Unsafe abortion as a birth control method: maternal mortality risks among unmarried cambodian migrant women on the Thai-Cambodia border.

PubMed

Hegde, Shalika; Hoban, Elizabeth; Nevill, Annemarie

2012-11-01

Reproductive health research and policies in Cambodia focus on safe motherhood programs particularly for married women, ignoring comprehensive fertility regulation programs for unmarried migrant women of reproductive age. Maternal mortality risks arising due to unsafe abortion methods practiced by unmarried Cambodian women, across the Thai-Cambodia border, can be considered as a public health emergency. Since Thailand has restrictive abortion laws, Cambodian migrant women who have irregular migration status in Thailand experimented with unsafe abortion methods that allowed them to terminate their pregnancies surreptitiously. Unmarried migrant women choose abortion as a preferred birth control method seeking repeat "unsafe" abortions instead of preventing conception. Drawing on the data collected through surveys, in-depth interviews, and document analysis in Chup Commune (pseudonym), Phnom Penh, and Bangkok, the authors describe the public health dimensions of maternal mortality risks faced by unmarried Cambodian migrant women due to various unsafe abortion methods employed as birth control methods.

Effective birth control use among women at risk for unintended pregnancy in Los Angeles, California.

PubMed

Phares, Tanya M; Cui, Yan; Baldwin, Susie

2012-01-01

Identifying sociodemographic and health-related risk factors associated with more effective versus less effective birth control use can help to identify barriers to effective birth control use and decrease risk for unintended pregnancy. Data used were from the 2007 Los Angeles County Health Survey. More effective birth control use was assessed among women ages 18 to 49, who were at risk for unintended pregnancy, residing in Los Angeles County. The study population consisted of 849 women. Multivariate associations of more effective birth control use with sociodemographic and health factors were assessed in logistic regression models. All analyses used weighted data. Women who used a more effective birth control method at last act of coitus were less likely to be Black (odds ratio [OR], 0.33) or Asian/Pacific Islander (OR, 0.49), have less than a high school education (OR, 0.33), be a smoker (OR, 0.52), and have public insurance (OR, 0.47) than women using a less effective birth control method. They were more likely to have received a pap test (OR, 2.66), describe their health as fair or poor (OR, 2.39), and have a household income of 200% to 299% of the federal poverty level (OR, 2.25) than women using a less effective birth control method. Sociodemographic factors, some of which underlie cultural diversity, predict the use of more effective birth control methods and should be considered when providing family planning services and preconception health counseling to unique populations. Copyright © 2012 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

Review of Qualitative Approaches for the Construction Industry: Designing a Risk Management Toolbox

PubMed Central

Spee, Ton; Gillen, Matt; Lentz, Thomas J.; Garrod, Andrew; Evans, Paul; Swuste, Paul

2011-01-01

Objectives This paper presents the framework and protocol design for a construction industry risk management toolbox. The construction industry needs a comprehensive, systematic approach to assess and control occupational risks. These risks span several professional health and safety disciplines, emphasized by multiple international occupational research agenda projects including: falls, electrocution, noise, silica, welding fumes, and musculoskeletal disorders. Yet, the International Social Security Association says, "whereas progress has been made in safety and health, the construction industry is still a high risk sector." Methods Small- and medium-sized enterprises (SMEs) employ about 80% of the world's construction workers. In recent years a strategy for qualitative occupational risk management, known as Control Banding (CB) has gained international attention as a simplified approach for reducing work-related risks. CB groups hazards into stratified risk 'bands', identifying commensurate controls to reduce the level of risk and promote worker health and safety. We review these qualitative solutions-based approaches and identify strengths and weaknesses toward designing a simplified CB 'toolbox' approach for use by SMEs in construction trades. Results This toolbox design proposal includes international input on multidisciplinary approaches for performing a qualitative risk assessment determining a risk 'band' for a given project. Risk bands are used to identify the appropriate level of training to oversee construction work, leading to commensurate and appropriate control methods to perform the work safely. Conclusion The Construction Toolbox presents a review-generated format to harness multiple solutions-based national programs and publications for controlling construction-related risks with simplified approaches across the occupational safety, health and hygiene professions. PMID:22953194

Importance of good manufacturing practices in microbiological monitoring in processing human tissues for transplant.

PubMed

Pianigiani, Elisa; Ierardi, Francesca; Fimiani, Michele

2013-12-01

Skin allografts represent an important therapeutic resource in the treatment of severe skin loss. The risk associated with application of processed tissues in humans is very low, however, human material always carries the risk of disease transmission. To minimise the risk of contamination of grafts, processing is carried out in clean rooms where air quality is monitored. Procedures and quality control tests are performed to standardise the production process and to guarantee the final product for human use. Since we only validate and distribute aseptic tissues, we conducted a study to determine what type of quality controls for skin processing are the most suitable for detecting processing errors and intercurrent contamination, and for faithfully mapping the process without unduly increasing production costs. Two different methods for quality control were statistically compared using the Fisher exact test. On the basis of the current study we selected our quality control procedure based on pre- and post-processing tissue controls, operator and environmental controls. Evaluation of the predictability of our control methods showed that tissue control was the most reliable method of revealing microbial contamination of grafts. We obtained 100 % sensitivity by doubling tissue controls, while maintaining high specificity (77 %).

Randomized Controlled Trial of a Preventive Intervention for Perinatal Depression in High-Risk Latinas

ERIC Educational Resources Information Center

Le, Huynh-Nhu; Perry, Deborah F.; Stuart, Elizabeth A.

2011-01-01

Objective: A randomized controlled trial was conducted to evaluate the efficacy of a cognitive-behavioral (CBT) intervention to prevent perinatal depression in high-risk Latinas. Method: A sample of 217 participants, predominantly low-income Central American immigrants who met demographic and depression risk criteria, were randomized into usual…

A case‐control study of airways obstruction among construction workers

PubMed Central

Welch, Laura; Ringen, Knut; Quinn, Patricia; Chen, Anna; Haas, Scott

2015-01-01

Background While smoking is the major cause of chronic obstructive pulmonary disease (COPD), occupational exposures to vapors, gases, dusts, and fumes (VGDF) increase COPD risk. This case‐control study estimated the risk of COPD attributable to occupational exposures among construction workers. Methods The study population included 834 cases and 1243 controls participating in a national medical screening program for older construction workers between 1997 and 2013. Qualitative exposure indices were developed based on lifetime work and exposure histories. Results Approximately 18% (95%CI = 2–24%) of COPD risk can be attributed to construction‐related exposures, which are additive to the risk contributed by smoking. A measure of all VGDF exposures combined was a strong predictor of COPD risk. Conclusions Construction workers are at increased risk of COPD as a result of broad and complex effects of many exposures acting independently or interactively. Control methods should be implemented to prevent worker exposures, and smoking cessation should be promoted. Am. J. Ind. Med. 58:1083–1097, 2015. © 2015 The Authors. American Journal of Industrial Medicine Published by Wiley Periodicals, Inc. PMID:26123003

A comparison of estimators from self-controlled case series, case-crossover design, and sequence symmetry analysis for pharmacoepidemiological studies.

PubMed

Takeuchi, Yoshinori; Shinozaki, Tomohiro; Matsuyama, Yutaka

2018-01-08

Despite the frequent use of self-controlled methods in pharmacoepidemiological studies, the factors that may bias the estimates from these methods have not been adequately compared in real-world settings. Here, we comparatively examined the impact of a time-varying confounder and its interactions with time-invariant confounders, time trends in exposures and events, restrictions, and misspecification of risk period durations on the estimators from three self-controlled methods. This study analyzed self-controlled case series (SCCS), case-crossover (CCO) design, and sequence symmetry analysis (SSA) using simulated and actual electronic medical records datasets. We evaluated the performance of the three self-controlled methods in simulated cohorts for the following scenarios: 1) time-invariant confounding with interactions between the confounders, 2) time-invariant and time-varying confounding without interactions, 3) time-invariant and time-varying confounding with interactions among the confounders, 4) time trends in exposures and events, 5) restricted follow-up time based on event occurrence, and 6) patient restriction based on event history. The sensitivity of the estimators to misspecified risk period durations was also evaluated. As a case study, we applied these methods to evaluate the risk of macrolides on liver injury using electronic medical records. In the simulation analysis, time-varying confounding produced bias in the SCCS and CCO design estimates, which aggravated in the presence of interactions between the time-invariant and time-varying confounders. The SCCS estimates were biased by time trends in both exposures and events. Erroneously short risk periods introduced bias to the CCO design estimate, whereas erroneously long risk periods introduced bias to the estimates of all three methods. Restricting the follow-up time led to severe bias in the SSA estimates. The SCCS estimates were sensitive to patient restriction. The case study showed that although macrolide use was significantly associated with increased liver injury occurrence in all methods, the value of the estimates varied. The estimations of the three self-controlled methods depended on various underlying assumptions, and the violation of these assumptions may cause non-negligible bias in the resulting estimates. Pharmacoepidemiologists should select the appropriate self-controlled method based on how well the relevant key assumptions are satisfied with respect to the available data.

Methods for analyzing matched designs with double controls: excess risk is easily estimated and misinterpreted when evaluating traffic deaths.

PubMed

Redelmeier, Donald A; Tibshirani, Robert J

2018-06-01

To demonstrate analytic approaches for matched studies where two controls are linked to each case and events are accumulating counts rather than binary outcomes. A secondary intent is to clarify the distinction between total risk and excess risk (unmatched vs. matched perspectives). We review past research testing whether elections can lead to increased traffic risks. The results are reinterpreted by analyzing both the total count of individuals in fatal crashes and the excess count of individuals in fatal crashes, each time accounting for the matched double controls. Overall, 1,546 individuals were in fatal crashes on the 10 election days (average = 155/d), and 2,593 individuals were in fatal crashes on the 20 control days (average = 130/d). Poisson regression of total counts yielded a relative risk of 1.19 (95% confidence interval: 1.12-1.27). Poisson regression of excess counts yielded a relative risk of 3.22 (95% confidence interval: 2.72-3.80). The discrepancy between analyses of total counts and excess counts replicated with alternative statistical models and was visualized in graphical displays. Available approaches provide methods for analyzing count data in matched designs with double controls and help clarify the distinction between increases in total risk and increases in excess risk. Copyright © 2018 Elsevier Inc. All rights reserved.

Spatial variation in mortality risk for haematological malignancies near a petrochemical refinery: a population-based case-control study

PubMed Central

Di Salvo, Francesca; Meneghini, Elisabetta; Vieira, Veronica; Baili, Paolo; Mariottini, Mauro; Baldini, Marco; Micheli, Andrea; Sant, Milena

2015-01-01

Introduction The study investigated the geographic variation of mortality risk for hematological malignancies (HMs) in order to identify potential high-risk areas near an Italian petrochemical refinery. Material and methods A population-based case-control study was conducted and residential histories for 171 cases and 338 sex- and age-matched controls were collected. Confounding factors were obtained from interviews with consenting relatives for 109 HM deaths and 267 controls. To produce risk mortality maps, two different approaches were applied. We mapped (1) adptive kernel density relative risk estimation (KDE) for case-control studies which estimates a spatial relative risk function using the ratio between cases and controls’ densities, and (2) estimated odds ratios for case-control study data using generalized additive models (GAMs) to smooth the effect of location, a proxy for exposure, while adjusting for confounding variables. Results No high-risk areas for HM mortality were identified among all subjects (men and women combined), by applying both approaches. Using the adaptive KDE approach, we found a significant increase in death risk only among women in a large area 2–6 km southeast of the refinery and the application of GAMs also identified a similarly-located significant high-risk area among women only (global p-value<0.025). Potential confounding risk factors we considered in the GAM did not alter the results. Conclusion Both approaches identified a high-risk area close to the refinery among women only. Those spatial methods are useful tools for public policy management to determine priority areas for intervention. Our findings suggest several directions for further research in order to identify other potential environmental exposures that may be assessed in forthcoming studies based on detailed exposure modeling. PMID:26073202

Animal food intake and cooking methods in relation to endometrial cancer risk in Shanghai

PubMed Central

Xu, W-H; Dai, Q; Xiang, Y-B; Zhao, G-M; Zheng, W; Gao, Y-T; Ruan, Z-X; Cheng, J-R; Shu, X-O

2006-01-01

We evaluated animal food intake and cooking methods in relation to endometrial cancer risk in a population-based case–control study in Shanghai, China. A validated food frequency questionnaire was used to collect the usual dietary habits of 1204 cases and 1212 controls aged 30–69 years between 1997 and 2003. Statistical analyses were based on an unconditional logistic regression model adjusting for potential confounders. High intake of meat and fish was associated with an increased risk of endometrial cancer, with adjusted odds ratios for the highest vs the lowest quartile groups being 1.7 (95% confidence interval: 1.3–2.2) and 2.4 (1.8–3.1), respectively. The elevated risk was observed for all types of meat and fish intake. Intake of eggs and milk was not related to risk. Cooking methods and doneness levels for meat and fish were not associated with risk, nor did they modify the association with meat and fish consumption. Our study suggests that animal food consumption may play an important role in the aetiology of endometrial cancer, but cooking methods have minimal influence on risk among Chinese women. PMID:17060930

Effects of a Worksite Weight-Control Programme in Obese Male Workers: A Randomized Controlled Crossover Trial

ERIC Educational Resources Information Center

Iriyama, Yae; Murayama, Nobuko

2014-01-01

Objective: We conducted a randomized controlled crossover trial to evaluate the effects of a new worksite weight-control programme designed for men with or at risk of obesity using a combination of nutrition education and nutrition environmental interventions. Subjects and methods: Male workers with or at risk of obesity were recruited for this…

Failure analysis in the identification of synergies between cleaning monitoring methods.

PubMed

Whiteley, Greg S; Derry, Chris; Glasbey, Trevor

2015-02-01

The 4 monitoring methods used to manage the quality assurance of cleaning outcomes within health care settings are visual inspection, microbial recovery, fluorescent marker assessment, and rapid ATP bioluminometry. These methods each generate different types of information, presenting a challenge to the successful integration of monitoring results. A systematic approach to safety and quality control can be used to interrogate the known qualities of cleaning monitoring methods and provide a prospective management tool for infection control professionals. We investigated the use of failure mode and effects analysis (FMEA) for measuring failure risk arising through each cleaning monitoring method. FMEA uses existing data in a structured risk assessment tool that identifies weaknesses in products or processes. Our FMEA approach used the literature and a small experienced team to construct a series of analyses to investigate the cleaning monitoring methods in a way that minimized identified failure risks. FMEA applied to each of the cleaning monitoring methods revealed failure modes for each. The combined use of cleaning monitoring methods in sequence is preferable to their use in isolation. When these 4 cleaning monitoring methods are used in combination in a logical sequence, the failure modes noted for any 1 can be complemented by the strengths of the alternatives, thereby circumventing the risk of failure of any individual cleaning monitoring method. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Green Jobs: Definition and Method of Appraisal of Chemical and Biological Risks

PubMed Central

Cheneval, Erwan; Busque, Marc-Antoine; Ostiguy, Claude; Lavoie, Jacques; Bourbonnais, Robert; Labrèche, France; Bakhiyi, Bouchra; Zayed, Joseph

2016-01-01

In the wake of sustainable development, green jobs are developing rapidly, changing the work environment. However a green job is not automatically a safe job. The aim of the study was to define green jobs, and to establish a preliminary risk assessment of chemical substances and biological agents for workers in Quebec. An operational definition was developed, along with criteria and sustainable development principles to discriminate green jobs from regular jobs. The potential toxicity or hazard associated with their chemical and biological exposures was assessed, and the workers’ exposure appraised using an expert assessment method. A control banding approach was then used to assess risks for workers in selected green jobs. A double entry model allowed us to set priorities in terms of chemical or biological risk. Among jobs that present the highest risk potential, several are related to waste management. The developed method is flexible and could be adapted to better appraise the risks that workers are facing or to propose control measures. PMID:26718400

Risk management in fly-by-wire systems

NASA Technical Reports Server (NTRS)

Knoll, Karyn T.

1993-01-01

A general description of various types of fly-by-wire systems is provided. The risks inherent in digital flight control systems, like those used in the Space Shuttle, are identified. The results of a literature survey examining risk management methods in use throughout the aerospace industry are presented. The applicability of these methods to the Space Shuttle program is discussed.

