft failure (return-to-dialysis or patient death) in second kidney transplant recipients (STR) compared to the first ones. Estimation of the parameters was based on partial likelihood maximization. Monte-Carlo simulations associated with bootstrap re-sampling was performed to calculate the standard deviations for the MRS. Results We demonstrate, for the first time in renal transplantation, that: (i) male donor gender is a specific risk factor for STR, (ii) the adverse effect of recipient age is enhanced for STR and (iii) the graft failure risk related to donor age is attenuated for STR. Conclusion While the traditional Cox model did not provide original results based on the renal transplantation literature, the proposed relative and stratified models revealed new findings that are useful for clinicians. These methodologies may be of interest in other medical fields when the principal objective is the comparison of risk factors between two populations. PMID:23915191

Common variants on 2p16.1, 6p22.1 and 10q24.32 are associated with schizophrenia in Han Chinese population.

PubMed

Yu, H; Yan, H; Li, J; Li, Z; Zhang, X; Ma, Y; Mei, L; Liu, C; Cai, L; Wang, Q; Zhang, F; Iwata, N; Ikeda, M; Wang, L; Lu, T; Li, M; Xu, H; Wu, X; Liu, B; Yang, J; Li, K; Lv, L; Ma, X; Wang, C; Li, L; Yang, F; Jiang, T; Shi, Y; Li, T; Zhang, D; Yue, W

2017-07-01

Many schizophrenia susceptibility loci have been identified through genome-wide association studies (GWASs) in European populations. However, until recently, schizophrenia GWASs in non-European populations were limited to small sample sizes and have yielded few loci associated with schizophrenia. To identify genetic risk variations for schizophrenia in the Han Chinese population, we performed a two-stage GWAS of schizophrenia comprising 4384 cases and 5770 controls, followed by independent replications of 13 single-nucleotide polymorphisms in an additional 4339 schizophrenia cases and 7043 controls of Han Chinese ancestry. Furthermore, we conducted additional analyses based on the results in the discovery stage. The combined analysis confirmed evidence of genome-wide significant associations in the Han Chinese population for three loci, at 2p16.1 (rs1051061, in an exon of VRK2, P=1.14 × 10 -12 , odds ratio (OR)=1.17), 6p22.1 (rs115070292 in an intron of GABBR1, P=4.96 × 10 -10 , OR=0.77) and 10q24.32 (rs10883795 in an intron of AS3MT, P=7.94 × 10 -10 , OR=0.87; rs10883765 at an intron of ARL3, P=3.06 × 10 -9 , OR=0.87). The polygenic risk score based on Psychiatric Genomics Consortium schizophrenia GWAS data modestly predicted case-control status in the Chinese population (Nagelkerke R 2 : 1.7% ~5.7%). Our pathway analysis suggested that neurological biological pathways such as GABAergic signaling, dopaminergic signaling, cell adhesion molecules and myelination pathways are involved in schizophrenia. These findings provide new insights into the pathogenesis of schizophrenia in the Han Chinese population. Further studies are needed to establish the biological context and potential clinical utility of these findings.

Analysis of intervention strategies for inhalation exposure to polycyclic aromatic hydrocarbons and associated lung cancer risk based on a Monte Carlo population exposure assessment model.

PubMed

Zhou, Bin; Zhao, Bin

2014-01-01

It is difficult to evaluate and compare interventions for reducing exposure to air pollutants, including polycyclic aromatic hydrocarbons (PAHs), a widely found air pollutant in both indoor and outdoor air. This study presents the first application of the Monte Carlo population exposure assessment model to quantify the effects of different intervention strategies on inhalation exposure to PAHs and the associated lung cancer risk. The method was applied to the population in Beijing, China, in the year 2006. Several intervention strategies were designed and studied, including atmospheric cleaning, smoking prohibition indoors, use of clean fuel for cooking, enhancing ventilation while cooking and use of indoor cleaners. Their performances were quantified by population attributable fraction (PAF) and potential impact fraction (PIF) of lung cancer risk, and the changes in indoor PAH concentrations and annual inhalation doses were also calculated and compared. The results showed that atmospheric cleaning and use of indoor cleaners were the two most effective interventions. The sensitivity analysis showed that several input parameters had major influence on the modeled PAH inhalation exposure and the rankings of different interventions. The ranking was reasonably robust for the remaining majority of parameters. The method itself can be extended to other pollutants and in different places. It enables the quantitative comparison of different intervention strategies and would benefit intervention design and relevant policy making.

Association between the MTHFR C677T polymorphism and risk of cancer: evidence from 446 case-control studies.

PubMed

Xie, Shu-Zhe; Liu, Zhi-Zhong; Yu, Jun-hua; Liu, Li; Wang, Wei; Xie, Dao-Lin; Qin, Jiang-Bo

2015-11-01

Many molecular epidemiological studies have been performed to explore the association between MTHFR C677T polymorphism and cancer risk in diverse populations. However, the results were inconsistent. Hence, we performed a meta-analysis to investigate the association between cancer risk and MTHFR C677T (150,086 cases and 200,699 controls from 446 studies) polymorphism. Overall, significantly increased cancer risk was found when all eligible studies were pooled into the meta-analysis. In the further stratified and sensitivity analyses, significantly increased breast cancer risk was found in Asians and Indians, significantly decreased colon cancer risk was found, significantly decreased colorectal cancer risk was found in male population, significantly increased gastric cancer risk was found in Caucasians and Asians, significantly increased hepatocellular cancer risk was found in Asians, significantly decreased adult acute lymphoblastic leukemia (AALL) risk was found in Caucasians, significantly decreased childhood acute lymphoblastic leukemia (CALL) risk was found in Asians, and significantly increased multiple myeloma and NHL risk was found in Caucasians. In summary, this meta-analysis suggests that MTHFR C677T polymorphism is associated with increased breast cancer, gastric cancer, and hepatocellular cancer risk in Asians, is associated with increased gastric cancer, multiple myeloma, and NHL risk in Caucasians, is associated with decreased AALL risk in Caucasians, is associated with decreased CALL risk in Asians, is associated with increased breast cancer risk in Asians, is associated with decreased colon cancer risk, and is associated with decreased colorectal cancer risk in male population. Moreover, this meta-analysis also points out the importance of new studies, such as Asians of HNC, Asians of lung cancer, and Indians of breast cancer, because they had high heterogeneity in this meta-analysis (I(2) > 75%).

Body mass index and risk of BPH: a meta-analysis.

PubMed

Wang, S; Mao, Q; Lin, Y; Wu, J; Wang, X; Zheng, X; Xie, L

2012-09-01

Epidemiological studies have reported conflicting results relating obesity to BPH. A meta-analysis of cohort and case-control studies was conducted to pool the risk estimates of the association between obesity and BPH. Eligible studies were retrieved by both computer searches and review of references. We analyzed abstracted data with random effects models to obtain the summary risk estimates. Dose-response meta-analysis was performed for studies reporting categorical risk estimates for a series of exposure levels. A total of 19 studies met the inclusion criteria of the meta-analysis. Positive association with body mass index (BMI) was observed in BPH and lower urinary tract symptoms (LUTS) combined group (odds ratio=1.27, 95% confidence intervals 1.05-1.53). In subgroup analysis, BMI exhibited a positive dose-response relationship with BPH/LUTS in population-based case-control studies and a marginal positive association was observed between risk of BPH and increased BMI. However, no association between BPH/LUTS and BMI was observed in other subgroups stratified by study design, geographical region or primary outcome. The overall current literatures suggested that BMI was associated with increased risk of BPH. Further efforts should be made to confirm these findings and clarify the underlying biological mechanisms.

Folic acid supplements and colorectal cancer risk: meta-analysis of randomized controlled trials

NASA Astrophysics Data System (ADS)

Qin, Tingting; Du, Mulong; Du, Haina; Shu, Yongqian; Wang, Meilin; Zhu, Lingjun

2015-07-01

Numerous studies have investigated the effects of folic acid supplementation on colorectal cancer risk, but conflicting results were reported. We herein performed a meta-analysis based on relevant studies to reach a more definitive conclusion. The PubMed and Embase databases were searched for quality randomized controlled trials (RCTs) published before October 2014. Eight articles met the inclusion criteria and were subsequently analyzed. The results suggested that folic acid treatment was not associated with colorectal cancer risk in the total population (relative risk [RR] = 1.00, 95% confidence interval [CI] = 0.82-1.22, P = 0.974). Moreover, no statistical effect was identified in further subgroup analyses stratified by ethnicity, gender, body mass index (BMI) and potential confounding factors. No significant heterogeneity or publication bias was observed. In conclusion, our meta-analysis demonstrated that folic acid supplementation had no effect on colorectal cancer risk. However, this finding must be validated by further large studies.

Correlation between educational status and cardiovascular risk factors in an overweight and obese Turkish female population.

PubMed

Tanyolaç, Sinan; Sertkaya Cikim, Ayşe; Doğan Azezli, Adil; Orhan, Yusuf

2008-10-01

The prevalence of obesity is rapidly increasing in Turkey as well as all over the world. Educational inequalities play an important role in the development of obesity. In this study, our aim is to evaluate how educational status affects obesity and cardiovascular risk factors in the overweight and obese Turkish female population. In this study, 3080 overweight (n=633) and obese (n=2447) Turkish women who applied to Istanbul Faculty of Medicine Obesity Outpatient Clinic were evaluated retrospectively. Educational status was classified according to the subjects' latest term of education. Subjects were evaluated in terms of anthropometric and biochemical parameters. The association of educational level with cardiovascular risk factors and metabolic syndrome were analyzed using logistic regression analysis. Educational levels after adjusted continuous variables (age and body mass index) showed significant correlation with waist circumference, total and high-density lipoprotein cholesterol, triglycerides, low-density lipoprotein cholesterol and glucose. Low educated class (LEC) had a 1.93 (95% CI--1.56-2.39, p=0.001) fold increased risk than high educated subjects for cardiovascular risk factors. Metabolic syndrome prevalence was more prevalent and significant risk increase was observed in LEC (OR=2.02, 95% CI--.53-2.67, p=0.001). Low educational status is a contributing factor for development of obesity and increased risk for obesity related disorders in the Turkish overweight and obese female population. Population based information and educational policies might prevent obesity related disorders and decrease cardiovascular mortality.

A case-control study: occupational cooking and the risk of uveal melanoma

PubMed Central

2010-01-01

Background A European-wide population based case-control study (European rare cancer study) undertaken in nine European countries examined risk factors for uveal melanoma. They found a positive association between cooks and the risk of uveal melanoma. In our study we examine whether cooks or people who worked in cook related jobs have an increased uveal melanoma risk. Methods We conducted a case-control study during 2002 and 2005. Overall, 1653 eligible subjects (age range: 20-74 years, living in Germany) participated. Interviews were conducted with 459 incident uveal melanoma cases, 827 population controls, 180 ophthalmologist controls and 187 sibling controls. Data on occupational exposure were obtained from a self-administered postal questionnaire and a computer-assisted telephone interview. We used conditional logistic regression to estimate odds ratios adjusting for the matching factors. Results Overall, we did not observe an increased risk of uveal melanoma among people who worked as cooks or who worked in cook related jobs. When we restricted the source population of our study to the population of the Federal State of Northrhine-Westphalia, we observed an increased risk among subjects who were categorized as cooks in the cases-control analysis. Conclusion Our results are in conflict with former results of the European rare cancer study. Considering the rarity of the disease laboratory in vitro studies of human uveal melanoma cell lines should be done to analyze potential exposure risk factors like radiation from microwaves, strong light from incandescent ovens, or infrared radiation. PMID:20969762

The potential value of sibling controls compared with population controls for association studies of lifestyle-related risk factors: an example from the Breast Cancer Family Registry.

PubMed

Milne, Roger L; John, Esther M; Knight, Julia A; Dite, Gillian S; Southey, Melissa C; Giles, Graham G; Apicella, Carmel; West, Dee W; Andrulis, Irene L; Whittemore, Alice S; Hopper, John L

2011-10-01

A previous Australian population-based breast cancer case-control study found indirect evidence that control participation, although high, was not random. We hypothesized that unaffected sisters may provide a more appropriate comparison group than unrelated population controls. Three population-based case-control-family studies of breast cancer in women of white European origin were carried out by the Australian, Ontario and Northern California sites of the Breast Cancer Family Registry. We compared risk factors between 3643 cases, 2444 of their unaffected sisters and 2877 population controls and conducted separate case-control analyses based on population and sister controls using unconditional multivariable logistic regression. Compared with sister controls, population controls were more highly educated, had an earlier age at menarche, fewer births, their first birth at a later age and their last birth more recently. The established breast cancer associations detected using sister controls, but not detected using population controls, were decreasing risk with each of later age at menarche, more births, younger age at first birth and greater time since last birth. Since participation of population controls might be unintentionally related to some risk factors, we hypothesize that sister controls could provide more valid relative risk estimates and be recruited at lower cost. Given declining study participation by population controls, this contention is highly relevant to epidemiologic research.

The ERICE-score: the new native cardiovascular score for the low-risk and aged Mediterranean population of Spain.

PubMed

Gabriel, Rafael; Brotons, Carlos; Tormo, M José; Segura, Antonio; Rigo, Fernando; Elosua, Roberto; Carbayo, Julio A; Gavrila, Diana; Moral, Irene; Tuomilehto, Jaakko; Muñiz, Javier

2015-03-01

In Spain, data based on large population-based cohorts adequate to provide an accurate prediction of cardiovascular risk have been scarce. Thus, calibration of the EuroSCORE and Framingham scores has been proposed and done for our population. The aim was to develop a native risk prediction score to accurately estimate the individual cardiovascular risk in the Spanish population. Seven Spanish population-based cohorts including middle-aged and elderly participants were assembled. There were 11800 people (6387 women) representing 107915 person-years of follow-up. A total of 1214 cardiovascular events were identified, of which 633 were fatal. Cox regression analyses were conducted to examine the contributions of the different variables to the 10-year total cardiovascular risk. Age was the strongest cardiovascular risk factor. High systolic blood pressure, diabetes mellitus and smoking were strong predictive factors. The contribution of serum total cholesterol was small. Antihypertensive treatment also had a significant impact on cardiovascular risk, greater in men than in women. The model showed a good discriminative power (C-statistic=0.789 in men and C=0.816 in women). Ten-year risk estimations are displayed graphically in risk charts separately for men and women. The ERICE is a new native cardiovascular risk score for the Spanish population derived from the background and contemporaneous risk of several Spanish cohorts. The ERICE score offers the direct and reliable estimation of total cardiovascular risk, taking in consideration the effect of diabetes mellitus and cardiovascular risk factor management. The ERICE score is a practical and useful tool for clinicians to estimate the total individual cardiovascular risk in Spain. Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

Leiomyomas in Pregnancy and Spontaneous Abortion: A Systematic Review and Meta-analysis.

PubMed

Sundermann, Alexandra C; Velez Edwards, Digna R; Bray, Michael J; Jones, Sarah H; Latham, Sanura M; Hartmann, Katherine E

2017-11-01

To systematically review studies reporting the risk of spontaneous abortion among pregnant women of typical reproductive potential with and without uterine leiomyomas. We searched PubMed, EMBASE, Web of Science, and ClinicalTrials.gov for publications from January 1970 to December 2016. We excluded studies that did not use imaging to uniformly document leiomyoma status of all participants, did not have a comparison group without leiomyomas, or primarily included women seeking care for recurrent miscarriage, infertility care, or assisted reproductive technologies. Two authors independently reviewed eligibility, extracted data, and assigned overall quality ratings based on predetermined criteria. Of 1,469 articles identified, nine were eligible. Five enrolled general obstetric populations and four included women undergoing amniocentesis. In five studies in general obstetric populations that included 21,829 pregnancies (1,394 women with leiomyomas and 20,435 without), only one adjusted for potential confounders. This meta-analysis revealed no increase in risk of spontaneous abortion among those with leiomyomas compared with those without (11.5% compared with 8.0%; risk ratio 1.16, 95% CI 0.80-1.52). When bias from confounding was estimated for nonadjusted studies, the aggregate calculated risk ratio was 0.83 (95% CI 0.68-0.98). Leiomyoma presence was not associated with increased risk of spontaneous abortion in an analysis of more than 20,000 pregnant women. Failure of prior studies to adjust for confounders may have led to the common clinical belief that leiomyomas are a risk factor for spontaneous abortion.

Improving estimates of insecticide-treated mosquito net coverage from household surveys: using geographic coordinates to account for endemicity

PubMed Central

2014-01-01

Background Coverage estimates of insecticide-treated nets (ITNs) are often calculated at the national level, but are intended to be a proxy for coverage among the population at risk of malaria. The analysis uses data for surveyed households, linking survey enumeration areas (clusters) with levels of malaria endemicity and adjusting coverage estimates based on the population at risk. This analysis proposes an approach that is not dependent on being able to identify malaria risk in a location during the survey design (since survey samples are typically selected on the basis of census sampling frames that do not include information on malaria zones), but rather being able to assign risk zones after a survey has already been completed. Methods The analysis uses data from 20 recent nationally representative Demographic and Health Survey (DHS), Malaria Indicator Surveys (MIS), an AIDS Indicator Survey (AIS), and an Anemia and Malaria Prevalence Survey (AMP). The malaria endemicity classification was assigned from the Malaria Atlas Project (MAP) 2010 interpolated data layers, using the Geographic Positioning System (GPS) location of the survey clusters. National ITN coverage estimates were compared with coverage estimates in intermediate/high endemicity zones (i.e., the population at risk of malaria) to determine whether the difference between estimates was statistically different from zero (p-value <0.5). Results Endemicity varies substantially in eight of the 20 studied countries. In these countries with heterogeneous transmission of malaria, stratification of households by endemicity zones shows that ITN coverage in intermediate/high endemicity zones is significantly higher than ITN coverage at the national level (Burundi, Kenya, Namibia, Rwanda, Tanzania, Senegal, Zambia, and Zimbabwe.). For example in Zimbabwe, the national ownership of ITNs is 28%, but ownership in the intermediate/high endemicity zone is 46%. Conclusion Incorporating this study’s basic and easily reproducible approach into estimates of ITN coverage is applicable and even preferable in countries with areas at no/low risk of malaria and will help ensure that the highest-quality data are available to inform programmatic decisions in countries affected by malaria. The extension of this type of analysis to other malaria interventions can provide further valuable information to support evidence-based decision-making. PMID:24993082

Investigation of Genetic Variation Underlying Central Obesity amongst South Asians.

PubMed

Scott, William R; Zhang, Weihua; Loh, Marie; Tan, Sian-Tsung; Lehne, Benjamin; Afzal, Uzma; Peralta, Juan; Saxena, Richa; Ralhan, Sarju; Wander, Gurpreet S; Bozaoglu, Kiymet; Sanghera, Dharambir K; Elliott, Paul; Scott, James; Chambers, John C; Kooner, Jaspal S

2016-01-01

South Asians are 1/4 of the world's population and have increased susceptibility to central obesity and related cardiometabolic disease. Knowledge of genetic variants affecting risk of central obesity is largely based on genome-wide association studies of common SNPs in Europeans. To evaluate the contribution of DNA sequence variation to the higher levels of central obesity (defined as waist hip ratio adjusted for body mass index, WHR) among South Asians compared to Europeans we carried out: i) a genome-wide association analysis of >6M genetic variants in 10,318 South Asians with focused analysis of population-specific SNPs; ii) an exome-wide association analysis of ~250K SNPs in protein-coding regions in 2,637 South Asians; iii) a comparison of risk allele frequencies and effect sizes of 48 known WHR SNPs in 12,240 South Asians compared to Europeans. In genome-wide analyses, we found no novel associations between common genetic variants and WHR in South Asians at P<5x10-8; variants showing equivocal association with WHR (P<1x10-5) did not replicate at P<0.05 in an independent cohort of South Asians (N = 1,922) or in published, predominantly European meta-analysis data. In the targeted analyses of 122,391 population-specific SNPs we also found no associations with WHR in South Asians at P<0.05 after multiple testing correction. Exome-wide analyses showed no new associations between genetic variants and WHR in South Asians, either individually at P<1.5x10-6 or grouped by gene locus at P<2.5x10-6. At known WHR loci, risk allele frequencies were not higher in South Asians compared to Europeans (P = 0.77), while effect sizes were unexpectedly smaller in South Asians than Europeans (P<5.0x10-8). Our findings argue against an important contribution for population-specific or cosmopolitan genetic variants underlying the increased risk of central obesity in South Asians compared to Europeans.

Investigation of Genetic Variation Underlying Central Obesity amongst South Asians

PubMed Central

Scott, William R.; Zhang, Weihua; Loh, Marie; Tan, Sian-Tsung; Lehne, Benjamin; Afzal, Uzma; Peralta, Juan; Saxena, Richa; Ralhan, Sarju; Wander, Gurpreet S.; Bozaoglu, Kiymet; Sanghera, Dharambir K.; Elliott, Paul; Scott, James; Chambers, John C.; Kooner, Jaspal S.

2016-01-01

South Asians are 1/4 of the world’s population and have increased susceptibility to central obesity and related cardiometabolic disease. Knowledge of genetic variants affecting risk of central obesity is largely based on genome-wide association studies of common SNPs in Europeans. To evaluate the contribution of DNA sequence variation to the higher levels of central obesity (defined as waist hip ratio adjusted for body mass index, WHR) among South Asians compared to Europeans we carried out: i) a genome-wide association analysis of >6M genetic variants in 10,318 South Asians with focused analysis of population-specific SNPs; ii) an exome-wide association analysis of ~250K SNPs in protein-coding regions in 2,637 South Asians; iii) a comparison of risk allele frequencies and effect sizes of 48 known WHR SNPs in 12,240 South Asians compared to Europeans. In genome-wide analyses, we found no novel associations between common genetic variants and WHR in South Asians at P<5x10-8; variants showing equivocal association with WHR (P<1x10-5) did not replicate at P<0.05 in an independent cohort of South Asians (N = 1,922) or in published, predominantly European meta-analysis data. In the targeted analyses of 122,391 population-specific SNPs we also found no associations with WHR in South Asians at P<0.05 after multiple testing correction. Exome-wide analyses showed no new associations between genetic variants and WHR in South Asians, either individually at P<1.5x10-6 or grouped by gene locus at P<2.5x10−6. At known WHR loci, risk allele frequencies were not higher in South Asians compared to Europeans (P = 0.77), while effect sizes were unexpectedly smaller in South Asians than Europeans (P<5.0x10-8). Our findings argue against an important contribution for population-specific or cosmopolitan genetic variants underlying the increased risk of central obesity in South Asians compared to Europeans. PMID:27195708

Methods Development for a Spatially Explicit Population-Level Risk Assessment, Uncertainty Analysis, and Comparison with Risk Quotient Approaches

EPA Science Inventory

The standard framework of Ecological Risk Assessment (ERA) uses organism-level assessment endpoints to qualitatively determine the risk to populations. While organism-level toxicity data provide the pathway by which a species may be affected by a chemical stressor, they neither i...

Predicting periodontitis progression?

PubMed

Ferraiolo, Debra M

2016-03-01

Cochrane Library, Ovid, Medline, Embase and LILACS were searched using no language restrictions and included information up to July 2014. Bibliographic references of included articles and related review articles were hand searched. On-line hand searching of recent issues of key periodontal journals was performed (Journal of Clinical Periodontology, Journal of Dental Research, Journal of Periodontal Research, Journal of Periodontology, Oral Health and Preventive Dentistry). Prospective and retrospective cohort studies were used for answering the question of prediction since there were no randomised controlled trials on this topic. Risk of bias was assessed using the validated Newcastle-Ottawa quality assessment scale for non-randomised studies. Cross-sectional studies were included in the summary of currently reported risk assessment tools but not for risk of progression of disease, due to the inability to properly assess bias in these types of studies. Titles and abstracts were scanned by two reviewers independently.Full reports were obtained for those articles meeting inclusion criteria or those with insufficient information in the title to make a decision. Any published risk assessment tool was considered. The tool was defined to include any composite measure of patient-level risk directed towards determining the probability for further disease progression in adults with periodontitis. Periodontitis was defined to include both chronic and aggressive forms in the adult population. Outcomes included changes in attachment levels and/or deepening of periodontal pockets in millimeters in study populations undergoing supportive periodontal therapy. Data extraction was performed independently and in collaboration by two reviewers; completed evidence tables were reviewed by three reviewers. Studies were each given a descriptive summary to assess the quantity of data as well as further assessment of study variations within study characteristics. This also allowed for determining the suitability of data for further quantitative analysis (meta-analysis). Unfortunately, the heterogeneity of the data did not allow. After screening, 19 studies fitted the inclusion criteria of identifying five different patient-based periodontal risk assessment tools. DenPlan Excel/Previsor Patient Assessment (DEP-PA) and its modifications were used in five studies. The HIDEP model, the dentition risk system (DRS) and the risk assessment-based individualised treatment (RABIT) were each used in one study. Lastly, the periodontal risk assessment (PRA) and its modifications were found in 12 publications.PRA uses the following factors to assess risk of recurrence of disease: Percentage of bleeding on probing, loss of teeth from a total of 28 teeth, loss of periodontal support in relation to the patient's age, prevalence of residual pockets greater than 4 mm (3-5 mm), systemic and genetic conditions and environmental factors, such as cigarette smoking.Ten included studies had cohort designs (N= 2130) spanning three to 12 years with different follow-up times. Generally, these studies reflected that different assessment tools were able to separate subjects with differing probability of disease progression and tooth loss. The observed effect was dose dependent (the higher the estimation of risk the higher the level of observed disease or tooth loss).Six cross sectional studies (N=1078) reported the comparison of different assessment tools, adjusted or unadjusted associations with periodontal disease and subjective risk assessments provided by the tools. There were three articles noted in the flow diagram as articles proposing the tool. Qualitative analysis reflects that parameters are similar across the studies but differences are present in how these parameters were assessed. In treated populations, results of patient-based risk assessments predicted periodontitis progression and tooth loss in various populations. Additional research on the utility of risk assessment and results in improving patient management are needed.

Association of metabolic syndrome and its components with all-cause and cardiovascular mortality in the elderly: A meta-analysis of prospective cohort studies.

PubMed

Ju, Sang-Yhun; Lee, June-Young; Kim, Do-Hoon

2017-11-01

There is increasing evidence regarding the relationship between metabolic syndrome and mortality. However, previous research examining metabolic syndrome and mortality in older populations has produced mixed results. In addition, there is a clear need to identify and manage individual components of metabolic syndrome to decrease cardiovascular disease (CVD) mortality. In this meta-analysis, we searched the MEDLINE databases using PubMed, Cochrane Library, and EMBASE databases. Based on 20 prospective cohort studies, metabolic syndrome was associated with a higher risk of all-cause mortality [relative risk (RR), 1.23; 95% confidence interval (CI), 1.15-1.32; I = 55.9%] and CVD mortality (RR, 1.24; 95% CI, 1.11-1.39; I = 58.1%). The risk estimates of all-cause mortality for single components of metabolic syndrome were significant for higher values of waist circumference or body mass index (RR, 0.94; 95% CI, 0.88-1.00), higher values of blood glucose (RR, 1.19; 95% CI, 1.05-1.34), and lower values of high-density lipoprotein (HDL) cholesterol (RR, 1.11; 95% CI, 1.02-1.21). In the elderly population, metabolic syndrome was associated with an increased risk of all-cause and CVD mortality. Among the individual components of metabolic syndrome, increased blood glucose and HDL cholesterol levels were significantly associated with increased mortality. However, older obese or overweight individuals may have a decreased mortality risk. Thus, the findings of the current meta-analysis raise questions about the utility of the definition of metabolic syndrome in predicting all-cause mortality and CVD mortality in the elderly population.