Is Wildlife Fertility Control Always Humane?

PubMed Central

Hampton, Jordan O.; Hyndman, Timothy H.; Barnes, Anne; Collins, Teresa

2015-01-01

Simple Summary There are various fertility control methods (modalities) currently available that aim to reduce the abundance of problematic free-ranging mammalian wildlife. Here, we propose that dissimilarities in the mechanism of action indicate these methods produce great variation in animal welfare outcomes. We present a framework to assist managers in minimising animal welfare risks. Abstract Investigation of fertility control techniques to reduce reproductive rates in wildlife populations has been the source of much research. Techniques targeting wildlife fertility have been diverse. Most research into fertility control methods has focused upon efficacy, with few studies rigorously assessing animal welfare beyond opportunistic anecdote. However, fertility control techniques represent several very different mechanisms of action (modalities), each with their own different animal welfare risks. We provide a review of the mechanisms of action for fertility control methods, and consider the role of manipulation of reproductive hormones (“endocrine suppression”) for the long-term ability of animals to behave normally. We consider the potential welfare costs of animal manipulation techniques that are required to administer fertility treatments, including capture, restraint, surgery and drug delivery, and the requirement for repeated administration within the lifetime of an animal. We challenge the assumption that fertility control modalities generate similar and desirable animal welfare outcomes, and we argue that knowledge of reproductive physiology and behaviour should be more adeptly applied to wild animal management decisions. We encourage wildlife managers to carefully assess long-term behavioural risks, associated animal handling techniques, and the importance of positive welfare states when selecting fertility control methods as a means of population control. PMID:26506395

Salmonella and eggs: from production to plate.

PubMed

Whiley, Harriet; Ross, Kirstin

2015-02-26

Salmonella contamination of eggs and egg shells has been identified as a public health concern worldwide. A recent shift in consumer preferences has impacted on the egg industry, with a push for cage-free egg production methods. There has also been an increased desire from consumers for raw and unprocessed foods, potentially increasing the risk of salmonellosis. In response to these changes, this review explores the current literature regarding Salmonella contamination of eggs during the production processing through to food handling protocols. The contamination of eggs with Salmonella during the production process is a complex issue, influenced by many variables including flock size, flock age, stress, feed, vaccination, and cleaning routines. Currently there is no consensus regarding the impact of caged, barn and free range egg production has on Salmonella contamination of eggs. The literature regarding the management and control strategies post-collection, during storage, transport and food handling is also reviewed. Pasteurisation and irradiation were identified as the only certain methods for controlling Salmonella and are essential for the protection of high risk groups, whereas control of temperature and pH were identified as potential control methods to minimise the risk for foods containing raw eggs; however, further research is required to provide more detailed control protocols and education programs to reduce the risk of salmonellosis from egg consumption.

Salmonella and Eggs: From Production to Plate

PubMed Central

Whiley, Harriet; Ross, Kirstin

2015-01-01

Salmonella contamination of eggs and egg shells has been identified as a public health concern worldwide. A recent shift in consumer preferences has impacted on the egg industry, with a push for cage-free egg production methods. There has also been an increased desire from consumers for raw and unprocessed foods, potentially increasing the risk of salmonellosis. In response to these changes, this review explores the current literature regarding Salmonella contamination of eggs during the production processing through to food handling protocols. The contamination of eggs with Salmonella during the production process is a complex issue, influenced by many variables including flock size, flock age, stress, feed, vaccination, and cleaning routines. Currently there is no consensus regarding the impact of caged, barn and free range egg production has on Salmonella contamination of eggs. The literature regarding the management and control strategies post-collection, during storage, transport and food handling is also reviewed. Pasteurisation and irradiation were identified as the only certain methods for controlling Salmonella and are essential for the protection of high risk groups, whereas control of temperature and pH were identified as potential control methods to minimise the risk for foods containing raw eggs; however, further research is required to provide more detailed control protocols and education programs to reduce the risk of salmonellosis from egg consumption. PMID:25730295

The clinical evaluation of International Normalized Ratio variability and control in conventional oral anticoagulant administration by use of the variance growth rate.

PubMed

Ibrahim, S; Jespersen, J; Poller, L

2013-08-01

The time in target International Normalized Ratio (INR) range (TIR) is used to assess the control and intensity of oral anticoagulation, but it does not measure variation in the INR. The value of assessing INR variability by use of the variance growth rate (VGR) as a predictor of events was investigated in patients treated with warfarin. Three different methods of VGR determination (A, B1, and B2) together with the TIR were studied. Method A measures both INR variability and control, but methods B1 and B2 measure variability only. The VGR and TIR were determined over three time periods: overall follow-up to an event, and 6 months and 3 months before an event. Six hundred and sixty-one control patients were matched to 158 cases (bleeding, thromboembolism, or death). With all VGR methods, the risk of an event was greater in unstable patients at 6 months before an event than in stable patients. Method A demonstrated the greatest risk 3 months before an event in the unstable VGR group as compared with the stable group (odds ratio 3.3, 95% confidence interval 1.9-5.7, P < 0.005). The risk of an event was 1.9 times greater in patients with a low TIR (< 39%) than in those with a high TIR (> 80%) in the 3-month period (P = 0.02). Risk of bleeding was significantly greater in the 3-month period in patients with unstable VGR, with the greatest risk found with method B2 (P < 0.01). Patients with unstable anticoagulation have a significantly increased risk of 'clinical events' at 3 and 6 months before an event. The VGR can be incorporated into computer-dosage programs, and may offer additional safety when oral anticoagulation is monitored. © 2013 International Society on Thrombosis and Haemostasis.

The solution of the problem of oil spill risk control in the Baltic Sea taking into account the processes of oil propagation and degradation

NASA Astrophysics Data System (ADS)

Aseev, Nikita; Agoshkov, Valery

2015-04-01

The report is devoted to the one approach to the problem of oil spill risk control of protected areas in the Baltic Sea (Aseev et al., 2014). By the problem of risk control is meant a problem of determination of optimal resources quantity which are necessary for decreasing the risk to some acceptable value. It is supposed that only moment of accident is a random variable. Mass of oil slick is chosen as a function of control. For the realization of the random variable the quadratic 'functional of cost' is introduced. It comprises cleaning costs and deviation of damage of oil pollution from its acceptable value. The problem of minimization of this functional is solved based on the methods of optimal control and the theory of adjoint equations (Agoshkov, 2003, Agoshkov et al., 2012). The solution of this problem is explicitly found. In order to solve the realistic problem of oil spill risk control in the Baltic Sea the 2d model of oil spill propagation on the sea surface based on the Seatrack Web model (Liungman, Mattson, 2011) is developed. The model takes into account such processes as oil transportation by sea currents and wind, turbulent diffusion, spreading, evaporation from sea surface, dispersion and formation of emulsion 'water-in-oil'. The model allows to calculate basic oil slick parameters: localization, mass, volume, thickness, density of oil, water content and viscosity of emulsion. The results of several numerical experiments in the Baltic Sea using the model and the methodology of oil spill risk control are presented. Along with moment of accident other parameters of oil spill and environment could be chosen as a random variables. The methodology of solution of oil spill risk control problem will remain the same but the computational complexity will increase. Conversion of the function of control to quantity of resources with a glance to methods of pollution removal should be processed. As a result, the developed 2d model of oil spill propagation combined with the methodology of solution of oil spill risk control problem could provide the basis for oil spill simulation systems, systems of evaluation and control of oil spill risk and damage in seas or decision support systems. References V.I. Agoshkov. The methods of optimal control and adjoint equations in problems of mathematical physics. // Moscow: INM RAS, 2003, 256 p. (in Russian). V.I. Agoshkov, N.A. Aseev, I.S. Novikov. The methods of investigation and solution of the problems of local sources and local or integral observations. // Moscow: INM RAS, 2012. 151 p. (in Russian). N.A. Aseev, V.I. Agoshkov, V.B. Zalesny, R. Aps, P. Kujala, and J. Rytkonen. The problem of control of oil pollution risk in the Baltic Sea // Russ. J. Numer. Analysis and Math. Modelling, 2014, V 29, No. 2, 93-105. O. Liungman, J. Mattson. Scientific documentation of Seatrack Web; physical processes, algorithms and references, 2011. // https://stw-helcom.smhi.se/

[Application of three control banding tools to occupational health risk assessment of titanium dioxide manufacturing factory].

PubMed

Xu, H D; Zhao, L; Tang, S C; Zhang, J; Kong, F L; Jia, G

2016-12-20

Objective: To explore and validate suitable risk assessment methods for titanium dioxide though applying three risk assessment tools for nanomaterials based on the control banding (CB) approach. Methods: A factory manufacturing titanium dioxide in Jinan city, Shandong province, was assessed using a quantitative exposure method and qualitative risk assessment methods in September, 2014. A condensation particle counter equipment was used to monitor the number concentration of particles at packaging workshop and jet milling workshop. We employed three control banding tools, including CB nanotool, Stoffenmanager nano and the Guidance on working safely with nanomaterials and nanoproducts (GWSNN) to evaluate the two workshops, then compared the evaluation results. Results: The increases of particle concentrations were generated directly by packaging and jet milling processes, the number concentration from (3.52±1.46) ×10(4)/cm(3) to (14.70±8.86) ×10(4)/cm(3) at packaging workshop and from (0.97±0.25) ×10(4)/cm(3) to (1.26±0.35) ×10(4)/cm(3) at milling workshop (both P <0.05) . The number concentrations at packaging workshop were higher than those at jet milling workshop during both manufacturing and break times (both P <0.05) . The results of CB nanotool showed that the risk level of the packaging workshop was classified as high and the risk level of the jet milling workshop was classified asmedium. The results of Stoffenmanager nano showed that the risk level of the packaging workshop was classified as medium and the risk level of the jet milling workshop was classified as low. The results of GWSNN showed that the risk level of packaging workshop was classified as high and the risk level of jet milling workshop was classified as low. Conclusion: The results of evaluation based on the three control banding tools are related and aligned with the results of quantitative monitoring, so they are all suitable to perform occupational health risk assessment on industrial scale production of titanium dioxideto some extent.

[Investigation of risk factors for ovarian tumors with the "case-control" method followed by automated prognostication for ovarian oncopathology].

PubMed

Kulinich, S I; Gertsekovich, D A; Cherniak, E V

1994-01-01

The results of questionnaire-based case-control screening for ovarian oncopathology in 478 patients and 478 healthy females are presented. The two groups matched with respect to age and place of residence. An 82.4% effective mathematical decision rule developed. It can be used as a method of early diagnosis of ovarian tumors as well as in formation of groups at high risk.

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

PubMed

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

2015-03-01

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

The ABCs of Non-Toxic Pest Control.

ERIC Educational Resources Information Center

Cooper, Susan

1990-01-01

Although chemical-intensive pest control methods have proven reasonably effective, a growing awareness of health and environmental risks associated with pesticides has sharpened public interest in safer alternatives. An integrated pest management approach reduces risks from pests while minimizing human exposure and reducing the toxicity of applied…

Measurement of Software Project Management Effectiveness

DTIC Science & Technology

2008-12-01

with technical, financial, policy, and non -technical concerns of stakeholders, to develop and select suitable risk control actions, and implementation...not intervene in their projects and therefore affect their views. In most research experiments, researchers apply a controlled event, method or...enable a consistency check among the responses and for other research purposes. Therefore, for the risk control area model, only the responses from

Estimating risk and rate levels, ratios and differences in case-control studies.

PubMed

King, Gary; Zeng, Langche

2002-05-30

Classic (or 'cumulative') case-control sampling designs do not admit inferences about quantities of interest other than risk ratios, and then only by making the rare events assumption. Probabilities, risk differences and other quantities cannot be computed without knowledge of the population incidence fraction. Similarly, density (or 'risk set') case-control sampling designs do not allow inferences about quantities other than the rate ratio. Rates, rate differences, cumulative rates, risks, and other quantities cannot be estimated unless auxiliary information about the underlying cohort such as the number of controls in each full risk set is available. Most scholars who have considered the issue recommend reporting more than just risk and rate ratios, but auxiliary population information needed to do this is not usually available. We address this problem by developing methods that allow valid inferences about all relevant quantities of interest from either type of case-control study when completely ignorant of or only partially knowledgeable about relevant auxiliary population information.

Qualitative risk assessment during polymer mortar test specimens preparation - methods comparison

NASA Astrophysics Data System (ADS)

Silva, F.; Sousa, S. P. B.; Arezes, P.; Swuste, P.; Ribeiro, M. C. S.; Baptista, J. S.

2015-05-01

Polymer binder modification with inorganic nanomaterials (NM) could be a potential and efficient solution to control matrix flammability of polymer concrete (PC) materials without sacrificing other important properties. Occupational exposures can occur all along the life cycle of a NM and “nanoproducts” from research through scale-up, product development, manufacturing, and end of life. The main objective of the present study is to analyse and compare different qualitative risk assessment methods during the production of polymer mortars (PM) with NM. The laboratory scale production process was divided in 3 main phases (pre-production, production and post-production), which allow testing the assessment methods in different situations. The risk assessment involved in the manufacturing process of PM was made by using the qualitative analyses based on: French Agency for Food, Environmental and Occupational Health & Safety method (ANSES); Control Banding Nanotool (CB Nanotool); Ecole Polytechnique Fédérale de Lausanne method (EPFL); Guidance working safely with nanomaterials and nanoproducts (GWSNN); Istituto Superiore per la Prevenzione e la Sicurezza del Lavoro, Italy method (ISPESL); Precautionary Matrix for Synthetic Nanomaterials (PMSN); and Stoffenmanager Nano. It was verified that the different methods applied also produce different final results. In phases 1 and 3 the risk assessment tends to be classified as medium-high risk, while for phase 2 the more common result is medium level. It is necessary to improve the use of qualitative methods by defining narrow criteria for the methods selection for each assessed situation, bearing in mind that the uncertainties are also a relevant factor when dealing with the risk related to nanotechnologies field.

Green Jobs: Definition and Method of Appraisal of Chemical and Biological Risks.

PubMed

Cheneval, Erwan; Busque, Marc-Antoine; Ostiguy, Claude; Lavoie, Jacques; Bourbonnais, Robert; Labrèche, France; Bakhiyi, Bouchra; Zayed, Joseph

2016-04-01

In the wake of sustainable development, green jobs are developing rapidly, changing the work environment. However a green job is not automatically a safe job. The aim of the study was to define green jobs, and to establish a preliminary risk assessment of chemical substances and biological agents for workers in Quebec. An operational definition was developed, along with criteria and sustainable development principles to discriminate green jobs from regular jobs. The potential toxicity or hazard associated with their chemical and biological exposures was assessed, and the workers' exposure appraised using an expert assessment method. A control banding approach was then used to assess risks for workers in selected green jobs. A double entry model allowed us to set priorities in terms of chemical or biological risk. Among jobs that present the highest risk potential, several are related to waste management. The developed method is flexible and could be adapted to better appraise the risks that workers are facing or to propose control measures. © The Author 2015. Published by Oxford University Press on behalf of the British Occupational Hygiene Society.

Disease Risk Score (DRS) as a Confounder Summary Method: Systematic Review and Recommendations

PubMed Central

Tadrous, Mina; Gagne, Joshua J.; Stürmer, Til; Cadarette, Suzanne M.