Evaluation of a Stratified National Breast Screening Program in the United Kingdom: An Early Model-Based Cost-Effectiveness Analysis.

PubMed

Gray, Ewan; Donten, Anna; Karssemeijer, Nico; van Gils, Carla; Evans, D Gareth; Astley, Sue; Payne, Katherine

2017-09-01

To identify the incremental costs and consequences of stratified national breast screening programs (stratified NBSPs) and drivers of relative cost-effectiveness. A decision-analytic model (discrete event simulation) was conceptualized to represent four stratified NBSPs (risk 1, risk 2, masking [supplemental screening for women with higher breast density], and masking and risk 1) compared with the current UK NBSP and no screening. The model assumed a lifetime horizon, the health service perspective to identify costs (£, 2015), and measured consequences in quality-adjusted life-years (QALYs). Multiple data sources were used: systematic reviews of effectiveness and utility, published studies reporting costs, and cohort studies embedded in existing NBSPs. Model parameter uncertainty was assessed using probabilistic sensitivity analysis and one-way sensitivity analysis. The base-case analysis, supported by probabilistic sensitivity analysis, suggested that the risk stratified NBSPs (risk 1 and risk-2) were relatively cost-effective when compared with the current UK NBSP, with incremental cost-effectiveness ratios of £16,689 per QALY and £23,924 per QALY, respectively. Stratified NBSP including masking approaches (supplemental screening for women with higher breast density) was not a cost-effective alternative, with incremental cost-effectiveness ratios of £212,947 per QALY (masking) and £75,254 per QALY (risk 1 and masking). When compared with no screening, all stratified NBSPs could be considered cost-effective. Key drivers of cost-effectiveness were discount rate, natural history model parameters, mammographic sensitivity, and biopsy rates for recalled cases. A key assumption was that the risk model used in the stratification process was perfectly calibrated to the population. This early model-based cost-effectiveness analysis provides indicative evidence for decision makers to understand the key drivers of costs and QALYs for exemplar stratified NBSP. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

[Cardiac risk profile in diabetes mellitus and impaired fasting glucose].

PubMed

Schaan, Beatriz D'Agord; Harzheim, Erno; Gus, Iseu

2004-08-01

Mortality of diabetic patients is higher than that of the population at large, and mainly results from cardiovascular diseases. The purpose of the present study was to identify the prevalence of cardiovascular risk factors in subjects with diabetes mellitus (DM) or abnormal fasting glucose (FG) in order to guide health actions. A population-based cross-sectional study was carried out in a representative random cluster sampling of 1,066 adult urban population (> or =20 years) in the state of Rio Grande do Sul between 1999 and 2000. A structured questionnaire on coronary risk factors was applied and sociodemographic characteristics of all adults older than 20 years living in the same dwelling were collected. Subjects were clinically evaluated and blood samples were obtained for measuring total cholesterol and fasting glycemia. Statistical analysis was performed using Stata 7 and a 5% significance level was set. Categorical variables were compared by Pearson's chi-square and continuous variables were compared using Student's t-test or Anova and multivariate analysis, all controlled for the cluster effect. Of 992 subjects, 12.4% were diabetic and 7.4% had impaired fasting glucose. Among the risk factors evaluated, subjects who presented any kind of glucose homeostasis abnormality were at a higher prevalence of obesity (17.8, 29.2 and 35.3% in healthy subjects, impaired fasting glucose and DM respectively, p<0.001), hypertension (30.1, 56.3 and 50.5% in healthy subjects, impaired fasting glucose and DM, respectively, p<0.001), and hypercholesterolemia (23.2, 35.1 and 39.5 in healthy subjects, impaired fasting glucose and DM respectively, p=0.01). Subjects with any kind of glucose homeostasis abnormality represent a group, which preventive individual and population health policies should target since they have higher prevalence of coronary artery disease risk factors.

Personalized Surgical Risk Assessment Using Population-Based Data Analysis

ERIC Educational Resources Information Center

AbuSalah, Ahmad Mohammad

2013-01-01

The volume of information generated by healthcare providers is growing at a relatively high speed. This tremendous growth has created a gap between knowledge and clinical practice that experts say could be narrowed with the proper use of healthcare data to guide clinical decisions and tools that support rapid information availability at the…

Risk factors for financial hardship in patients receiving adjuvant chemotherapy for colon cancer: a population-based exploratory analysis.

PubMed

Shankaran, Veena; Jolly, Sanjay; Blough, David; Ramsey, Scott D

2012-05-10

Characteristics that predispose patients to financial hardship during cancer treatment are poorly understood. We therefore conducted a population-based exploratory analysis of potential factors associated with financial hardship and treatment nonadherence during and following adjuvant chemotherapy for colon cancer. Patients diagnosed with stage III colon cancer between 2008 and 2010 were identified from a population-based cancer registry representing 13 counties in Washington state. Patients were asked to complete a comprehensive survey on treatment-related costs. Patients were considered to have experienced financial hardship if they accrued debt, sold or refinanced their home, borrowed money from friends or family, or experienced a 20% or greater decline in their annual income as a result of treatment-related expenses. Logistic regression analysis was used to investigate factors associated with financial hardship and treatment nonadherence. A total of 284 responses were obtained from 555 eligible patients (response rate, 51.2%). Nearly all patients in the final sample were insured during treatment. In this sample, 38% of patients reported one or more financial hardships as a result of treatment. The factors most closely associated with treatment-related financial hardship were younger age and lower annual household income. Younger age, lower income, and unemployment or disability (which occurred in most instances following diagnosis) were most closely associated with treatment nonadherence. A significant proportion of patients undergoing adjuvant chemotherapy for stage III colon cancer may experience financial hardship, despite having health insurance coverage. Interventions to help at-risk patients early on during therapy may prevent long-term financial adverse effects.

Extreme umbilical cord lengths, cord knot and entanglement: Risk factors and risk of adverse outcomes, a population-based study

PubMed Central

Kessler, Jörg

2018-01-01

Objectives To determine risk factors for short and long umbilical cord, entanglement and knot. Explore their associated risks of adverse maternal and perinatal outcome, including risk of recurrence in a subsequent pregnancy. To provide population based gestational age and sex and parity specific reference ranges for cord length. Design Population based registry study. Setting Medical Birth Registry of Norway 1999–2013. Population All singleton births (gestational age>22weeks<45 weeks) (n = 856 300). Methods Descriptive statistics and odds ratios of risk factors for extreme cord length and adverse outcomes based on logistic regression adjusted for confounders. Main outcome measures Short or long cord (<10th or >90th percentile), cord knot and entanglement, adverse pregnancy outcomes including perinatal and intrauterine death. Results Increasing parity, maternal height and body mass index, and diabetes were associated with increased risk of a long cord. Large placental and birth weight, and fetal male sex were factors for a long cord, which again was associated with a doubled risk of intrauterine and perinatal death, and increased risk of adverse neonatal outcome. Anomalous cord insertion, female sex, and a small placenta were associated with a short cord, which was associated with increased risk of fetal malformations, placental complications, caesarean delivery, non-cephalic presentation, perinatal and intrauterine death. At term, cord knot was associated with a quadrupled risk of perinatal death. The combination of a cord knot and entanglement had a more than additive effect to the association to perinatal death. There was a more than doubled risk of recurrence of a long or short cord, knot and entanglement in a subsequent pregnancy of the same woman. Conclusion Cord length is influenced both by maternal and fetal factors, and there is increased risk of recurrence. Extreme cord length, entanglement and cord knot are associated with increased risk of adverse outcomes including perinatal death. We provide population based reference ranges for umbilical cord length. PMID:29584790

Most Common SNPs Associated with Rheumatoid Arthritis in Subjects of European Ancestry Confer Risk of Rheumatoid Arthritis in African-Americans

PubMed Central

Hughes, Laura B.; Reynolds, Richard J.; Brown, Elizabeth E.; Kelley, James M.; Thomson, Brian; Conn, Doyt L.; Jonas, Beth L.; Westfall, Andrew O.; Padilla, Miguel A.; Callahan, Leigh F.; Smith, Edwin A.; Brasington, Richard D.; Edberg, Jeffrey C.; Kimberly, Robert P.; Moreland, Larry W.; Plenge, Robert M.; Bridges, S. Louis

2010-01-01

Objective Large-scale genetic association studies have identified over 20 rheumatoid arthritis (RA) risk alleles among individuals of European ancestry. The influence of these risk alleles has not been comprehensively studied in African-Americans. We therefore sought to examine whether these validated RA risk alleles are associated with RA in an African-American population. Methods 27 candidate SNPs were genotyped in 556 autoantibody-positive African-Americans with RA and 791 healthy African-American controls. Odds ratios (OR) and 95% confidence intervals (CI) for each SNP were compared to previously published ORs of RA patients of European ancestry. We then calculated a composite Genetic Risk Score (GRS) for each individual based on the sum of all risk alleles. Results There was overlap in the OR and 95% CI between the European and African-American populations in 24 of the 27 candidate SNPs. Conversely, 3 of the 27 SNPs (CCR6 rs3093023, TAGAP rs394581, TNFAIP3 rs6920220) demonstrated an OR in the opposite direction from those reported in RA patients of European ancestry. The GRS analysis indicated a small but highly significant probability that African-American cases were enriched for the European RA risk alleles relative to controls (p=0.00005). Conclusion The majority of RA risk alleles previously validated among European ancestry RA patients showed similar ORs in our population of African-Americans with RA. Furthermore, the aggregate GRS supports the hypothesis that these SNPs are risk alleles for RA in the African-American population. Future large-scale genetic studies are needed to validate these risk alleles and identify novel risk alleles for RA in African-Americans. PMID:21120996

Artificial sweeteners and absence of bladder cancer risk in Copenhagen.

PubMed

Møller-Jensen, O; Knudsen, J B; Sørensen, B L; Clemmesen, J

1983-11-15

During the years 1979 to 1981 a population-based case-control study of bladder cancer including papillomas was performed in Greater Copenhagen. After exclusions some 388 patients (290 males; 98 females) and an age- and sex-matched group of 787 controls (592 males; 195 females) remained for analysis. Controls were selected at random from the general population of the study area. All persons were interviewed concerning use of artificial sweeteners in addition to their exposure to a number of other known or suspected risk factors for bladder cancer. Fifty-five male bladder cancer patients (19.4%) and 150 controls (25.7%) had at some time used artificial sweeteners regularly. Among females 27.1% of cases and 25.9% of controls regularly used sweeteners. In neither sex was the relative risk significantly increased in users compared with non-users of artificial sweeteners. The relative risk of 0.78 in the two sexes combined was not significantly different from 1.0 (95% C.I.: 0.58-1.05). There was no indication of a regular increase in risk with increasing daily consumption of table-top sweeteners nor was there any indication of an increase in risk with a duration of regular use of artificial sweeteners. Taking into account a possible latency period between first regular use and bladder cancer development did not change the finding of an absence of association between use of artificial sweeteners and the risk of bladder cancer. Neither saccharine nor cyclamate users had an increased risk of bladder cancer. This population-based case-control investigation provides further evidence that it is highly unlikely that the consumption of artificial sweeteners has contributed to current bladder cancer rates in man.

Occurence of internet addiction in a general population sample: a latent class analysis.

PubMed

Rumpf, Hans-Jürgen; Vermulst, Ad A; Bischof, Anja; Kastirke, Nadin; Gürtler, Diana; Bischof, Gallus; Meerkerk, Gert-Jan; John, Ulrich; Meyer, Christian

2014-01-01

Prevalence studies of Internet addiction in the general population are rare. In addition, a lack of approved criteria hampers estimation of its occurrence. This study conducted a latent class analysis (LCA) in a large general population sample to estimate prevalence. A telephone survey was conducted based on a random digit dialling procedure including landline telephone (n=14,022) and cell phone numbers (n=1,001) in participants aged 14-64. The Compulsive Internet Use Scale (CIUS) served as the basis for a LCA used to look for subgroups representing participants with Internet addiction or at-risk use. CIUS was given to participants reporting to use the Internet for private purposes at least 1 h on a typical weekday or at least 1 h on a day at the weekend (n=8,130). A 6-class model showed best model fit and included two groups likely to represent Internet addiction and at-risk Internet use. Both groups showed less social participation and the Internet addiction group less general trust in other people. Proportions of probable Internet addiction were 1.0% (CI 0.9-1.2) among the entire sample, 2.4% (CI 1.9-3.1) in the age group 14-24, and 4.0% (CI 2.7-5.7) in the age group 14-16. No difference in estimated proportions between males and females was found. Unemployment (OR 3.13; CI 1.74-5.65) and migration background (OR 3.04; CI 2.12-4.36) were related to Internet addiction. This LCA-based study differentiated groups likely to have Internet addiction and at-risk use in the general population and provides characteristics to further define this rather new disorder. © 2013 S. Karger AG, Basel.

Mirabel: an integrated project for risk and cost/benefit analysis of peanut allergy.

PubMed

Crépet, A; Papadopoulos, A; Elegbede, C F; Ait-Dahmane, S; Loynet, C; Millet, G; Van Der Brempt, X; Bruyère, O; Marette, S; Moneret-Vautrin, D A

2015-03-01

Food allergy is a major public health issue. However, no regulatory measures exist when allergens are present at trace levels and the different risk components are poorly described. Thus, knowledge on exposure components such as the allergens present in foods and the consumption behaviour of allergic consumers and models to estimate the related risk need to be enriched. Mirabel proposes for the first time studying each risk component using an integrated approach in order to improve the quality of life of the allergic population. Field surveys were conducted in order to fill in the current gaps in unintentional allergen traces in food, allergic consumers' food behaviour, threshold doses of allergic reaction, allergy symptoms and severity. The aim is also to propose methodological and operational tools to quantify allergic risk, to test management scenarios and to produce a cost/benefit analysis. Medical data on the peanut allergies of 785 patients were collected in the MIRABEL survey and 443 patients answered the food consumption questionnaire. The population surveyed was mostly paediatric - 86% were children under 16 years of age, with a high percentage of males (60%). This project will generate tangible results on peanut allergen exposure and risk which could be used in future risk assessment work and particularly to provide science-based guidance to set up concentration limits for peanut traces on packages. Copyright © 2014 Elsevier Inc. All rights reserved.

Risk factors of hepatitis B virus infection among blood donors in Duhok city, Kurdistan Region, Iraq.

PubMed

R Hussein, Nawfal

2018-01-01

Hepatitis B virus (HBV) infection is a public health problem. The lack of information about the seroprevalence and risk factors is an obstacle for preventive public health plans to reduce the burden of viral hepatitis. Therefore, this study was conducted in Iraq, where no studies had been performed to determine the prevalence and risk factors of HBV infection. Blood samples were collected form 438 blood donors attending blood bank in Duhok city. Serum samples were tested for HBV core-antibodies (HBcAb) and HBV surface-antigen (HBsAg) by ELISA. Various risk factors were recorded and multivariate analysis was performed. 5/438 (1.14%) of the subjects were HBsAg positive (HBsAg and HBcAb positive) and 36/438 (8.2%) were HBcAb positive. Hence, 41 cases were exposed to HBV and data analysis was based on that. Univariate analysis showed that there were significant associations between history of illegitimate sexual contact, history of alcohol or history of dental surgeries and HBV exposure (p<0.05 for all). Then, multivariate analysis was conducted to find HBV exposure predictive factors. It was found that history of dental surgery was a predictive factor for exposure to the virus (P=0.03, OR: 2.397). This study suggested that the history of dental surgery was predictive for HBV transmission in Duhok city. Further population-based study is needed to determine HBV risk factors in the society and public health plan based on that should be considered.

Trimming the fat: identification of risk factors associated with obesity in a pediatric emergency department.

PubMed

Thundiyil, Josef G; Christiano-Smith, Danielle; Greenberger, Sarah; Cramm, Kelly; Latimer-Pierson, Janese; Modica, Renee F

2010-10-01

The purpose of this study was to assess which knowledge deficits and dietary habits in an urban pediatric emergency department (ED) population are risk factors for obesity. This cross-sectional study in an urban pediatric ED used a modified version of the Diet and Health Knowledge Survey, an in-person interview questionnaire, to collect data on demographics, dietary knowledge, and practices. All patients aged 2 to 17 years were enrolled in the study over a 4-month period. Subjects were excluded if they were in extremis, pregnant, incarcerated, institutionalized, considered an emancipated minor, or consumed only a modified consistency diet. One hundred seventy-nine subjects were enrolled in this study. Based on body mass index, the prevalence of obesity in our study population was 24%. Parents with obese children answered a mean of 62.9% (95% confidence interval, 60.4%-65.5%) of knowledge questions correctly, whereas all others scored 60.3% (95% confidence interval, 58.3%-62.3%) correctly. Based on the univariate analysis, 10 predictors met inclusion criteria into logistic regression analysis: screen time (P = 0.03), race (P = 0.08), sex (P = 0.04), parental education (P = 0.08), parental estimation that child is overweight (P < 0.0001), parental estimation that child is underweight (P = 0.003), trimming fat from meat (P = 0.06), soft-drink consumption (P = 0.03), exercise (P = 0.07), and chip consumption (P = 0.04). In a multivariate analysis, only male sex, regularly trimming fat from meat, and parental assessment of obesity were independently associated with obesity. Knowledge deficiencies regarding healthy nutrition among parents in an urban pediatric ED population were not significantly associated with having obese children; however, specific habits were. Emergency physicians may provide a valuable role in identification and brief behavioral intervention in high-risk populations during the current epidemic of childhood obesity.

Geo-ethical dimension of community's safety: rural and urban population vulnerability analysis methodology

NASA Astrophysics Data System (ADS)

Kostyuchenko, Yuriy; Movchan, Dmytro; Kopachevsky, Ivan; Yuschenko, Maxim

2016-04-01

Modern world based on relations more than on causalities, so communicative, socio-economic, and socio-cultural issues are important to understand nature of risks and to make correct, ethical decisions. Today major part of risk analysts declared new nature of modern risks. We faced coherent or systemic risks, realization of which leads to domino effect, unexpected growing of losses and fatalities. This type of risks originated by complicated nature of heterogeneous environment, close interconnection of engineering networks, and changing structure of society. Heterogeneous multi-agent environment generates systemic risks, which requires analyze multi-source data with sophisticated tools. Formal basis for analysis of this type of risks is developed during last 5-7 years. But issues of social fairness, ethics, and education require further development. One aspect of analysis of social issues of risk management is studied in this paper. Formal algorithm for quantitative analysis of multi-source data analysis is proposed. As it was demonstrated, using proposed methodological base and the algorithm, it is possible to obtain regularized spatial-temporal distribution of investigated parameters over whole observation period with rectified reliability and controlled uncertainty. The result of disaster data analysis demonstrates that about half of direct disaster damage might be caused by social factors: education, experience and social behaviour. Using data presented also possible to estimate quantitative parameters of the losses distributions: a relation between education, age, experience, and losses; as well as vulnerability (in terms of probable damage) toward financial status in current social density. It is demonstrated that on wide-scale range an education determines risk perception and so vulnerability of societies. But on the local level there are important heterogeneities. Land-use and urbanization structure influencing to vulnerability essentially. The way to calculate a distribution of losses connected with decision making in land-use is demonstrated. Rural community's vulnerability determines by water availability, quality of soils, effectiveness of land use (including climate change adaptation), intensity of pollutions, crop productivity variations during the period of crop rotation, annual national distribution of crops output, and distance to city centres. It should noted here that "distance to city centres" is not comprehensive indicator of market accessibility in general case: quality and availability of transport infrastructure should be described more detailed on the next stages of analysis. Urban population vulnerability determines by distribution of urban fractures and quality urban environment: density, quality and availability of infrastructure, balance between industrial, residential and recreational zones, effectiveness of urban land use and landscape management, and social policy, particularly, employment. Population density is closely connected with social density, with communications and decision making. Social learning, as the function of social communications, is the way to increase sustainability. Also it possible to say that social sustainability is a function of intensity and efficiency of communications between interlinked and interacted networks in the heterogeneous environment. Therefore the results of study demonstrated that risk management study should includes issues of risk and threats perception, which should be described in framework of appropriate tools and approaches connected with ethical dimension of vulnerability. For instance, problems of accessibility and availability of safety resources in view of social fairness and socio-economic dynamics should be included into future studies in field of risk analysis.

Population and High-Risk Group Screening for Glaucoma: The Los Angeles Latino Eye Study

PubMed Central

Francis, Brian A.; Vigen, Cheryl; Lai, Mei-Ying; Winarko, Jonathan; Nguyen, Betsy; Azen, Stanley

2011-01-01

Purpose. To evaluate the ability of various screening tests, both individually and in combination, to detect glaucoma in the general Latino population and high-risk subgroups. Methods. The Los Angeles Latino Eye Study is a population-based study of eye disease in Latinos 40 years of age and older. Participants (n = 6082) underwent Humphrey visual field testing (HVF), frequency doubling technology (FDT) perimetry, measurement of intraocular pressure (IOP) and central corneal thickness (CCT), and independent assessment of optic nerve vertical cup disc (C/D) ratio. Screening parameters were evaluated for three definitions of glaucoma based on optic disc, visual field, and a combination of both. Analyses were also conducted for high-risk subgroups (family history of glaucoma, diabetes mellitus, and age ≥65 years). Sensitivity, specificity, and receiver operating characteristic curves were calculated for those continuous parameters independently associated with glaucoma. Classification and regression tree (CART) analysis was used to develop a multivariate algorithm for glaucoma screening. Results. Preset cutoffs for screening parameters yielded a generally poor balance of sensitivity and specificity (sensitivity/specificity for IOP ≥21 mm Hg and C/D ≥0.8 was 0.24/0.97 and 0.60/0.98, respectively). Assessment of high-risk subgroups did not improve the sensitivity/specificity of individual screening parameters. A CART analysis using multiple screening parameters—C/D, HVF, and IOP—substantially improved the balance of sensitivity and specificity (sensitivity/specificity 0.92/0.92). Conclusions. No single screening parameter is useful for glaucoma screening. However, a combination of vertical C/D ratio, HVF, and IOP provides the best balance of sensitivity/specificity and is likely to provide the highest yield in glaucoma screening programs. PMID:21245400

Quantifying the heritability of testicular germ cell tumour using both population-based and genomic approaches.

PubMed

Litchfield, Kevin; Thomsen, Hauke; Mitchell, Jonathan S; Sundquist, Jan; Houlston, Richard S; Hemminki, Kari; Turnbull, Clare

2015-09-09

A sizable fraction of testicular germ cell tumour (TGCT) risk is expected to be explained by heritable factors. Recent genome-wide association studies (GWAS) have successfully identified a number of common SNPs associated with TGCT. It is however, unclear how much common variation there is left to be accounted for by other, yet to be identified, common SNPs and what contribution common genetic variation makes to the heritable risk of TGCT. We approached this question using two complimentary analytical techniques. We undertook a population-based analysis of the Swedish family-cancer database, through which we estimated that the heritability of TGCT at 48.9% (CI:47.2%-52.3%). We also applied Genome-Wide Complex Trait Analysis to 922 cases and 4,842 controls to estimate the heritability of TGCT. The heritability explained by known common risk SNPs identified by GWAS was 9.1%, whereas the heritability explained by all common SNPs was 37.4% (CI:27.6%-47.2%). These complementary findings indicate that the known TGCT SNPs only explain a small proportion of the heritability and many additional common SNPs remain to be identified. The data also suggests that a fraction of the heritability of TGCT is likely to be explained by other classes of genetic variation, such as rare disease-causing alleles.

Risk analysis reveals global hotspots for marine debris ingestion by sea turtles.

PubMed

Schuyler, Qamar A; Wilcox, Chris; Townsend, Kathy A; Wedemeyer-Strombel, Kathryn R; Balazs, George; van Sebille, Erik; Hardesty, Britta Denise

2016-02-01

Plastic marine debris pollution is rapidly becoming one of the critical environmental concerns facing wildlife in the 21st century. Here we present a risk analysis for plastic ingestion by sea turtles on a global scale. We combined global marine plastic distributions based on ocean drifter data with sea turtle habitat maps to predict exposure levels to plastic pollution. Empirical data from necropsies of deceased animals were then utilised to assess the consequence of exposure to plastics. We modelled the risk (probability of debris ingestion) by incorporating exposure to debris and consequence of exposure, and included life history stage, species of sea turtle and date of stranding observation as possible additional explanatory factors. Life history stage is the best predictor of debris ingestion, but the best-fit model also incorporates encounter rates within a limited distance from stranding location, marine debris predictions specific to the date of the stranding study and turtle species. There is no difference in ingestion rates between stranded turtles vs. those caught as bycatch from fishing activity, suggesting that stranded animals are not a biased representation of debris ingestion rates in the background population. Oceanic life-stage sea turtles are at the highest risk of debris ingestion, and olive ridley turtles are the most at-risk species. The regions of highest risk to global sea turtle populations are off of the east coasts of the USA, Australia and South Africa; the east Indian Ocean, and Southeast Asia. Model results can be used to predict the number of sea turtles globally at risk of debris ingestion. Based on currently available data, initial calculations indicate that up to 52% of sea turtles may have ingested debris. © 2015 John Wiley & Sons Ltd.

Risk Analysis Reveals Global Hotspots for Marine Debris Ingestion by Sea Turtles

NASA Astrophysics Data System (ADS)

Schuyler, Q. A.; Wilcox, C.; Townsend, K.; Wedemeyer-Strombel, K.; Balazs, G.; van Sebille, E.; Hardesty, B. D.

2016-02-01

Plastic marine debris pollution is rapidly becoming one of the critical environmental concerns facing wildlife in the 21st century. Here we present a risk analysis for plastic ingestion by sea turtles on a global scale. We combined global marine plastic distributions based on ocean drifter data with sea turtle habitat maps to predict exposure levels to plastic pollution. Empirical data from necropsies of deceased animals were then utilised to assess the consequence of exposure to plastics. We modelled the risk (probability of debris ingestion) by incorporating exposure to debris and consequence of exposure, and included life history stage, species of sea turtle, and date of stranding observation as possible additional explanatory factors. Life history stage is the best predictor of debris ingestion, but the best-fit model also incorporates encounter rates within a limited distance from stranding location, marine debris predictions specific to the date of the stranding study, and turtle species. There was no difference in ingestion rates between stranded turtles vs. those caught as bycatch from fishing activity, suggesting that stranded animals are not a biased representation of debris ingestion rates in the background population. Oceanic life-stage sea turtles are at the highest risk of debris ingestion, and olive ridley turtles are the most at-risk species. The regions of highest risk to global sea turtle populations are off of the east coasts of the USA, Australia, and South Africa; the east Indian Ocean, and Southeast Asia. Model results can be used to predict the number of sea turtles globally at risk of debris ingestion. Based on currently available data, initial calculations indicate that up to 52% of sea turtles may have ingested debris.

The Risk of Developing Diabetes Mellitus in Patients with Psoriatic Arthritis: A Cohort Study.