2013-01-01

Purpose To systematically examine trends and applications of the disease risk score (DRS) as a confounder summary method. Methods We completed a systematic search of MEDLINE and Web of Science® to identify all English language articles that applied DRS methods. We tabulated the number of publications by year and type (empirical application, methodological contribution, or review paper) and summarized methods used in empirical applications overall and by publication year (<2000, ≥2000). Results Of 714 unique articles identified, 97 examined DRS methods and 86 were empirical applications. We observed a bimodal distribution in the number of publications over time, with a peak 1979-1980, and resurgence since 2000. The majority of applications with methodological detail derived DRS using logistic regression (47%), used DRS as a categorical variable in regression (93%), and applied DRS in a non-experimental cohort (47%) or case-control (42%) study. Few studies examined effect modification by outcome risk (23%). Conclusion Use of DRS methods has increased yet remains low. Comparative effectiveness research may benefit from more DRS applications, particularly to examine effect modification by outcome risk. Standardized terminology may facilitate identification, application, and comprehension of DRS methods. More research is needed to support the application of DRS methods, particularly in case-control studies. PMID:23172692

Injury risk in runners using standard or motion control shoes: a randomised controlled trial with participant and assessor blinding

PubMed Central

Malisoux, Laurent; Chambon, Nicolas; Delattre, Nicolas; Gueguen, Nils; Urhausen, Axel; Theisen, Daniel

2016-01-01

Background/aim This randomised controlled trial investigated if the usage of running shoes with a motion control system modifies injury risk in regular leisure-time runners compared to standard shoes, and if this influence depends on foot morphology. Methods Recreational runners (n=372) were given either the motion control or the standard version of a regular running shoe model and were followed up for 6 months regarding running activity and injury. Foot morphology was analysed using the Foot Posture Index method. Cox regression analyses were used to compare injury risk between the two groups, based on HRs and their 95% CIs, controlling for potential confounders. Stratified analyses were conducted to evaluate the effect of motion control system in runners with supinated, neutral and pronated feet. Results The overall injury risk was lower among the participants who had received motion control shoes (HR=0.55; 95% CI 0.36 to 0.85) compared to those receiving standard shoes. This positive effect was only observed in the stratum of runners with pronated feet (n=94; HR=0.34; 95% CI 0.13 to 0.84); there was no difference in runners with neutral (n=218; HR=0.78; 95% CI 0.44 to 1.37) or supinated feet (n=60; HR=0.59; 95% CI 0.20 to 1.73). Runners with pronated feet using standard shoes had a higher injury risk compared to those with neutral feet (HR=1.80; 95% CI 1.01 to 3.22). Conclusions The overall injury risk was lower in participants who had received motion control shoes. Based on secondary analysis, those with pronated feet may benefit most from this shoe type. PMID:26746907

Cerebrovascular accidents in patients treated for choroidal neovascularization with ranibizumab in randomized controlled trials.

PubMed

Bressler, Neil M; Boyer, David S; Williams, David F; Butler, Steven; Francom, Steven F; Brown, Benton; Di Nucci, Flavia; Cramm, Timothy; Tuomi, Lisa L; Ianchulev, Tsontcho; Rubio, Roman G

2012-10-01

To analyze cerebrovascular accidents (CVAs) pooled from large, randomized, controlled clinical trials of ranibizumab treatment for neovascular age-related macular degeneration. Events in five trials (FOCUS, MARINA, ANCHOR, PIER, and SAILOR) were analyzed using a standard safety monitoring process. Exact methods, stratified by study, were used to test for treatment differences based on odds ratios. A stepwise logistic regression model was fit to classify subjects' risk for CVA based on medical history. Treatment differences in CVA rates at 1 year or 2 years were evaluated within risk groups using stratified exact methods. Pooled 2-year CVA rates were <3%; odds ratios (95% confidence intervals) for CVA risk were 1.2 (0.4-4.4) for ranibizumab 0.3-mg versus control, 2.2 (0.8-7.1) for 0.5 mg versus control, and 1.5 (0.8-3.0) for 0.5-mg versus 0.3-mg ranibizumab. No substantial increased risk of CVA for 0.5 mg versus 0.3 mg was identified in pooled analyses or any of the individual trials. In pooled analyses, the difference between 0.5-mg ranibizumab and control was larger (7.7 [1.2-177]) among high-risk CVA patients. This analysis provided some evidence, although not definitive, of a potential increased risk of CVA with ranibizumab versus control or with 0.5-mg versus 0.3-mg ranibizumab. Continued monitoring for CVA within clinical trials seems warrented.

Job strain (demands and control model) as a predictor of cardiovascular risk factors among petrochemical personnel

PubMed Central

Habibi, Ehsanollah; Poorabdian, Siamak; Shakerian, Mahnaz

2015-01-01

Background: One of the practical models for the assessment of stressful working conditions due to job strain is job demand and control model, which explains how physical and psychological adverse consequences, including cardiovascular risk factors can be established due to high work demands (the amount of workload, in addition to time limitations to complete that work) and low control of the worker on his/her work (lack of decision making) in the workplace. The aim of this study was to investigate how certain cardiovascular risk factors (including body mass index [BMI], heart rate, blood pressure, cholesterol and smoking) and the job demand and job control are related to each other. Materials and Methods: This prospective cohort study was conducted on 500 workers of the petrochemical industry in south of Iran, 2009. The study population was selected using simple random statistical method. They completed job demand and control questionnaire. The cardiovascular risk factors data was extracted from the workers hygiene profiles. Chi-square (χ2) test and hypothesis test (η) were used to assess the possible relationship between different quantified variables, individual demographic and cardiovascular risk factors. Results: The results of this study revealed that a significant relationship can be found between job demand control model and cardiovascular risk factors. Chi-square test result for the heart rate showed the highest (χ2 = 145.078) relationship, the corresponding results for smoking and BMI were χ2 = 85.652 and χ2 = 30.941, respectively. Subsequently, hypothesis testing results for cholesterol and hypertension was 0.469 and 0.684, respectively. Discussion: Job strain is likely to be associated with an increased risk of cardiovascular risk factors among male staff in a petrochemical company in Iran. The parameters illustrated in the Job demands and control model can act as acceptable predictors for the probability of job stress occurrence followed by showing a high trend of CVD risk factors. PMID:25861661

Bias correction of risk estimates in vaccine safety studies with rare adverse events using a self-controlled case series design.

PubMed

Zeng, Chan; Newcomer, Sophia R; Glanz, Jason M; Shoup, Jo Ann; Daley, Matthew F; Hambidge, Simon J; Xu, Stanley

2013-12-15

The self-controlled case series (SCCS) method is often used to examine the temporal association between vaccination and adverse events using only data from patients who experienced such events. Conditional Poisson regression models are used to estimate incidence rate ratios, and these models perform well with large or medium-sized case samples. However, in some vaccine safety studies, the adverse events studied are rare and the maximum likelihood estimates may be biased. Several bias correction methods have been examined in case-control studies using conditional logistic regression, but none of these methods have been evaluated in studies using the SCCS design. In this study, we used simulations to evaluate 2 bias correction approaches-the Firth penalized maximum likelihood method and Cordeiro and McCullagh's bias reduction after maximum likelihood estimation-with small sample sizes in studies using the SCCS design. The simulations showed that the bias under the SCCS design with a small number of cases can be large and is also sensitive to a short risk period. The Firth correction method provides finite and less biased estimates than the maximum likelihood method and Cordeiro and McCullagh's method. However, limitations still exist when the risk period in the SCCS design is short relative to the entire observation period.

Disease risk score as a confounder summary method: systematic review and recommendations.

PubMed

Tadrous, Mina; Gagne, Joshua J; Stürmer, Til; Cadarette, Suzanne M

2013-02-01

To systematically examine trends and applications of the disease risk score (DRS) as a confounder summary method. We completed a systematic search of MEDLINE and Web of Science® to identify all English language articles that applied DRS methods. We tabulated the number of publications by year and type (empirical application, methodological contribution, or review paper) and summarized methods used in empirical applications overall and by publication year (<2000, ≥2000). Of 714 unique articles identified, 97 examined DRS methods and 86 were empirical applications. We observed a bimodal distribution in the number of publications over time, with a peak 1979-1980, and resurgence since 2000. The majority of applications with methodological detail derived DRS using logistic regression (47%), used DRS as a categorical variable in regression (93%), and applied DRS in a non-experimental cohort (47%) or case-control (42%) study. Few studies examined effect modification by outcome risk (23%). Use of DRS methods has increased yet remains low. Comparative effectiveness research may benefit from more DRS applications, particularly to examine effect modification by outcome risk. Standardized terminology may facilitate identification, application, and comprehension of DRS methods. More research is needed to support the application of DRS methods, particularly in case-control studies. Copyright © 2012 John Wiley & Sons, Ltd.

[Assessment of cardiovascular risk in population groups. Comparison of Score system and Framingham in hypertensive patients].

PubMed

Cosín Aguilar, J; Hernándiz Martínez, A; Rodríguez Padial, L; Zamorano Gómez, J L; Arístegui Urrestarazu, R; Armada Peláez, B; Aguilar Llopis, A; Masramon Morell, X

2006-04-01

Calculation of cardiovascular risk in populations allows for developing and assessing of intervention programs and adapting health resources. While the Framingham System has been used in the past, a group of European researchers have proposed a different method called the Score project. The purpose of this paper is to compare the value of both methods for assessing cardiovascular risk. In 6,775 evaluable hypertensive patients distributed over the 17 Spanish autonomous communities (ACs), the 10-year risk of experiencing a coronary event (CR) was calculated using the Framingham equation, while risk of coronary death (RCD) and vascular death (RVD) was calculated using the Score project system, both at baseline and after one year of blood pressure control with amlodipine at the required dose. A comparison was made of the capacity to detect risk differences by both methods between populations with known different risks, and in the same population as a result of blood pressure control. Both the Score and the Framingham systems detected the significant decrease in both CR and RCD or RVD at one year of application of the CORONARIA study protocol. Risk decrease measured by any of the two methods was significant (p < 0.05) overall, by genders, and by ACs. However, the Score System, unlike the Framingham system, could not detect the reported differences in the mortality risk for coronary and vascular disease between the ACs of the North and the South-East parts of Spain.

Bridging the etiologic and prognostic outlooks in individualized assessment of absolute risk of an illness: application in lung cancer.

PubMed

Karp, Igor; Sylvestre, Marie-Pierre; Abrahamowicz, Michal; Leffondré, Karen; Siemiatycki, Jack

2016-11-01

Assessment of individual risk of illness is an important activity in preventive medicine. Development of risk-assessment models has heretofore relied predominantly on studies involving follow-up of cohort-type populations, while case-control studies have generally been considered unfit for this purpose. To present a method for individualized assessment of absolute risk of an illness (as illustrated by lung cancer) based on data from a 'non-nested' case-control study. We used data from a case-control study conducted in Montreal, Canada in 1996-2001. Individuals diagnosed with lung cancer (n = 920) and age- and sex-matched lung-cancer-free subjects (n = 1288) completed questionnaires documenting life-time cigarette-smoking history and occupational, medical, and family history. Unweighted and weighted logistic models were fitted. Model overfitting was assessed using bootstrap-based cross-validation and 'shrinkage.' The discriminating ability was assessed by the c-statistic, and the risk-stratifying performance was assessed by examination of the variability in risk estimates over hypothetical risk-profiles. In the logistic models, the logarithm of incidence-density of lung cancer was expressed as a function of age, sex, cigarette-smoking history, history of respiratory conditions and exposure to occupational carcinogens, and family history of lung cancer. The models entailed a minimal degree of overfitting ('shrinkage' factor: 0.97 for both unweighted and weighted models) and moderately high discriminating ability (c-statistic: 0.82 for the unweighted model and 0.66 for the weighted model). The method's risk-stratifying performance was quite high. The presented method allows for individualized assessment of risk of lung cancer and can be used for development of risk-assessment models for other illnesses.

Research on the method of information system risk state estimation based on clustering particle filter

NASA Astrophysics Data System (ADS)

Cui, Jia; Hong, Bei; Jiang, Xuepeng; Chen, Qinghua

2017-05-01

With the purpose of reinforcing correlation analysis of risk assessment threat factors, a dynamic assessment method of safety risks based on particle filtering is proposed, which takes threat analysis as the core. Based on the risk assessment standards, the method selects threat indicates, applies a particle filtering algorithm to calculate influencing weight of threat indications, and confirms information system risk levels by combining with state estimation theory. In order to improve the calculating efficiency of the particle filtering algorithm, the k-means cluster algorithm is introduced to the particle filtering algorithm. By clustering all particles, the author regards centroid as the representative to operate, so as to reduce calculated amount. The empirical experience indicates that the method can embody the relation of mutual dependence and influence in risk elements reasonably. Under the circumstance of limited information, it provides the scientific basis on fabricating a risk management control strategy.

Effect of Tubal Sterilization Technique on Risk of Serous Ovarian and Primary Peritoneal Carcinoma

PubMed Central

LESSARD-ANDERSON, Collette R.; HANDLOGTEN, Kathryn S.; MOLITOR, Rochelle J.; DOWDY, Sean C.; CLIBY, William A.; WEAVER, Amy L.; SAUVER, Jennifer ST.; BAKKUM-GAMEZ, Jamie N.

2014-01-01

Objective To determine the effect of excisional tubal sterilization on subsequent development of serous epithelial ovarian cancer (EOC) or primary peritoneal cancer (PPC). Methods We performed a population-based, nested case-control study using the Rochester Epidemiology Project. We identified all patients with a diagnosis of serous EOC or PPC from 1966 through 2009. Each case was age-matched to 2 controls without either diagnosis. Odds ratios (ORs) and corresponding 95% CIs were estimated from conditional logistic regression models. Models were adjusted for prior hysterectomy, prior salpingo-oophorectomy, oral contraceptive use, endometriosis, infertility, gravidity, and parity. Results In total, we identified 194 cases of serous EOC and PPC during the study period and matched them with 388 controls (mean [SD] age, 61.4 [15.2] years). Fourteen cases (7.2%) and 46 controls (11.9%) had undergone tubal sterilization. Adjusted risk of serous EOC or PPC was slightly lower after any tubal sterilization (OR, 0.59 [95% CI, 0.29–1.17]; P=.13). The rate of excisional tubal sterilization was lower in cases than controls (2.6% vs 6.4%). Adjusted risk of serous EOC and PPC was decreased by 64% after excisional tubal sterilization (OR, 0.36 [95% CI, 0.13–1.02]; P=.054) compared with those without sterilization or with nonexcisional tubal sterilization. Conclusions We present a population-based investigation of the effects of excisional tubal sterilization on the risk of serous EOC and PPC. Excisional methods may confer greater risk reduction than other sterilization methods. PMID:25316178

Clinical and sonographic risk factors and complications of shoulder dystocia - a case-control study with parity and gestational age matched controls.

PubMed

Parantainen, Jukka; Palomäki, Outi; Talola, Nina; Uotila, Jukka

2014-06-01

To examine the clinical risk factors and complications of shoulder dystocia today and to evaluate ultrasound methods predicting it. Retrospective, matched case-control study at a University Hospital with 5000 annual deliveries. The study population consisted of 152 deliveries complicated by shoulder dystocia over a period of 8.5 years (January 2004-June 2012) and 152 controls matched for gestational age and parity. The data was collected from the medical records of mothers and children and analyzed by conditional logistic regression. Incidences and odds ratios were calculated for risk factors and complications. Antenatal ultrasound data was analyzed when available by conditional logistic regression to test for significant differences between study groups. Birthweight (OR 12.1 for ≥4000 g; 95% CI 4.18-35.0) and vacuum extraction (OR 3.98; 95% CI 1.25-12.7) remained the most significant clinical risk factors. Only a trend of an association of pregestational or gestational diabetes was noticed (OR 1.87; 95% CI 0.997-3.495, probability of type II error 51%). Of the complications of shoulder dystocia the incidence of brachial plexus palsies was high (40%). Antenatal ultrasound method based on the difference between abdominal and biparietal diameters had a significant difference between cases and controls. The impact of diabetes as a risk factor has diminished, which may reflect improved screening and treatment. Antenatal ultrasound methods are showing some promise, but the predictive value of ultrasound alone is probably low. Copyright © 2014. Published by Elsevier Ireland Ltd.

Reading and Language Intervention for Children at Risk of Dyslexia: A Randomised Controlled Trial

ERIC Educational Resources Information Center

Duff, Fiona J.; Hulme, Charles; Grainger, Katy; Hardwick, Samantha J.; Miles, Jeremy N. V.; Snowling, Margaret J.

2014-01-01

Background: Intervention studies for children at risk of dyslexia have typically been delivered preschool, and show short-term effects on letter knowledge and phoneme awareness, with little transfer to literacy. Methods: This randomised controlled trial evaluated the effectiveness of a reading and language intervention for 6-year-old children…

Plasma fatty acids, oxylipins, and risk of myocardial infarction: the Singapore Chinese health study

USDA-ARS?s Scientific Manuscript database

Objective: We aimed to examine the prospective association between plasma fatty acids (FAs), oxylipins and risk of acute myocardial infarction (AMI) in a Singapore Chinese population. Methods: A nested case-control study with 744 incident AMI cases and 744 matched controls aged 47-83 years was condu...