PubMed

Eder, Lihi; Chandran, Vinod; Cook, Richard; Gladman, Dafna D

2017-03-01

To estimate the prevalence of diabetes mellitus (DM) in patients with psoriatic arthritis (PsA) in comparison with the general population and to assess whether the level of disease activity over time predicts the development of DM in these patients. A cohort analysis was conducted in patients followed in a large PsA clinic from 1978 to 2014. The prevalence of DM in the patients was compared with the general population of Ontario, Canada, and the age-standardized prevalence ratio (SPR) was calculated. For the assessment of risk factors for DM, time-weighted arithmetic mean (AM) levels of PsA-related disease activity measures were assessed as predictors for the development of DM. Multivariable Cox proportional hazards models were used to compute HR for incident DM after controlling for potential confounders. A total of 1305 patients were included in the analysis. The SPR of DM in PsA compared with the general population in Ontario was 1.43 (p = 0.002). Of the 1065 patients who were included in the time-to-event analysis, 73 patients were observed to develop DM. Based on multivariable analyses, AM tender joint count (HR 1.53, 95% CI 1.08-2.18, p = 0.02) and AM erythrocyte sedimentation rate (HR 1.21, 95% CI 1.03-1.41, p = 0.02) predicted the development of DM. The prevalence of DM is higher in patients with PsA compared with the general population. Patients with elevated levels of disease activity are at higher risk of developing DM.

Suicide by people in a community justice pathway: population-based nested case–control study

PubMed Central

King, Carlene; Senior, Jane; Webb, Roger T.; Millar, Tim; Piper, Mary; Pearsall, Alison; Humber, Naomi; Appleby, Louis; Shaw, Jenny

2015-01-01

The elevated risk of suicide in prison and after release is a well-recognised and serious problem. Despite this, evidence concerning community-based offenders' suicide risk is sparse. We conducted a population-based nested case–control study of all people in a community justice pathway in England and Wales. Our data show 13% of general population suicides were in community justice pathways before death. Suicide risks were highest among individuals receiving police cautions, and those having recent, or impending prosecution for sexual offences. Findings have implications for the training and practice of clinicians identifying and assessing suicidality, and offering support to those at elevated risk. PMID:26159602

Sensitivity Analysis of Median Lifetime on Radiation Risks Estimates for Cancer and Circulatory Disease amongst Never-Smokers

NASA Technical Reports Server (NTRS)

Chappell, Lori J.; Cucinotta, Francis A.

2011-01-01

Radiation risks are estimated in a competing risk formalism where age or time after exposure estimates of increased risks for cancer and circulatory diseases are folded with a probability to survive to a given age. The survival function, also called the life-table, changes with calendar year, gender, smoking status and other demographic variables. An outstanding problem in risk estimation is the method of risk transfer between exposed populations and a second population where risks are to be estimated. Approaches used to transfer risks are based on: 1) Multiplicative risk transfer models -proportional to background disease rates. 2) Additive risk transfer model -risks independent of background rates. In addition, a Mixture model is often considered where the multiplicative and additive transfer assumptions are given weighted contributions. We studied the influence of the survival probability on the risk of exposure induced cancer and circulatory disease morbidity and mortality in the Multiplicative transfer model and the Mixture model. Risks for never-smokers (NS) compared to the average U.S. population are estimated to be reduced between 30% and 60% dependent on model assumptions. Lung cancer is the major contributor to the reduction for NS, with additional contributions from circulatory diseases and cancers of the stomach, liver, bladder, oral cavity, esophagus, colon, a portion of the solid cancer remainder, and leukemia. Greater improvements in risk estimates for NS s are possible, and would be dependent on improved understanding of risk transfer models, and elucidating the role of space radiation on the various stages of disease formation (e.g. initiation, promotion, and progression).

Association of workplace and population characteristics with prevalence of hypertension among Brazilian industry workers: a multilevel analysis

PubMed Central

Vinholes, Daniele B; Bassanesi, Sérgio L; Chaves Junior, Hilton de Castro; Machado, Carlos Alberto; Melo, Ione M F; Fuchs, Flavio Danni

2017-01-01

Background Exposure to risk factors for hypertension may be influenced by the characteristics of the workplace, where workers spend most of their daily time. Objectives To evaluate the association between features of the companies, particularly the presence of facilities to provide meals, and of population characteristics and the prevalence of hypertension, taking into account individual risk factors for hypertension. Material and methods This multilevel analysis was based on a cross-sectional study with individual and company data from the SESI (Serviço Social da Indústria–Social Service of Industries) study and population-based data from the national census statistics. Workers aged ≥15 years were randomly selected from small (20–99), medium (100–499) and large (≥500 employees) companies per state using multistage sampling. Logistic regression was used to analyse the association between hypertension and individual, workplace and population variables, with odds ratios (ORs; 95% CI) adjusted for three-level variables. Results 4818 Workers from 157 companies were interviewed and their blood pressure, weight and height were measured. Overall, 77% were men, aged 35.4 ±10.7 years, with 8.7 ±4.1 years of schooling and mostly worked in companies with a staff canteen (66%). Besides individual characteristics—being male, ageing, low schooling, alcohol abuse and higher BMI—a workplace with no staff canteen (OR=1.28; 95% CI 1.08 to 1.52), small companies (OR=1.31; 95% CI 1.07 to 1.60) and living in cities with higher economic inequality (OR=1.47; 95% CI 1.23 to 1.76) were associated with a higher risk for hypertension. Conclusion Among Brazilian workers, the prevalence of hypertension is associated with individual risk factors, lack of a canteen at the workplace, small companies and higher economic inequalities of cities. These three-level characteristics help to interpret differences in the prevalence of hypertension between regions or countries. PMID:28827245

Suicide Risk by Military Occupation in the DoD Active Component Population

ERIC Educational Resources Information Center

Trofimovich, Lily; Reger, Mark A.; Luxton, David D.; Oetjen-Gerdes, Lynne A.

2013-01-01

Suicide risk based on occupational cohorts within the U.S. military was investigated. Rates of suicide based on military occupational categories were computed for the Department of Defense (DoD) active component population between 2001 and 2010. The combined infantry, gun crews, and seamanship specialist group was at increased risk of suicide…

Analysis of Fat Intake Based on the US Department of ...

EPA Pesticide Factsheets

EPA released the final report, Analysis of Fat Intake Based on USDA’s 1994-1996, 1998 Continuing Survey of Food Intakes by Individuals (CSFII, Final Report). For this report, the EPA conducted an analysis of fat consumption across the U.S. population based on data derived from the U.S. Department of Agriculture's 1994-96, 1998 Continuing Survey of Food Intakes by Individuals (CSFII) and EPA's Food Commodity Intake Database (FCID). Percentiles of fat consumption were calculated on the basis of total mass and on a per-unit body-weight basis for 12 food categories and 98 demographic cohorts. In addition, dietary breakdown and fat intake percentiles were calculated for a subset of the sample population whose consumption of animal fats exceeded the 90th percentile within its age group. Many chemicals found in the environment tend to accumulate in fatty tissue. Assessing risks from these chemicals requires knowledge of dietary habits and the amount of fat present in various types of foods.

Population-based case-control study of amyotrophic lateral sclerosis in western Washington State. II. Diet.

PubMed

Nelson, L M; Matkin, C; Longstreth, W T; McGuire, V

2000-01-15

The association of nutrient intake with the risk of amyotrophic lateral sclerosis (ALS) was investigated in a population-based case-control study conducted in three counties of western Washington State from 1990 to 1994. Incident ALS cases (n = 161) were identified and individually matched on age and gender to population controls (n = 321). A self-administered food frequency questionnaire was used to assess nutrient intake. Conditional logistic regression analysis was used to compute odds ratios adjusted for education, smoking, and total energy intake. The authors found that dietary fat intake was associated with an increased risk of ALS (highest vs. lowest quartile, fiber-adjusted odds ratio (OR) = 2.7, 95% confidence interval (CI): 0.9, 8.0; p for trend = 0.06), while dietary fiber intake was associated with a decreased risk of ALS (highest vs. lowest quartile, fat-adjusted OR = 0.3, 95% CI: 0.1, 0.7; p for trend = 0.02). Glutamate intake was associated with an increased risk of ALS (adjusted OR for highest vs. lowest quartile = 3.2, 95% CI: 1.2, 8.0; p for trend < 0.02). Consumption of antioxidant vitamins from diet or supplement sources did not alter the risk. The positive association with glutamate intake is consistent with the etiologic theory that implicates glutamate excitotoxicity in the pathogenesis of ALS, whereas the associations with fat and fiber intake warrant further study and biologic explanation.

Occupational health and safety experiences among self-identified immigrant workers living or working in Somerville, MA by ethnicity, years in the US, and English proficiency.

PubMed

Panikkar, Bindu; Woodin, Mark A; Brugge, Doug; Desmarais, Anne Marie; Hyatt, Raymond; Goldman, Rose; Pirie, Alex; Goldstein-Gelb, Marcy; Galvão, Heloisa; Chianelli, Monica; Vasquez, Ismael; McWhinney, Melissa; Dalembert, Franklin; Gute, David M

2012-12-06

In this community based research initiative, we employed a survey instrument predominately developed and administered by Teen Educators to assess occupational health risks for Haitian, Salvadoran, and Brazilian immigrants (n = 405) in Somerville, MA, USA. We demonstrate that a combined analysis of ethnicity, years in the US, and English proficiency better characterized the occupational experience of immigrant workers than considering these variables individually. While years in the US (negatively) and English proficiency (positively) explained the occurrence of health risks, the country of origin identified the most vulnerable populations in the community. Brazilians, Salvadorans, and other Hispanic, all of whom who have been in the US varying length of time, with varying proficiency in English language had twice the odds of reporting injuries due to work compared to other immigrants. Although this observation was not significant it indicates that years in the US and English proficiency alone do not predict health risks among this population. We recommend the initiation of larger studies employing c community based participatory research methods to confirm these differences and to further explore work and health issues of immigrant populations. This study is one of the small number of research efforts to utilize a contemporaneous assessment of occupational health problems in three distinct immigrant populations at the community level within a specific Environmental Justice context and social milieu.

Revealing the underlying drivers of disaster risk: a global analysis

NASA Astrophysics Data System (ADS)

Peduzzi, Pascal

2017-04-01

Disasters events are perfect examples of compound events. Disaster risk lies at the intersection of several independent components such as hazard, exposure and vulnerability. Understanding the weight of each component requires extensive standardisation. Here, I show how footprints of past disastrous events were generated using GIS modelling techniques and used for extracting population and economic exposures based on distribution models. Using past event losses, it was possible to identify and quantify a wide range of socio-politico-economic drivers associated with human vulnerability. The analysis was applied to about nine thousand individual past disastrous events covering earthquakes, floods and tropical cyclones. Using a multiple regression analysis on these individual events it was possible to quantify each risk component and assess how vulnerability is influenced by various hazard intensities. The results show that hazard intensity, exposure, poverty, governance as well as other underlying factors (e.g. remoteness) can explain the magnitude of past disasters. Analysis was also performed to highlight the role of future trends in population and climate change and how this may impacts exposure to tropical cyclones in the future. GIS models combined with statistical multiple regression analysis provided a powerful methodology to identify, quantify and model disaster risk taking into account its various components. The same methodology can be applied to various types of risk at local to global scale. This method was applied and developed for the Global Risk Analysis of the Global Assessment Report on Disaster Risk Reduction (GAR). It was first applied on mortality risk in GAR 2009 and GAR 2011. New models ranging from global assets exposure and global flood hazard models were also recently developed to improve the resolution of the risk analysis and applied through CAPRA software to provide probabilistic economic risk assessments such as Average Annual Losses (AAL) and Probable Maximum Losses (PML) in GAR 2013 and GAR 2015. In parallel similar methodologies were developed to highlitght the role of ecosystems for Climate Change Adaptation (CCA) and Disaster Risk Reduction (DRR). New developments may include slow hazards (such as e.g. soil degradation and droughts), natech hazards (by intersecting with georeferenced critical infrastructures) The various global hazard, exposure and risk models can be visualized and download through the PREVIEW Global Risk Data Platform.

Male suicide rates in German prisons and the role of citizenship

PubMed Central

Lempp, Thomas; Kettner, Mattias; Rauf, Amna; Bennefeld-Kersten, Katharina; Freitag, Christine M.

2017-01-01

Purpose Prisoners are at a particularly high risk of suicide. In contrast to other psychosocial risk factors it remains unclear to what degree the risk of suicide differs between prisoners with local citizenship and foreigners. In order to provide more detailed information for suicide prevention in prisons, this study aims to compare suicide rates (SR) between these populations in German criminal custody. Methods Based on a German national database of completed suicide in custody, suicides by prisoners were analysed and compared with epidemiological data of the prison population and the general population, stratified for German and foreign citizenship. Data analysis was adjusted for differences in the age distribution of both populations by calculating standard mortality ratios (SMR) for suicide. Results SR were higher in prisoners with German citizenship than those with foreign citizenship (SR = 76.5 vs. SR = 42.8, P<0.01). This association was not specific to the prison population, as the higher SR in citizens compared to non-citizens (SR = 19.3 vs. SR = 9.0, P<0.01) were also found in the general population. The association between prison suicide and citizenship was comparable in juvenile and adult prisoners, indicating its relevance to both the juvenile and adult detention systems. Conclusion Imprisonment is associated with a substantially increased risk of suicide in both German and non-German citizens, a finding which needs to be taken into consideration by the justice system. The lower suicide risk in non-German citizens is independent of whether or not they are in custody. PMID:28591187

Short-term population-based non-linear concentration-response associations between fine particulate matter and respiratory diseases in Taipei (Taiwan): a spatiotemporal analysis.

PubMed

Yu, Hwa-Lung; Chien, Lung-Chang

2016-01-01

Fine particulate matter <2.5 μm (PM2.5) has been associated with human health issues; however, findings regarding the influence of PM2.5 on respiratory disease remain inconsistent. The short-term, population-based association between the respiratory clinic visits of children and PM2.5 exposure levels were investigated by considering both the spatiotemporal distributions of ambient pollution and clinic visit data. We applied a spatiotemporal structured additive regression model to examine the concentration-response (C-R) association between children's respiratory clinic visits and PM2.5 concentrations. This analysis was separately performed on three respiratory disease categories that were selected from the Taiwanese National Health Insurance database, which includes 41 districts in the Taipei area of Taiwan from 2005 to 2007. The findings reveal a non-linear C-R pattern of PM2.5, particularly in acute respiratory infections. However, a PM2.5 increase at relatively lower levels can elevate the same-day respiratory health risks of both preschool children (<6 years old) and schoolchildren (6-14 years old). In preschool children, same-day health risks rise when concentrations increase from 0.76 to 7.44 μg/m(3), and in schoolchildren, same-day health risks rise when concentrations increase from 0.76 to 7.52 μg/m(3). Changes in PM2.5 levels generally exhibited no significant association with same-day respiratory risks, except in instances where PM2.5 levels are extremely high, and these occurrences do exhibit a significant positive influence on respiratory health that is especially notable in schoolchildren. A significant high relative rate of respiratory clinic visits are concentrated in highly populated areas. We highlight the non-linearity of the respiratory health effects of PM2.5 on children to investigate this population-based association. The C-R relationship in this study can provide a highly valuable alternative for assessing the effects of ambient air pollution on human health.

History of having a macrosomic infant and the risk of diabetes: the Japan public health center-based prospective diabetes study.

PubMed

Kabeya, Yusuke; Goto, Atsushi; Kato, Masayuki; Takahashi, Yoshihiko; Matsushita, Yumi; Inoue, Manami; Mizoue, Tetsuya; Tsugane, Shoichiro; Kadowaki, Takashi; Noda, Mitsuhiko

2013-01-01

The aim of the present study was to test a hypothesis that a history of having a macrosomic infant (≥ 4000 g) is associated with the risk of diabetes. Data on the Japan Public Health Center-based Prospective diabetes cohort were analyzed, which is a population-based cohort study on diabetes. The survey of diabetes was performed at baseline and at the 5-year follow-up. A history of having a macrosomic infant was assessed using a self-administered questionnaire. A cross-sectional analysis was performed among 12,153 women who participated in the 5-year survey of the cohort. Logistic regression was used to examine the relationship between a history of having a macrosomic infant and the presence of diabetes. A longitudinal analysis was also conducted among 7,300 women without diabetes who participated in the baseline survey. Logistic regression was used to investigate the relationship between a history of having a macrosomic infant and the incidence of diabetes between the baseline survey and the 5-year survey. In the cross-sectional analysis, parous women with a positive history were more likely to have diabetes in relation to parous women without (OR = 1.44, 95% CI = 1.13-1.83). The longitudinal analysis showed a modest but non-significant increased risk of developing diabetes among women with a positive history (OR = 1.24, 95% CI = 0.80-1.94). An increased risk of diabetes was implied among women with a history of having a macrosomic infant although the longitudinal analysis showed a non-significant increased risk.

An assessment of the geographical risks of wild and vaccine-derived poliomyelitis outbreaks in Africa and Asia.

PubMed

O'Reilly, Kathleen M; Lamoureux, Christine; Molodecky, Natalie A; Lyons, Hil; Grassly, Nicholas C; Tallis, Graham

2017-05-26

The international spread of wild poliomyelitis outbreaks continues to threaten eradication of poliomyelitis and in 2014 a public health emergency of international concern was declared. Here we describe a risk scoring system that has been used to assess country-level risks of wild poliomyelitis outbreaks, to inform prioritisation of mass vaccination planning, and describe the change in risk from 2014 to 2016. The methods were also used to assess the risk of emergence of vaccine-derived poliomyelitis outbreaks. Potential explanatory variables were tested against the reported outbreaks of wild poliomyelitis since 2003 using multivariable regression analysis. The regression analysis was translated to a risk score and used to classify countries as Low, Medium, Medium High and High risk, based on the predictive ability of the score. Indicators of population immunity, population displacement and diarrhoeal disease were associated with an increased risk of both wild and vaccine-derived outbreaks. High migration from countries with wild cases was associated with wild outbreaks. High birth numbers were associated with an increased risk of vaccine-derived outbreaks. Use of the scoring system is a transparent and rapid approach to assess country risk of wild and vaccine-derived poliomyelitis outbreaks. Since 2008 there has been a steep reduction in the number of wild poliomyelitis outbreaks and the reduction in countries classified as High and Medium High risk has reflected this. The risk of vaccine-derived poliomyelitis outbreaks has varied geographically. These findings highlight that many countries remain susceptible to poliomyelitis outbreaks and maintenance or improvement in routine immunisation is vital.

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

PubMed Central

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

2014-01-01

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

Enhancing the Value of Population-Based Risk Scores for Institutional-Level Use.

PubMed

Raza, Sajjad; Sabik, Joseph F; Rajeswaran, Jeevanantham; Idrees, Jay J; Trezzi, Matteo; Riaz, Haris; Javadikasgari, Hoda; Nowicki, Edward R; Svensson, Lars G; Blackstone, Eugene H

2016-07-01

We hypothesized that factors associated with an institution's residual risk unaccounted for by population-based models may be identifiable and used to enhance the value of population-based risk scores for quality improvement. From January 2000 to January 2010, 4,971 patients underwent aortic valve replacement (AVR), either isolated (n = 2,660) or with concomitant coronary artery bypass grafting (AVR+CABG; n = 2,311). Operative mortality and major morbidity and mortality predicted by The Society of Thoracic Surgeons (STS) risk models were compared with observed values. After adjusting for patients' STS score, additional and refined risk factors were sought to explain residual risk. Differences between STS model coefficients (risk-factor strength) and those specific to our institution were calculated. Observed operative mortality was less than predicted for AVR (1.6% [42 of 2,660] vs 2.8%, p < 0.0001) and AVR+CABG (2.6% [59 of 2,311] vs 4.9%, p < 0.0001). Observed major morbidity and mortality was also lower than predicted for isolated AVR (14.6% [389 of 2,660] vs 17.5%, p < 0.0001) and AVR+CABG (20.0% [462 of 2,311] vs 25.8%, p < 0.0001). Shorter height, higher bilirubin, and lower albumin were identified as additional institution-specific risk factors, and body surface area, creatinine, glomerular filtration rate, blood urea nitrogen, and heart failure across all levels of functional class were identified as refined risk-factor variables associated with residual risk. In many instances, risk-factor strength differed substantially from that of STS models. Scores derived from population-based models can be enhanced for institutional level use by adjusting for institution-specific additional and refined risk factors. Identifying these and measuring differences in institution-specific versus population-based risk-factor strength can identify areas to target for quality improvement initiatives. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Image Based Biomarker of Breast Cancer Risk: Analysis of Risk Disparity Among Minority Populations

DTIC Science & Technology

2015-02-01

health disparity. • On August 2-5, 2011, Fengshan Liu and Charlie Wilson attended and presented at the Department of Defense Breast Cancer Research...DSU faculty met with UPENN mentors on January 24, 2011 and August 9, 2010 to discuss the progress and the future work of each DSU faculty. 14...training, focus on parenchymal texture 03/06/2012: Training on MIRC database 03/09/2012: Additional training on MIRC database • In August 2013

A Population-based survey of risk for cancer in individuals diagnosed with myotonic dystrophy

PubMed Central

Abbott, Diana; Johnson, Nicholas E; Cannon-Albright, Lisa A.

2018-01-01

Introduction The risk of cancer in patients diagnosed with myotonic dystrophy (DM) is reported for the homogeneous Utah population. Methods Clinical data accessed from the largest Utah healthcare providers have been record-linked to the Utah Population Database (UPDB), a population-based resource also linked to the Utah Cancer Registry. Relative risks were estimated for 36 cancers of different types in 281 DM patients. Results Testicular cancer (RR=10.74; 95% CI: 1.91, 38.79), endometrial cancer (6.98; 1.24, 25.22), and Non-Hodgkins lymphoma (4.25; 1.16, 12.43) were all observed at significant excess in DM patients. Discussion This study confirms an overall increased risk of cancer in DM. Individuals diagnosed with DM might benefit from risk counseling. PMID:27064430

Suicide among immigrant population in Norway: a national register-based study.

PubMed

Puzo, Q; Mehlum, L; Qin, P

2017-06-01

To investigate differences in suicide risk among immigrant population in Norway compared with native Norwegians, with respect to associated country group of origin. Based on the entire national population, a nested case-control design was adopted using Norwegian national longitudinal registers to obtain 23 073 suicide cases having occurred in 1969-2012 and 373 178 controls. Odds ratios (ORs) for suicide were estimated using conditional logistic regression analysis adjusting for socio-economic factors. Compared with native Norwegians, suicide risk was significantly lower in first- and second-generation immigrants but higher in Norwegian-born with one foreign-born parent and foreign-born individuals with at least one Norwegian-born parent. When stratifying data by country group of origin, first-generation immigrants had lower ORs in most of the strata. Subjects born in Asia and in Central and South America with at least one Norwegian-born parent had a significantly higher risk of suicide. The observed results remained mostly unchanged in the analyses controlled for socio-economic status. Suicide risk is lower in first- and second-generation immigrants but higher in subjects born in Norway with one foreign-born parent and those born abroad with at least one Norwegian-born parent, with notable differences by country group of origin. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Developing a synthetic national population to investigate the impact of different cardiovascular disease risk management strategies: A derivation and validation study

PubMed Central

Jackson, Rod

2017-01-01

Background Many national cardiovascular disease (CVD) risk factor management guidelines now recommend that drug treatment decisions should be informed primarily by patients’ multi-variable predicted risk of CVD, rather than on the basis of single risk factor thresholds. To investigate the potential impact of treatment guidelines based on CVD risk thresholds at a national level requires individual level data representing the multi-variable CVD risk factor profiles for a country’s total adult population. As these data are seldom, if ever, available, we aimed to create a synthetic population, representing the joint CVD risk factor distributions of the adult New Zealand population. Methods and results A synthetic population of 2,451,278 individuals, representing the actual age, gender, ethnicity and social deprivation composition of people aged 30–84 years who completed the 2013 New Zealand census was generated using Monte Carlo sampling. Each ‘synthetic’ person was then probabilistically assigned values of the remaining cardiovascular disease (CVD) risk factors required for predicting their CVD risk, based on data from the national census national hospitalisation and drug dispensing databases and a large regional cohort study, using Monte Carlo sampling and multiple imputation. Where possible, the synthetic population CVD risk distributions for each non-demographic risk factor were validated against independent New Zealand data sources. Conclusions We were able to develop a synthetic national population with realistic multi-variable CVD risk characteristics. The construction of this population is the first step in the development of a micro-simulation model intended to investigate the likely impact of a range of national CVD risk management strategies that will inform CVD risk management guideline updates in New Zealand and elsewhere. PMID:28384217

Developing a synthetic national population to investigate the impact of different cardiovascular disease risk management strategies: A derivation and validation study.

PubMed

Knight, Josh; Wells, Susan; Marshall, Roger; Exeter, Daniel; Jackson, Rod

2017-01-01

Many national cardiovascular disease (CVD) risk factor management guidelines now recommend that drug treatment decisions should be informed primarily by patients' multi-variable predicted risk of CVD, rather than on the basis of single risk factor thresholds. To investigate the potential impact of treatment guidelines based on CVD risk thresholds at a national level requires individual level data representing the multi-variable CVD risk factor profiles for a country's total adult population. As these data are seldom, if ever, available, we aimed to create a synthetic population, representing the joint CVD risk factor distributions of the adult New Zealand population. A synthetic population of 2,451,278 individuals, representing the actual age, gender, ethnicity and social deprivation composition of people aged 30-84 years who completed the 2013 New Zealand census was generated using Monte Carlo sampling. Each 'synthetic' person was then probabilistically assigned values of the remaining cardiovascular disease (CVD) risk factors required for predicting their CVD risk, based on data from the national census national hospitalisation and drug dispensing databases and a large regional cohort study, using Monte Carlo sampling and multiple imputation. Where possible, the synthetic population CVD risk distributions for each non-demographic risk factor were validated against independent New Zealand data sources. We were able to develop a synthetic national population with realistic multi-variable CVD risk characteristics. The construction of this population is the first step in the development of a micro-simulation model intended to investigate the likely impact of a range of national CVD risk management strategies that will inform CVD risk management guideline updates in New Zealand and elsewhere.

Cost effectiveness of ramipril treatment for cardiovascular risk reduction.

PubMed

Malik, I S; Bhatia, V K; Kooner, J S

2001-05-01

To assess the cost effectiveness of ramipril treatment in patients at low, medium, and high risk of cardiovascular death. Population based cost effectiveness analysis from the perspective of the health care provider in the UK. Effectiveness was modelled using data from the HOPE (heart outcome prevention evaluation) trial. The life table method was used to predict mortality in a medium risk cohort, as in the HOPE trial (2.44% annual mortality), and in low and high risk groups (1% and 4.5% annual mortality, respectively). UK population using 1998 government actuary department data. Cost per life year gained at five years and lifetime treatment with ramipril. Cost effectiveness was pound36 600, pound13 600, and pound4000 per life year gained at five years and pound5300, pound1900, and pound100 per life year gained at 20 years (lifetime treatment) in low, medium, and high risk groups, respectively. Cost effectiveness at 20 years remained well below that of haemodialysis ( pound25 000 per life year gained) over a range of potential drug costs and savings. Treatment of the HOPE population would cost the UK National Health Service (NHS) an additional pound360 million but would prevent 12 000 deaths per annum. Ramipril is cost effective treatment for cardiovascular risk reduction in patients at medium, high, and low pretreatment risk, with a cost effectiveness comparable with the use of statins. Implementation of ramipril treatment in a medium risk population would result in a major reduction in cardiovascular deaths but would increase annual NHS spending by pound360 million.

A case control study of senile cataract in a hospital based population.

PubMed

Badrinath, S S; Sharma, T; Biswas, J; Srinivas, V

1996-12-01

A case-control study (244 cases and 264 controls) was done during 1986-89 on a hospital based population to evaluate the risk factors associated with the etiology of senile cataract. Patient with age between 40-60 years, visual acuity of 6/9 or less, and presence of lenticular opacity of senile origin were included as cases. Age matched individuals with absence of lenticular opacity made up the controls. Multivariate logistic regression analysis revealed that higher systolic BP and number of meals were significantly (P < or = 0.05) associated with presence of senile cataract; whereas higher weight, education and income, and utilization of cooking water had a significant protective effect against senile cataract. The present study helps the clinician to understand the possible risk factors associated with the development of senile cataract and could be helpful in designing a intervention strategy in future.