Ranking malaria risk factors to guide malaria control efforts in African highlands.

PubMed

Protopopoff, Natacha; Van Bortel, Wim; Speybroeck, Niko; Van Geertruyden, Jean-Pierre; Baza, Dismas; D'Alessandro, Umberto; Coosemans, Marc

2009-11-25

Malaria is re-emerging in most of the African highlands exposing the non immune population to deadly epidemics. A better understanding of the factors impacting transmission in the highlands is crucial to improve well targeted malaria control strategies. A conceptual model of potential malaria risk factors in the highlands was built based on the available literature. Furthermore, the relative importance of these factors on malaria can be estimated through "classification and regression trees", an unexploited statistical method in the malaria field. This CART method was used to analyse the malaria risk factors in the Burundi highlands. The results showed that Anopheles density was the best predictor for high malaria prevalence. Then lower rainfall, no vector control, higher minimum temperature and houses near breeding sites were associated by order of importance to higher Anopheles density. In Burundi highlands monitoring Anopheles densities when rainfall is low may be able to predict epidemics. The conceptual model combined with the CART analysis is a decision support tool that could provide an important contribution toward the prevention and control of malaria by identifying major risk factors.

Bayes and empirical Bayes methods for reduced rank regression models in matched case-control studies.

PubMed

Satagopan, Jaya M; Sen, Ananda; Zhou, Qin; Lan, Qing; Rothman, Nathaniel; Langseth, Hilde; Engel, Lawrence S

2016-06-01

Matched case-control studies are popular designs used in epidemiology for assessing the effects of exposures on binary traits. Modern studies increasingly enjoy the ability to examine a large number of exposures in a comprehensive manner. However, several risk factors often tend to be related in a nontrivial way, undermining efforts to identify the risk factors using standard analytic methods due to inflated type-I errors and possible masking of effects. Epidemiologists often use data reduction techniques by grouping the prognostic factors using a thematic approach, with themes deriving from biological considerations. We propose shrinkage-type estimators based on Bayesian penalization methods to estimate the effects of the risk factors using these themes. The properties of the estimators are examined using extensive simulations. The methodology is illustrated using data from a matched case-control study of polychlorinated biphenyls in relation to the etiology of non-Hodgkin's lymphoma. © 2015, The International Biometric Society.

Fish intake, cooking practices, and risk of prostate cancer: results from a multi-ethnic case-control study.

PubMed

Joshi, Amit D; John, Esther M; Koo, Jocelyn; Ingles, Sue A; Stern, Mariana C

2012-03-01

Studies conducted to assess the association between fish consumption and prostate cancer (PCA) risk are inconclusive. However, few studies have distinguished between fatty and lean fish, and no studies have considered the role of different cooking practices, which may lead to differential accumulation of chemical carcinogens. In this study, we investigated the association between fish intake and localized and advanced PCA taking into account fish types (lean vs. fatty) and cooking practices. We analyzed data for 1,096 controls, 717 localized and 1,140 advanced cases from the California Collaborative Prostate Cancer Study, a multiethnic, population-based case-control study. We used multivariate conditional logistic regression to estimate odds ratios using nutrient density converted variables of fried fish, tuna, dark fish and white fish consumption. We tested for effect modification by cooking methods (high- vs. low-temperature methods) and levels of doneness. We observed that high white fish intake was associated with increased risk of advanced PCA among men who cooked with high-temperature methods (pan-frying, oven-broiling and grilling) until fish was well done (p (trend) = 0.001). No associations were found among men who cooked fish at low temperature and/or just until done (white fish x cooking method p (interaction) = 0.040). Our results indicate that consideration of fish type (oily vs. lean), specific fish cooking practices and levels of doneness of cooked fish helps elucidate the association between fish intake and PCA risk and suggest that avoiding high-temperature cooking methods for white fish may lower PCA risk.

Assessment of contamination and misclassification biases in a randomized controlled trial of a social network peer education intervention to reduce HIV risk behaviors among drug users and risk partners in Philadelphia, PA and Chiang Mai, Thailand

PubMed Central

Simmons, Nicole; Donnell, Deborah; Ou, San-san; Celentano, David D.; Aramrattana, Apinun; Davis-Vogel, Annet; Metzger, David; Latkin, Carl

2015-01-01

Context Controlled trials of educational interventions are susceptible to contamination. Objectives To test a contamination measure based on recall of terms. Main study A randomized controlled trial of a social network peer education intervention among 1,123 injection drug users and risk partners in Philadelphia, PA and Chiang Mai, Thailand. Methods We assessed the recall of test, negative and positive control terms by intervention and control arm participants and compared the relative odds (OR) of recall of test vs. negative control terms between study arms. Results The contamination measure showed good discriminant ability only among participants from Chiang Mai. In Philadelphia there was no evidence of contamination and little evidence of diffusion. In Chiang Mai there was evidence of diffusion and contamination of 4 of 5 terms tested. Conclusions Network structure and peer education in Chiang Mai likely led to contamination. Recall of intervention materials can be a useful method to detect contamination in trials of educational interventions. PMID:25935214

Child Maltreatment as a Risk Factor for Opioid Dependence: Comparison of Family Characteristics and Type and Severity of Child Maltreatment with a Matched Control Group

ERIC Educational Resources Information Center

Conroy, Elizabeth; Degenhardt, Louisa; Mattick, Richard P.; Nelson, Elliot C.

2009-01-01

Objective: To examine the prevalence, characteristics and risk factors for child maltreatment among opioid-dependent persons compared to a community sample of similar social disadvantage. Method: The study employed a case-control design. Cases had a history of opioid pharmacotherapy. Controls were frequency matched to cases with regard to age, sex…

Evaluating performance of risk identification methods through a large-scale simulation of observational data.

PubMed

Ryan, Patrick B; Schuemie, Martijn J

2013-10-01

There has been only limited evaluation of statistical methods for identifying safety risks of drug exposure in observational healthcare data. Simulations can support empirical evaluation, but have not been shown to adequately model the real-world phenomena that challenge observational analyses. To design and evaluate a probabilistic framework (OSIM2) for generating simulated observational healthcare data, and to use this data for evaluating the performance of methods in identifying associations between drug exposure and health outcomes of interest. Seven observational designs, including case-control, cohort, self-controlled case series, and self-controlled cohort design were applied to 399 drug-outcome scenarios in 6 simulated datasets with no effect and injected relative risks of 1.25, 1.5, 2, 4, and 10, respectively. Longitudinal data for 10 million simulated patients were generated using a model derived from an administrative claims database, with associated demographics, periods of drug exposure derived from pharmacy dispensings, and medical conditions derived from diagnoses on medical claims. Simulation validation was performed through descriptive comparison with real source data. Method performance was evaluated using Area Under ROC Curve (AUC), bias, and mean squared error. OSIM2 replicates prevalence and types of confounding observed in real claims data. When simulated data are injected with relative risks (RR) ≥ 2, all designs have good predictive accuracy (AUC > 0.90), but when RR < 2, no methods achieve 100 % predictions. Each method exhibits a different bias profile, which changes with the effect size. OSIM2 can support methodological research. Results from simulation suggest method operating characteristics are far from nominal properties.

Dynamic probability control limits for risk-adjusted Bernoulli CUSUM charts.

PubMed

Zhang, Xiang; Woodall, William H

2015-11-10

The risk-adjusted Bernoulli cumulative sum (CUSUM) chart developed by Steiner et al. (2000) is an increasingly popular tool for monitoring clinical and surgical performance. In practice, however, the use of a fixed control limit for the chart leads to a quite variable in-control average run length performance for patient populations with different risk score distributions. To overcome this problem, we determine simulation-based dynamic probability control limits (DPCLs) patient-by-patient for the risk-adjusted Bernoulli CUSUM charts. By maintaining the probability of a false alarm at a constant level conditional on no false alarm for previous observations, our risk-adjusted CUSUM charts with DPCLs have consistent in-control performance at the desired level with approximately geometrically distributed run lengths. Our simulation results demonstrate that our method does not rely on any information or assumptions about the patients' risk distributions. The use of DPCLs for risk-adjusted Bernoulli CUSUM charts allows each chart to be designed for the corresponding particular sequence of patients for a surgeon or hospital. Copyright © 2015 John Wiley & Sons, Ltd.

Variation in Breast Cancer-Risk Factor Associations by Method of Detection: Results From a Series of Case-Control Studies.

PubMed

Sprague, Brian L; Gangnon, Ronald E; Hampton, John M; Egan, Kathleen M; Titus, Linda J; Kerlikowske, Karla; Remington, Patrick L; Newcomb, Polly A; Trentham-Dietz, Amy

2015-06-15

Concerns about breast cancer overdiagnosis have increased the need to understand how cancers detected through screening mammography differ from those first detected by a woman or her clinician. We investigated risk factor associations for invasive breast cancer by method of detection within a series of case-control studies (1992-2007) carried out in Wisconsin, Massachusetts, and New Hampshire (n=15,648 invasive breast cancer patients and 17,602 controls aged 40-79 years). Approximately half of case women reported that their cancer had been detected by mammographic screening and half that they or their clinician had detected it. In polytomous logistic regression models, parity and age at first birth were more strongly associated with risk of mammography-detected breast cancer than with risk of woman/clinician-detected breast cancer (P≤0.01; adjusted for mammography utilization). Among postmenopausal women, estrogen-progestin hormone use was predominantly associated with risk of woman/clinician-detected breast cancer (odds ratio (OR)=1.49, 95% confidence interval (CI): 1.29, 1.72), whereas obesity was predominantly associated with risk of mammography-detected breast cancer (OR=1.72, 95% CI: 1.54, 1.92). Among regularly screened premenopausal women, obesity was not associated with increased risk of mammography-detected breast cancer (OR=0.99, 95% CI: 0.83, 1.18), but it was associated with reduced risk of woman/clinician-detected breast cancer (OR=0.53, 95% CI: 0.43, 0.64). These findings indicate important differences in breast cancer risk factors according to method of detection. © The Author 2015. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Stability, Correlates, and Outcome of Adolescent Suicidal Risk

ERIC Educational Resources Information Center

Steinhausen, Hans-Christoph; Bosiger, Ruth; Metzke, Christa Winkler

2006-01-01

Background: The goal of this study was to investigate the stability and correlates of adolescent suicidal risk across adolescence. Methods: Suicidal risk was studied longitudinally in N = 593 subjects in 1994, 1997, and 2001 at mean ages of 13, 16, and 20 years. Three partly overlapping suicidal risk groups were compared to three control groups…

Are there effective interventions to prevent hospital-acquired Legionnaires' disease or to reduce environmental reservoirs of Legionella in hospitals? A systematic review.

PubMed

Almeida, Dejanira; Cristovam, Elisabete; Caldeira, Daniel; Ferreira, Joaquim J; Marques, Teresa

2016-11-01

Legionnaires' disease (LD) is recognized as an important hospital-acquired disease. Despite the several methods available, the optimal method to control hospital-acquired LD is not well established and their overall efficacy requires further evaluation. To systematically review all controlled trials evaluating the efficacy of interventions to prevent hospital-acquired LD in patients at high risk of developing the disease and its effects on environmental colonization. A database search was performed through PubMed and the Cochrane Central Register of Controlled Trials (inception-November 2014). Eligible studies included all controlled studies evaluating interventions to prevent hospital-acquired LD in patients at high risk or evaluating the effect on environmental colonization. Both individual and pooled risk estimates were reported using risk ratio (RR) and 95% confidence intervals (95% CIs). There were no studies evaluating the risk reduction in hospital-acquired LD, but 4 studies evaluated the influence of copper-silver ionization and ultraviolet light in the reduction of environmental reservoirs of Legionella. The meta-analysis showed a significant 95% risk reduction of Legionella positivity in environmental samples using copper-silver ionization (RR, 0.05; 95% CI, 0.01-0.17) and 97% risk reduction with ultraviolet light (RR, 0.03; 95% CI, 0.002-0.41). The best available evidence suggests that copper-silver ionization and ultraviolet light are effective in reducing Legionella positivity in environmental samples. Nevertheless, the low quality of evidence weakens the robustness of conclusions. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

12 CFR Appendix B to Part 741 - Guidance for an Interest Rate Risk Policy and an Effective Program

Code of Federal Regulations, 2013 CFR

2013-01-01

... Measurement Methods C. Components of IRR Measurement Methods V. Internal Controls VI. Decision-Making Informed... effective IRR management program identifies, measures, monitors, and controls IRR and is central to safe and... critical to the control of IRR exposure. All FICUs required to have an IRR policy and program should...

12 CFR Appendix B to Part 741 - Guidance for an Interest Rate Risk Policy and an Effective Program

Code of Federal Regulations, 2014 CFR

2014-01-01

... Measurement Methods C. Components of IRR Measurement Methods V. Internal Controls VI. Decision-Making Informed... effective IRR management program identifies, measures, monitors, and controls IRR and is central to safe and... critical to the control of IRR exposure. All FICUs required to have an IRR policy and program should...

[Application of three risk assessment models in occupational health risk assessment of dimethylformamide].

PubMed

Wu, Z J; Xu, B; Jiang, H; Zheng, M; Zhang, M; Zhao, W J; Cheng, J

2016-08-20

Objective: To investigate the application of United States Environmental Protection Agency (EPA) inhalation risk assessment model, Singapore semi-quantitative risk assessment model, and occupational hazards risk assessment index method in occupational health risk in enterprises using dimethylformamide (DMF) in a certain area in Jiangsu, China, and to put forward related risk control measures. Methods: The industries involving DMF exposure in Jiangsu province were chosen as the evaluation objects in 2013 and three risk assessment models were used in the evaluation. EPA inhalation risk assessment model: HQ=EC/RfC; Singapore semi-quantitative risk assessment model: Risk= (HR×ER) 1/2 ; Occupational hazards risk assessment index=2 Health effect level ×2 exposure ratio ×Operation condition level. Results: The results of hazard quotient (HQ>1) from EPA inhalation risk assessment model suggested that all the workshops (dry method, wet method and printing) and work positions (pasting, burdening, unreeling, rolling, assisting) were high risk. The results of Singapore semi-quantitative risk assessment model indicated that the workshop risk level of dry method, wet method and printing were 3.5 (high) , 3.5 (high) and 2.8 (general) , and position risk level of pasting, burdening, unreeling, rolling, assisting were 4 (high) , 4 (high) , 2.8 (general) , 2.8 (general) and 2.8 (general) . The results of occupational hazards risk assessment index method demonstrated that the position risk index of pasting, burdening, unreeling, rolling, assisting were 42 (high) , 33 (high) , 23 (middle) , 21 (middle) and 22 (middle) . The results of Singapore semi-quantitative risk assessment model and occupational hazards risk assessment index method were similar, while EPA inhalation risk assessment model indicated all the workshops and positions were high risk. Conclusion: The occupational hazards risk assessment index method fully considers health effects, exposure, and operating conditions and can comprehensively and accurately evaluate occupational health risk caused by DMF.

A New Method for Synthesizing Radiation Dose-Response Data From Multiple Trials Applied to Prostate Cancer

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

Diez, Patricia; Vogelius, Ivan S.; Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792

2010-07-15

Purpose: A new method is presented for synthesizing dose-response data for biochemical control of prostate cancer according to study design (randomized vs. nonrandomized) and risk group (low vs. intermediate-high). Methods and Materials: Nine published prostate cancer dose escalation studies including 6,539 patients were identified in the MEDLINE and CINAHL databases and reviewed to assess the relationship between dose and biochemical control. A novel method of analysis is presented in which the normalized dose-response gradient, {gamma}{sub 50}, is estimated for each study and subsequently synthesized across studies. Our method does not assume that biochemical control rates are directly comparable between studies.more » Results: Nonrandomized studies produced a statistically significantly higher {gamma}{sub 50} than randomized studies for intermediate- to high-risk patients ({gamma}{sub 50} = 1.63 vs. {gamma}{sub 50} = 0.93, p = 0.03) and a borderline significantly higher ({gamma}{sub 50} = 1.78 vs. {gamma}{sub 50} = 0.56, p = 0.08) for low-risk patients. No statistically significant difference in {gamma}{sub 50} was found between low- and intermediate- to high-risk patients (p = 0.31). From the pooled data of low and intermediate- to high-risk patients in randomized trials, we obtain the overall best estimate of {gamma}{sub 50} = 0.84 with 95% confidence interval 0.54-1.15. Conclusions: Nonrandomized studies overestimate the steepness of the dose-response curve as compared with randomized trials. This is probably the result of stage migration, improved treatment techniques, and a shorter follow-up in higher dose patients that were typically entered more recently. This overestimation leads to inflated expectations regarding the benefit from dose-escalation and could lead to underpowered clinical trials. There is no evidence of a steeper dose response for intermediate- to high-risk compared with low-risk patients.« less

Risk of unsafe abortion associated with long-term contraception behaviour: a case control study from Sri Lanka.