Risk factors for common mental disorders in women. Population-based longitudinal study.

PubMed

Patel, Vikram; Kirkwood, Betty R; Pednekar, Sulochana; Weiss, Helen; Mabey, David

2006-12-01

The determinants of common mental disorders in women have not been described in longitudinal studies from a low-income country. Population-based cohort study of 2494 women aged 18 to 50 years, in India. The Revised Clinical Interview Schedule was used for the detection of common mental disorders. There were 39 incident cases of common mental disorder in 2166 participants eligible for analysis (12-month rate 1.8%, 95% CI 1.3-2.4%). The following baseline factors were independently associated with the risk for common mental disorder: poverty (low income and having difficulty making ends meet); being married as compared with being single; use of tobacco; experiencing abnormal vaginal discharge; reporting a chronic physical illness; and having higher psychological symptom scores at baseline. Programmes to reduce the burden of common mental disorder in women should target poorer women, women with chronic physical illness and who have gynaecological symptoms, and women who use tobacco.

Risk of community-acquired pneumonia in patients with a diagnosis of pernicious anemia: a population-based retrospective cohort study.

PubMed

Almario, Christopher V; Metz, David C; Haynes, Kevin; Yang, Yu-Xiao

2015-11-01

Pernicious anemia (PA) is an autoimmune disease that causes achlorhydria or profound hypochlorhydria. We conducted a population-based study to determine whether individuals with PA are at an increased risk for community-acquired pneumonia (CAP). We performed a retrospective cohort study using The Health Improvement Network (THIN) from the UK (1993-2009). The eligible study cohort included individuals 18 years of age or older, with at least 1 year of THIN follow-up. The exposed group consisted of individuals with a diagnosis code for PA. The unexposed group consisted of individuals without a diagnosis of PA and was frequency matched with the exposed group with respect to age, sex, and practice site. Cox regression analysis was used to determine the hazard ratio with the 95% confidence interval for CAP associated with PA, accounting for a comprehensive list of potential confounders. The study included 13,605 individuals with PA and 50,586 non-PA individuals. The crude incidence rate of CAP was 9.4/1000 person-years for those with PA, versus 6.4/1000 person-years for those without PA. The multivariable adjusted hazard ratio for CAP associated with PA was 1.18 (95% confidence interval 1.08-1.29). In this large population-based cohort study, individuals with PA and presumed chronic achlorhydria were at an increased risk for CAP.

Global Prevalence and Major Risk Factors of Diabetic Retinopathy

PubMed Central

Yau, Joanne W.Y.; Rogers, Sophie L.; Kawasaki, Ryo; Lamoureux, Ecosse L.; Kowalski, Jonathan W.; Bek, Toke; Chen, Shih-Jen; Dekker, Jacqueline M.; Fletcher, Astrid; Grauslund, Jakob; Haffner, Steven; Hamman, Richard F.; Ikram, M. Kamran; Kayama, Takamasa; Klein, Barbara E.K.; Klein, Ronald; Krishnaiah, Sannapaneni; Mayurasakorn, Korapat; O’Hare, Joseph P.; Orchard, Trevor J.; Porta, Massimo; Rema, Mohan; Roy, Monique S.; Sharma, Tarun; Shaw, Jonathan; Taylor, Hugh; Tielsch, James M.; Varma, Rohit; Wang, Jie Jin; Wang, Ningli; West, Sheila; Xu, Liang; Yasuda, Miho; Zhang, Xinzhi; Mitchell, Paul; Wong, Tien Y.

2012-01-01

OBJECTIVE To examine the global prevalence and major risk factors for diabetic retinopathy (DR) and vision-threatening diabetic retinopathy (VTDR) among people with diabetes. RESEARCH DESIGN AND METHODS A pooled analysis using individual participant data from population-based studies around the world was performed. A systematic literature review was conducted to identify all population-based studies in general populations or individuals with diabetes who had ascertained DR from retinal photographs. Studies provided data for DR end points, including any DR, proliferative DR, diabetic macular edema, and VTDR, and also major systemic risk factors. Pooled prevalence estimates were directly age-standardized to the 2010 World Diabetes Population aged 20–79 years. RESULTS A total of 35 studies (1980–2008) provided data from 22,896 individuals with diabetes. The overall prevalence was 34.6% (95% CI 34.5–34.8) for any DR, 6.96% (6.87–7.04) for proliferative DR, 6.81% (6.74–6.89) for diabetic macular edema, and 10.2% (10.1–10.3) for VTDR. All DR prevalence end points increased with diabetes duration, hemoglobin A1c, and blood pressure levels and were higher in people with type 1 compared with type 2 diabetes. CONCLUSIONS There are approximately 93 million people with DR, 17 million with proliferative DR, 21 million with diabetic macular edema, and 28 million with VTDR worldwide. Longer diabetes duration and poorer glycemic and blood pressure control are strongly associated with DR. These data highlight the substantial worldwide public health burden of DR and the importance of modifiable risk factors in its occurrence. This study is limited by data pooled from studies at different time points, with different methodologies and population characteristics. PMID:22301125

Global prevalence and major risk factors of diabetic retinopathy.

PubMed

Yau, Joanne W Y; Rogers, Sophie L; Kawasaki, Ryo; Lamoureux, Ecosse L; Kowalski, Jonathan W; Bek, Toke; Chen, Shih-Jen; Dekker, Jacqueline M; Fletcher, Astrid; Grauslund, Jakob; Haffner, Steven; Hamman, Richard F; Ikram, M Kamran; Kayama, Takamasa; Klein, Barbara E K; Klein, Ronald; Krishnaiah, Sannapaneni; Mayurasakorn, Korapat; O'Hare, Joseph P; Orchard, Trevor J; Porta, Massimo; Rema, Mohan; Roy, Monique S; Sharma, Tarun; Shaw, Jonathan; Taylor, Hugh; Tielsch, James M; Varma, Rohit; Wang, Jie Jin; Wang, Ningli; West, Sheila; Xu, Liang; Yasuda, Miho; Zhang, Xinzhi; Mitchell, Paul; Wong, Tien Y

2012-03-01

To examine the global prevalence and major risk factors for diabetic retinopathy (DR) and vision-threatening diabetic retinopathy (VTDR) among people with diabetes. A pooled analysis using individual participant data from population-based studies around the world was performed. A systematic literature review was conducted to identify all population-based studies in general populations or individuals with diabetes who had ascertained DR from retinal photographs. Studies provided data for DR end points, including any DR, proliferative DR, diabetic macular edema, and VTDR, and also major systemic risk factors. Pooled prevalence estimates were directly age-standardized to the 2010 World Diabetes Population aged 20-79 years. A total of 35 studies (1980-2008) provided data from 22,896 individuals with diabetes. The overall prevalence was 34.6% (95% CI 34.5-34.8) for any DR, 6.96% (6.87-7.04) for proliferative DR, 6.81% (6.74-6.89) for diabetic macular edema, and 10.2% (10.1-10.3) for VTDR. All DR prevalence end points increased with diabetes duration, hemoglobin A(1c), and blood pressure levels and were higher in people with type 1 compared with type 2 diabetes. There are approximately 93 million people with DR, 17 million with proliferative DR, 21 million with diabetic macular edema, and 28 million with VTDR worldwide. Longer diabetes duration and poorer glycemic and blood pressure control are strongly associated with DR. These data highlight the substantial worldwide public health burden of DR and the importance of modifiable risk factors in its occurrence. This study is limited by data pooled from studies at different time points, with different methodologies and population characteristics.

Risk of retained placenta in women previously delivered by caesarean section: a population-based cohort study.

PubMed

Belachew, J; Cnattingius, S; Mulic-Lutvica, A; Eurenius, K; Axelsson, O; Wikström, A K

2014-01-01

To evaluate whether women with a caesarean section at their first delivery have an increased risk of retained placenta at their second delivery. Population-based cohort study. Sweden. All women with their first and second singleton deliveries in Sweden during the years 1994-2006 (n = 258,608). Women with caesarean section or placental abruption in their second pregnancy were not included in the study population. The risk of retained placenta at second delivery was estimated for women with a first delivery by caesarean section (n = 19,458), using women with a first vaginal delivery as reference (n = 239,150). Risks were calculated as odds ratios by unconditional logistic regression analysis with 95% confidence intervals (95%) after adjustments for maternal, delivery, and infant characteristics. Retained placenta with normal (≤1000 ml) and heavy (>1000 ml) bleeding. The overall rate of retained placenta was 2.07%. In women with a previous caesarean section and in women with previous vaginal delivery, the corresponding rates were 3.44% and 1.96%, respectively. Compared with women with a previous vaginal delivery, women with a previous caesarean section had an increased risk of retained placenta (adjusted OR 1.45; 95% CI 1.32-1.59), and the association was more pronounced for retained placenta with heavy bleeding (adjusted OR 1.61; 95% CI 1.44-1.79). Our report shows an increased risk for retained placenta in women previously delivered by caesarean section, a finding that should be considered in discussions of mode of delivery. © 2013 Royal College of Obstetricians and Gynaecologists.

Individual progression of carotid intima media thickness as a surrogate for vascular risk (PROG-IMT): Rationale and design of a meta-analysis project

PubMed Central

Lorenz, Matthias W.; Bickel, Horst; Bots, Michiel L.; Breteler, Monique M.B.; Catapano, Alberico L.; Desvarieux, Moise; Hedblad, Bo; Iglseder, Bernhard; Johnsen, Stein Harald; Juraska, Michal; Kiechl, Stefan; Mathiesen, Ellisiv B.; Norata, Giuseppe D.; Grigore, Liliana; Polak, Joseph; Poppert, Holger; Rosvall, Maria; Rundek, Tatjana; Sacco, Ralph L.; Sander, Dirk; Sitzer, Matthias; Steinmetz, Helmuth; Stensland, Eva; Willeit, Johann; Witteman, Jacqueline; Yanez, David; Thompson, Simon G.

2013-01-01

Carotid intima media thickness (IMT) progression is increasingly used as a surrogate for vascular risk. This use is supported by data from a few clinical trials investigating statins, but established criteria of surrogacy are only partially fulfilled. To provide a valid basis for the use of IMT progression as a study end point, we are performing a 3-step meta-analysis project based on individual participant data. Objectives of the 3 successive stages are to investigate (1) whether IMT progression prospectively predicts myocardial infarction, stroke, or death in population-based samples; (2) whether it does so in prevalent disease cohorts; and (3) whether interventions affecting IMT progression predict a therapeutic effect on clinical end points. Recruitment strategies, inclusion criteria, and estimates of the expected numbers of eligible studies are presented along with a detailed analysis plan. PMID:20435179

Ancestry of the Timorese: age-related macular degeneration associated genotype and allele sharing among human populations from throughout the world

PubMed Central

Morrison, Margaux A.; Magalhaes, Tiago R.; Ramke, Jacqueline; Smith, Silvia E.; Ennis, Sean; Simpson, Claire L.; Portas, Laura; Murgia, Federico; Ahn, Jeeyun; Dardenne, Caitlin; Mayne, Katie; Robinson, Rosann; Morgan, Denise J.; Brian, Garry; Lee, Lucy; Woo, Se J.; Zacharaki, Fani; Tsironi, Evangelia E.; Miller, Joan W.; Kim, Ivana K.; Park, Kyu H.; Bailey-Wilson, Joan E.; Farrer, Lindsay A.; Stambolian, Dwight; DeAngelis, Margaret M.

2015-01-01

We observed that the third leading cause of blindness in the world, age-related macular degeneration (AMD), occurs at a very low documented frequency in a population-based cohort from Timor-Leste. Thus, we determined a complete catalog of the ancestry of the Timorese by analysis of whole exome chip data and haplogroup analysis of SNP genotypes determined by sequencing the Hypervariable I and II regions of the mitochondrial genome and 17 genotyped YSTR markers obtained from 535 individuals. We genotyped 20 previously reported AMD-associated SNPs in the Timorese to examine their allele frequencies compared to and between previously documented AMD cohorts of varying ethnicities. For those without AMD (average age > 55 years), genotype and allele frequencies were similar for most SNPs with a few exceptions. The major risk allele of HTRA1 rs11200638 (10q26) was at a significantly higher frequency in the Timorese, as well as 3 of the 5 protective CFH (1q32) SNPs (rs800292, rs2284664, and rs12066959). Additionally, the most commonly associated AMD-risk SNP, CFH rs1061170 (Y402H), was also seen at a much lower frequency in the Korean and Timorese populations than in the assessed Caucasian populations (C ~7 vs. ~40%, respectively). The difference in allele frequencies between the Timorese population and the other genotyped populations, along with the haplogroup analysis, also highlight the genetic diversity of the Timorese. Specifically, the most common ancestry groupings were Oceanic (Melanesian and Papuan) and Eastern Asian (specifically Han Chinese). The low prevalence of AMD in the Timorese population (2 of 535 randomly selected participants) may be due to the enrichment of protective alleles in this population at the 1q32 locus. PMID:26217379

Vernal keratoconjunctivitis in school children in Rwanda and its association with socio-economic status: a population-based survey.

PubMed

Smedt, Stefan De; Nkurikiye, John; Fonteyne, Yannick; Hogewoning, Arjan; Esbroeck, Marjan Van; Bacquer, Dirk De; Tuft, Stephen; Gilbert, Clare; Delanghe, Joris; Kestelyn, Philippe

2011-10-01

Vernal keratoconjunctivitis (VKC) is an allergic eye disease and an important cause of hospital referral among children in Africa and Asia. Hospital-based studies have suggested a role for parasites in its pathogenesis. To determine the prevalence and risk factors for VKC in Central Africa, we conducted a nested population-based case control study in Rwanda, involving randomly selected primary schools from different environments (rural/urban) and climate. A prevalence of VKC of 4.0% (95% confidence interval 3.3-4.7%) was found among 3,041 children studied (participation rate 94.7%). The intestinal parasitic burden was not related to VKC. Besides hot dry climate (odds ratio [OR] = 1.5, P = 0.05) and male gender (OR = 1.7, P = 0.005), multivariate analysis identified higher economic status as a risk for VKC (OR = 1.4, P = 0.005). The effect on VKC of higher economic status appears not to act through differences in parasitic intestinal load.

Vernal Keratoconjunctivitis in School Children in Rwanda and Its Association with Socio-Economic Status: A Population-Based Survey

PubMed Central

Smedt, Stefan De; Nkurikiye, John; Fonteyne, Yannick; Hogewoning, Arjan; Esbroeck, Marjan Van; Bacquer, Dirk De; Tuft, Stephen; Gilbert, Clare; Delanghe, Joris; Kestelyn, Philippe

2011-01-01

Vernal keratoconjunctivitis (VKC) is an allergic eye disease and an important cause of hospital referral among children in Africa and Asia. Hospital-based studies have suggested a role for parasites in its pathogenesis. To determine the prevalence and risk factors for VKC in Central Africa, we conducted a nested population-based case control study in Rwanda, involving randomly selected primary schools from different environments (rural/urban) and climate. A prevalence of VKC of 4.0% (95% confidence interval 3.3–4.7%) was found among 3,041 children studied (participation rate 94.7%). The intestinal parasitic burden was not related to VKC. Besides hot dry climate (odds ratio [OR] = 1.5, P = 0.05) and male gender (OR = 1.7, P = 0.005), multivariate analysis identified higher economic status as a risk for VKC (OR = 1.4, P = 0.005). The effect on VKC of higher economic status appears not to act through differences in parasitic intestinal load. PMID:21976577

Association of daily tar and nicotine intake with incident myocardial infarction: Results from the population-based MONICA/KORA Augsburg Cohort Study 1984 - 2002

PubMed Central

2011-01-01

Background Cigarette smoking has been shown to be one of the most important risk factors for cardiovascular diseases. However, little is known about cumulative effects of daily tar and nicotine intake on the risk of incident myocardial infarction (MI) so far. To bridge this gap, we conducted an analysis in a large prospective study from Southern Germany investigating associations of daily tar and nicotine intake with an incident MI event. Methods The study was based on 4,099 men and 4,197 women participating in two population-based MONICA Augsburg surveys between 1984 and 1990 and followed up within the KORA framework until 2002. During a mean follow-up of 13.3 years, a number of 307 men and 80 women developed an incident MI event. Relative risks were calculated as hazard ratios (HRs) estimated by Cox proportional hazards models adjusted for cardiovascular risk factors. Results In the present study, male regular smokers consumed on average more cigarettes per day than female regular smokers (20 versus 15) and had a higher tar and nicotine intake per day. In men, the MI risk compared to never-smokers increased with higher tar intake: HRs were 2.24 (95% CI 1.40-3.56) for 1-129 mg/day, 2.12 (95% CI 1.37-3.29) for 130-259 mg/day and 3.01 (95% CI 2.08-4.36) for ≥ 260 mg/day. In women, the corresponding associations were comparable but more pronounced for high tar intake (HR 4.67, 95% CI 1.76-12.40). Similar associations were observed for nicotine intake. Conclusions The present study based on a large population-based sample adds important evidence of cumulative effects of tar and nicotine intake on the risk of incident MI. Even low or medium tar and nicotine intake revealed substantial risk increases as compared to never-smokers. Therefore, reduction of tar and nicotine contents in cigarettes cannot be seen as a suitable public health policy in preventing myocardial infarction. PMID:21542909

Risk of yellow fever vaccine-associated viscerotropic disease among the elderly: a systematic review.

PubMed

Rafferty, Ellen; Duclos, Philippe; Yactayo, Sergio; Schuster, Melanie

2013-12-02

Yellow fever vaccine-associated viscerotropic disease (YEL-AVD) is a rare and serious adverse event of the yellow fever (YF) vaccine that mimics wild-type YF. Research shows there may be an increased risk of YEL-AVD among the elderly population (≥ 60-65 years old), however this research has yet to be accumulated and reviewed in order to make policy recommendations to countries currently administering the YF vaccine. This paper systematically reviewed all information available on YEL-AVD to determine if there is an increased risk among the elderly, for both travelers and endemic populations. Age-specific reporting rates (RRs) were re-calculated from the literature using the Brighton Collaboration case definition for YEL-AVD and were then analyzed to determine if there was a significant difference between the RRs of younger and older age groups. Two out of the five studies found a significantly higher rate of YEL-AVD among the elderly population. Our findings suggest unexposed elders may be at an increased risk of developing YEF-AVD, however the evidence remains limited. Therefore, our findings for YF vaccination of elderly populations support the recommendations made by the Strategic Advisory Group of Experts (SAGE) in their April 2013 meeting, mainly vaccination of the elderly should be based on a careful risk-benefit analysis. Copyright © 2013 World Health Organization (WHO). Published by Elsevier Ltd.. All rights reserved.

A Framework for the Next Generation of Risk Science

PubMed Central

Krewski, Daniel; Andersen, Melvin E.; Paoli, Gregory M.; Chiu, Weihsueh A.; Al-Zoughool, Mustafa; Croteau, Maxine C.; Burgoon, Lyle D.; Cote, Ila

2014-01-01

Objectives: In 2011, the U.S. Environmental Protection Agency initiated the NexGen project to develop a new paradigm for the next generation of risk science. Methods: The NexGen framework was built on three cornerstones: the availability of new data on toxicity pathways made possible by fundamental advances in basic biology and toxicological science, the incorporation of a population health perspective that recognizes that most adverse health outcomes involve multiple determinants, and a renewed focus on new risk assessment methodologies designed to better inform risk management decision making. Results: The NexGen framework has three phases. Phase I (objectives) focuses on problem formulation and scoping, taking into account the risk context and the range of available risk management decision-making options. Phase II (risk assessment) seeks to identify critical toxicity pathway perturbations using new toxicity testing tools and technologies, and to better characterize risks and uncertainties using advanced risk assessment methodologies. Phase III (risk management) involves the development of evidence-based population health risk management strategies of a regulatory, economic, advisory, community-based, or technological nature, using sound principles of risk management decision making. Conclusions: Analysis of a series of case study prototypes indicated that many aspects of the NexGen framework are already beginning to be adopted in practice. Citation: Krewski D, Westphal M, Andersen ME, Paoli GM, Chiu WA, Al-Zoughool M, Croteau MC, Burgoon LD, Cote I. 2014. A framework for the next generation of risk science. Environ Health Perspect 122:796–805; http://dx.doi.org/10.1289/ehp.1307260 PMID:24727499

HLA-DRB1 Alleles Are Associated with the Susceptibility to Sporadic Parkinson’s Disease in Chinese Han Population

PubMed Central

Sun, Congcong; Wei, Lei; Luo, Feifei; Li, Yi; Li, Jiaobiao; Zhu, Feiqi; Kang, Ping; Xu, Rensi; Xiao, LuLu; Liu, Zhuolin; Xu, Pingyi

2012-01-01

Immune disorders may play an important role in the pathogenesis of Parkinson's disease (PD). Recently, polymorphisms in the HLA-DR region have been found to be associated with sporadic PD in European ancestry populations. However, polymorphisms in the HLA complex are highly variable with ethnic and geographic origin. To explore the relationships between polymorphisms of the HLA-DR region and sporadic PD in Chinese Han population, we genotyped 567 sporadic PD patients and 746 healthy controls in two independent series for the HLA-DRB1 locus with Polymerase chain reaction-sequence based typing(PCR-SBT). The χ2 test was used to evaluate the distribution of allele frequencies between the patients and healthy controls. The impact of HLA-DRB1 alleles on PD risk was estimated by unconditional logistic regression. We found a significant higher frequency of HLA-DRB1*0301 in sporadic PD patients than in healthy controls and a positive association, which was independent of onset age, between HLA-DRB1*0301 and PD risk. Conversely, a lower frequency of HLA-DRB1*0406 was found in sporadic PD patients than in healthy controls, with a negative association between HLA-DRB1*0406 and PD risk. Furthermore, a meta-analysis involving 195205 individuals was conducted to summarize the frequencies of these two alleles in populations from various ethnic regions, we found a higher frequency of HLA-DRB1*0301, but a lower frequency of HLA-DRB1*0406 in European ancestry populations than that in Asians, this was consistent with the higher prevalence of sporadic PD in European ancestry populations. Based on these results, we speculate that HLA-DRB1 alleles are associated with the susceptibility to sporadic PD in Chinese Han population, among them HLA-DRB1*0301 is a risk allele while the effect of HLA-DRB1*0406 deserves debate. PMID:23139797

Vulnerability of populations and man-made facilities to seismic hazards

NASA Astrophysics Data System (ADS)

Badal, J.; Vazquez-Prada, M.; Gonzalez, A.; Chourak, M.; Samardzhieva, E.; Zhang, Z.

2003-04-01

Earthquakes become major societal risks when they impinge on vulnerable populations. According to the available worldwide data during the twentieth century (NEIC Catalog of Earthquakes 1980-1999), almost half a thousand of earthquakes resulted in more than 1,615,000 human victims. Besides human casualty levels, destructive earthquakes frequently inflict huge economic losses. An additional problem of very different nature, but also worthy of being considered in a damage and loss analysis, is the direct cost associated with the damages derived from a strong seismic impact. We focus our attention on both aspects to their rapid quantitative assessment, and to lessen the earthquake disaster in areas affected by relatively strong earthquakes. Our final goal is the knowledge of potential losses from earthquakes to forward national programs in emergency management, and consequently the minimization of the life loss due to earthquakes, and to aid in response and recovery tasks. For this purpose we follow a suitable and comprehensible methodology for risk-based loss analysis, and simulate the occurence of a seismic event in densely populated areas of Spain.

A cost-effectiveness evaluation of hospital discharge counseling by pharmacists.

PubMed

Chinthammit, Chanadda; Armstrong, Edward P; Warholak, Terri L

2012-04-01

This study estimated the cost-effectiveness of pharmacist discharge counseling on medication-related morbidity in both the high-risk elderly and general US population. A cost-effectiveness decision analytic model was developed using a health care system perspective based on published clinical trials. Costs included direct medical costs, and the effectiveness unit was patients discharged without suffering a subsequent adverse drug event. A systematic review of published studies was conducted to estimate variable probabilities in the cost-effectiveness model. To test the robustness of the results, a second-order probabilistic sensitivity analysis (Monte Carlo simulation) was used to run 10 000 cases through the model sampling across all distributions simultaneously. Pharmacist counseling at hospital discharge provided a small, but statistically significant, clinical improvement at a similar overall cost. Pharmacist counseling was cost saving in approximately 48% of scenarios and in the remaining scenarios had a low willingness-to-pay threshold for all scenarios being cost-effective. In addition, discharge counseling was more cost-effective in the high-risk elderly population compared to the general population. This cost-effectiveness analysis suggests that discharge counseling by pharmacists is quite cost-effective and estimated to be cost saving in over 48% of cases. High-risk elderly patients appear to especially benefit from these pharmacist services.

Association between RTEL1 gene polymorphisms and COPD susceptibility in a Chinese Han population.

PubMed

Ding, Yipeng; Xu, Heping; Yao, Jinjian; Xu, Dongchuan; He, Ping; Yi, Shengyang; Li, Quanni; Liu, Yuanshui; Wu, Cibing; Tian, Zhongjie

2017-01-01

We investigated the association between single-nucleotide polymorphisms in regulation of telomere elongation helicase 1 ( RTEL1 ), which has been associated with telomere length in several brain cancers and age-related diseases, and the risk of chronic obstructive pulmonary disease (COPD) in a Chinese Han population. In a case-control study that included 279 COPD cases and 290 healthy controls, five single-nucleotide polymorphisms in RTEL1 were selected and genotyped using the Sequenom MassARRAY platform. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using unconditional logistic regression after adjusting for age and gender. In the genotype model analysis, we determined that rs4809324 polymorphism had a decreased effect on the risk of COPD (CC versus TT: OR =0.28; 95% CI =0.10-0.82; P =0.02). In the genetic model analysis, we found that the "C/C" genotype of rs4809324 was associated with a decreased risk of COPD based on the codominant model (OR =0.33; 95% CI =0.13-0.86; P =0.022) and recessive model (OR =0.32; 95% CI =0.12-0.80; P =0.009). Our data shed new light on the association between genetic polymorphisms of RTEL1 and COPD susceptibility in the Chinese Han population.

Age distribution and age-related outcomes of olfactory neuroblastoma: a population-based analysis.

PubMed

Yin, Zhenzhen; Wang, Youyou; Wu, Yuemei; Zhang, Ximei; Wang, Fengming; Wang, Peiguo; Tao, Zhen; Yuan, Zhiyong

2018-01-01

The objective of the study was to describe the age distribution and to evaluate the role of prognostic value of age on survival in patients diagnosed with olfactory neuroblastoma (ONB). A population-based retrospective analysis was conducted. The population-based study of patients in the Surveillance, Epidemiology, and End Results (SEER) tumor registry, who were diagnosed with ONB from 1973 to 2014, were retrospectively analyzed. The cohort included 876 patients with a median age of 54 years. There was a unimodal distribution of age and ONBs most frequently occurred in the fifth to sixth decades of life. Kaplan-Meier analysis demonstrated overall survival (OS) and cancer-specific survival (CSS) rates of 69% and 78% at 5 years. Multivariable Cox regression analysis showed that age, SEER stage, and surgery were independent prognostic factors for CSS. The risk of overall death and cancer-specific death increased 3.1% and 1.6% per year, respectively. Patients aged >60 years presented significantly poor OS and CSS compared with patients aged ≤60 years, even in patients with loco-regional disease or in those treated with surgery. This study highlights the growing evidence that there is a unimodal age distribution of ONB and that age is an important adverse prognostic factor.