PubMed

Arambepola, Carukshi; Rajapaksa, Lalini C

2017-06-29

When faced with an unintended pregnancy, some women choose to undergo an unsafe abortion, while others do not. This choice may depend on long-term contraception that shapes the fertility goals of women, along with many other risk factors. We assessed the risk for unsafe abortion associated with contraceptive practices based on women's long-term behaviour, and its likely modification by the use of different types of contraceptives among women in Sri Lanka. An unmatched case-control study was conducted in nine hospitals among 171 women admitted for care following an unsafe abortion (Cases) and 600 women admitted to same hospitals for delivery of an unintended term pregnancy (Controls). Interviewer-administered-questionnaires assessed their socio-economic, reproductive and fertility (decisions on family size, family completion) characteristics, contraceptive method last used (traditional, modern), reasons for discontinuation/never-use, and contraceptive practices assessed at different time points. Using several regression models, the risk of abortion was assessed for 'non-use' of contraception against 'ineffective use' at conception; for non-use further categorised as 'never-use', 'early-discontinuation' (discontinued before last birth interval) and 'late-discontinuation' (discontinued during last birth interval); and for any interaction between the contraceptive practice and contraceptive method last used among the ever-users of contraception. At conception, 'non-use' of contraception imparted a two-fold risk for abortion against ineffective use (adjusted-OR = 2.0; 95% CI: 1.2-3.2). The abortion risk on 'non-use' varied further according to 'early' (adjusted-OR = 1.7; 95% CI: 1.1-3.1) and 'late' (adjusted-OR = 2.3; 95% CI: 1.5-3.6) discontinuation of contraception, but not with 'never-use' (crude-OR = 1.1; 95% CI: 0.6-2.3). Among the ever-users, the risk of abortion varied within each contraceptive practice by their last used contraceptive method and reasons for discontinuation. A significant interaction between modern contraceptives and early discontinuation (adjusted-OR = 1.4; 95% CI = 1.1-3.1) demonstrated a seven-fold abortion risk for early discontinuation of modern methods against its ineffective use. In particular, hormonal methods seemed to be responsible for this risk (51.1% cases versus 42.5% controls). Long-term contraceptive practices showed varying risk for abortion, and was further modified by early discontinuation of modern contraceptives. This knowledge should be applied during postnatal visits by public-health staff.

Residual Risk Assessment for the Ferroalloys Source Category in Support of the September Supplemental Proposal

EPA Pesticide Factsheets

This document contains the methods and the results of baseline risk assessments (i.e., after the implementation of the MACT standard) and the results of the post-control scenario risk assessment performed for the ferroalloys source category.

Parental Perceptions of Neighborhood Processes, Stress, Personal Control, and Risk for Physical Child Abuse and Neglect

ERIC Educational Resources Information Center

Guterman, Neil B.; Lee, Shawna J.; Taylor, Catherine A.; Rathouz, Paul J.

2009-01-01

Objective: This study set out to examine whether mothers' individual perceptions of their neighborhood social processes predict their risk for physical child abuse and neglect directly and/or indirectly via pathways involving parents' reported stress and sense of personal control in the parenting role. Methods: In-home and phone interview data…

Risk Management Implementation Tool

NASA Technical Reports Server (NTRS)

Wright, Shayla L.

2004-01-01

Continuous Risk Management (CM) is a software engineering practice with processes, methods, and tools for managing risk in a project. It provides a controlled environment for practical decision making, in order to assess continually what could go wrong, determine which risk are important to deal with, implement strategies to deal with those risk and assure the measure effectiveness of the implemented strategies. Continuous Risk Management provides many training workshops and courses to teach the staff how to implement risk management to their various experiments and projects. The steps of the CRM process are identification, analysis, planning, tracking, and control. These steps and the various methods and tools that go along with them, identification, and dealing with risk is clear-cut. The office that I worked in was the Risk Management Office (RMO). The RMO at NASA works hard to uphold NASA s mission of exploration and advancement of scientific knowledge and technology by defining and reducing program risk. The RMO is one of the divisions that fall under the Safety and Assurance Directorate (SAAD). I worked under Cynthia Calhoun, Flight Software Systems Engineer. My task was to develop a help screen for the Continuous Risk Management Implementation Tool (RMIT). The Risk Management Implementation Tool will be used by many NASA managers to identify, analyze, track, control, and communicate risks in their programs and projects. The RMIT will provide a means for NASA to continuously assess risks. The goals and purposes for this tool is to provide a simple means to manage risks, be used by program and project managers throughout NASA for managing risk, and to take an aggressive approach to advertise and advocate the use of RMIT at each NASA center.

The Distinct Role of Comparative Risk Perceptions in a Breast Cancer Prevention Program

PubMed Central

Dillard, Amanda J.; Ubel, Peter A.; Smith, Dylan M.; Zikmund-Fisher, Brian J.; Nair, Vijay; Derry, Holly A.; Zhang, Aijun; Pitsch, Rosemarie K.; Alford, Sharon Hensley; McClure, Jennifer B.; Fagerlin, Angela

2013-01-01

Background Comparative risk perceptions may rival other types of information in terms of effects on health behavior decisions. Purpose We examined associations between comparative risk perceptions, affect, and behavior while controlling for absolute risk perceptions and actual risk. Methods Women at an increased risk of breast cancer participated in a program to learn about tamoxifen which can reduce the risk of breast cancer. Women reported comparative risk perceptions of breast cancer and completed measures of anxiety, knowledge, and tamoxifen-related behavior intentions. Three months later, women reported their behavior. Results Comparative risk perceptions were positively correlated with anxiety, knowledge, intentions, and behavior three months later. After controlling for participants’ actual risk of breast cancer and absolute risk perceptions, comparative risk perceptions predicted anxiety and knowledge, but not intentions or behavior. Conclusions Comparative risk perceptions can affect patient outcomes like anxiety and knowledge independently of absolute risk perceptions and actual risk information. PMID:21698518

Research on Occupational Safety, Health Management and Risk Control Technology in Coal Mines.

PubMed

Zhou, Lu-Jie; Cao, Qing-Gui; Yu, Kai; Wang, Lin-Lin; Wang, Hai-Bin

2018-04-26

This paper studies the occupational safety and health management methods as well as risk control technology associated with the coal mining industry, including daily management of occupational safety and health, identification and assessment of risks, early warning and dynamic monitoring of risks, etc.; also, a B/S mode software (Geting Coal Mine, Jining, Shandong, China), i.e., Coal Mine Occupational Safety and Health Management and Risk Control System, is developed to attain the aforementioned objectives, namely promoting the coal mine occupational safety and health management based on early warning and dynamic monitoring of risks. Furthermore, the practical effectiveness and the associated pattern for applying this software package to coal mining is analyzed. The study indicates that the presently developed coal mine occupational safety and health management and risk control technology and the associated software can support the occupational safety and health management efforts in coal mines in a standardized and effective manner. It can also control the accident risks scientifically and effectively; its effective implementation can further improve the coal mine occupational safety and health management mechanism, and further enhance the risk management approaches. Besides, its implementation indicates that the occupational safety and health management and risk control technology has been established based on a benign cycle involving dynamic feedback and scientific development, which can provide a reliable assurance to the safe operation of coal mines.

Research on Occupational Safety, Health Management and Risk Control Technology in Coal Mines

PubMed Central

Zhou, Lu-jie; Cao, Qing-gui; Yu, Kai; Wang, Lin-lin; Wang, Hai-bin

2018-01-01

This paper studies the occupational safety and health management methods as well as risk control technology associated with the coal mining industry, including daily management of occupational safety and health, identification and assessment of risks, early warning and dynamic monitoring of risks, etc.; also, a B/S mode software (Geting Coal Mine, Jining, Shandong, China), i.e., Coal Mine Occupational Safety and Health Management and Risk Control System, is developed to attain the aforementioned objectives, namely promoting the coal mine occupational safety and health management based on early warning and dynamic monitoring of risks. Furthermore, the practical effectiveness and the associated pattern for applying this software package to coal mining is analyzed. The study indicates that the presently developed coal mine occupational safety and health management and risk control technology and the associated software can support the occupational safety and health management efforts in coal mines in a standardized and effective manner. It can also control the accident risks scientifically and effectively; its effective implementation can further improve the coal mine occupational safety and health management mechanism, and further enhance the risk management approaches. Besides, its implementation indicates that the occupational safety and health management and risk control technology has been established based on a benign cycle involving dynamic feedback and scientific development, which can provide a reliable assurance to the safe operation of coal mines. PMID:29701715

Occupation and thyroid cancer: a population-based case-control study in Connecticut

PubMed Central

Ba, Yue; Huang, Huang; Lerro, Catherine C.; Li, Shuzhen; Zhao, Nan; Li, Anqi; Ma, Shuangge; Udelsman, Robert; Zhang, Yawei

2016-01-01

Objective The study aims to explore the associations between various occupations and thyroid cancer risk. Methods A population-based case-control study involving 462 histologically confirmed incident cases and 498 controls was conducted in Connecticut in 2010–2011. Results A significantly increased risk of thyroid cancer, particularly papillary microcarcinoma, was observed for those working as the healthcare practitioners and technical workers, health diagnosing and treating practitioners and registered nurses. Those working in building and grounds cleaning, maintenance occupations, pest control, retail sales, and customer service also had increased risk for papillary thyroid cancer. Subjects who worked as cooks, janitors, cleaners, and customer service representatives were at an increased risk of papillary thyroid cancer with tumor size >1 cm. Conclusions Certain occupations were associated with an increased risk of thyroid cancer, with some tumor size and subtype specificity. PMID:26949881

Dietary food groups intake and cooking methods associations with pancreatic cancer: a case-control study.

PubMed

Ghorbani, Zeinab; Hekmatdoost, Azita; Zinab, Hassan Eini; Farrokhzad, Solmaz; Rahimi, Roya; Malekzadeh, Reza; Pourshams, Akram

2015-05-01

The role of dietary habits in the etiology of pancreatic cancer (PC) has not yet been well elucidated. The aim of the present study was to examine the association of the frequency of different food groups' intake and their cooking methods with PC risk based on a well-designed case-control study. A case-control study including 307 PC patients and 322 controls referred to four tertiary endosonography centers was conducted from January 2011 to January 2014 to compare the frequency intake of different food items and their cooking methods between cases and controls. After adjustment for gender, age, body mass index, years of education, diabetes and alcohol history, smoking status, and opium use, a significant direct relationship was observed between PC risk and intake frequency (time/week) of bread (OR = 1.50; 95 % CI 1.05-2.13; p-value 0.024), rice (OR = 2.10; 95 % CI 1.15-3.82; p for trend 0.034), and red meat (OR = 2.25; 95 % CI 1.22-4.14; p for trend 0.033) (time/day), when comparing the highest category of intake frequency with the lowest, while increasing frequency of fish consumption was associated with a lower risk of PC (OR = 0.93; 95 % CI0.59-1.47; p for trend 0.009). Increasing consumption of barbecuing red meat and deep fried vegetables was associated with 67 % and 70 % increased risk of PC (p-value 0.025 and 0.006, respectively). Our results indicate that increased frequency of intake of bread, rice, and red meat (especially barbecued) and deep fried vegetables can aggregate PC risk, while increased frequency of fish consumption can protect against PC. However, more studies are still needed.

A Framework for Flood Risk Analysis and Benefit Assessment of Flood Control Measures in Urban Areas

PubMed Central

Li, Chaochao; Cheng, Xiaotao; Li, Na; Du, Xiaohe; Yu, Qian; Kan, Guangyuan

2016-01-01

Flood risk analysis is more complex in urban areas than that in rural areas because of their closely packed buildings, different kinds of land uses, and large number of flood control works and drainage systems. The purpose of this paper is to propose a practical framework for flood risk analysis and benefit assessment of flood control measures in urban areas. Based on the concept of disaster risk triangle (hazard, vulnerability and exposure), a comprehensive analysis method and a general procedure were proposed for urban flood risk analysis. Urban Flood Simulation Model (UFSM) and Urban Flood Damage Assessment Model (UFDAM) were integrated to estimate the flood risk in the Pudong flood protection area (Shanghai, China). S-shaped functions were adopted to represent flood return period and damage (R-D) curves. The study results show that flood control works could significantly reduce the flood risk within the 66-year flood return period and the flood risk was reduced by 15.59%. However, the flood risk was only reduced by 7.06% when the flood return period exceeded 66-years. Hence, it is difficult to meet the increasing demands for flood control solely relying on structural measures. The R-D function is suitable to describe the changes of flood control capacity. This frame work can assess the flood risk reduction due to flood control measures, and provide crucial information for strategy development and planning adaptation. PMID:27527202

Problems of Mathematical Finance by Stochastic Control Methods

NASA Astrophysics Data System (ADS)

Stettner, Łukasz

The purpose of this paper is to present main ideas of mathematics of finance using the stochastic control methods. There is an interplay between stochastic control and mathematics of finance. On the one hand stochastic control is a powerful tool to study financial problems. On the other hand financial applications have stimulated development in several research subareas of stochastic control in the last two decades. We start with pricing of financial derivatives and modeling of asset prices, studying the conditions for the absence of arbitrage. Then we consider pricing of defaultable contingent claims. Investments in bonds lead us to the term structure modeling problems. Special attention is devoted to historical static portfolio analysis called Markowitz theory. We also briefly sketch dynamic portfolio problems using viscosity solutions to Hamilton-Jacobi-Bellman equation, martingale-convex analysis method or stochastic maximum principle together with backward stochastic differential equation. Finally, long time portfolio analysis for both risk neutral and risk sensitive functionals is introduced.

An Ethnographic Study Examining the Impact of Service-Learning in an Alternative School Setting

ERIC Educational Resources Information Center

Bodish, Rebecca

2017-01-01

Alternative schools are an option for students considered to be at risk. Behaviorism methods are widely used and accepted in alternative schools, yet, not all students in respond to the skill and drill methods and controlled environment behaviorism entails. Success for students at-risk, especially those behind academically, requires motivation,…

Integrating the Ergonomics Techniques with Multi Criteria Decision Making as a New Approach for Risk Management: An Assessment of Repetitive Tasks -Entropy Case Study.

PubMed

Khandan, Mohammad; Nili, Majid; Koohpaei, Alireza; Mosaferchi, Saeedeh

2016-01-01

Nowadays, the health work decision makers need to analyze a huge amount of data and consider many conflicting evaluation criteria and sub-criteria. Therefore, an ergonomic evaluation in the work environment in order to the control occupational disorders is considered as the Multi Criteria Decision Making (MCDM) problem. In this study, the ergonomic risks factors, which may influence health, were evaluated in a manufacturing company in 2014. Then entropy method was applied to prioritize the different risk factors. This study was done with a descriptive-analytical approach and 13 tasks were included from total number of employees who were working in the seven halls of an ark opal manufacturing (240). Required information was gathered by the demographic questionnaire and Assessment of Repetitive Tasks (ART) method for repetitive task assessment. In addition, entropy was used to prioritize the risk factors based on the ergonomic control needs. The total exposure score based on the ART method calculated was equal to 30.07 ±12.43. Data analysis illustrated that 179 cases (74.6% of tasks) were in the high level of risk area and 13.8% were in the medium level of risk. ART- entropy results revealed that based on the weighted factors, higher value belongs to grip factor and the lowest value was related to neck and hand posture and duration. Based on the limited financial resources, it seems that MCDM in many challenging situations such as control procedures and priority approaches could be used successfully. Other MCDM methods for evaluating and prioritizing the ergonomic problems are recommended.

An integrated optimization method for river water quality management and risk analysis in a rural system.

PubMed

Liu, J; Li, Y P; Huang, G H; Zeng, X T; Nie, S

2016-01-01

In this study, an interval-stochastic-based risk analysis (RSRA) method is developed for supporting river water quality management in a rural system under uncertainty (i.e., uncertainties exist in a number of system components as well as their interrelationships). The RSRA method is effective in risk management and policy analysis, particularly when the inputs (such as allowable pollutant discharge and pollutant discharge rate) are expressed as probability distributions and interval values. Moreover, decision-makers' attitudes towards system risk can be reflected using a restricted resource measure by controlling the variability of the recourse cost. The RSRA method is then applied to a real case of water quality management in the Heshui River Basin (a rural area of China), where chemical oxygen demand (COD), total nitrogen (TN), total phosphorus (TP), and soil loss are selected as major indicators to identify the water pollution control strategies. Results reveal that uncertainties and risk attitudes have significant effects on both pollutant discharge and system benefit. A high risk measure level can lead to a reduced system benefit; however, this reduction also corresponds to raised system reliability. Results also disclose that (a) agriculture is the dominant contributor to soil loss, TN, and TP loads, and abatement actions should be mainly carried out for paddy and dry farms; (b) livestock husbandry is the main COD discharger, and abatement measures should be mainly conducted for poultry farm; (c) fishery accounts for a high percentage of TN, TP, and COD discharges but a has low percentage of overall net benefit, and it may be beneficial to cease fishery activities in the basin. The findings can facilitate the local authority in identifying desired pollution control strategies with the tradeoff between socioeconomic development and environmental sustainability.

A case-control study of airways obstruction among construction workers.

PubMed

Dement, John; Welch, Laura; Ringen, Knut; Quinn, Patricia; Chen, Anna; Haas, Scott

2015-10-01

While smoking is the major cause of chronic obstructive pulmonary disease (COPD), occupational exposures to vapors, gases, dusts, and fumes (VGDF) increase COPD risk. This case-control study estimated the risk of COPD attributable to occupational exposures among construction workers. The study population included 834 cases and 1243 controls participating in a national medical screening program for older construction workers between 1997 and 2013. Qualitative exposure indices were developed based on lifetime work and exposure histories. Approximately 18% (95% CI = 2-24%) of COPD risk can be attributed to construction-related exposures, which are additive to the risk contributed by smoking. A measure of all VGDF exposures combined was a strong predictor of COPD risk. Construction workers are at increased risk of COPD as a result of broad and complex effects of many exposures acting independently or interactively. Control methods should be implemented to prevent worker exposures, and smoking cessation should be promoted. © 2015 The Authors. American Journal of Industrial Medicine Published by Wiley Periodicals, Inc.

National study of suicide method in violent criminal offenders.

PubMed

Webb, R T; Qin, P; Stevens, H; Shaw, J; Appleby, L; Mortensen, P B

2013-09-05

Gaining a greater knowledge of the mechanisms and means by which violent offenders die by suicide can inform tailored preventive strategies. Using interlinked national Danish registry data we constructed a nested case-control study dataset of all adult suicides during 1994-2006: N=9708 cases and N=188,134 age and gender matched living controls. Completely ascertained International Classification of Diseases 10th revision cause-specific mortality codes were examined, with all criminal charges since 1980, and covariate information on psychiatric treatment and socio-demographics. Self-poisonings were classified as 'nonviolent' suicide and all other methods as being 'violent' ones. Compared with the general population, risk among male and female violent offenders was strongly and significantly elevated for suicide by either a violent or a nonviolent method, although the relative risk was greater for nonviolent suicide. These patterns were also observed among nonviolent offenders, albeit with smaller effect sizes. Risk was especially raised for self-poisoning with narcotics & hallucinogens. We could only examine the full range of suicide methods in male violent offenders. In these men, hanging was the most frequently used method, although risk was markedly and significantly elevated virtually across the entire range of regularly used suicide methods. We lacked sufficient statistical power for undertaking a detailed profiling of specific suicide methods among female violent offenders. Our findings indicate that comprehensive and broadly-based preventive approaches are needed for tackling the markedly raised risk of suicide by both violent and nonviolent means in this population. Their high relative risk for self-poisoning by illicit or illegal drugs underlines the importance of access to means and of prevailing subculture. Copyright © 2013 Elsevier B.V. All rights reserved.

Evaluation of biologic occupational risk control practices: quality indicators development and validation.

PubMed

Takahashi, Renata Ferreira; Gryschek, Anna Luíza F P L; Izumi Nichiata, Lúcia Yasuko; Lacerda, Rúbia Aparecida; Ciosak, Suely Itsuko; Gir, Elucir; Padoveze, Maria Clara

2010-05-01

There is growing demand for the adoption of qualification systems for health care practices. This study is aimed at describing the development and validation of indicators for evaluation of biologic occupational risk control programs. The study involved 3 stages: (1) setting up a research team, (2) development of indicators, and (3) validation of the indicators by a team of specialists recruited to validate each attribute of the developed indicators. The content validation method was used for the validation, and a psychometric scale was developed for the specialists' assessment. A consensus technique was used, and every attribute that obtained a Content Validity Index of at least 0.75 was approved. Eight indicators were developed for the evaluation of the biologic occupational risk prevention program, with emphasis on accidents caused by sharp instruments and occupational tuberculosis prevention. The indicators included evaluation of the structure, process, and results at the prevention and biologic risk control levels. The majority of indicators achieved a favorable consensus regarding all validated attributes. The developed indicators were considered validated, and the method used for construction and validation proved to be effective. Copyright (c) 2010 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

Field-based random sampling without a sampling frame: control selection for a case-control study in rural Africa.

PubMed

Crampin, A C; Mwinuka, V; Malema, S S; Glynn, J R; Fine, P E

2001-01-01

Selection bias, particularly of controls, is common in case-control studies and may materially affect the results. Methods of control selection should be tailored both for the risk factors and disease under investigation and for the population being studied. We present here a control selection method devised for a case-control study of tuberculosis in rural Africa (Karonga, northern Malawi) that selects an age/sex frequency-matched random sample of the population, with a geographical distribution in proportion to the population density. We also present an audit of the selection process, and discuss the potential of this method in other settings.

Intracardiac Shunting and Stroke in Children: A Systematic Review

PubMed Central

Dowling, Michael M.; Ikemba, Catherine M.

2017-01-01

In adults, patent foramen ovale or other potential intracardiac shunts are established risk factors for stroke via paradoxical embolization. Stroke is less common in children and risk factors differ. The authors examined the literature on intracardiac shunting and stroke in children, identifying the methods employed, the prevalence of detectible intracardiac shunts, associated conditions, and treatments. PubMed searches with keywords related to intracardiac shunting and stroke in children identified articles of interest. Additional articles were identified via citations in these articles or in reviews. The authors found that studies of intracardiac shunting in children with stroke are limited. No controlled studies were identified. Detection methods vary and the prevalence of echocardiographically detectible intracardiac shunting appears lower than reported in adults and autopsy studies. Defining the role of intracardiac shunting in pediatric stroke will require controlled studies with unified detection methods in populations stratified by additional risk factors for paradoxical embolization. Optimal treatment is unclear. PMID:21212453

Rare, evolutionarily unlikely missense substitutions in CHEK2 contribute to breast cancer susceptibility: results from a breast cancer family registry case-control mutation-screening study.

PubMed

Le Calvez-Kelm, Florence; Lesueur, Fabienne; Damiola, Francesca; Vallée, Maxime; Voegele, Catherine; Babikyan, Davit; Durand, Geoffroy; Forey, Nathalie; McKay-Chopin, Sandrine; Robinot, Nivonirina; Nguyen-Dumont, Tù; Thomas, Alun; Byrnes, Graham B; Hopper, John L; Southey, Melissa C; Andrulis, Irene L; John, Esther M; Tavtigian, Sean V

2011-01-18

Both protein-truncating variants and some missense substitutions in CHEK2 confer increased risk of breast cancer. However, no large-scale study has used full open reading frame mutation screening to assess the contribution of rare missense substitutions in CHEK2 to breast cancer risk. This absence has been due in part to a lack of validated statistical methods for summarizing risk attributable to large numbers of individually rare missense substitutions. Previously, we adapted an in silico assessment of missense substitutions used for analysis of unclassified missense substitutions in BRCA1 and BRCA2 to the problem of assessing candidate genes using rare missense substitution data observed in case-control mutation-screening studies. The method involves stratifying rare missense substitutions observed in cases and/or controls into a series of grades ordered a priori from least to most likely to be evolutionarily deleterious, followed by a logistic regression test for trends to compare the frequency distributions of the graded missense substitutions in cases versus controls. Here we used this approach to analyze CHEK2 mutation-screening data from a population-based series of 1,303 female breast cancer patients and 1,109 unaffected female controls. We found evidence of risk associated with rare, evolutionarily unlikely CHEK2 missense substitutions. Additional findings were that (1) the risk estimate for the most severe grade of CHEK2 missense substitutions (denoted C65) is approximately equivalent to that of CHEK2 protein-truncating variants; (2) the population attributable fraction and the familial relative risk explained by the pool of rare missense substitutions were similar to those explained by the pool of protein-truncating variants; and (3) post hoc power calculations implied that scaling up case-control mutation screening to examine entire biochemical pathways would require roughly 2,000 cases and controls to achieve acceptable statistical power. This study shows that CHEK2 harbors many rare sequence variants that confer increased risk of breast cancer and that a substantial proportion of these are missense substitutions. The study validates our analytic approach to rare missense substitutions and provides a method to combine data from protein-truncating variants and rare missense substitutions into a one degree of freedom per gene test.

Attention regulates anger and fear to predict changes in adolescent risk-taking behaviors

PubMed Central

Kim-Spoon, Jungmeen; Holmes, Christopher; Deater-Deckard, Kirby

2014-01-01

Background Regulation of negative affect is critical to healthy development in childhood and adolescence. We conducted a longitudinal study examining the moderating role of attention control in the effects of anger and fear on changes in risk-taking behaviors from early to middle adolescence. Method The sample involved participants from the Study of Early Child Care and Youth Development (SECCYD), assessed at 9, 11, and 15 years of age. Composite scores for anger, fear, and attention control were computed using indicators from multiple informants, and risk-taking behaviors were assessed based on adolescents’ self-reports. Results Latent difference score analysis indicated significant moderating effects of attention control showing that increased anger between 9 and 11 years was related to increases in risk-taking behaviors between 11 and 15 years only for adolescents with low attention control but not for adolescents with high attention control. In contrast, significant moderating effects of attention control for the link between fear and risk-taking behaviors suggested increased fear between 9 and 11 years tended to be associated with decreases in risk-taking behaviors between 11 and 15 years only for adolescents with high attention control but not for adolescents with low attention control. Conclusions Attention control regulates the connections between negative affect such as anger and fear with changes in adolescent risk-taking behaviors. Our data suggest the protective role of strong attention control against the development of risk-taking behaviors in adolescence as it demotes the effects of anger and promotes the effects of fear. PMID:25280179

Optimizing the Primary Prevention of Type-2 Diabetes in Primary Health Care

ClinicalTrials.gov

2017-08-18

Interprofessional Relations; Primary Health Care/Organization & Administration; Diabetes Mellitus, Type 2/Prevention & Control; Primary Prevention/Methods; Risk Reduction Behavior; Randomized Controlled Trial; Life Style

Cascade reservoir flood control operation based on risk grading and warning in the Upper Yellow River

NASA Astrophysics Data System (ADS)

Xuejiao, M.; Chang, J.; Wang, Y.

2017-12-01

Flood risk reduction with non-engineering measures has become the main idea for flood management. It is more effective for flood risk management to take various non-engineering measures. In this paper, a flood control operation model for cascade reservoirs in the Upper Yellow River was proposed to lower the flood risk of the water system with multi-reservoir by combining the reservoir flood control operation (RFCO) and flood early warning together. Specifically, a discharge control chart was employed to build the joint RFCO simulation model for cascade reservoirs in the Upper Yellow River. And entropy-weighted fuzzy comprehensive evaluation method was adopted to establish a multi-factorial risk assessment model for flood warning grade. Furthermore, after determining the implementing mode of countermeasures with future inflow, an intelligent optimization algorithm was used to solve the optimization model for applicable water release scheme. In addition, another model without any countermeasure was set to be a comparative experiment. The results show that the model developed in this paper can further decrease the flood risk of water system with cascade reservoirs. It provides a new approach to flood risk management by coupling flood control operation and flood early warning of cascade reservoirs.

Characterizing vaccine-associated risks using cubic smoothing splines.

PubMed

Brookhart, M Alan; Walker, Alexander M; Lu, Yun; Polakowski, Laura; Li, Jie; Paeglow, Corrie; Puenpatom, Tosmai; Izurieta, Hector; Daniel, Gregory W

2012-11-15

Estimating risks associated with the use of childhood vaccines is challenging. The authors propose a new approach for studying short-term vaccine-related risks. The method uses a cubic smoothing spline to flexibly estimate the daily risk of an event after vaccination. The predicted incidence rates from the spline regression are then compared with the expected rates under a log-linear trend that excludes the days surrounding vaccination. The 2 models are then used to estimate the excess cumulative incidence attributable to the vaccination during the 42-day period after vaccination. Confidence intervals are obtained using a model-based bootstrap procedure. The method is applied to a study of known effects (positive controls) and expected noneffects (negative controls) of the measles, mumps, and rubella and measles, mumps, rubella, and varicella vaccines among children who are 1 year of age. The splines revealed well-resolved spikes in fever, rash, and adenopathy diagnoses, with the maximum incidence occurring between 9 and 11 days after vaccination. For the negative control outcomes, the spline model yielded a predicted incidence more consistent with the modeled day-specific risks, although there was evidence of increased risk of diagnoses of congenital malformations after vaccination, possibly because of a "provider visit effect." The proposed approach may be useful for vaccine safety surveillance.

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

Alerting device and method for reminding a person of a risk

DOEpatents

Runyon, Larry [Richland, WA; Gunter, Wayne M [West Richland, WA; Pratt, Richard M [Richland, WA

2001-11-27

An alerting device and method to remind personnel of a risk is disclosed. The device has at least two sensors, a logic controller, a power source, and an annunciator that delivers a visual message, with or without an audible alarm, about a risk to a person when the sensors detect the person exiting a predetermined space. In particular, the present invention reminds a person of a security, safety, or health risk upon exiting a predetermined space. More particularly, the present invention reminds a person of an information security risk relating to sensitive, proprietary, confidential, trade secret, classified, or intellectual property information.

Integrated Environmental Risk Assessment and Whole-Process Management System in Chemical Industry Parks

PubMed Central

Shao, Chaofeng; Yang, Juan; Tian, Xiaogang; Ju, Meiting; Huang, Lei

2013-01-01

Chemical industry parks in China are considered high-risk areas because they present numerous risks that can damage the environment, such as pollution incidents. In order to identify the environmental risks and the principal risk factors in these areas, we have developed a simple physical model of a regional environmental risk field (ERF) using existing dispersal patterns and migration models. The regional ERF zoning was also conducted and a reference value for diagnostic methods was developed to determine risk-acceptable, risk-warning, and risk-mitigation zones, which can provide a risk source layout for chemical industry parks. In accordance with the environmental risk control requirements, this study focused on the three stages of control and management of environmental risk and established an environmental risk management system including risk source identification and assessment, environmental safety planning, early risk warning, emergency management, assessment of environmental effects, and environmental remediation of pollution accidents. By using this model, the environmental risks in Tianjin Binhai New Area, the largest chemical industry park in China, were assessed and the environmental risk zoning map was drawn, which suggested the existence of many unacceptable environmental risks in this area. Thus, relevant suggestions have been proposed from the perspective of the adjustment of risk source layout, intensified management of environmental risk control and so on. PMID:23603866

Integrated environmental risk assessment and whole-process management system in chemical industry parks.