Association of genetic and non-genetic risk factors with the development of prostate cancer in Malaysian men.

PubMed

Munretnam, Khamsigan; Alex, Livy; Ramzi, Nurul Hanis; Chahil, Jagdish Kaur; Kavitha, I S; Hashim, Nikman Adli Nor; Lye, Say Hean; Velapasamy, Sharmila; Ler, Lian Wee

2014-01-01

There is growing global interest to stratify men into different levels of risk to developing prostate cancer, thus it is important to identify common genetic variants that confer the risk. Although many studies have identified more than a dozen common genetic variants which are highly associated with prostate cancer, none have been done in Malaysian population. To determine the association of such variants in Malaysian men with prostate cancer, we evaluated a panel of 768 SNPs found previously associated with various cancers which also included the prostate specific SNPs in a population based case control study (51 case subjects with prostate cancer and 51 control subjects) in Malaysian men of Malay, Chinese and Indian ethnicity. We identified 21 SNPs significantly associated with prostate cancer. Among these, 12 SNPs were strongly associated with increased risk of prostate cancer while remaining nine SNPs were associated with reduced risk. However, data analysis based on ethnic stratification led to only five SNPs in Malays and 3 SNPs in Chinese which remained significant. This could be due to small sample size in each ethnic group. Significant non-genetic risk factors were also identified for their association with prostate cancer. Our study is the first to investigate the involvement of multiple variants towards susceptibility for PC in Malaysian men using genotyping approach. Identified SNPs and non-genetic risk factors have a significant association with prostate cancer.

PROJECTED LIFETIME CANCER RISKS FROM EXPOSURE TO REGIONAL RADIOACTIVE FALLOUT IN THE MARSHALL ISLANDS

PubMed Central

Land, Charles E.; Bouville, Andre; Apostoaei, Iulian; Simon, Steven L.

2013-01-01

Radioactive fallout from nuclear test detonations during 1946–1958 at Bikini and Enewetak atolls in the Marshall Islands (MI) exposed populations living elsewhere in the archipelago. A comprehensive analysis, presented in seven companion papers, has produced estimates of tissue-specific radiation absorbed dose to MI residents at all historically inhabited atolls from internal (ingested) and external radioactive components of fallout, by calendar year, and by age of the population at time of exposure. The present report deals, for the first time, with the implications of these doses on cancer risk among exposed members of the MI population. Radiation doses differed by geographic location and year of birth, and radiation-related cancer risk depends upon age at exposure and age at observation for risk. Using dose-response models based on committee reports published by the National Research Council and the National Institutes of Health, we project that, during the lifetimes of members of the MI population potentially exposed to ionizing radiation from weapons test fallout deposited during the testing period (1948–1958) and from residual radioactive sources during the subsequent 12 years (1959–1970), perhaps 1.6% (with 90% uncertainty range 0.4% and 3.4%) of all cancers might be attributable to fallout-related radiation exposures. The projected proportion of cancers attributable to radiation from fallout from all nuclear tests conducted in the Marshall Islands is 55% (28%–69%) among 82 persons exposed in 1954 on Rongelap and Ailinginae, 10% (2%–22%) for 157 persons exposed on Utrik, and 2% (0.5%–5%) and 1% (0.2%–2%), respectively, for the much larger populations exposed in mid-latitude locations including Kwajalein and in southern locations including Majuro. By cancer type, point estimates of attributable risk varied by location, between 12% and 95% for thyroid cancer, between 2% and 78% for leukemia, and between 1% and 55% for all cancers combined. The largest projected risks pertain to the Rongelap Island community and the lowest risks pertain to the populations resident on the southern-most atolls. While the projected cancer risks are smaller than those estimated by the National Cancer Institute in simplistic analyses conducted in 2004, these estimates of cancer risk are the best available as they are based on the most detailed dose reconstruction to date and comprehensively include populations at all locations and dose contributions from all nuclear tests. PMID:20622551

Estimating and mapping the population at risk of sleeping sickness.

PubMed

Simarro, Pere P; Cecchi, Giuliano; Franco, José R; Paone, Massimo; Diarra, Abdoulaye; Ruiz-Postigo, José Antonio; Fèvre, Eric M; Mattioli, Raffaele C; Jannin, Jean G

2012-01-01

Human African trypanosomiasis (HAT), also known as sleeping sickness, persists as a public health problem in several sub-Saharan countries. Evidence-based, spatially explicit estimates of population at risk are needed to inform planning and implementation of field interventions, monitor disease trends, raise awareness and support advocacy. Comprehensive, geo-referenced epidemiological records from HAT-affected countries were combined with human population layers to map five categories of risk, ranging from "very high" to "very low," and to estimate the corresponding at-risk population. Approximately 70 million people distributed over a surface of 1.55 million km(2) are estimated to be at different levels of risk of contracting HAT. Trypanosoma brucei gambiense accounts for 82.2% of the population at risk, the remaining 17.8% being at risk of infection from T. b. rhodesiense. Twenty-one million people live in areas classified as moderate to very high risk, where more than 1 HAT case per 10,000 inhabitants per annum is reported. Updated estimates of the population at risk of sleeping sickness were made, based on quantitative information on the reported cases and the geographic distribution of human population. Due to substantial methodological differences, it is not possible to make direct comparisons with previous figures for at-risk population. By contrast, it will be possible to explore trends in the future. The presented maps of different HAT risk levels will help to develop site-specific strategies for control and surveillance, and to monitor progress achieved by ongoing efforts aimed at the elimination of sleeping sickness.

Comparing population exposure to multiple Washington earthquake scenarios for prioritizing loss estimation studies

USGS Publications Warehouse

Wood, Nathan J.; Ratliff, Jamie L.; Schelling, John; Weaver, Craig S.

2014-01-01

Scenario-based, loss-estimation studies are useful for gauging potential societal impacts from earthquakes but can be challenging to undertake in areas with multiple scenarios and jurisdictions. We present a geospatial approach using various population data for comparing earthquake scenarios and jurisdictions to help emergency managers prioritize where to focus limited resources on data development and loss-estimation studies. Using 20 earthquake scenarios developed for the State of Washington (USA), we demonstrate how a population-exposure analysis across multiple jurisdictions based on Modified Mercalli Intensity (MMI) classes helps emergency managers understand and communicate where potential loss of life may be concentrated and where impacts may be more related to quality of life. Results indicate that certain well-known scenarios may directly impact the greatest number of people, whereas other, potentially lesser-known, scenarios impact fewer people but consequences could be more severe. The use of economic data to profile each jurisdiction’s workforce in earthquake hazard zones also provides additional insight on at-risk populations. This approach can serve as a first step in understanding societal impacts of earthquakes and helping practitioners to efficiently use their limited risk-reduction resources.

Topography- and nightlight-based national flood risk assessment in Canada

NASA Astrophysics Data System (ADS)

Elshorbagy, Amin; Bharath, Raja; Lakhanpal, Anchit; Ceola, Serena; Montanari, Alberto; Lindenschmidt, Karl-Erich

2017-04-01

In Canada, flood analysis and water resource management, in general, are tasks conducted at the provincial level; therefore, unified national-scale approaches to water-related problems are uncommon. In this study, a national-scale flood risk assessment approach is proposed and developed. The study focuses on using global and national datasets available with various resolutions to create flood risk maps. First, a flood hazard map of Canada is developed using topography-based parameters derived from digital elevation models, namely, elevation above nearest drainage (EAND) and distance from nearest drainage (DFND). This flood hazard mapping method is tested on a smaller area around the city of Calgary, Alberta, against a flood inundation map produced by the city using hydraulic modelling. Second, a flood exposure map of Canada is developed using a land-use map and the satellite-based nightlight luminosity data as two exposure parameters. Third, an economic flood risk map is produced, and subsequently overlaid with population density information to produce a socioeconomic flood risk map for Canada. All three maps of hazard, exposure, and risk are classified into five classes, ranging from very low to severe. A simple way to include flood protection measures in hazard estimation is also demonstrated using the example of the city of Winnipeg, Manitoba. This could be done for the entire country if information on flood protection across Canada were available. The evaluation of the flood hazard map shows that the topography-based method adopted in this study is both practical and reliable for large-scale analysis. Sensitivity analysis regarding the resolution of the digital elevation model is needed to identify the resolution that is fine enough for reliable hazard mapping, but coarse enough for computational tractability. The nightlight data are found to be useful for exposure and risk mapping in Canada; however, uncertainty analysis should be conducted to investigate the effect of the overglow phenomenon on flood risk mapping.

Assessing population exposure for landslide risk analysis using dasymetric cartography

NASA Astrophysics Data System (ADS)

Garcia, Ricardo A. C.; Oliveira, Sérgio C.; Zêzere, José L.

2016-12-01

Assessing the number and locations of exposed people is a crucial step in landslide risk management and emergency planning. The available population statistical data frequently have insufficient detail for an accurate assessment of potentially exposed people to hazardous events, mainly when they occur at the local scale, such as with landslides. The present study aims to apply dasymetric cartography to improving population spatial resolution and to assess the potentially exposed population. An additional objective is to compare the results with those obtained with a more common approach that uses, as spatial units, basic census units, which are the best spatial data disaggregation and detailed information available for regional studies in Portugal. Considering the Portuguese census data and a layer of residential building footprint, which was used as ancillary information, the number of exposed inhabitants differs significantly according to the approach used. When the census unit approach is used, considering the three highest landslide susceptible classes, the number of exposed inhabitants is in general overestimated. Despite the associated uncertainties of a general cost-benefit analysis, the presented methodology seems to be a reliable approach for gaining a first approximation of a more detailed estimation of exposed people. The approach based on dasymetric cartography allows the spatial resolution of population over large areas to be increased and enables the use of detailed landslide susceptibility maps, which are valuable for improving the exposed population assessment.

Target prioritization and strategy selection for active case-finding of pulmonary tuberculosis: a tool to support country-level project planning.

PubMed

Nishikiori, Nobuyuki; Van Weezenbeek, Catharina

2013-02-02

Despite the progress made in the past decade, tuberculosis (TB) control still faces significant challenges. In many countries with declining TB incidence, the disease tends to concentrate in vulnerable populations that often have limited access to health care. In light of the limitations of the current case-finding approach and the global urgency to improve case detection, active case-finding (ACF) has been suggested as an important complementary strategy to accelerate tuberculosis control especially among high-risk populations. The present exercise aims to develop a model that can be used for county-level project planning. A simple deterministic model was developed to calculate the number of estimated TB cases diagnosed and the associated costs of diagnosis. The model was designed to compare cost-effectiveness parameters, such as the cost per case detected, for different diagnostic algorithms when they are applied to different risk populations. The model was transformed into a web-based tool that can support national TB programmes and civil society partners in designing ACF activities. According to the model output, tuberculosis active case-finding can be a costly endeavor, depending on the target population and the diagnostic strategy. The analysis suggests the following: (1) Active case-finding activities are cost-effective only if the tuberculosis prevalence among the target population is high. (2) Extensive diagnostic methods (e.g. X-ray screening for the entire group, use of sputum culture or molecular diagnostics) can be applied only to very high-risk groups such as TB contacts, prisoners or people living with human immunodeficiency virus (HIV) infection. (3) Basic diagnostic approaches such as TB symptom screening are always applicable although the diagnostic yield is very limited. The cost-effectiveness parameter was sensitive to local diagnostic costs and the tuberculosis prevalence of target populations. The prioritization of appropriate target populations and careful selection of cost-effective diagnostic strategies are critical prerequisites for rational active case-finding activities. A decision to conduct such activities should be based on the setting-specific cost-effectiveness analysis and programmatic assessment. A web-based tool was developed and is available to support national tuberculosis programmes and partners in the formulation of cost-effective active case-finding activities at the national and subnational levels.

Populations at Risk for Alveolar Echinococcosis, France

PubMed Central

Piarroux, Martine; Piarroux, Renaud; Knapp, Jenny; Bardonnet, Karine; Dumortier, Jérôme; Watelet, Jérôme; Gerard, Alain; Beytout, Jean; Abergel, Armand; Bresson-Hadni, Solange

2013-01-01

During 1982–2007, alveolar echinococcosis (AE) was diagnosed in 407 patients in France, a country previously known to register half of all European patients. To better define high-risk groups in France, we conducted a national registry-based study to identify areas where persons were at risk and spatial clusters of cases. We interviewed 180 AE patients about their way of life and compared responses to those of 517 controls. We found that almost all AE patients lived in 22 départements in eastern and central France (relative risk 78.63, 95% CI 52.84–117.02). Classification and regression tree analysis showed that the main risk factor was living in AE-endemic areas. There, most at-risk populations lived in rural settings (odds ratio [OR] 66.67, 95% CI 6.21–464.51 for farmers and OR 6.98, 95% CI 2.88–18.25 for other persons) or gardened in nonrural settings (OR 4.30, 95% CI 1.82–10.91). These findings can help sensitization campaigns focus on specific groups. PMID:23647623

Tailored community cancer education programs: Pawsox and prostates.

PubMed

Glicksman, Arvin S; Meyer, Andrea; Dipiero, Maureen

2010-06-01

To assess the prostate cancer screening practices in Rhode Island, we designed a questionnaire which was sent to 150 primary care physicians. A population-based survey was distributed to 194 men over 40 asking about screening history and risk factors. Eighty-five percent of primary care physicians reported performing annual prostate-specific antigen tests (PSAs) and digital rectal exams, 63% recognized family history as a risk factor, and 14% identified African Americans as a high-risk population. The survey found that 48% of men recognized family history as a risk factor and 6% understood that African Americans were at high risk. Each year, 200 men, primarily SED, are invited to a PawSox baseball game where physicians provide information on prostate cancer risk, treatment options, and outcomes. Free PSAs are provided. The questionnaire and survey demonstrate a need for more public education regarding prostate cancer in high-risk populations. Tailored community-based interventions, such as the Pawsox & Prostate program, can be effective professional and public education strategies to increase screening in high-risk populations.

Prognosis of Parkinson disease: risk of dementia and mortality: the Rotterdam Study.

PubMed

de Lau, Lonneke M L; Schipper, C Maarten A; Hofman, Albert; Koudstaal, Peter J; Breteler, Monique M B

2005-08-01

Most prognostic studies on Parkinson disease have been hospital based or have applied register-based case-finding methods. Potential under-representation of mild cases may have given biased results. To evaluate whether Parkinson disease is associated with an increased risk of dementia and death. Population-based cohort study. Parkinson disease and dementia were assessed through in-person examination at baseline (1990-1993) and 2 follow-up visits (1993-1994 and 1997-1999). Computerized linkage to medical and municipality records provided additional information on disease outcomes and mortality. General population. A total of 6969 participants, including 99 prevalent and 67 incident cases of Parkinson disease. Incident dementia and death. Adjusted hazard ratios were calculated through Cox proportional hazards regression analysis. Patients with Parkinson disease had an increased risk of dementia (hazard ratio, 2.8; 95% confidence interval, 1.8-4.4), which was especially pronounced in participants carrying at least 1 apolipoprotein E gene (APOE) epsilon2 allele (13.5; 4.5-40.6). Parkinson disease was associated with an increased mortality risk (1.8; 1.5-2.3). The association consistently diminished when analyses were sequentially restricted to patients with shorter disease duration and after adjustment for the occurrence of dementia. Especially patients with Parkinson disease who carry an APOE epsilon2 allele have an increased risk of developing dementia. Increased mortality risk in Parkinson disease is dependent on disease duration and is only modest in the absence of dementia.

Towards a Global Water Scarcity Risk Assessment Framework: Incorporation of Probability Distributions and Hydro-Climatic Variability

NASA Technical Reports Server (NTRS)

Veldkamp, T. I. E.; Wada, Y.; Aerts, J. C. J. H.; Ward, P. J.

2016-01-01

Changing hydro-climatic and socioeconomic conditions increasingly put pressure on fresh water resources and are expected to aggravate water scarcity conditions towards the future. Despite numerous calls for risk-based water scarcity assessments, a global-scale framework that includes UNISDR's definition of risk does not yet exist. This study provides a first step towards such a risk based assessment, applying a Gamma distribution to estimate water scarcity conditions at the global scale under historic and future conditions, using multiple climate change and population growth scenarios. Our study highlights that water scarcity risk, expressed in terms of expected annual exposed population, increases given all future scenarios, up to greater than 56.2% of the global population in 2080. Looking at the drivers of risk, we find that population growth outweigh the impacts of climate change at global and regional scales. Using a risk-based method to assess water scarcity, we show the results to be less sensitive than traditional water scarcity assessments to the use of fixed threshold to represent different levels of water scarcity. This becomes especially important when moving from global to local scales, whereby deviations increase up to 50% of estimated risk levels.

Subsidence Induced Faulting Hazard risk maps in Mexico City and Morelia, central Mexico

NASA Astrophysics Data System (ADS)

Cabral-Cano, E.; Solano-Rojas, D.; Hernández-Espriu, J.; Cigna, F.; Wdowinski, S.; Osmanoglu, B.; Falorni, G.; Bohane, A.; Colombo, D.

2012-12-01

Subsidence and surface faulting have affected urban areas in Central Mexico for decades and the process has intensified as a consequence of urban sprawl and economic growth. This process causes substantial damages to the urban infrastructure and housing structures and in several cities it is becoming a major factor to be considered when planning urban development, land use zoning and hazard mitigation strategies in the next decades. Subsidence is usually associated with aggressive groundwater extraction rates and a general decrease of aquifer static level that promotes soil consolidation, deformation and ultimately, surface faulting. However, local stratigraphic and structural conditions also play an important role in the development and extension of faults. Despite its potential for damaging housing, and other urban infrastructure, the economic impact of this phenomena is poorly known, in part because detailed, city-wide subsidence induced faulting risk maps have not been published before. Nevertheless, modern remote sensing techniques are most suitable for this task. We present the results of a risk analysis for subsidence induced surface faulting in two cities in central Mexico: Morelia and Mexico City. Our analysis in Mexico City and Morelia is based on a risk matrix using the horizontal subsidence gradient from a Persistent Scatterer InSAR (Morelia) and SqueeSAR (Mexico City) analysis and 2010 census population distribution data from Mexico's National Institute of Statistics and Geography. Defining subsidence induced surface faulting vulnerability within these urbanized areas is best determined using both magnitude and horizontal subsidence gradient. Our Morelia analysis (597,000 inhabitants with localized subsidence rates up to 80 mm/yr) shows that 7% of the urbanized area is under a high to very high risk level, and 14% of its population (11.7% and 2.3% respectively) lives within these areas. In the case of the Mexico City (15'490,000 inhabitants for the Mexico city Metropolitan area included within our map, and up to 370 mm/yr subsidence rate) our risk map shows that 13.5% of the urbanized area is under a high to very high risk level, and 26.2% of its population (22.1% and 4.4% respectively) lives within these areas.

Evaluation of association between common genetic variants on chromosome 9p21 and coronary artery disease in Turkish population.

PubMed

Çakmak, Hüseyin Altuğ; Bayoğlu, Burcu; Durmaz, Eser; Can, Günay; Karadağ, Bilgehan; Cengiz, Müjgan; Vural, Vural Ali; Yüksel, Hüsniye

2015-03-01

Coronary artery disease (CAD), which develops from complex interactions between genetic and enviromental factors, is a leading cause of death worldwide. Based on genome-wide association studies (GWAS), the chromosomal region 9p21 has been identified as the most relevant locus presenting a strong association with CAD in different populations. The aim of the present study was to investigate the association of two SNPs on chromosome 9p21 on susceptibility to CAD and the effect of these SNPs along with cardiovascular risk factors on the severity of CAD in the Turkish population. This study had an observational case-control design. We genotyped 460 subjects, aged 30-65 years, to investigate the association of 2 SNPs (rs1333049, rs2383207) on chromosome 9p21 and CAD risk in Turkish population. Real-time polymerase chain reaction (RT-PCR) was used to analyze the 2 SNPs in CAD patients and healthy controls. The genotype and allelic variations of these SNPs with the severity of CAD was also assessed using semi-quantitative methods such as the Gensini score. Student's t test and multiple regression analysis were used for statistical analysis. The SNPs rs1333049 and rs2383207 were found to be associated with CAD with an adjusted OR of 1.81 (95% Cl 1.05-3.12) and 2.12 (95% CI 1.19-4.10) respectively. After adjustment of CAD risk factors such as smoking, family history of CAD and diabetes, the homozygous AA genotype for rs2383207 increased the CAD risk with an OR 3.69. Also a very strong association was found between rs1333049 and rs2383207 and Gensini scores representing the severity of CAD (p<0.001). The rs2383207 and rs1333049 SNPs on 9p21 chromosome were significantly associated with the risk and severity of CAD in the Turkish population.

LINE-1 hypomethylation is associated with the risk of coronary heart disease in Chinese population.

PubMed

Wei, Li; Liu, Shuchuan; Su, Zhendong; Cheng, Rongchao; Bai, Xiuping; Li, Xueqi

2014-05-01

Global methylation level in blood leukocyte DNA has been associated with the risk of coronary heart disease (CHD), with inconsistent results in various populations. Similar data are lacking in Chinese population where different genetic, lifestyle and environmental factors may affect DNA methylation and its risk relationship with CHD. To examine whether global methylation is associated with the risk of CHD in Chinese population. A total of 334 cases with CHD and 788 healthy controls were included. Global methylation in blood leukocyte DNA was estimated by analyzing LINE-1 repeats using bisulfite pyrosequencing. In an initial analysis restricted to control subjects, LINE-1 level reduced significantly with aging, elevated total cholesterol, and diagnosis of diabetes. In the case-control analysis, reduced LINE-1 methylation was associated with increased risk of CHD; analysis by quartile revealed odds ratios (95%CI) of 0.9 (0.6-1.4), 1.9 (1.3-2.9) and 2.3 (1.6-3.5) for the third, second and first (lowest) quartile (Ptrend < 0.001), respectively, compared to the fourth (highest) quartile. Lower (

Population-based absolute risk estimation with survey data

PubMed Central

Kovalchik, Stephanie A.; Pfeiffer, Ruth M.

2013-01-01

Absolute risk is the probability that a cause-specific event occurs in a given time interval in the presence of competing events. We present methods to estimate population-based absolute risk from a complex survey cohort that can accommodate multiple exposure-specific competing risks. The hazard function for each event type consists of an individualized relative risk multiplied by a baseline hazard function, which is modeled nonparametrically or parametrically with a piecewise exponential model. An influence method is used to derive a Taylor-linearized variance estimate for the absolute risk estimates. We introduce novel measures of the cause-specific influences that can guide modeling choices for the competing event components of the model. To illustrate our methodology, we build and validate cause-specific absolute risk models for cardiovascular and cancer deaths using data from the National Health and Nutrition Examination Survey. Our applications demonstrate the usefulness of survey-based risk prediction models for predicting health outcomes and quantifying the potential impact of disease prevention programs at the population level. PMID:23686614

Cardiovascular Disease Risk in a Large, Population-Based Cohort of Breast Cancer Survivors

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

Boekel, Naomi B.; Schaapveld, Michael; Gietema, Jourik A.

Purpose: To conduct a large, population-based study on cardiovascular disease (CVD) in breast cancer (BC) survivors treated in 1989 or later. Methods and Materials: A large, population-based cohort comprising 70,230 surgically treated stage I to III BC patients diagnosed before age 75 years between 1989 and 2005 was linked with population-based registries for CVD. Cardiovascular disease risks were compared with the general population, and within the cohort using competing risk analyses. Results: Compared with the general Dutch population, BC patients had a slightly lower CVD mortality risk (standardized mortality ratio 0.92, 95% confidence interval [CI] 0.88-0.97). Only death due to valvular heartmore » disease was more frequent (standardized mortality ratio 1.28, 95% CI 1.08-1.52). Left-sided radiation therapy after mastectomy increased the risk of any cardiovascular event compared with both surgery alone (subdistribution hazard ratio (sHR) 1.23, 95% CI 1.11-1.36) and right-sided radiation therapy (sHR 1.19, 95% CI 1.04-1.36). Radiation-associated risks were found for not only ischemic heart disease, but also for valvular heart disease and congestive heart failure (CHF). Risks were more pronounced in patients aged <50 years at BC diagnosis (sHR 1.48, 95% CI 1.07-2.04 for left- vs right-sided radiation therapy after mastectomy). Left- versus right-sided radiation therapy after wide local excision did not increase the risk of all CVD combined, yet an increased ischemic heart disease risk was found (sHR 1.14, 95% CI 1.01-1.28). Analyses including detailed radiation therapy information showed an increased CVD risk for left-sided chest wall irradiation alone, left-sided breast irradiation alone, and internal mammary chain field irradiation, all compared with right-sided breast irradiation alone. Compared with patients not treated with chemotherapy, chemotherapy used ≥1997 (ie, anthracyline-based chemotherapy) increased the risk of CHF (sHR 1.35, 95% CI 1.00-1.83). Conclusion: Radiation therapy regimens used in BC treatment between 1989 and 2005 increased the risk of CVD, and anthracycline-based chemotherapy regimens increased the risk of CHF.« less

Spatial analysis of environment and population at risk of natural gas fracking in the state of Pennsylvania, USA.

PubMed

Meng, Qingmin

2015-05-15

Hydraulic fracturing, also known as fracking, has been increasing exponentially across the United States, which holds the largest known shale gas reserves in the world. Studies have found that the high-volume horizontal hydraulic fracturing process (HVHFP) threatens water resources, harms air quality, changes landscapes, and damages ecosystems. However, there is minimal research focusing on the spatial study of environmental and human risks of HVHFP, which is necessary for state and federal governments to administer, regulate, and assess fracking. Integrating GIS and spatial kernel functions, we study the presently operating fracking wells across the state of Pennsylvania (PA), which is the main part of the current hottest Marcellus Shale in US. We geographically process the location data of hydraulic fracturing wells, 2010 census block data, urbanized region data, railway data, local road data, open water data, river data, and wetland data for the state of PA. From this we develop a distance based risk assessment in order to understand the environmental and urban risks. We generate the surface data of fracking well intensity and population intensity by integrating spatial dependence, semivariogram modeling, and a quadratic kernel function. The surface data of population risk generated by the division of fracking well intensity and population intensity provide a novel insight into the local and regional regulation of hydraulic fracturing activities in terms of environmental and health related risks due to the proximity of fracking wells. Copyright © 2015 Elsevier B.V. All rights reserved.

Perceived risks and benefits of cigarette smoking among Nepalese adolescents: a population-based cross-sectional study.

PubMed

Aryal, Umesh Raj; Petzold, Max; Krettek, Alexandra

2013-03-02

The perceived risks and benefits of smoking may play an important role in determining adolescents' susceptibility to initiating smoking. Our study examined the perceived risks and benefits of smoking among adolescents who demonstrated susceptibility or non susceptibility to smoking initiation. In October-November 2011, we conducted a population-based cross-sectional study in Jhaukhel and Duwakot Villages in Nepal. Located in the mid-hills of Bhaktapur District, 13 kilometers east of Kathmandu, Jhaukhel and Duwakot represent the prototypical urbanizing villages that surround Nepal's major urban centers, where young people have easy access to tobacco products and are influenced by advertising. Jhaukhel and Duwakot had a total population of 13,669, of which 15% were smokers. Trained enumerators used a semi-structured questionnaire to interview 352 randomly selected 14- to 16-year-old adolescents. The enumerators asked the adolescents to estimate their likelihood (0%-100%) of experiencing various smoking-related risks and benefits in a hypothetical scenario. Principal component analysis extracted four perceived risk and benefit components, excluding addiction risk: (i) physical risk I (lung cancer, heart disease, wrinkles, bad colds); (ii) physical risk II (bad cough, bad breath, trouble breathing); (iii) social risk (getting into trouble, smelling like an ashtray); and (iv) social benefit (looking cool, feeling relaxed, becoming popular, and feeling grown-up). The adjusted odds ratio of susceptibility increased 1.20-fold with each increased quartile in perception of physical Risk I. Susceptibility to smoking was 0.27- and 0.90-fold less among adolescents who provided the highest estimates of physical Risk II and social risk, respectively. Similarly, susceptibility was 2.16-fold greater among adolescents who provided the highest estimates of addiction risk. Physical risk I, addiction risk, and social benefits of cigarette smoking related positively, and physical risk II and social risk related negatively, with susceptibility to smoking. To discourage or prevent adolescents from initiating smoking, future intervention programs should focus on communicating not only the health risks but also the social and addiction risks as well as counteract the social benefits of smoking.

[Suicide risk and suicide attempt in North Pas de Calais Region. Lessons from the survey Mental Health in General Population].

PubMed

Danel, T; Vilain, J; Roelandt, J L; Salleron, J; Vaiva, G; Amariei, A; Amarie, A; Plancke, L; Plance, L; Duhamel, A

2010-01-01

The Santé Mentale en Population Générale Survey (Mental Health in General Population Survey (MHGP)) is a multicentre international research and action project initiated by the World Health Organisation Collaboration Centre for research and training in mental health. Its aims are to assess the prevalence of the major mental health disorders in the general adult population and from this to record perceptions associated with "mental illness", "madness" and "depression" together with different means of assistance and specialist or lay care. In this work we present the analysis of data on risks of suicide and past history of suicide attempts in the Nord pas de Calais region. We present the qualitative features of these phenomena and correlations with socio-economic, cultural and psychopathological factors, which are discussed in terms of both protective and vulnerability factors. Risk of suicide is present in 15% of the Nord pas de Calais population and is divided into 10.44% slight risk, 2.37% moderate risk and 2.2% high risk. A comparison with data from the MHGP survey in other regions reveals the high risk of suicide in the NPDC region. A risk of suicide is present is 13% of the population in other SMPG survey regions, broken down into 9.1% low risk, 2.1% medium risk and 1.7% high risk. Compared to the 2.2% high risk figure for NPDC, the population in this category is 21% larger. In terms of risk and protective factors, a bivariate analysis of socio-economic and cultural factors confirms the classical risk factors of sex, marital, occupational and educational status and income. The odds-ratio for these socio-economic and cultural factors can be calculated from logistic regression and the protective factors ranked in decreasing order from religion (Muslim versus other religions), martial status (marked versus separated), age (over 58 years old), occupational status (working or retired versus unemployed), income (more than 1300 euros versus less than 840 euros), sex (men versus women) and immigration. For mental illness, the bivariate analysis confirms that the risk of suicide is significantly higher regardless of the mental disorder in question. Logistic regression categorises the mental illnesses as risk factors in the following order: depression, psychotic disorders, anxiety, alcohol abuse disorders, other drugs and insomnia. Suicide attempts have been made by 9.7% of the study population. This figure should be compared with the 8% of the study population in other regions in the survey and represents 29% more attempts. For the risk and protective factors the results of the bivariate analysis of socio-economic on cultural and psychopathological factors are superimposeable on those found for risk of suicide. The ranking of protective factors obtained from logistic regression places age in first position followed in decreasing order by religion, martial status, income, employment status and finally sex and immigration. The same ranking of mental illnesses by logistic regression places depression as the greatest risk factor followed by anxiety, psychotic disorders, alcohol abuse disorders, drugs and insomnia. Copyright 2010 L’Encéphale. Published by Elsevier Masson SAS.. All rights reserved.

A population health approach to reducing observational intensity bias in health risk adjustment: cross sectional analysis of insurance claims

PubMed Central

Sharp, Sandra M; Bevan, Gwyn; Skinner, Jonathan S; Gottlieb, Daniel J

2014-01-01

Objective To compare the performance of two new approaches to risk adjustment that are free of the influence of observational intensity with methods that depend on diagnoses listed in administrative databases. Setting Administrative data from the US Medicare program for services provided in 2007 among 306 US hospital referral regions. Design Cross sectional analysis. Participants 20% sample of fee for service Medicare beneficiaries residing in one of 306 hospital referral regions in the United States in 2007 (n=5 153 877). Main outcome measures The effect of health risk adjustment on age, sex, and race adjusted mortality and spending rates among hospital referral regions using four indices: the standard Centers for Medicare and Medicaid Services—Hierarchical Condition Categories (HCC) index used by the US Medicare program (calculated from diagnoses listed in Medicare’s administrative database); a visit corrected HCC index (to reduce the effects of observational intensity on frequency of diagnoses); a poverty index (based on US census); and a population health index (calculated using data on incidence of hip fractures and strokes, and responses from a population based annual survey of health from the Centers for Disease Control and Prevention). Results Estimated variation in age, sex, and race adjusted mortality rates across hospital referral regions was reduced using the indices based on population health, poverty, and visit corrected HCC, but increased using the standard HCC index. Most of the residual variation in age, sex, and race adjusted mortality was explained (in terms of weighted R2) by the population health index: R2=0.65. The other indices explained less: R2=0.20 for the visit corrected HCC index; 0.19 for the poverty index, and 0.02 for the standard HCC index. The residual variation in age, sex, race, and price adjusted spending per capita across the 306 hospital referral regions explained by the indices (in terms of weighted R2) were 0.50 for the standard HCC index, 0.21 for the population health index, 0.12 for the poverty index, and 0.07 for the visit corrected HCC index, implying that only a modest amount of the variation in spending can be explained by factors most closely related to mortality. Further, once the HCC index is visit corrected it accounts for almost none of the residual variation in age, sex, and race adjusted spending. Conclusion Health risk adjustment using either the poverty index or the population health index performed substantially better in terms of explaining actual mortality than the indices that relied on diagnoses from administrative databases; the population health index explained the majority of residual variation in age, sex, and race adjusted mortality. Owing to the influence of observational intensity on diagnoses from administrative databases, the standard HCC index over-adjusts for regional differences in spending. Research to improve health risk adjustment methods should focus on developing measures of risk that do not depend on observation influenced diagnoses recorded in administrative databases. PMID:24721838

A population-based case-control teratologic study of furazidine, a nitrofuran-derivative treatment during pregnancy.

PubMed

Czeizel, A E; Rockenbauer, M; Sørensen, H T; Olsen, J

2000-04-01

To study human teratogenic potential of furazidine treatment during pregnancy. Pair analysis of cases with congenital abnormalities and matched population controls. The Hungarian Case-Control Surveillance of Congenital Abnormalities. 38,151 pregnant women who had newborn infants without any defects (population control group) and 22,865 pregnant women who had newborns or fetuses with congenital abnormalities between 1980 and 1996. In the case group, 157 (0.7%) and in the control group, 254 (0.7%) pregnant women were treated with furazidine. The case-control pair analysis did not indicate a teratogenic potential of furazidine use during the second to third months of gestation, i.e. in the critical period for major congenital abnormalities. Treatment with furazidine during pregnancy did not show teratogenic risk to the fetus.

Risk for myocardial infarction and stroke after community-acquired bacteremia: a 20-year population-based cohort study.

PubMed

Dalager-Pedersen, Michael; Søgaard, Mette; Schønheyder, Henrik Carl; Nielsen, Henrik; Thomsen, Reimar Wernich

2014-04-01

Infections may trigger acute cardiovascular events, but the risk after community-acquired bacteremia is unknown. We assessed the risk for acute myocardial infarction and ischemic stroke within 1 year of community-acquired bacteremia. This population-based cohort study was conducted in Northern Denmark. We included 4389 hospitalized medical patients with positive blood cultures obtained on the day of admission. Patients hospitalized with bacteremia were matched with up to 10 general population controls and up to 5 acutely admitted nonbacteremic controls, matched on age, sex, and calendar time. All incident events of myocardial infarction and stroke during the following 365 days were ascertained from population-based healthcare databases. Multivariable regression analyses were used to assess relative risks with 95% confidence intervals (CIs) for myocardial infarction and stroke among bacteremia patients and their controls. The risk for myocardial infarction or stroke was greatly increased within 30 days of community-acquired bacteremia: 3.6% versus 0.2% among population controls (adjusted relative risk, 20.86; 95% CI, 15.38-28.29) and 1.7% among hospitalized controls (adjusted relative risk, 2.18; 95% CI, 1.80-2.65). The risks for myocardial infarction or stroke remained modestly increased from 31 to 180 days after bacteremia in comparison with population controls (adjusted hazard ratio, 1.64; 95% CI, 1.18-2.27), but not versus hospitalized controls (adjusted hazard ratio, 0.95; 95% CI, 0.69-1.32). No differences in cardiovascular risk were seen after >6 months. Increased 30-day risks were consistently found for a variety of etiologic agents and infectious foci. Community-acquired bacteremia is associated with increased short-term risk of myocardial infarction and stroke.

Poor oral health is associated with an increased risk of esophageal squamous cell carcinoma - a population-based case-control study in China.

PubMed

Chen, Xingdong; Yuan, Ziyu; Lu, Ming; Zhang, Yuechan; Jin, Li; Ye, Weimin

2017-02-01

To further examine the association between oral hygiene and esophageal squamous cell carcinoma (ESCC) risk and the effect modification of other exposures, we conducted a population-based case-control study between 2010 and 2012 in Taixing, China, a high-risk area for ESCC. Cases were primarily recruited from endoscopy units at local hospitals, supplemented by linkage to the local Cancer Registry. Control subjects were frequency matched to cases by sex and age (5-year groups) and were randomly selected from the Taixing Population Registry. For the current analysis, data from 616 histopathologically confirmed cases and 770 controls with complete information on oral hygiene were analyzed. Unconditional logistic regression models, including oral hygiene indicators and potential behavioral confounders, were used to derive odds ratios (ORs) and 95% confidence intervals (CIs). Tooth loss was only marginally significantly associated with ESCC risk (yes vs. no, OR = 1.29, 95% CI 0.94-1.74). However, the excess risk increased with increasing numbers of lost teeth (more than 6 teeth lost vs. none, OR = 1.48, 95% CI 1.04-2.11). Tooth brushing once or less per day, compared with tooth brushing twice or more per day, was associated with a 1.81-fold increased risk of ESCC. In the stratification analyses, the increased risks associated with these indicators of oral health were more pronounced in older subjects (age ≥ 70 years), women, non-smokers, and non-drinkers. Further studies are warranted to verify these findings and to explore the underlying mechanisms, e.g., changed oral microbiota, associated with poor oral hygiene. © 2016 UICC.

Secondary Primary Malignancy Risk in Patients With Ovarian Cancer in Taiwan: A Nationwide Population-Based Study.

PubMed

Hung, Yi-Ping; Liu, Chia-Jen; Hu, Yu-Wen; Chen, Min-Huang; Li, Chun-Pin; Yeh, Chiu-Mei; Chiou, Tzeon-Jye; Chen, Tzeng-Ji; Yang, Muh-Hwa; Chao, Yee

2015-09-01

To evaluate the incidence of secondary primary malignancy (SPM) in patients with ovarian cancer using a nationwide retrospective population-based dataset. Patients newly diagnosed with ovarian cancer between 1997 and 2010 were identified using Taiwan's National Health Insurance database. Patients with antecedent malignancies were excluded. Standardized incidence ratios (SIRs) for SPM were calculated and compared with the cancer incidence in the general population. Risk factors for cancer development were analyzed using Cox proportional hazard models. Effects of surgery, chemotherapy, and radiotherapy after ovarian cancer diagnosis were regarded as time-dependent variables to prevent immortal time bias. During the 14-year study period (follow-up of 56,214 person-years), 707 cancers developed in 12,127 patients with ovarian cancer. The SIR for all cancers was 2.78 (95% confidence interval 2.58-3.00). SIRs for follow-up periods of >5, 1-5, and <1 year were 1.87, 2.04, and 6.40, respectively. After the exclusion of SPM occurring within 1 year of ovarian cancer diagnosis, SIRs were significantly higher for cancers of the colon, rectum, and anus (2.14); lung and mediastinum (1.58); breast (1.68); cervix (1.65); uterus (7.96); bladder (3.17), and thyroid (2.23); as well as for leukemia (3.98) and others (3.83). Multivariate analysis showed that age ≥ 50 years was a significant SPM risk factor (hazard ratio [HR] 1.60). Different treatments for ovarian cancer, including radiotherapy (HR 2.07) and chemotherapy (HR 1.27), had different impacts on SPM risk. Patients with ovarian cancer are at increased risk of SPM development. Age ≥ 50 years, radiotherapy, and chemotherapy are independent risk factors. Close surveillance of patients at high risk should be considered for the early detection of SPM.

Red and processed meat consumption and risk of glioma in adults: A systematic review and meta-analysis of observational studies

PubMed Central

Saneei, Parvane; Willett, Walter; Esmaillzadeh, Ahmad

2015-01-01

Background: These findings from several observational studies, investigated the association between red meat consumption and gliomas, were inconsistent. We conducted a systematic review and meta-analysis of observational studies to summarize available date on the relation between meat intake and risk of glioma. Materials and Methods: A systematic literature search of relevant reports published until May 2014 of the PubMed/Medline, ISI Web of Knowledge, Excerpta Medica database, Ovid database, Google Scholar, and Scopus databases was conducted. From 723 articles yielded in the preliminary literature search, data from eighteen publications (14 case-control, three cohort, and one nested case-control study) on unprocessed red meat, processed meat, and/or total red meat consumption in relation to glioma in adults were included in the analysis. Quality assessment of studies was performed. Random effects model was used to conduct the meta-analysis. Results: We found a positive significant association between unprocessed red meat intake and risk of glioma (relative risk [RR] = 1.30; 95% confidence interval [CI]: 1.08-1.58) after excluding three studies with uncertain type of brain cancer. This analysis included only one cohort study which revealed no relation between unprocessed red meat intake and glioma (RR = 1.75; 95% CI: 0.35-8.77). Consumption of processed meats was not related to increased risk of glioma in population-based case-control studies (RR = 1.26; 95% CI: 1.05-1.51) and reduced risk in hospital-based case-controls (RR = 0.79; 95% CI: 0.65-0.97). No significant association was seen between processed red meat intake and risk of glioma in cohort studies (RR: 1.08; 95% CI: 0.84-1.37). Total red meat consumption was not associated with risk of adult glioma in case-control or cohort studies. Conclusion: In this meta-analysis of 18 observational studies, we found a modest positive association between unprocessed red meat intake and risk of gliomas based almost entirely on case-control studies. Processed red meat was overall not associated with risk of gliomas in case-control or cohort studies. PMID:26600837

A cost-utility analysis of transcatheter versus surgical aortic valve replacement for the treatment of aortic stenosis in the population with intermediate surgical risk.

PubMed

Tam, Derrick Y; Hughes, Avery; Fremes, Stephen E; Youn, Saerom; Hancock-Howard, Rebecca L; Coyte, Peter C; Wijeysundera, Harindra C

2018-05-01

Although transcatheter aortic valve implantation has been shown to be noninferior to surgical aortic valve replacement in patients with severe aortic stenosis at intermediate surgical risk, the cost-effectiveness of this strategy in this population is unknown. Our objective was to conduct a cost-utility analysis comparing transcatheter aortic valve implantation with surgical aortic valve replacement in the population with intermediate risk severe aortic stenosis. A fully probabilistic Markov model with 30-day cycles was constructed from the Canadian third-party payer's perspective to estimate the difference in cost and effectiveness (measured as quality-adjusted life years) of transcatheter aortic valve implantation versus surgical aortic valve replacement for intermediate-risk patients over a lifetime time horizon, discounted at 1.5% per annum. Clinical trial data from The Placement of Aortic Transcatheter Valve 2 informed the efficacy inputs. Costs (adjusted to 2016 Canadian dollars) were obtained from the Canadian Institute of Health Information and the Ontario Schedule of Benefits. Incremental cost-effectiveness ratios were calculated. In the base-case analysis, total lifetime costs for transcatheter aortic valve implantation were $10,548 higher than surgical aortic valve replacement but added 0.23 quality-adjusted life years, for an incremental cost-effectiveness ratio of $46,083/quality-adjusted life-years gained. Deterministic 1-way analyses showed that the incremental cost-effectiveness ratio was sensitive to rates of complications and cost of the transcatheter aortic valve implantation prosthesis. There was moderate-to-high parameter uncertainty; transcatheter aortic valve implantation was the preferred option in only 52.7% and 55.4% of the simulations at a $50,000 and $100,000 per quality-adjusted life years willingness-to-pay thresholds, respectively. On the basis of current evidence, transcatheter aortic valve implantation may be cost-effective for the treatment of severe aortic stenosis in patients with intermediate surgical risk. There remains moderate-to-high uncertainty surrounding the base-case incremental cost-effectiveness ratio. Copyright © 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Association between hepatitis B virus/hepatitis C virus infection and primary hepatocellular carcinoma risk: A meta-analysis based on Chinese population.

PubMed

Li, Libo; Lan, Xiaolin

2016-12-01

To assess the relationship between hepatitis B virus (HBV), hepatitis C virus (HCV), and HBV/HCV double infection and hepatocellular carcinoma risk in Chinese population. The databases of PubMed and CNKI were electronic searched by reviewers according to the searching words of HBV, HCV, and hepatocellular carcinoma. The related case-control studies or cohort studies were included. The association between virus infection and hepatocellular carcinoma risk was demonstrated by odds ratio (OR) and 95% confidence interval (95% CI). The data were pooled by fixed or random effects model according to the statistical heterogeneity. The publication bias was assessed by Begg's funnel plot and Egger's linear regression test. Finally, 13 publications were included in this meta-analysis. For significant statistical heterogeneity (I2 = 99.8%,P = 0.00), the OR was pooled by random effects model. The pooled results showed that HBV infection can significantly increase the risk of developing hepatocellular carcinoma (OR = 58.01, 95% CI: 44.27-71.75); statistical heterogeneity analysis showed that significant heterogeneity existed in evaluation of HCV infection and hepatocellular carcinoma risk across the included 13 studies I2 = 77.78%, P = 0.00). The OR was pooled by random effects model. The pooled results showed that HCV infection can significantly increase the risk of developing hepatocellular carcinoma (OR = 2.34, 95% CI: 1.20-3.47); significant heterogeneity did not exist in evaluation HBV/HCV double infection and hepatocellular carcinoma risk for the included 13 studies (I2 = 0.00%,P = 0.80). The OR was pooled by fixed effects model. The pooled results showed that HBV/HCV double infection can significantly increase the risk of developing hepatocellular carcinoma (OR = 11.39, 95% CI: 4.58-18.20). No publication bias was found in the aspects of HBV, HCV, and HBV/HCV double infection and hepatocellular carcinoma. For Chinese population, HBV, HCV or HBV/HCV double infection can significantly increase the risk of developing hepatocellular carcinoma.

Temporal correlations in population trends: Conservation implications from time-series analysis of diverse animal taxa

Treesearch

David Keith; H. Resit Akcakaya; Stuart H.M. Butchart; Ben Collen; Nicholas K. Dulvy; Elizabeth E. Holmes; Jeffrey A. Hutchings; Doug Keinath; Michael K. Schwartz; Andrew O. Shelton; Robin S. Waples

2015-01-01

Population trends play a large role in species risk assessments and conservation planning, and species are often considered threatened if their recent rate of decline meets certain thresholds, regardless how large the population is. But how reliable an indicator of extinction risk is a single estimate of population trend? Given the integral role this decline-...

A cost-effectiveness analysis evaluating endoscopic surveillance for gastric cancer for populations with low to intermediate risk.

PubMed

Zhou, Hui Jun; Dan, Yock Young; Naidoo, Nasheen; Li, Shu Chuen; Yeoh, Khay Guan

2013-01-01

Gastric cancer (GC) surveillance based on oesophagogastroduodenoscopy (OGD) appears to be a promising strategy for GC prevention. By evaluating the cost-effectiveness of endoscopic surveillance in Singaporean Chinese, this study aimed to inform the implementation of such a program in a population with a low to intermediate GC risk. USING A REFERENCE STRATEGY OF NO OGD INTERVENTION, WE EVALUATED FOUR STRATEGIES: 2-yearly OGD surveillance, annual OGD surveillance, 2-yearly OGD screening and 2-yearly screening plus annual surveillance in Singaporean Chinese aged 50-69 years. From a perspective of the healthcare system, Markov models were built to simulate the life experience of the target population. The models projected discounted lifetime costs ($), quality adjusted life year (QALY), and incremental cost-effectiveness ratio (ICER) indicating the cost-effectiveness of each strategy against a Singapore willingness-to-pay of $46,200/QALY. Deterministic and probabilistic sensitivity analyses were used to identify the influential variables and their associated thresholds, and to quantify the influence of parameter uncertainties respectively. With an ICER of $44,098/QALY, the annual OGD surveillance was the optimal strategy while the 2-yearly surveillance was the most cost-effective strategy (ICER = $25,949/QALY). The screening-based strategies were either extendedly dominated or cost-ineffective. The cost-effectiveness heterogeneity of the four strategies was observed across age-gender subgroups. Eight influential parameters were identified each with their specific thresholds to define the choice of optimal strategy. Accounting for the model uncertainties, the probability that the annual surveillance is the optimal strategy in Singapore was 44.5%. Endoscopic surveillance is potentially cost-effective in the prevention of GC for populations at low to intermediate risk. Regarding program implementation, a detailed analysis of influential factors and their associated thresholds is necessary. Multiple strategies should be considered in order to recommend the right strategy for the right population.

Computer simulation models of pre-diabetes populations: a systematic review protocol

PubMed Central

Khurshid, Waqar; Pagano, Eva; Feenstra, Talitha

2017-01-01

Introduction Diabetes is a major public health problem and prediabetes (intermediate hyperglycaemia) is associated with a high risk of developing diabetes. With evidence supporting the use of preventive interventions for prediabetes populations and the discovery of novel biomarkers stratifying the risk of progression, there is a need to evaluate their cost-effectiveness across jurisdictions. In diabetes and prediabetes, it is relevant to inform cost-effectiveness analysis using decision models due to their ability to forecast long-term health outcomes and costs beyond the time frame of clinical trials. To support good implementation and reimbursement decisions of interventions in these populations, models should be clinically credible, based on best available evidence, reproducible and validated against clinical data. Our aim is to identify recent studies on computer simulation models and model-based economic evaluations of populations of individuals with prediabetes, qualify them and discuss the knowledge gaps, challenges and opportunities that need to be addressed for future evaluations. Methods and analysis A systematic review will be conducted in MEDLINE, Embase, EconLit and National Health Service Economic Evaluation Database. We will extract peer-reviewed studies published between 2000 and 2016 that describe computer simulation models of the natural history of individuals with prediabetes and/or decision models to evaluate the impact of interventions, risk stratification and/or screening on these populations. Two reviewers will independently assess each study for inclusion. Data will be extracted using a predefined pro forma developed using best practice. Study quality will be assessed using a modelling checklist. A narrative synthesis of all studies will be presented, focussing on model structure, quality of models and input data, and validation status. Ethics and dissemination This systematic review is exempt from ethics approval because the work is carried out on published documents. The findings of the review will be disseminated in a related peer-reviewed journal and presented at conferences. Reviewregistration number CRD42016047228. PMID:28982807

Spatial Analysis of Human Health Risk Due to Arsenic Exposure through Drinking Groundwater in Taiwan's Pingtung Plain.

PubMed

Liang, Ching-Ping; Chien, Yi-Chi; Jang, Cheng-Shin; Chen, Ching-Fang; Chen, Jui-Sheng

2017-01-14

Chronic arsenic (As) exposure continues to be a public health problem of major concern worldwide, affecting hundreds of millions of people. A long-term groundwater quality survey has revealed that 20% of the groundwater in southern Taiwan's Pingtung Plain is clearly contaminated with a measured As concentration in excess of the maximum level of 10 µg/L recommended by the World Health Organization. The situation is further complicated by the fact that more than half of the inhabitants in this area continue to use groundwater for drinking. Efforts to assess the health risk associated with the ingestion of As from the contaminated drinking water are required in order to determine the priorities for health risk management. The conventional approach to conducting a human health risk assessment may be insufficient for this purpose, so this study adopts a geostatistical Kriging method to perform a spatial analysis of the health risk associated with ingesting As through drinking groundwater in the Pingtung Plain. The health risk is assessed based on the hazard quotient (HQ) and target cancer risk (TR) established by the U.S. Environmental Protection Agency. The results show that most areas where the HQ exceeds 1 are in the southwestern part of the study area. In addition, the high-population density townships of Daliao, Linyuan, Donggang, Linbian, Jiadong, and Fangliao presently have exceedingly high TR values that are two orders of magnitude higher than the acceptable standard. Thus, the use of groundwater for drinking in these townships should be strictly avoided. A map that delineates areas with high TR values and high population densities is provided. The findings broaden the scope of the spatial analysis of human health risk and provide a basis for improving the decision-making process.

Spatial Analysis of Human Health Risk Due to Arsenic Exposure through Drinking Groundwater in Taiwan’s Pingtung Plain

PubMed Central

Liang, Ching-Ping; Chien, Yi-Chi; Jang, Cheng-Shin; Chen, Ching-Fang; Chen, Jui-Sheng

2017-01-01

Chronic arsenic (As) exposure continues to be a public health problem of major concern worldwide, affecting hundreds of millions of people. A long-term groundwater quality survey has revealed that 20% of the groundwater in southern Taiwan’s Pingtung Plain is clearly contaminated with a measured As concentration in excess of the maximum level of 10 µg/L recommended by the World Health Organization. The situation is further complicated by the fact that more than half of the inhabitants in this area continue to use groundwater for drinking. Efforts to assess the health risk associated with the ingestion of As from the contaminated drinking water are required in order to determine the priorities for health risk management. The conventional approach to conducting a human health risk assessment may be insufficient for this purpose, so this study adopts a geostatistical Kriging method to perform a spatial analysis of the health risk associated with ingesting As through drinking groundwater in the Pingtung Plain. The health risk is assessed based on the hazard quotient (HQ) and target cancer risk (TR) established by the U.S. Environmental Protection Agency. The results show that most areas where the HQ exceeds 1 are in the southwestern part of the study area. In addition, the high-population density townships of Daliao, Linyuan, Donggang, Linbian, Jiadong, and Fangliao presently have exceedingly high TR values that are two orders of magnitude higher than the acceptable standard. Thus, the use of groundwater for drinking in these townships should be strictly avoided. A map that delineates areas with high TR values and high population densities is provided. The findings broaden the scope of the spatial analysis of human health risk and provide a basis for improving the decision-making process. PMID:28098817

Health-Related Lifestyle Factors and Sexual Dysfunction: A Meta-Analysis of Population-Based Research.