PubMed

Shao, Chaofeng; Yang, Juan; Tian, Xiaogang; Ju, Meiting; Huang, Lei

2013-04-19

Chemical industry parks in China are considered high-risk areas because they present numerous risks that can damage the environment, such as pollution incidents. In order to identify the environmental risks and the principal risk factors in these areas, we have developed a simple physical model of a regional environmental risk field (ERF) using existing dispersal patterns and migration models. The regional ERF zoning was also conducted and a reference value for diagnostic methods was developed to determine risk-acceptable, risk-warning, and risk-mitigation zones, which can provide a risk source layout for chemical industry parks. In accordance with the environmental risk control requirements, this study focused on the three stages of control and management of environmental risk and established an environmental risk management system including risk source identification and assessment, environmental safety planning, early risk warning, emergency management, assessment of environmental effects, and environmental remediation of pollution accidents. By using this model, the environmental risks in Tianjin Binhai New Area, the largest chemical industry park in China, were assessed and the environmental risk zoning map was drawn, which suggested the existence of many unacceptable environmental risks in this area. Thus, relevant suggestions have been proposed from the perspective of the adjustment of risk source layout, intensified management of environmental risk control and so on.

Application of hazard analysis and critical control point methodology and risk-based grading to consumer food safety surveys.

PubMed

Røssvoll, Elin Halbach; Ueland, Øydis; Hagtvedt, Therese; Jacobsen, Eivind; Lavik, Randi; Langsrud, Solveig

2012-09-01

Traditionally, consumer food safety survey responses have been classified as either "right" or "wrong" and food handling practices that are associated with high risk of infection have been treated in the same way as practices with lower risks. In this study, a risk-based method for consumer food safety surveys has been developed, and HACCP (hazard analysis and critical control point) methodology was used for selecting relevant questions. We conducted a nationally representative Web-based survey (n = 2,008), and to fit the self-reported answers we adjusted a risk-based grading system originally developed for observational studies. The results of the survey were analyzed both with the traditional "right" and "wrong" classification and with the risk-based grading system. The results using the two methods were very different. Only 5 of the 10 most frequent food handling violations were among the 10 practices associated with the highest risk. These 10 practices dealt with different aspects of heat treatment (lacking or insufficient), whereas the majority of the most frequent violations involved storing food at room temperature for too long. Use of the risk-based grading system for survey responses gave a more realistic picture of risks associated with domestic food handling practices. The method highlighted important violations and minor errors, which are performed by most people and are not associated with significant risk. Surveys built on a HACCP-based approach with risk-based grading will contribute to a better understanding of domestic food handling practices and will be of great value for targeted information and educational activities.

NASA's human system risk management approach and its applicability to commercial spaceflight.

PubMed

Law, Jennifer; Mathers, Charles H; Fondy, Susan R E; Vanderploeg, James M; Kerstman, Eric L

2013-01-01

As planning continues for commercial spaceflight, attention is turned to NASA to assess whether its human system risk management approach can be applied to mitigate the risks associated with commercial suborbital and orbital flights. NASA uses a variety of methods to assess the risks to the human system based on their likelihood and consequences. In this article, we review these methods and categorize the risks in the system as "definite," "possible," or "least" concern for commercial spaceflight. As with career astronauts, these risks will be primarily mitigated by screening and environmental control. Despite its focus on long-duration exploration missions, NASA's human system risk management approach can serve as a preliminary knowledge base to help medical planners prepare for commercial spaceflights.

Risk Assessment and Hierarchical Risk Management of Enterprises in Chemical Industrial Parks Based on Catastrophe Theory

PubMed Central

Chen, Yu; Song, Guobao; Yang, Fenglin; Zhang, Shushen; Zhang, Yun; Liu, Zhenyu

2012-01-01

According to risk systems theory and the characteristics of the chemical industry, an index system was established for risk assessment of enterprises in chemical industrial parks (CIPs) based on the inherent risk of the source, effectiveness of the prevention and control mechanism, and vulnerability of the receptor. A comprehensive risk assessment method based on catastrophe theory was then proposed and used to analyze the risk levels of ten major chemical enterprises in the Songmu Island CIP, China. According to the principle of equal distribution function, the chemical enterprise risk level was divided into the following five levels: 1.0 (very safe), 0.8 (safe), 0.6 (generally recognized as safe, GRAS), 0.4 (unsafe), 0.2 (very unsafe). The results revealed five enterprises (50%) with an unsafe risk level, and another five enterprises (50%) at the generally recognized as safe risk level. This method solves the multi-objective evaluation and decision-making problem. Additionally, this method involves simple calculations and provides an effective technique for risk assessment and hierarchical risk management of enterprises in CIPs. PMID:23208298

Predictive Control of the Blood Glucose Level in Type I Diabetic Patient Using Delay Differential Equation Wang Model.

PubMed

Esna-Ashari, Mojgan; Zekri, Maryam; Askari, Masood; Khalili, Noushin

2017-01-01

Because of increasing risk of diabetes, the measurement along with control of blood sugar has been of great importance in recent decades. In type I diabetes, because of the lack of insulin secretion, the cells cannot absorb glucose leading to low level of glucose. To control blood glucose (BG), the insulin must be injected to the body. This paper proposes a method for BG level regulation in type I diabetes. The control strategy is based on nonlinear model predictive control. The aim of the proposed controller optimized with genetics algorithms is to measure BG level each time and predict it for the next time interval. This merit causes a less amount of control effort, which is the rate of insulin delivered to the patient body. Consequently, this method can decrease the risk of hypoglycemia, a lethal phenomenon in regulating BG level in diabetes caused by a low BG level. Two delay differential equation models, namely Wang model and Enhanced Wang model, are applied as controller model and plant, respectively. The simulation results exhibit an acceptable performance of the proposed controller in meal disturbance rejection and robustness against parameter changes. As a result, if the nutrition of the person decreases instantly, the hypoglycemia will not happen. Furthermore, comparing this method with other works, it was shown that the new method outperforms previous studies.

Predictive Control of the Blood Glucose Level in Type I Diabetic Patient Using Delay Differential Equation Wang Model

PubMed Central

Esna-Ashari, Mojgan; Zekri, Maryam; Askari, Masood; Khalili, Noushin

2017-01-01

Because of increasing risk of diabetes, the measurement along with control of blood sugar has been of great importance in recent decades. In type I diabetes, because of the lack of insulin secretion, the cells cannot absorb glucose leading to low level of glucose. To control blood glucose (BG), the insulin must be injected to the body. This paper proposes a method for BG level regulation in type I diabetes. The control strategy is based on nonlinear model predictive control. The aim of the proposed controller optimized with genetics algorithms is to measure BG level each time and predict it for the next time interval. This merit causes a less amount of control effort, which is the rate of insulin delivered to the patient body. Consequently, this method can decrease the risk of hypoglycemia, a lethal phenomenon in regulating BG level in diabetes caused by a low BG level. Two delay differential equation models, namely Wang model and Enhanced Wang model, are applied as controller model and plant, respectively. The simulation results exhibit an acceptable performance of the proposed controller in meal disturbance rejection and robustness against parameter changes. As a result, if the nutrition of the person decreases instantly, the hypoglycemia will not happen. Furthermore, comparing this method with other works, it was shown that the new method outperforms previous studies. PMID:28487828

Occupational health risk assessment of volatile organic compounds emitted from the coke production unit of a steel plant.

PubMed

Dehghani, Fateme; Omidi, Fariborz; Heravizadeh, Omidreza; Barati Chamgordani, Saied; Gharibi, Vahid; Sotoudeh Manesh, Akbar

2018-03-27

In this study, cancer and non-cancer risks of exposure to volatile organic compounds in the coke production unit of a steel plant were evaluated. To determine individual exposure to benzene, toluene, xylene and ethylbenzene, personal samples were taken from the breathing zone of workers according to National Institute for Occupational Safety and Health (NIOSH) method 1501. Cancer and non-cancer risk assessment was performed, using US Environmental Protection Agency (US EPA) methods. Samples analysis showed that the concentration of benzene in the energy and biochemistry and the benzol refinement sections was higher than occupational exposure limits. The cancer risk for benzene in all sections was significantly higher than allowable limit; the non-cancer risk for benzene in all sections and toluene in the benzol refinement section was also higher than 1.0. In conclusion, the current control measures are not sufficient and should be improved for efficient control of occupational exposures.

XRCC2 Polymorphisms and Environmental Factors Predict High Risk of Colorectal Cancer.

PubMed

Wang, Lijie; Ma, Junxun; Yang, Bo; Jing, Fangfang; Hu, Yi

2018-05-07

BACKGROUND This case-control study aimed to analyze the association of [i]XRCC2[/i] polymorphisms (rs3218408 and rs3218384) with colorectal cancer (CRC) risk. The interaction of [i]XRCC2[/i] polymorphisms with environmental factors was investigated as well. MATERIAL AND METHODS We enrolled 147 CRC patients and 114 healthy individuals into the study. Polymerase chain reaction (PCR)-sequencing method was performed to detect rs3218408 and rs3218384 polymorphisms. Hardy-Weinberg equilibrium (HWE) was checked in the control group. Odds ratio (OR) with 95% confidence interval (CI) represented the risk of CRC. Cross-table method was used in analyzing the interaction effects. RESULTS Compared to the control group, the frequency of smokers was much higher in the case group ([i]P[/i]<0.001). A similar result was observed in drinkers (55.8% [i]vs.[/i] 40.4%, [i]P[/i]=0.013). Dietary habits of all subjects were investigated as well, showing that CRC patients ate fewer vegetables than did healthy controls (P<0.001). In the analysis of polymorphisms, rs3218408 appeared to be an independent risk factor of CRC (GG: OR=2.048, 95%CI=1.032-4.061; G allele: OR=1.445, 95%CI=1.019-2.049). There were 68 (76.4%) C allele carriers (rs3218384) among smokers, which was higher than the number of G allele carriers ([i]P[/i]<0.001). A similar outcome was observed for alcohol drinkers ([i]P[/i]=0.048), which suggests a relationship of rs3218384 with smoking and drinking. Further analysis indicated that interaction of rs3218384 with smoking increased the risk of CRC (GG and smoking: OR=3.250, 95%CI=1.235-8.556; GC+CC and smoking: OR=2.167, 95%CI=1.175-3.996). CONCLUSIONS We found that rs3218408 was related with increased risk of CRC, and the interaction of rs3218384 with smoking increased the risk of CRC.

Case-control geographic clustering for residential histories accounting for risk factors and covariates.

PubMed

Jacquez, Geoffrey M; Meliker, Jaymie R; Avruskin, Gillian A; Goovaerts, Pierre; Kaufmann, Andy; Wilson, Mark L; Nriagu, Jerome

2006-08-03

Methods for analyzing space-time variation in risk in case-control studies typically ignore residential mobility. We develop an approach for analyzing case-control data for mobile individuals and apply it to study bladder cancer in 11 counties in southeastern Michigan. At this time data collection is incomplete and no inferences should be drawn - we analyze these data to demonstrate the novel methods. Global, local and focused clustering of residential histories for 219 cases and 437 controls is quantified using time-dependent nearest neighbor relationships. Business address histories for 268 industries that release known or suspected bladder cancer carcinogens are analyzed. A logistic model accounting for smoking, gender, age, race and education specifies the probability of being a case, and is incorporated into the cluster randomization procedures. Sensitivity of clustering to definition of the proximity metric is assessed for 1 to 75 k nearest neighbors. Global clustering is partly explained by the covariates but remains statistically significant at 12 of the 14 levels of k considered. After accounting for the covariates 26 Local clusters are found in Lapeer, Ingham, Oakland and Jackson counties, with the clusters in Ingham and Oakland counties appearing in 1950 and persisting to the present. Statistically significant focused clusters are found about the business address histories of 22 industries located in Oakland (19 clusters), Ingham (2) and Jackson (1) counties. Clusters in central and southeastern Oakland County appear in the 1930's and persist to the present day. These methods provide a systematic approach for evaluating a series of increasingly realistic alternative hypotheses regarding the sources of excess risk. So long as selection of cases and controls is population-based and not geographically biased, these tools can provide insights into geographic risk factors that were not specifically assessed in the case-control study design.

Association of FAS A-670G Polymorphism and Risk of Uterine Leiomyoma in a Southeast Iranian Population

PubMed Central

Mohammadpour-Gharehbagh, Abbas; Salimi, Saeedeh; Keshavarzi, Farshid; Zakerian, Sepideh; Sajadian, Mojtaba; Mokhtari, Mojgan

2016-01-01

Background: Uterine leiomyoma (UL) is a benign tumor of uterine smooth muscle that affects women in reproductive ages. FAS has an important role in initial stages of apoptosis. Previous studies have shown an association between the FAS gene and tumorigenesis. In the present study, we evaluated the relationship between FAS A-670G (rs 1800682) and UL risk Methods: The FAS gene polymorphism of 155 women with UL and 157 healthy controls was analyzed by the polymerase chain reaction restriction fragment length polymorphism method Results: The AA, AG, and GG genotype frequencies of the FAS A-670G polymorphism were respectively 37.4, 42.6, and 20% in women with UL, and 46, 42.6, and 11.5% in healthy controls. The risk of UL in women was 1.5-fold greater in GG-genotype women than in AA-genotype women. The G allele frequencies were 41% in women with UL and 33% in healthy controls and statistically different (P = 0.03) Conclusion: The FAS polymorphism was associated with the risk of UL in a sample of Iranian women. PMID:28070535

Predicting and controlling risks from human exposures to vibration and mechanical shock: flag waving and flag weaving.

PubMed

Griffin, Michael J

2015-01-01

At work or in leisure activities, many people are exposed to vibration or mechanical shocks associated with risks of injury or disease. This paper identifies information that can be used to decide whether there may be a risk from exposure to hand-transmitted vibration or whole-body vibration and shock, and suggests actions that can control the risks. The complex and time-varying nature of human exposures to vibration and shock, the complexity of the different disorders and uncertainty as to the mechanisms of injury and the factors influencing injury have prevented the definition of dose-response relationships well proven by scientific study. It is necessary to wave a flag indicating when there is a need to control risks from exposure to vibration and shock while scientific enquiry provides understanding needed to weave a better flag. It is concluded that quantifying exposure severity is often neither necessary nor sufficient to either identify risks or implement measures that control the risks. The identification of risks associated with exposure to vibration and mechanical shock cannot, and need not, rely solely on the quantification of exposure severity. Qualitative methods can provide a sufficient indication of the need for control measures, which should not be restricted to reducing standardised measures of exposure severity.

Relationships among Subjective Social Status, Weight Perception, Weight Control Behaviors, and Weight Status in Adolescents: Findings from the 2009 Korea Youth Risk Behaviors Web-Based Survey

ERIC Educational Resources Information Center

Ha, Yeongmi; Choi, Eunsook; Seo, Yeongmi; Kim, Tae-gu

2013-01-01

Background: This study identified relationships among subjective social status (SSS), weight perception, weight control behaviors, and weight status in Korean adolescents using nationally representative data collected from the 2009 Korea Youth Risk Behaviors Web-Based Survey. Methods: Data from 67,185 students aged 12-18 years were analyzed.…

Aviation Security, Risk Assessment, and Risk Aversion for Public Decisionmaking

ERIC Educational Resources Information Center

Stewart, Mark G.; Mueller, John

2013-01-01

This paper estimates risk reductions for each layer of security designed to prevent commercial passenger airliners from being commandeered by terrorists, kept under control for some time, and then crashed into specific targets. Probabilistic methods are used to characterize the uncertainty of rates of deterrence, detection, and disruption, as well…

Single Nucleotide Polymorphism in ATM Gene, Cooking Oil Fumes and Lung Adenocarcinoma Susceptibility in Chinese Female Non-Smokers: A Case-Control Study

PubMed Central

Shen, Li; Yin, Zhihua; Wu, Wei; Ren, Yangwu; Li, Xuelian; Zhou, Baosen

2014-01-01

Background The ataxia-telangiectasia mutated (ATM) gene plays an important role in the DNA double-strand breaks repair pathway. Single nucleotide polymorphisms (SNPs) of DNA repair genes are suspected to influence the risk of lung cancer. This study aimed to investigate the association between the ATM -111G>A (rs189037) polymorphism, environmental risk factors and the risk of lung adenocarcinoma in Chinese female non-smokers. Methods A hospital-based case-control study of 487 lung cancer patients and 516 matched cancer-free controls was conducted. Information concerning demographic and environmental risk factors was obtained for each case and control by a trained interviewer. After informed consent was obtained, 10 ml venous blood was collected from each subject for biomarker testing. Single nucleotide polymorphism was determined by using TaqMan method. Results This study showed that the individuals with ATM rs189037 AA genotype were at an increased risk for lung adenocarcinoma compared with those carrying the GA or GG genotype (adjusted odds ratios (OR) 1.44, 95% confidence interval (CI) 1.02–2.02, P = 0.039). The stratified analysis suggested that increased risk associated with ATM rs189037 AA genotype in individuals who never or seldom were exposed to cooking oil fumes (adjusted OR 1.89, 95%CI 1.03–3.49, P = 0.040). Conclusions ATM rs189037 might be associated with the risk of lung adenocarcinoma in Chinese non-smoking females. Furthermore, ATM rs189037 AA genotype might be a risk factor of lung adenocarcinoma among female non-smokers without cooking oil fume exposure. PMID:24819391

Pregnancy risk among black, white, and Hispanic teen girls in New York City public schools.