PubMed

Allen, Mark S; Walter, Emma E

2018-04-01

Sexual dysfunction is a common problem among men and women and is associated with negative individual functioning, relationship difficulties, and lower quality of life. To determine the magnitude of associations between 6 health-related lifestyle factors (cigarette smoking, alcohol intake, physical activity, diet, caffeine, and cannabis use) and 3 common sexual dysfunctions (erectile dysfunction, premature ejaculation, and female sexual dysfunction). A comprehensive literature search of 10 electronic databases identified 89 studies that met the inclusion criteria (452 effect sizes; N = 348,865). Pooled mean effects (for univariate, age-adjusted, and multivariable-adjusted estimates) were computed using inverse-variance weighted random-effects meta-analysis and moderation by study and population characteristics were tested using random-effects meta-regression. Mean effect sizes from 92 separate meta-analyses provided evidence that health-related lifestyle factors are important for sexual dysfunction. Cigarette smoking (past and current), alcohol intake, and physical activity had dose-dependent associations with erectile dysfunction. Risk of erectile dysfunction increased with greater cigarette smoking and decreased with greater physical activity. Alcohol had a curvilinear association such that moderate intake was associated with a lower risk of erectile dysfunction. Participation in physical activity was associated with a lower risk of female sexual dysfunction. There was some evidence that a healthy diet was related to a lower risk of erectile dysfunction and female sexual dysfunction, and caffeine intake was unrelated to erectile dysfunction. Publication bias appeared minimal and findings were similar for clinical and non-clinical samples. Modification of lifestyle factors would appear to be a useful low-risk approach to decreasing the risk of erectile dysfunction and female sexual dysfunction. Strengths include the testing of age-adjusted and multivariable-adjusted models and tests of potential moderators using meta-regression. Limitations include low statistical power in models testing diet, caffeine, and cannabis use as risk factors. Results provide compelling evidence that cigarette smoking, alcohol, and physical activity are important for sexual dysfunction. Insufficient research was available to draw conclusions regarding risk factors for premature ejaculation or for cannabis use as a risk factor. These findings should be of interest to clinicians treating men and women with complaints relating to symptoms of sexual dysfunction. Allen MS, Walter EE. Health-Related Lifestyle Factors and Sexual Dysfunction: A Meta-Analysis of Population-Based Research. J Sex Med 2018;15:458-475. Copyright © 2018 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

Special Populations At-Risk for Dropping out of School: A Discipline-Based Analysis of STEM Educators

ERIC Educational Resources Information Center

Williams, Thomas O., Jr.; Ernst, Jeremy V.; Kaui, Toni Marie

2015-01-01

This study investigated, from a national perspective, the instructional teaching load of STEM educators specific to students with disabilities and limited English Proficiency (LEP). The most recent School and Staffing Survey results of in-service science, technology, and mathematics teachers were compiled and analyzed to form subject area…

Artistic creativity and risk for schizophrenia, bipolar disorder and unipolar depression: a Swedish population-based case-control study and sib-pair analysis.

PubMed

MacCabe, J H; Sariaslan, A; Almqvist, C; Lichtenstein, P; Larsson, H; Kyaga, S

2018-06-01

Many studies have addressed the question of whether mental disorder is associated with creativity, but high-quality epidemiological evidence has been lacking.AimsTo test for an association between studying a creative subject at high school or university and later mental disorder. In a case-control study using linked population-based registries in Sweden (N = 4 454 763), we tested for associations between tertiary education in an artistic field and hospital admission with schizophrenia (N = 20 333), bipolar disorder (N = 28 293) or unipolar depression (N = 148 365). Compared with the general population, individuals with an artistic education had increased odds of developing schizophrenia (odds ratio = 1.90, 95% CI = [1.69; 2.12]) bipolar disorder (odds ratio = 1.62 [1.50; 1.75]) and unipolar depression (odds ratio = 1.39 [1.34; 1.44]. The results remained after adjustment for IQ and other potential confounders. Students of artistic subjects at university are at increased risk of developing schizophrenia, bipolar disorder and unipolar depression in adulthood.Declaration of interestNone.

Adapting Technological Interventions to Meet the Needs of Priority Populations.

PubMed

Linke, Sarah E; Larsen, Britta A; Marquez, Becky; Mendoza-Vasconez, Andrea; Marcus, Bess H

2016-01-01

Cardiovascular diseases (CVD) comprise the leading cause of mortality worldwide, accounting for 3 in 10 deaths. Individuals with certain risk factors, including tobacco use, obesity, low levels of physical activity, type 2 diabetes mellitus, racial/ethnic minority status and low socioeconomic status, experience higher rates of CVD and are, therefore, considered priority populations. Technological devices such as computers and smartphones are now routinely utilized in research studies aiming to prevent CVD and its risk factors, and they are also rampant in the public and private health sectors. Traditional health behavior interventions targeting these risk factors have been adapted for technology-based approaches. This review provides an overview of technology-based interventions conducted in these priority populations as well as the challenges and gaps to be addressed in future research. Researchers currently possess tremendous opportunities to engage in technology-based implementation and dissemination science to help spread evidence-based programs focusing on CVD risk factors in these and other priority populations. Copyright © 2016 Elsevier Inc. All rights reserved.

Factors Significantly Associated With the Increased Prevalence of Carotid Atherosclerosis in a Northeast Chinese Middle-aged and Elderly Population: A Cross-sectional Study.

PubMed

Pan, Xi-Feng; Lai, Ya-Xin; Gu, Jian-Qiu; Wang, Hao-Yu; Liu, Ai-Hua; Shan, Zhong-Yan

2016-04-01

Carotid atherosclerosis is associated with many serious cardiovascular diseases; hence, it is necessary to identify factors related to its occurrence in order to develop preventive and therapeutic strategies. This study was conducted to identify risk factors associated with carotid atherosclerosis among the population residing in Northeast China.This epidemiological survey was conducted in a representative group of relatively healthy community residents. All participants answered questions about their medical histories and underwent physical examination, blood biochemical analysis, and ultrasonography examinations of their necks and abdomens. The prevalence rates of carotid atherosclerosis under different factors and conditions were then analyzed.The results of this study showed that age, gender, and diabetes significantly affected the prevalence of carotid atherosclerosis in this Northeast Chinese population. In addition, gender-based subgroup analysis revealed additional factors correlated with the prevalence of carotid atherosclerosis in men or women, although their correlations were not significant in the overall population. While high serum TC and LDL-C levels were risk factors for carotid atherosclerosis in men, it showed no clear correlation with the prevalence of carotid atherosclerosis in women. In contrast, the prevalence of carotid atherosclerosis in female participants with high serum TG level, hypertension, obesity and nonalcoholic fatty liver disease were higher than that of the control population, a trend not observed in male participants.Older age, male sex, and diabetes were independently associated with increased risk of carotid atherosclerosis in Northeast China. These findings could lead to improved screening for carotid atherosclerosis for better disease management.

Association between C677T and A1298C polymorphisms of the MTHFR gene and risk of male infertility: a meta-analysis.

PubMed

Yang, Y; Luo, Y Y; Wu, S; Tang, Y D; Rao, X D; Xiong, L; Tan, M; Deng, M Z; Liu, H

2016-04-26

Published studies on the association between the C677T and A1298C polymorphisms of the methylenetetrahydrofolate reductase (MTHFR) gene and male infertility risk are controversial. To obtain a more precise evaluation, we performed a meta-analysis based on published case-control studies. We conducted an electronic search of PubMed, EMBASE, the Cochrane Library, the Web of Science, and the China Knowledge Resource Integrated Database for papers on MTHFR gene C677T and A1298C polymorphisms and male infertility risk. Pooled odds ratios (ORs) with 95% confidence intervals (95%CIs) were used to assess the strength of association in homozygote, heterozygote, dominant, recessive, and additive models. Statistical heterogeneity, test of publication bias, and sensitivity analysis were carried out using the STATA software (Version 13.0). Overall, 21 studies of C677T (4505 cases and 4024 controls) and 13 studies of A1298C (2785 cases and 3094 controls) were included in this meta-analysis. For C677T, the homozygote comparison results were OR = 1.629, 95%CI (1.215- 2.184), and the recessive model results were OR = 1.462 (1.155- 1.850). For A1298C, the homozygote comparison results were OR = 1.289 (1.029-1.616), and the recessive model results were OR = 1.288 (1.034-1.604). In conclusion, the current meta-analysis showed that the MTHFR C677T polymorphism was associated with a significantly increased male infertility risk in the Asian and overall populations, but not in the Caucasian population, and there was a significant association between the A1298C polymorphism and male infertility risk in the Asian, Caucasian, and overall groups.

The Impact of the Built Environment on Children's School Conduct Grades: The Role of Diversity of Use in a Hispanic Neighborhood

PubMed Central

Szapocznik, José; Lombard, Joanna; Martinez, Frank; Mason, Craig A.; Gorman-Smith, Deborah; Plater-Zyberk, Elizabeth; Brown, Scott C.; Spokane, Arnold

2013-01-01

A population-based study examined the relationship between diversity of use of the built environment and teacher reports of children's grades. Diversity of use of the built environment (i.e., proportion of a block that is residential, institutional, commercial and vacant) was assessed for all 403 city blocks in East Little Havana, Miami—a Hispanic neighborhood. Cluster analysis identified three block-types, based on diversity of use: Residential, Mixed-Use, and Commercial. Cross-classified hierarchical linear modeling was used to examine the impact of diversity of use, school, gender, and year-in-school on academic and conduct grades for 2857 public school children who lived in these blocks. Contrary to popular belief, mixed-use blocks were associated with optimal outcomes. Specifically, follow-up analyses found that a youth living on a residential block had a 74% greater odds of being in the lowest 10% of conduct grades (conduct GPA <2.17) than a youth living on a mixed-use block. In fact, an analysis of the population attributable fraction suggests that if the risk associated with residential blocks could be reduced to the level of risk associated with mixed-use blocks, a 38% reduction in Conduct GPAs <2.17 could be achieved in the total population. These findings suggest that public policy targeting the built environment may be a mechanism for community-based interventions to enhance children's classroom conduct, and potentially related sequelae. PMID:16967342

Company observational post-marketing studies: drug risk assessment and drug research in special populations--a study-based analysis.

PubMed

Hasford, J; Lamprecht, T

1998-01-01

Company observational post-marketing studies (COPS) claim to provide essential data about drug risks and effectiveness in special populations not admitted to pre-approval clinical trials. Since COPS are often mainly regarded as a marketing activity, this study-based analysis tries to evaluate the scientific contributions of COPS. Thirty-five COPS were identified by hand-searching through medical journals, writing to pharmaceutical manufacturers and using MEDLINE. Fourteen COPS evaluated cardiovascular drugs, 9 evaluated NSAIDs and 12 evaluated various other indications. Thirty-five COPS listed effectiveness, 31 listed safety and 8 listed patient compliance as principal objectives. Not a single COPS included a control group. Seventeen of 21 evaluable COPS mentioned extensive exclusion criteria similar to those in clinical trials. Median observation time was 8 weeks, too short for chronic diseases and for adverse drug reactions with longer latency periods. One new adverse event was regarded. Global assessments of the outcomes by physicians dominated and were not based on objective clinical findings. None of the studies specified any details concerning the standardisation of observations or quality-control procedures. The current COPS scheme does not contribute significantly to our knowledge of drug safety and the effects in special populations. Despite serious criticism over the past 20 years, the poor quality of COPS compared with dramatic improvements of pre-approval trials - implies a need for detailed guidelines for non-experimental phase IV research, similar to the Good Clinical Practice-Guideline of the European Community.

Age, Gender, and Race-Based Coronary Artery Calcium Score Percentiles in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

PubMed

Pereira, Alexandre C; Gomez, Luz M; Bittencourt, Marcio Sommer; Staniak, Henrique Lane; Sharovsky, Rodolfo; Foppa, Murilo; Blaha, Michael J; Bensenor, Isabela M; Lotufo, Paulo A

2016-06-01

Coronary artery calcium (CAC) has been demonstrated to independently predict the risk of cardiovascular events and all-cause mortality, especially among White populations. Although the population distribution of CAC has been determined for several White populations, the distribution in ethnically admixed groups has not been well established. The CAC distribution, stratified for age, gender and race, is similar to the previously described distribution in the MESA study. The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) is a prospective cohort study designed to investigate subclinical cardiovascular disease in 6 different centers of Brazil. Similar to previous studies, individuals with self-reported coronary or cerebrovascular disease and those treated for diabetes mellitus were excluded from analysis. Percentiles of CAC distribution were estimated with nonparametric techniques. The analysis included 3616 individuals (54% female; mean age, 50 years). As expected, CAC prevalence and burden were steadily higher with increasing age, as well as increased in men and in White individuals. Our results revealed that for a given CAC score, the ELSA-derived CAC percentile would be lower in men compared with the Multi-Ethnic Study of Atherosclerosis (MESA) and would be higher in women compared with MESA. In our sample of the Brazilian population, we observed significant differences in CAC by sex, age, and race. Adjusted for age and sex, low-risk individuals from the Brazilian population present with significantly lower CAC prevalence and burden compared with other low-risk individuals from other worldwide populations. Using US-derived percentiles in Brazilian individuals may lead to overestimating relative CAC burden in men and underestimating relative CAC burden in women. © 2016 Wiley Periodicals, Inc.

Association between F508 deletion in CFTR and chronic pancreatitis risk.

PubMed

Zhao, Dong; Xu, Yanzhen; Li, Jiatong; Fu, Shien; Xiao, Feifan; Song, Xiaowei; Xie, Zhibin; Jiang, Min; He, Yan; Liu, Chengwu; Wen, Qiongxian; Yang, Xiaoli

2017-09-01

The cystic fibrosis transmembrane conductance regulator (CFTR) has been reported to influence individual susceptibility to chronic pancreatitis (CP), but the results of previous studies are controversial. We performed a study to demonstrate the relationship between CFTR and CP. We searched PubMed, Scopus, and Embase for studies of patients with CP. Seven studies from 1995 to 2016 were identified, and included 64,832 patients. Pooled prevalence and 95% confidence intervals (CIs) were calculated. F508 deletion in CFTR was significantly positively associated with CP risk in the overall analysis (odds ratio [OR]=3.20, 95% CI: 2.30-4.44, I 2 =31.7%). In subgroup analysis stratified by ethnicity, F508 deletion was significantly associated with CP risk in Indian populations, using a fixed effects model (ORs=5.45, 95% CI: 2.52-11.79, I 2 =0.0%), and in non-Indian populations, using a random effects model (ORs=3.59, 95% CI: 1.73-7.48, I 2 =60.9%). At the same time, we found that Indians with F508 deletion had much higher CP prevalence than non-Indians. Interestingly, F508 deletion was also associated with CP and idiopathic CP risk in subgroup analysis stratified by aeitiology, using the fixed effects model. Based on current evidence, F508 deletion is a risk factor for CP, and Indians with F508 deletion have much higher CP morbidity. Copyright © 2017 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

A meta-analysis of 87,040 individuals identifies 23 new susceptibility loci for prostate cancer.

PubMed

Al Olama, Ali Amin; Kote-Jarai, Zsofia; Berndt, Sonja I; Conti, David V; Schumacher, Fredrick; Han, Ying; Benlloch, Sara; Hazelett, Dennis J; Wang, Zhaoming; Saunders, Ed; Leongamornlert, Daniel; Lindstrom, Sara; Jugurnauth-Little, Sara; Dadaev, Tokhir; Tymrakiewicz, Malgorzata; Stram, Daniel O; Rand, Kristin; Wan, Peggy; Stram, Alex; Sheng, Xin; Pooler, Loreall C; Park, Karen; Xia, Lucy; Tyrer, Jonathan; Kolonel, Laurence N; Le Marchand, Loic; Hoover, Robert N; Machiela, Mitchell J; Yeager, Merideth; Burdette, Laurie; Chung, Charles C; Hutchinson, Amy; Yu, Kai; Goh, Chee; Ahmed, Mahbubl; Govindasami, Koveela; Guy, Michelle; Tammela, Teuvo L J; Auvinen, Anssi; Wahlfors, Tiina; Schleutker, Johanna; Visakorpi, Tapio; Leinonen, Katri A; Xu, Jianfeng; Aly, Markus; Donovan, Jenny; Travis, Ruth C; Key, Tim J; Siddiq, Afshan; Canzian, Federico; Khaw, Kay-Tee; Takahashi, Atsushi; Kubo, Michiaki; Pharoah, Paul; Pashayan, Nora; Weischer, Maren; Nordestgaard, Borge G; Nielsen, Sune F; Klarskov, Peter; Røder, Martin Andreas; Iversen, Peter; Thibodeau, Stephen N; McDonnell, Shannon K; Schaid, Daniel J; Stanford, Janet L; Kolb, Suzanne; Holt, Sarah; Knudsen, Beatrice; Coll, Antonio Hurtado; Gapstur, Susan M; Diver, W Ryan; Stevens, Victoria L; Maier, Christiane; Luedeke, Manuel; Herkommer, Kathleen; Rinckleb, Antje E; Strom, Sara S; Pettaway, Curtis; Yeboah, Edward D; Tettey, Yao; Biritwum, Richard B; Adjei, Andrew A; Tay, Evelyn; Truelove, Ann; Niwa, Shelley; Chokkalingam, Anand P; Cannon-Albright, Lisa; Cybulski, Cezary; Wokołorczyk, Dominika; Kluźniak, Wojciech; Park, Jong; Sellers, Thomas; Lin, Hui-Yi; Isaacs, William B; Partin, Alan W; Brenner, Hermann; Dieffenbach, Aida Karina; Stegmaier, Christa; Chen, Constance; Giovannucci, Edward L; Ma, Jing; Stampfer, Meir; Penney, Kathryn L; Mucci, Lorelei; John, Esther M; Ingles, Sue A; Kittles, Rick A; Murphy, Adam B; Pandha, Hardev; Michael, Agnieszka; Kierzek, Andrzej M; Blot, William; Signorello, Lisa B; Zheng, Wei; Albanes, Demetrius; Virtamo, Jarmo; Weinstein, Stephanie; Nemesure, Barbara; Carpten, John; Leske, Cristina; Wu, Suh-Yuh; Hennis, Anselm; Kibel, Adam S; Rybicki, Benjamin A; Neslund-Dudas, Christine; Hsing, Ann W; Chu, Lisa; Goodman, Phyllis J; Klein, Eric A; Zheng, S Lilly; Batra, Jyotsna; Clements, Judith; Spurdle, Amanda; Teixeira, Manuel R; Paulo, Paula; Maia, Sofia; Slavov, Chavdar; Kaneva, Radka; Mitev, Vanio; Witte, John S; Casey, Graham; Gillanders, Elizabeth M; Seminara, Daniella; Riboli, Elio; Hamdy, Freddie C; Coetzee, Gerhard A; Li, Qiyuan; Freedman, Matthew L; Hunter, David J; Muir, Kenneth; Gronberg, Henrik; Neal, David E; Southey, Melissa; Giles, Graham G; Severi, Gianluca; Cook, Michael B; Nakagawa, Hidewaki; Wiklund, Fredrik; Kraft, Peter; Chanock, Stephen J; Henderson, Brian E; Easton, Douglas F; Eeles, Rosalind A; Haiman, Christopher A

2014-10-01

Genome-wide association studies (GWAS) have identified 76 variants associated with prostate cancer risk predominantly in populations of European ancestry. To identify additional susceptibility loci for this common cancer, we conducted a meta-analysis of > 10 million SNPs in 43,303 prostate cancer cases and 43,737 controls from studies in populations of European, African, Japanese and Latino ancestry. Twenty-three new susceptibility loci were identified at association P < 5 × 10(-8); 15 variants were identified among men of European ancestry, 7 were identified in multi-ancestry analyses and 1 was associated with early-onset prostate cancer. These 23 variants, in combination with known prostate cancer risk variants, explain 33% of the familial risk for this disease in European-ancestry populations. These findings provide new regions for investigation into the pathogenesis of prostate cancer and demonstrate the usefulness of combining ancestrally diverse populations to discover risk loci for disease.

Statin Eligibility in Primary Prevention: From a Risk-Based Strategy to a Personalized Approach Based on the Predicted Benefit.

PubMed

Cesena, Fernando H Y; Laurinavicius, Antonio G; Valente, Viviane A; Conceição, Raquel D; Nasir, Khurram; Santos, Raul D; Bittencourt, Marcio S

2018-06-01

Guidelines have recommended statin initiation based on the absolute cardiovascular risk. We tested the hypothesis that a strategy based on the predicted cardiovascular benefit, compared with the risk-based approach, modifies statin eligibility and the estimated benefit in a population in primary cardiovascular prevention. The study included 16,008 subjects (48 ± 6 years, 73% men) with low-density lipoprotein cholesterol levels of 70 to <190 mg/dl, not on lipid-lowering drugs, who underwent a routine health screening in a single center. For the risk-based strategy, criterion for statin eligibility was defined as a 10-year atherosclerotic cardiovascular disease (ASCVD) risk of ≥7.5%. In the benefit-based strategy, subjects were considered for statin according to the predicted absolute cardiovascular risk reduction, so that the number of statin candidates would be the same as in the risk-based strategy. The benefit-based strategy would replace 11% of statin candidates allocated in the risk-based approach with younger, lower risk subjects with higher low-density lipoprotein cholesterol. Using the benefit-based strategy, 13% of subjects with 5.0% to < 7.5% ASCVD risk would shift from a statin-ineligible to a statin-eligible status, whereas 24% of those with 7.5% to <10.0% ASCVD risk would become statin ineligible. These effects would transfer the benefit from higher to lower risk subjects. In the entire population, no clinically meaningful change in the benefit would be expected. In conclusion, switching from a risk-based strategy to a benefit-based approach, while keeping the same rate of statin use in the population, is expected to promote substantial changes in statin eligibility in subjects at intermediate cardiovascular risk, modifying the subpopulation to be benefited by the treatment. Copyright © 2018 Elsevier Inc. All rights reserved.

Pyogenic Liver Abscess as Endemic Disease, Taiwan

PubMed Central

Tsai, Feng-Chiao; Huang, Yu-Tsung; Chang, Luan-Yin

2008-01-01

Pyogenic liver abscess has become a health problem in Taiwanese society. However, the extent of this problem has remained unclear because of the lack of a population-based study. We therefore performed a nationwide analysis of pyogenic liver abscess in Taiwan from 1996 through 2004. We analyzed 29,703 cases from the Taiwan National Health Insurance database and 506 cases from National Taiwan University Hospital. Our analysis showed that the annual incidence of pyogenic liver abscess increased steadily from 11.15/100,000 population in 1996 to 17.59/100,000 in 2004. Diabetes, malignancy, renal disease, and pneumonia were associated with a higher risk for the disease. By contrast, death due to pyogenic liver abscess decreased over time, although population-based abscess-related death increased slightly. Renal disease, malignancy, pneumonia, and heart disease correlated with higher death rates; Klebsiella pneumoniae infection and therapeutic procedures were related to lower death rates. Diabetes did not significantly change death rates for the 506 patients from the hospital. PMID:18826824

Industrial Accidents Triggered by Natural Hazards: an Emerging Risk Issue

NASA Astrophysics Data System (ADS)

Renni, Elisabetta; Krausmann, Elisabeth; Basco, Anna; Salzano, Ernesto; Cozzani, Valerio

2010-05-01

Natural disasters such as earthquakes, tsunamis, flooding or hurricanes have recently and dramatically hit several countries worldwide. Both direct and indirect consequences involved the population, causing on the one hand a high number of fatalities and on the other hand so relevant economical losses that the national gross product may be affected for many years. Loss of critical industrial infrastructures (electricity generation and distribution, gas pipelines, oil refineries, etc.) also occurred, causing further indirect damage to the population. In several cases, accident scenarios with large releases of hazardous materials were triggered by these natural events, causing so-called "Natech events", in which the overall damage resulted from the simultaneous consequences of the natural event and of the release of hazardous substances. Toxic releases, large fires and explosions, as well as possible long-term environmental pollution, economical losses, and overloading of emergency systems were recognised by post-event studies as the main issues of these Natech scenarios. In recent years the increasing frequency and severity of some natural hazards due to climate change has slowly increased the awareness of Natech risk as an emerging risk among the stakeholders. Indeed, the iNTeg-Risk project, co-funded by the European Commission within the 7th Framework Program specifically addresses these scenarios among new technological issues on public safety. The present study, in part carried out within the iNTeg-Risk project, was aimed at the analysis and further development of methods and tools for the assessment and mitigation of Natech accidents. Available tools and knowledge gaps in the assessment of Natech scenarios were highlighted. The analysis mainly addressed the potential impact of flood, lightning and earthquake events on industrial installations where hazardous substances are present. Preliminary screening methodologies and more detailed methods based on quantitative risk analysis were developed. Strategies based on the use of multiple information layers aiming at the identification of mitigation and early warning systems were also explored. A case-study in the Emilia-Romagna region is presented.

Racial and Ethnic Disparities in Nonalcoholic Fatty Liver Disease Prevalence, Severity, and Outcomes in the United States: A Systematic Review and Meta-analysis.

PubMed

Rich, Nicole E; Oji, Stefany; Mufti, Arjmand R; Browning, Jeffrey D; Parikh, Neehar D; Odewole, Mobolaji; Mayo, Helen; Singal, Amit G

2018-02-01

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the United States, affecting 75-100 million Americans. However, the disease burden may not be equally distributed among races or ethnicities. We conducted a systematic review and meta-analysis to characterize racial and ethnic disparities in NAFLD prevalence, severity, and prognosis. We searched MEDLINE, EMBASE, and Cochrane databases through August 2016 for studies that reported NAFLD prevalence in population-based or high-risk cohorts, NAFLD severity including presence of nonalcoholic steatohepatitis (NASH) and significant fibrosis, and NAFLD prognosis including development of cirrhosis complications and mortality. Pooled relative risks, according to race and ethnicity, were calculated for each outcome using the DerSimonian and Laird method for a random-effects model. We identified 34 studies comprising 368,569 unique patients that characterized disparities in NAFLD prevalence, severity, or prognosis. NAFLD prevalence was highest in Hispanics, intermediate in Whites, and lowest in Blacks, although differences between groups were smaller in high-risk cohorts (range 47.6%-55.5%) than population-based cohorts (range, 13.0%-22.9%). Among patients with NAFLD, risk of NASH was higher in Hispanics (relative risk, 1.09; 95% CI, 0.98-1.21) and lower in Blacks (relative risk, 0.72; 95% CI, 0.60-0.87) than Whites. However, the proportion of patients with significant fibrosis did not significantly differ among racial or ethnic groups. Data were limited and discordant on racial or ethnic disparities in outcomes of patients with NAFLD. In a systematic review and meta-analysis, we found significant racial and ethnic disparities in NAFLD prevalence and severity in the United States, with the highest burden in Hispanics and lowest burden in Blacks. However, data are discordant on racial or ethnic differences in outcomes of patients with NAFLD. Copyright © 2018 AGA Institute. Published by Elsevier Inc. All rights reserved.

Risk factor studies of age-at-onset in a sample ascertained for Parkinson disease affected sibling pairs: a cautionary tale

PubMed Central

Wilk, Jemma B; Lash, Timothy L

2007-01-01

An association between exposure to a risk factor and age-at-onset of disease may reflect an effect on the rate of disease occurrence or an acceleration of the disease process. The difference in age-at-onset arising from case-only studies, however, may also reflect secular trends in the prevalence of exposure to the risk factor. Comparisons of age-at-onset associated with risk factors are commonly performed in case series enrolled for genetic linkage analysis of late onset diseases. We describe how the results of age-at-onset studies of environmental risk factors reflect the underlying structure of the source population, rather than an association with age-at-onset, by contrasting the effects of coffee drinking and cigarette smoking on Parkinson disease age-at-onset with the effects on age-at-enrollment in a population based study sample. Despite earlier evidence to suggest a protective association of coffee drinking and cigarette smoking with Parkinson disease risk, the age-at-onset results are comparable to the patterns observed in the population sample, and thus a causal inference from the age-at-onset effect may not be justified. Protective effects of multivitamin use on PD age-at-onset are also shown to be subject to a bias from the relationship between age and multivitamin initiation. Case-only studies of age-at-onset must be performed with an appreciation for the association between risk factors and age and ageing in the source population. PMID:17408493

Child abuse and the prevalence of suicide attempts among those reporting suicide ideation.

PubMed

Martin, Michael S; Dykxhoorn, Jennifer; Afifi, Tracie O; Colman, Ian

2016-11-01

Victims of child abuse may be at increased risk of acting on suicide ideation, although this has not been empirically tested. We estimated the risk of suicide attempts associated with child abuse among individuals who reported suicide ideation. Secondary analysis of data from the population-based Canadian Community Health Survey Mental Health (n = 828). This population-based survey included various structured questionnaires, including the Composite International Diagnostic Interview to assess mental illness and suicidal thoughts and behaviours. Approximately 80 % of those who attempted suicide had a history of child abuse. Poor mental health, financial difficulties, poor coping skills, and reporting a suicide plan were also associated with an increased prevalence of attempting suicide; adjusted for these factors, child abuse was associated with a 1.77-fold increased prevalence (95 % CI 0.93, 3.36) of suicide attempts. Most individuals who attempt suicide experience child abuse, and worse health and social functioning. Adopting a life-course perspective to understand trajectories of suicide risk factors may inform prevention and treatment.

Osteoporosis in adult patients with atopic dermatitis: A nationwide population-based study

PubMed Central

Lu, Chun-Ching; Su, Yu-Feng; Tsai, Tai-Hsin; Wu, Chieh-Hsin

2017-01-01

The aim of this study was to investigate osteoporosis risk in atopic dermatitis (AD) patients. This study included patients in the Taiwan National Health Insurance Research dataset. The population-based study included all patients aged 20–49 years who had been diagnosed with AD during 1996–2010. In total, 35,229 age and gender-matched patients without AD in a 1:1 ratio were randomly selected as the non-AD group. Cox proportional-hazards regression and Kaplan–Meier analyses were used to measure the hazard ratios and the cumulative incidences of osteoporosis, respectively. During the follow-up period, 360(1.02%) AD patients and 127(0.36%) non-AD patients developed osteoporosis. The overall incidence of osteoporosis was4.72-fold greater in the AD patients compared to the non-AD patients (1.82 vs. 0.24 per 1,000 person-years, respectively) after adjusting for potential confounding factors. Osteoporosis risk factors included female gender, age, advanced Charlson Comorbidity Index, depression and use of corticosteroids. The dataset analysis showed that AD was significantly associated with subsequent risk of osteoporosis. PMID:28207767

Prenatal antidepressant use and risk of attention-deficit/hyperactivity disorder in offspring: population based cohort study

PubMed Central

Man, Kenneth K C; Chan, Esther W; Ip, Patrick; Coghill, David; Simonoff, Emily; Chan, Phyllis K L; Lau, Wallis C Y; Schuemie, Martijn J; Sturkenboom, Miriam C J M

2017-01-01

Objective To assess the potential association between prenatal use of antidepressants and the risk of attention-deficit/hyperactivity disorder (ADHD) in offspring. Design Population based cohort study. Setting Data from the Hong Kong population based electronic medical records on the Clinical Data Analysis and Reporting System. Participants 190 618 children born in Hong Kong public hospitals between January 2001 and December 2009 and followed-up to December 2015. Main outcome measure Hazard ratio of maternal antidepressant use during pregnancy and ADHD in children aged 6 to 14 years, with an average follow-up time of 9.3 years (range 7.4-11.0 years). Results Among 190 618 children, 1252 had a mother who used prenatal antidepressants. 5659 children (3.0%) were given a diagnosis of ADHD or received treatment for ADHD. The crude hazard ratio of maternal antidepressant use during pregnancy was 2.26 (P<0.01) compared with non-use. After adjustment for potential confounding factors, including maternal psychiatric disorders and use of other psychiatric drugs, the adjusted hazard ratio was reduced to 1.39 (95% confidence interval 1.07 to 1.82, P=0.01). Likewise, similar results were observed when comparing children of mothers who had used antidepressants before pregnancy with those who were never users (1.76, 1.36 to 2.30, P<0.01). The risk of ADHD in the children of mothers with psychiatric disorders was higher compared with the children of mothers without psychiatric disorders even if the mothers had never used antidepressants (1.84, 1.54 to 2.18, P<0.01). All sensitivity analyses yielded similar results. Sibling matched analysis identified no significant difference in risk of ADHD in siblings exposed to antidepressants during gestation and those not exposed during gestation (0.54, 0.17 to 1.74, P=0.30). Conclusions The findings suggest that the association between prenatal use of antidepressants and risk of ADHD in offspring can be partially explained by confounding by indication of antidepressants. If there is a causal association, the size of the effect is probably smaller than that reported previously. PMID:28566274

Blood pressure, serum cholesterol and nutritional state in Tanzania and in the Amazon: comparison with an Italian population.

PubMed

Pavan, L; Casiglia, E; Pauletto, P; Batista, S L; Ginocchio, G; Kwankam, M M; Biasin, R; Mazza, A; Puato, M; Russo, E; Pessina, A C

1997-10-01

To confirm that westernization of dietary habits represents a stimulus for the expression of cardiovascular risk. Three representative age- and sex-matched samples of general populations of three continents were compared cross-sectionally by analysis of variance. In total 1110 subjects aged 22-89 years, divided into three groups (370 from Tanzania and Uganda, 370 from the Amazonian region of Brazil, and 370 from northern Italy; 111 men and 259 women in each group). The blood pressure of Africans eating a low-salt fish and vegetable' diet was lower than those of Brazilians, whose diet was based on cereals and meat, and highly urbanized Italians. The systolic blood pressure was correlated to the body mass index for all three populations, but with age only for the Brazilians and Italians. The total cholesterol level and body mass index, both of which are low among Africans, increased progressively with increasing economic level. Transition from a rural to an urbanized lifestyle is accompanied by a rise in the main cardiovascular risk factors; the present data also show that environmental rather than racial factors have a crucial impact on the risk pattern of populations.

Risk of Psoriasis Following Terbinafine or Itraconazole Treatment for Onychomycosis: A Population-Based Case-Control Comparative Study.

PubMed

Chiu, Hsien-Yi; Chang, Wei-Lun; Tsai, Tsen-Fang; Tsai, Yi-Wen; Shiu, Ming-Neng

2018-03-01

Several case studies have reported an association between antifungal drug use and psoriasis risk. The objective of this study was to investigate the association between terbinafine/itraconazole exposure and psoriasis incidence. Among patients with onychomycosis in the Taiwan National Health Insurance Research Database, 3831 incident psoriasis cases were identified during 2004-2010 and compared with 3831 age- and sex-matched controls with the same look-back period. Multivariate conditional logistic regression was used for the analysis. The psoriasis cases were significantly more likely than matched controls to have used terbinafine or itraconazole (59.85 vs. 42.70%, respectively; p < 0.0001). After adjusting for potential confounders and cumulative duration of antifungal drug prescription, terbinafine/itraconazole use was associated with an increased psoriasis risk (adjusted odds ratio 1.33, 95% confidence interval 1.15-1.54). The association was stronger for more recent drug exposure (adjusted odds ratio 2.96, 95% confidence interval 2.25-3.90 for ≤ 90 days before the sampling date; adjusted odds ratio 1.04, 95% confidence interval 0.89-1.22 for > 360 days). In a comparison of patients receiving terbinafine or itraconazole only, psoriasis risk was higher for itraconazole (adjusted odds ratio 1.21, 95% confidence interval 1.05-1.40). This large population-based case-control analysis showed that exposure to terbinafine or itraconazole is associated with an increased risk of incident psoriasis. The finding of an increased psoriasis risk for antifungal drug users, particularly for itraconazole, deserves attention in clinical practice although further prospective studies are necessary to confirm our findings and clarify the biological mechanisms that underlie these associations.

Multidimensional analysis of the effect of occupational exposure to organic solvents on lung cancer risk: the ICARE study

PubMed Central

Mattei, Francesca; Liverani, Silvia; Guida, Florence; Matrat, Mireille; Cenée, Sylvie; Azizi, Lamiae; Menvielle, Gwenn; Sanchez, Marie; Pilorget, Corinne; Lapôtre-Ledoux, Bénédicte; Luce, Danièle; Richardson, Sylvia; Stücker, Isabelle

2016-01-01

Background The association between lung cancer and occupational exposure to organic solvents is discussed. Since different solvents are often used simultaneously, it is difficult to assess the role of individual substances. Objectives The present study is focused on an in-depth investigation of the potential association between lung cancer risk and occupational exposure to a large group of organic solvents, taking into account the well-known risk factors for lung cancer, tobacco smoking and occupational exposure to asbestos. Methods We analysed data from the Investigation of occupational and environmental causes of respiratory cancers (ICARE) study, a large French population-based case–control study, set up between 2001 and 2007. A total of 2276 male cases and 2780 male controls were interviewed, and long-life occupational history was collected. In order to overcome the analytical difficulties created by multiple correlated exposures, we carried out a novel type of analysis based on Bayesian profile regression. Results After analysis with conventional logistic regression methods, none of the 11 solvents examined were associated with lung cancer risk. Through a profile regression approach, we did not observe any significant association between solvent exposure and lung cancer. However, we identified clusters at high risk that are related to occupations known to be at risk of developing lung cancer, such as painters. Conclusions Organic solvents do not appear to be substantial contributors to the occupational risk of lung cancer for the occupations known to be at risk. PMID:26911986

Exploring cardiovascular health: the Healthy Life in Suriname (HELISUR) study. A protocol of a cross-sectional study.

PubMed

Diemer, Frederieke S; Aartman, Jet Q; Karamat, Fares A; Baldew, Sergio M; Jarbandhan, Ameerani V; van Montfrans, Gert A; Oehlers, Glenn P; Brewster, Lizzy M

2014-12-23

Obesity, hypertension and diabetes are on a dramatic rise in low-income and middle-income countries, and this foretells an overwhelming increase in chronic disease burden from cardiovascular disease. Therefore, rapid action should be taken through preventive population-based programmes. However, in these regions, data on the population distribution of cardiovascular risk factors, and of intermediate and final end points for cardiovascular disease are scarce. The Healthy Life in Suriname (HELISUR) study is a cardiovascular population study in Suriname, which is part of the Caribbean Community. The HELISUR study is dedicated to provide data on risk factors and prevalent cardiovascular disease in the multiethnic population, which is mainly of African and Asian descent. In a cross-sectional, observational population-based setting, a random representative sample of 1800 citizens aged between 18 and 70 years will be selected using a cluster household sampling method. Self-reported demographic, socioeconomic and (cardiovascular) health-related data will be collected. Physical examination will include the assessment of cardiovascular risk factors and prevalent cardiovascular disease. In addition, we will study cardiovascular haemodynamics non-invasively, as a novel intermediate outcome. Finally, fasting blood and overnight urine samples will be collected to monitor cardiometabolic risk factors. The main outcome will be descriptive in reporting the prevalence of risk factors and measures of (sub) clinical end organ damage, stratified for ethnicity and sex-age groups. Ethical approval has been obtained from the State Secretary of Health. Data analysis and manuscript submission are scheduled for 2016. Findings will be disseminated in peer-reviewed journals, and at national, regional and international scientific meetings. Importantly, data will be presented to Surinamese policymakers and healthcare workers, to develop preventive strategies to combat the rapid rise of cardiovascular disease. 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.

The 10-year Absolute Risk of Cardiovascular (CV) Events in Northern Iran: a Population Based Study

PubMed Central

Motamed, Nima; Mardanshahi, Alireza; Saravi, Benyamin Mohseni; Siamian, Hasan; Maadi, Mansooreh; Zamani, Farhad

2015-01-01

Background: The present study was conducted to estimate 10-year cardiovascular disease events (CVD) risk using three instruments in northern Iran. Material and methods: Baseline data of 3201 participants 40-79 of a population based cohort which was conducted in Northern Iran were analyzed. Framingham risk score (FRS), World Health Organization (WHO) risk prediction charts and American college of cardiovascular / American heart association (ACC/AHA) tool were applied to assess 10-year CVD events risk. The agreement values between the risk assessment instruments were determined using the kappa statistics. Results: Our study estimated 53.5%of male population aged 40-79 had a 10 –year risk of CVD events≥10% based on ACC/AHA approach, 48.9% based on FRS and 11.8% based on WHO risk charts. A 10 –year risk≥10% was estimated among 20.1% of women using the ACC/AHA approach, 11.9%using FRS and 5.7%using WHO tool. ACC/AHA and Framingham tools had closest agreement in the estimation of 10-year risk≥10% (κ=0.7757) in meanwhile ACC/AHA and WHO approaches displayed highest agreement (κ=0.6123) in women. Conclusion: Different estimations of 10-year risk of CVD event were provided by ACC/AHA, FRS and WHO approaches. PMID:26236160

Global assessment of human losses due to earthquakes

USGS Publications Warehouse

Silva, Vitor; Jaiswal, Kishor; Weatherill, Graeme; Crowley, Helen

2014-01-01

Current studies have demonstrated a sharp increase in human losses due to earthquakes. These alarming levels of casualties suggest the need for large-scale investment in seismic risk mitigation, which, in turn, requires an adequate understanding of the extent of the losses, and location of the most affected regions. Recent developments in global and uniform datasets such as instrumental and historical earthquake catalogues, population spatial distribution and country-based vulnerability functions, have opened an unprecedented possibility for a reliable assessment of earthquake consequences at a global scale. In this study, a uniform probabilistic seismic hazard assessment (PSHA) model was employed to derive a set of global seismic hazard curves, using the open-source software OpenQuake for seismic hazard and risk analysis. These results were combined with a collection of empirical fatality vulnerability functions and a population dataset to calculate average annual human losses at the country level. The results from this study highlight the regions/countries in the world with a higher seismic risk, and thus where risk reduction measures should be prioritized.

Association between nasopharyngeal carcinoma and risk of optic neuropathy: A population-based cohort study.

PubMed

Fan, Chao-Yueh; Jen, Yee-Min; Su, Yuan-Chih; Chao, Hsing-Lung; Lin, Chun-Shu; Huang, Wen-Yen; Lin, Miao-Jung; Kao, Chia-Hung

2018-04-16

The purpose of this study was to assess the predictive factors of optic neuropathy among patients with nasopharyngeal carcinoma (NPC). The analysis included 16 297 patients with NPC and 65 187 controls. Each patient with NPC was randomly frequency-matched with 4 individuals without NPC by age, sex, and index year. Cox proportional hazard models were applied to measure the hazard ratios (HRs) and 95% confidence intervals (CIs) of optic neuropathy development associated with NPC. The risk of optic neuropathy was significantly higher in the NPC cohort (adjusted HR [aHR] 3.42; 95% CI 2.85-4.09; P < .001). Independent risk factors for optic neuropathy among patients with NPC included stroke (aHR 1.7; 95% CI 1.07-2.7; P = .03) and receipt of chemotherapy (aHR 1.55; 95% CI 1.17-2.06; P = .002). The risk of optic neuropathy was significantly higher in patients with NPC than in the general population. © 2018 Wiley Periodicals, Inc.

Predictors of sickness absence in college and university educated self-employed: a historic register study

PubMed Central

2014-01-01

Background Despite a large proportion of the workforce being self-employed, few studies have been conducted on risk factors for sickness absence in this population. The aim of this study is to identify risk factors for future sickness absence in a population of college and university educated self-employed. Methods In a historic register study based on insurance company files risk factors were identified by means of logistic regression analysis. Data collected at application for private disability insurance from 634 applicants were related to subsequent sickness absence periods of 30 days or more during a follow-up period of 7.95 years. Variables studied were self-reported lifestyle variables, variables concerning medical history and present health conditions and variables derived from the general medical examination including blood tests and urinary analysis. Results Results from analysis of data from 634 applicants for private disability insurance show that previous periods of sickness absence (OR 2.07), female gender (OR 2.04), health complaints listed in the health declaration (OR 1.88), elevated erythrocyte sedimentation rate (ESR) (OR 4.05) and the nature of the profession were related to a higher risk of sickness absence. Conclusions Sickness absence was found to be related to demographic variables (gender, profession), medical variables (health complaints and erythrocyte sedimentation rate) and to variables with both a medical and a behavioural component (previous sickness absence). PMID:24886527

Socio-economic, Knowledge Attitude Practices (KAP), household related and demographic based appearance of non-dengue infected individuals in high dengue risk areas of Kandy District, Sri Lanka.

PubMed

Udayanga, Lahiru; Gunathilaka, Nayana; Iqbal, M C M; Pahalagedara, Kusumawathie; Amarasinghe, Upali S; Abeyewickreme, Wimaladharma

2018-02-21

Socio-economic, demographic factors and Knowledge Attitude Practices (KAPs) have been recognized as critical factors that influence the incidence and transmission of dengue epidemics. However, studies that characterize above features of a risk free or low risk population are rare. Therefore, the present study was conducted to characterize the household related, demographic, socio-economic factors and KAPs status of five selected dengue free communities. An analytical cross-sectional survey was conducted on selected demographic, socio-economic, household related and KAPs in five selected dengue free communities living in dengue risk areas within Kandy District, Central Province, Sri Lanka. Household heads of 1000 randomly selected houses were interviewed in this study. Chi-square test for independence, cluster analysis and Principal Coordinates (PCO) analysis were used for data analysis. Knowledge and awareness regarding dengue, (prevention of the vector breeding, bites of mosquitoes, disease symptoms and waste management) and attitudes of the community (towards home gardening, composting, waste management and maintenance of a clean and dengue free environment) are associated with the dengue free status of the study populations. The vector controlling authorities should focus on socio-economic, demographic and KAPs in stimulating the community to cooperate in the integrated vector management strategies to improve vector control and reduce transmission of dengue within Kandy District.

Dietary Magnesium Intake and Metabolic Syndrome in the Adult Population: Dose-Response Meta-Analysis and Meta-Regression

PubMed Central

Ju, Sang-Yhun; Choi, Whan-Seok; Ock, Sun-Myeong; Kim, Chul-Min; Kim, Do-Hoon

2014-01-01

Increasing evidence has suggested an association between dietary magnesium intake and metabolic syndrome. However, previous research examining dietary magnesium intake and metabolic syndrome has produced mixed results. Our objective was to determine the relationship between dietary magnesium intake and metabolic syndrome in the adult population using a dose-response meta-analysis. We searched the PubMed, Embase and the Cochrane Library databases from August, 1965, to May, 2014. Observational studies reporting risk ratios with 95% confidence intervals (CIs) for metabolic syndrome in ≥3 categories of dietary magnesium intake levels were selected. The data extraction was performed independently by two authors, and the quality of the studies was evaluated using the Risk of Bias Assessment Tool for Nonrandomized Studies (RoBANS). Based on eight cross-sectional studies and two prospective cohort studies, the pooled relative risks of metabolic syndrome per 150 mg/day increment in magnesium intake was 0.88 (95% CI, 0.84–0.93; I2 = 36.3%). The meta-regression model showed a generally linear, inverse relationship between magnesium intake (mg/day) and metabolic syndrome. This dose-response meta-analysis indicates that dietary magnesium intake is significantly and inversely associated with the risk of metabolic syndrome. However, randomized clinical trials will be necessary to address the issue of causality and to determine whether magnesium supplementation is effective for the prevention of metabolic syndrome. PMID:25533010

Should studies of risk factors for musculoskeletal disorders be stratified by gender? Lessons from the 1998 Québec Health and Social Survey.

PubMed

Messing, Karen; Stock, Susan R; Tissot, France

2009-03-01

Several studies have reported male-female differences in the prevalence of symptoms of work-related musculoskeletal disorders (MSD), some arising from workplace exposure differences. The objective of this paper was to compare two strategies analyzing a single dataset for the relationships between risk factors and MSD in a population-based sample with a wide range of exposures. The 1998 Québec Health and Social Survey surveyed 11 735 respondents in paid work and reported "significant" musculoskeletal pain in 11 body regions during the previous 12 months and a range of personal, physical, and psychosocial risk factors. Five studies concerning risk factors for four musculoskeletal outcomes were carried out on these data. Each included analyses with multiple logistic regression (MLR) performed separately for women, men, and the total study population. The results from these gender-stratified and unstratified analyses were compared. In the unstratified MLR models, gender was significantly associated with musculoskeletal pain in the neck and lower extremities, but not with low-back pain. The gender-stratified MLR models identified significant associations between each specific musculoskeletal outcome and a variety of personal characteristics and physical and psychosocial workplace exposures for each gender. Most of the associations, if present for one gender, were also found in the total population. But several risk factors present for only one gender could be detected only in a stratified analysis, whereas the unstratified analysis added little information. Stratifying analyses by gender is necessary if a full range of associations between exposures and MSD is to be detected and understood.

Human papillomavirus in semen and the risk for male infertility: a systematic review and meta-analysis.

PubMed

Lyu, Zhangyan; Feng, Xiaoshuang; Li, Ni; Zhao, Wei; Wei, Luopei; Chen, Yuheng; Yang, Wenjing; Ma, Hongxia; Yao, Bing; Zhang, Kai; Hu, Zhibin; Shen, Hongbing; Hang, Dong; Dai, Min

2017-11-09

Human papillomavirus (HPV) is one of the most prevalent sexually transmitted viruses. Despite the increasing evidence of HPV prevalence in semen, the worldwide distribution of HPV types in semen and risk for male infertility remain inconclusive. Four electronic databases were searched for English language studies conducted between January 1990 and December 2016 that reported HPV DNA prevalence in semen. Based on the PRISMA guidelines, HPV prevalence was estimated among general population and fertility clinic attendees, respectively, and heterogeneity testing was performed using Cochran's Q and I 2 statistics. The association between HPV positivity and male infertility was evaluated by a meta-analysis of case-control studies. A total of 31 eligible studies comprising 5194 males were included. The overall prevalence of HPV DNA in semen was 11.4% (95% CI = 7.8-15.0%) in general population (n = 2122) and 20.4% (95% CI = 16.2-24.6%) in fertility clinic attendees (n = 3072). High-risk type prevalence was 10.0% (95% CI = 5.9-14.0%) and 15.5% (95% CI = 11.4-19.7%), respectively. HPV16 was the most common type, with a prevalence of 4.8% (95% CI = 1.7-7.8%) in general population and 6.0% (95% CI = 3.8-8.2%) in fertility clinic attendees. A significantly increased risk of infertility was found for males with HPV positivity in semen (OR = 2.93, 95% CI = 2.03-4.24). Seminal HPV infection is common worldwide, which may contribute to the risk of male infertility.

Protecting Privacy of Shared Epidemiologic Data without Compromising Analysis Potential

DOE PAGES

Cologne, John; Grant, Eric J.; Nakashima, Eiji; ...

2012-01-01

Objective . Ensuring privacy of research subjects when epidemiologic data are shared with outside collaborators involves masking (modifying) the data, but overmasking can compromise utility (analysis potential). Methods of statistical disclosure control for protecting privacy may be impractical for individual researchers involved in small-scale collaborations. Methods . We investigated a simple approach based on measures of disclosure risk and analytical utility that are straightforward for epidemiologic researchers to derive. The method is illustrated using data from the Japanese Atomic-bomb Survivor population. Results . Masking by modest rounding did not adequately enhance security but rounding to remove several digits of relativemore » accuracy effectively reduced the risk of identification without substantially reducing utility. Grouping or adding random noise led to noticeable bias. Conclusions . When sharing epidemiologic data, it is recommended that masking be performed using rounding. Specific treatment should be determined separately in individual situations after consideration of the disclosure risks and analysis needs.« less

Protecting Privacy of Shared Epidemiologic Data without Compromising Analysis Potential

PubMed Central

Cologne, John; Grant, Eric J.; Nakashima, Eiji; Chen, Yun; Funamoto, Sachiyo; Katayama, Hiroaki

2012-01-01

Objective. Ensuring privacy of research subjects when epidemiologic data are shared with outside collaborators involves masking (modifying) the data, but overmasking can compromise utility (analysis potential). Methods of statistical disclosure control for protecting privacy may be impractical for individual researchers involved in small-scale collaborations. Methods. We investigated a simple approach based on measures of disclosure risk and analytical utility that are straightforward for epidemiologic researchers to derive. The method is illustrated using data from the Japanese Atomic-bomb Survivor population. Results. Masking by modest rounding did not adequately enhance security but rounding to remove several digits of relative accuracy effectively reduced the risk of identification without substantially reducing utility. Grouping or adding random noise led to noticeable bias. Conclusions. When sharing epidemiologic data, it is recommended that masking be performed using rounding. Specific treatment should be determined separately in individual situations after consideration of the disclosure risks and analysis needs. PMID:22505949

Protecting privacy of shared epidemiologic data without compromising analysis potential.

PubMed

Cologne, John; Grant, Eric J; Nakashima, Eiji; Chen, Yun; Funamoto, Sachiyo; Katayama, Hiroaki

2012-01-01

Ensuring privacy of research subjects when epidemiologic data are shared with outside collaborators involves masking (modifying) the data, but overmasking can compromise utility (analysis potential). Methods of statistical disclosure control for protecting privacy may be impractical for individual researchers involved in small-scale collaborations. We investigated a simple approach based on measures of disclosure risk and analytical utility that are straightforward for epidemiologic researchers to derive. The method is illustrated using data from the Japanese Atomic-bomb Survivor population. Masking by modest rounding did not adequately enhance security but rounding to remove several digits of relative accuracy effectively reduced the risk of identification without substantially reducing utility. Grouping or adding random noise led to noticeable bias. When sharing epidemiologic data, it is recommended that masking be performed using rounding. Specific treatment should be determined separately in individual situations after consideration of the disclosure risks and analysis needs.

Lifestyle interventions in preventing new type 2 diabetes in Asian populations.

PubMed

Modesti, Pietro Amedeo; Galanti, Giorgio; Cala', Piergiuseppe; Calabrese, Maria

2016-04-01

The aim of this study was to review current evidence on interventional studies aimed at the prevention of type 2 diabetes in Asian population with lifestyle interventions. Prevalence of type 2 diabetes sharply increased in most Asian countries during the last decades. This issue has now also relevant implication for Europe where different surveys are also consistently revealing an higher prevalence of type 2 diabetes and other and major CVD risk factors among subjects originating from Asian Countries than in the native population. Nutrition and lifestyle transition seem to play a role in disclosing the predisposition for the development of type 2 diabetes and great interest is now shown toward the possibility to intervene with lifestyle intervention on at risk populations. A meta-analysis of Randomized Controlled Trials showed that lifestyle interventions are highly effective also in the Asian population. All studies were, however, conducted with an individual approach based on the identification of high-risk individuals. When ethnic minority groups have to be addressed, an approach directed to the community rather than to the individual might, however, be more effective. This review reinforces the importance for policy-makers to consider the involvement of the whole community of minority immigrant groups with lifestyle intervention programs.

Risk factors of diarrhoea among flood victims: a controlled epidemiological study.

PubMed

Mondal, N C; Biswas, R; Manna, A

2001-01-01

The concept and practice of 'disaster preparedness and response', instead of traditional casualty relief, is relatively new. Vulnerability analysis and health risks assessment of disaster prone communities are important prerequisites of meaningful preparedness and effective response against any calamity. In this community based study, the risk of diarrhoeal disease and its related epidemiological factors were analysed by collecting data from two selected flood prone block of Midnapur district of West Bengal. The information was compared with that of another population living in two non-flood prone blocks of the same district. The study showed that diarrhoeal disease was the commonest morbidity in flood prone population. Some behaviours, like use of pond water for utensil wash and kitchen purpose, hand washing after defecation without soap, improper hand washing before eating, open field defecation, storage of drinking water in wide mouth vessels etc. were found to be associated with high attack rate of diarrhoea, in both study and control population during flood season compared to pre-flood season. Attack rates were also significantly higher in flood prone population than that of population in non-flood prone area during the same season. Necessity of both community education for proper water use behaviour and personal hygiene along with ensuring safe water and sanitation facilities of flood affected communities were emphasized.