PubMed

Waddell, Elizabeth Needham; Orr, Mark G; Sackoff, Judith; Santelli, John S

2010-05-01

Disparities in teen pregnancy rates are explained by different rates of sexual activity and contraceptive use. Identifying other components of risk such as race/ethnicity and neighborhood can inform strategies for teen pregnancy prevention. Data from the 2005 and 2007 New York City Youth Risk Behavior Surveys were used to model demographic differences in odds of recent sexual activity and birth control use among black, white, and Hispanic public high school girls. Overall pregnancy risk was calculated using pregnancy risk index (PRI) methodology, which estimates probability of pregnancy based on current sexual activity and birth control method at last intercourse. Factors of race/ethnicity, grade level, age, borough, and school neighborhood were assessed. Whites reported lower rates of current sexual activity (23.4%) than blacks (35.4%) or Hispanics (32.7%), and had lower predicted pregnancy risk (PRI = 5.4% vs. 9.0% and 10.5%, respectively). Among sexually active females, hormonal contraception use rates were low in all groups (11.6% among whites, 7.8% among blacks, and 7.5% among Hispanics). Compared to white teens, much of the difference in PRI was attributable to poorer contraceptive use (19% among blacks and 50% among Hispanics). Significant differences in contraceptive use were also observed by school neighborhood after adjusting for age group and race/ethnicity. Interventions to reduce teen pregnancy among diverse populations should include messages promoting delayed sexual activity, condom use and use of highly effective birth control methods. Access to long-acting contraceptive methods must be expanded for all sexually active high school students.

Agent of opportunity risk mitigation: people, engineering, and security efficacy.

PubMed

Graham, Margaret E; Tunik, Michael G; Farmer, Brenna M; Bendzans, Carly; McCrillis, Aileen M; Nelson, Lewis S; Portelli, Ian; Smith, Silas; Goldberg, Judith D; Zhang, Meng; Rosenberg, Sheldon D; Goldfrank, Lewis R

2010-12-01

Agents of opportunity (AO) are potentially harmful biological, chemical, radiological, and pharmaceutical substances commonly used for health care delivery and research. AOs are present in all academic medical centers (AMC), creating vulnerability in the health care sector; AO attributes and dissemination methods likely predict risk; and AMCs are inadequately secured against a purposeful AO dissemination, with limited budgets and competing priorities. We explored health care workers' perceptions of AMC security and the impact of those perceptions on AO risk. Qualitative methods (survey, interviews, and workshops) were used to collect opinions from staff working in a medical school and 4 AMC-affiliated hospitals concerning AOs and the risk to hospital infrastructure associated with their uncontrolled presence. Secondary to this goal, staff perception concerning security, or opinions about security behaviors of others, were extracted, analyzed, and grouped into themes. We provide a framework for depicting the interaction of staff behavior and access control engineering, including the tendency of staff to "defeat" inconvenient access controls. In addition, 8 security themes emerged: staff security behavior is a significant source of AO risk; the wide range of opinions about "open" front-door policies among AMC staff illustrates a disparity of perceptions about the need for security; interviewees expressed profound skepticism concerning the effectiveness of front-door access controls; an AO risk assessment requires reconsideration of the security levels historically assigned to areas such as the loading dock and central distribution sites, where many AOs are delivered and may remain unattended for substantial periods of time; researchers' view of AMC security is influenced by the ongoing debate within the scientific community about the wisdom of engaging in bioterrorism research; there was no agreement about which areas of the AMC should be subject to stronger access controls; security personnel play dual roles of security and customer service, creating the negative perception that neither role is done well; and budget was described as an important factor in explaining the state of security controls. We determined that AMCs seeking to reduce AO risk should assess their institutionally unique AO risks, understand staff security perceptions, and install access controls that are responsive to the staff's tendency to defeat them. The development of AO attribute fact sheets is desirable for AO risk assessment; new funding and administrative or legislative tools to improve AMC security are required; and security practices and methods that are convenient and effective should be engineered.

Cranberry Reduces the Risk of Urinary Tract Infection Recurrence in Otherwise Healthy Women: A Systematic Review and Meta-Analysis.

PubMed

Fu, Zhuxuan; Liska, DeAnn; Talan, David; Chung, Mei

2017-12-01

Background: Cranberry ( Vaccinium spp.) has been advocated for treatment of urinary tract infection (UTI); however, its efficacy is controversial. Women have a 50% risk of UTI over their lifetime, and ∼20-30% experience a subsequent UTI recurrence. Objective: We conducted this meta-analysis to assess the effect of cranberry on the risk of UTI recurrence in otherwise healthy women. Methods: Literature published before January 2011 was obtained from 2 published systematic reviews, and we conducted updated searches in EMBASE and MEDLINE (through July 2017). We included randomized controlled trials that were conducted in generally healthy nonpregnant women aged ≥18 y with a history of UTI, compared cranberry intervention to a placebo or control, and reported the outcome as the number of participants experiencing a UTI. Two researchers conducted abstract and full-text screenings, data extractions, and risk of bias assessments independently, and discrepancies were resolved by group consensus. Meta-analyses were performed by using Stata SE software (version 13). We employed a fixed-effect model using the Mantel-Haenszel method to estimate the summary risk if the heterogeneity was low to moderate ( I 2 < 50%). Otherwise, we applied a random-effects model using the DerSimonian-Laird method. Results: We identified 7 randomized controlled trials conducted in healthy women at risk of UTI ( n = 1498 participants). Results of the meta-analysis showed that cranberry reduced the risk of UTI by 26% (pooled risk ratio: 0.74; 95% CI: 0.55, 0.98; I 2 = 54%). Risk of bias indicated that 2 studies had high loss to follow-up or selective outcome reporting. Overall, the studies were relatively small, with only 2 having >300 participants. Conclusion: These results suggest that cranberry may be effective in preventing UTI recurrence in generally healthy women; however, larger high-quality studies are needed to confirm these findings. This trial was registered at crd.york.ac.uk/prospero as CRD42015024439. © 2017 American Society for Nutrition.

Suicide Among Patients in the Veterans Affairs Health System: Rural–Urban Differences in Rates, Risks, and Methods

PubMed Central

Blow, Frederic C.; Ignacio, Rosalinda V.; Ilgen, Mark A.; Austin, Karen L.; Valenstein, Marcia

2012-01-01

Objectives. Using national patient cohorts, we assessed rural–urban differences in suicide rates, risks, and methods in veterans. Methods. We identified all Department of Veterans Affairs (VA) patients in fiscal years 2003 to 2004 (FY03–04) alive at the start of FY04 (n = 5 447 257) and all patients in FY06–07 alive at the start of FY07 (n = 5 709 077). Mortality (FY04–05 and FY07–08) was assessed from National Death Index searches. Census criteria defined rurality. We used proportional hazards regressions to calculate rural–urban differences in risks, controlling for age, gender, psychiatric diagnoses, VA mental health services accessibility, and regional administrative network. Suicide method was categorized as firearms, poisoning, strangulation, or other. Results. Rural patients had higher suicide rates (38.8 vs 31.4/100 000 person-years in FY04–05; 39.6 vs 32.4/100 000 in FY07–08). Rural residence was associated with greater suicide risks (20% greater, FY04–05; 22% greater, FY07–08). Firearm deaths were more common in rural suicides (76.8% vs 61.5% in FY07–08). Conclusions. Rural residence is a suicide risk factor, even after controlling for mental health accessibility. Public health and health system suicide prevention should address risks in rural areas. PMID:22390583

A conceptual framework for coupling the biophysical and social dimensions of wildfire to improve fireshed planning and risk mitigation

Treesearch

Jeff Kline; Alan A. Ager; Paige Fischer

2015-01-01

The need for improved methods for managing wildfire risk is becoming apparent as uncharacteristically large wildfires in the western US and elsewhere exceed government capacities for their control and suppression. We propose a coupled biophysical-social framework to managing wildfire risk that relies on wildfire simulation to identify spatial patterns of wildfire risk...

Revision of Viable Environmental Monitoring in a Development Pilot Plant Based on Quality Risk Assessment: A Case Study.

PubMed

Ziegler, Ildikó; Borbély-Jakab, Judit; Sugó, Lilla; Kovács, Réka J

2017-01-01

In this case study, the principles of quality risk management were applied to review sampling points and monitoring frequencies in the hormonal tableting unit of a formulation development pilot plant. In the cleanroom area, premises of different functions are located. Therefore a general method was established for risk evaluation based on the Hazard Analysis and Critical Control Points (HACCP) method to evaluate these premises (i.e., production area itself and ancillary clean areas) from the point of view of microbial load and state in order to observe whether the existing monitoring program met the emerged advanced monitoring practice. LAY ABSTRACT: In pharmaceutical production, cleanrooms are needed for the manufacturing of final dosage forms of drugs-intended for human or veterinary use-in order to protect the patient's weakened body from further infections. Cleanrooms are premises with a controlled level of contamination that is specified by the number of particles per cubic meter at a specified particle size or number of microorganisms (i.e. microbial count) per surface area. To ensure a low microbial count over time, microorganisms are detected and counted by environmental monitoring methods regularly. It is reasonable to find the easily infected places by risk analysis to make sure the obtained results really represent the state of the whole room. This paper presents a risk analysis method for the optimization of environmental monitoring and verification of the suitability of the method. © PDA, Inc. 2017.

Proactive Motor Control Reduces Monetary Risk Taking in Gambling

PubMed Central

Adams, Rachel; Chambers, Christopher D.

2012-01-01

Less supervision by the executive system after disruption of the right prefrontal cortex leads to increased risk taking in gambling because superficially attractive—but risky—choices are not suppressed. Similarly, people might gamble more in multitask situations than in single-task situations because concurrent executive processes usually interfere with each other. In the study reported here, we used a novel monetary decision-making paradigm to investigate whether multitasking could reduce rather than increase risk taking in gambling. We found that performing a task that induced cautious motor responding reduced gambling in a multitask situation (Experiment 1). We then found that a short period of inhibitory training lessened risk taking in gambling at least 2 hr later (Experiments 2 and 3). Our findings indicate that proactive motor control strongly affects monetary risk taking in gambling. The link between control systems at different cognitive levels might be exploited to develop new methods for rehabilitation of addiction and impulse-control disorders. PMID:22692336

HIV quality report cards: impact of case-mix adjustment and statistical methods.

PubMed

Ohl, Michael E; Richardson, Kelly K; Goto, Michihiko; Vaughan-Sarrazin, Mary; Schweizer, Marin L; Perencevich, Eli N

2014-10-15

There will be increasing pressure to publicly report and rank the performance of healthcare systems on human immunodeficiency virus (HIV) quality measures. To inform discussion of public reporting, we evaluated the influence of case-mix adjustment when ranking individual care systems on the viral control quality measure. We used data from the Veterans Health Administration (VHA) HIV Clinical Case Registry and administrative databases to estimate case-mix adjusted viral control for 91 local systems caring for 12 368 patients. We compared results using 2 adjustment methods, the observed-to-expected estimator and the risk-standardized ratio. Overall, 10 913 patients (88.2%) achieved viral control (viral load ≤400 copies/mL). Prior to case-mix adjustment, system-level viral control ranged from 51% to 100%. Seventeen (19%) systems were labeled as low outliers (performance significantly below the overall mean) and 11 (12%) as high outliers. Adjustment for case mix (patient demographics, comorbidity, CD4 nadir, time on therapy, and income from VHA administrative databases) reduced the number of low outliers by approximately one-third, but results differed by method. The adjustment model had moderate discrimination (c statistic = 0.66), suggesting potential for unadjusted risk when using administrative data to measure case mix. Case-mix adjustment affects rankings of care systems on the viral control quality measure. Given the sensitivity of rankings to selection of case-mix adjustment methods-and potential for unadjusted risk when using variables limited to current administrative databases-the HIV care community should explore optimal methods for case-mix adjustment before moving forward with public reporting. Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2014. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Review of qualitative approaches for the construction industry: designing a risk management toolbox.

PubMed

Zalk, David M; Spee, Ton; Gillen, Matt; Lentz, Thomas J; Garrod, Andrew; Evans, Paul; Swuste, Paul

2011-06-01

This paper presents the framework and protocol design for a construction industry risk management toolbox. The construction industry needs a comprehensive, systematic approach to assess and control occupational risks. These risks span several professional health and safety disciplines, emphasized by multiple international occupational research agenda projects including: falls, electrocution, noise, silica, welding fumes, and musculoskeletal disorders. Yet, the International Social Security Association says, "whereas progress has been made in safety and health, the construction industry is still a high risk sector." Small- and medium-sized enterprises (SMEs) employ about 80% of the world's construction workers. In recent years a strategy for qualitative occupational risk management, known as Control Banding (CB) has gained international attention as a simplified approach for reducing work-related risks. CB groups hazards into stratified risk 'bands', identifying commensurate controls to reduce the level of risk and promote worker health and safety. We review these qualitative solutions-based approaches and identify strengths and weaknesses toward designing a simplified CB 'toolbox' approach for use by SMEs in construction trades. This toolbox design proposal includes international input on multidisciplinary approaches for performing a qualitative risk assessment determining a risk 'band' for a given project. Risk bands are used to identify the appropriate level of training to oversee construction work, leading to commensurate and appropriate control methods to perform the work safely. The Construction Toolbox presents a review-generated format to harness multiple solutions-based national programs and publications for controlling construction-related risks with simplified approaches across the occupational safety, health and hygiene professions.

Apgar Score Is Related to Development of Atopic Dermatitis: Cotwin Control Study

PubMed Central

Naeser, Vibeke; Kahr, Niklas; Stensballe, Lone Graff; Kyvik, Kirsten Ohm; Skytthe, Axel; Backer, Vibeke

2013-01-01

Aim. To study the impact of birth characteristics on the risk of atopic dermatitis in a twin population. Methods. In a population-based questionnaire study of 10,809 twins, 3–9 years of age, from the Danish Twin Registry, we identified 907 twin pairs discordant for parent-reported atopic dermatitis. We cross-linked with data from the Danish National Birth Registry and performed cotwin control analysis in order to test the impact of birth characteristics on the risk of atopic dermatitis. Results. Apgar score, OR (per unit) = 1.23 (1.06–1.44), P = 0.008, and female sex, OR = 1.31 (1.06–1.61), P = 0.012, were risk factors for atopic dermatitis in cotwin control analysis, whereas birth anthropometric factors were not significantly related to disease development. Risk estimates in monozygotic and dizygotic twins were not significantly different for the identified risk factors. Conclusions. In this population-based cotwin control study, high Apgar score was a risk factor for atopic dermatitis. This novel finding must be confirmed in subsequent studies. PMID:24222775

Risk assessment for construction projects of transport infrastructure objects

NASA Astrophysics Data System (ADS)

Titarenko, Boris

2017-10-01

The paper analyzes and compares different methods of risk assessment for construction projects of transport objects. The management of such type of projects demands application of special probabilistic methods due to large level of uncertainty of their implementation. Risk management in the projects requires the use of probabilistic and statistical methods. The aim of the work is to develop a methodology for using traditional methods in combination with robust methods that allow obtaining reliable risk assessments in projects. The robust approach is based on the principle of maximum likelihood and in assessing the risk allows the researcher to obtain reliable results in situations of great uncertainty. The application of robust procedures allows to carry out a quantitative assessment of the main risk indicators of projects when solving the tasks of managing innovation-investment projects. Calculation of damage from the onset of a risky event is possible by any competent specialist. And an assessment of the probability of occurrence of a risky event requires the involvement of special probabilistic methods based on the proposed robust approaches. Practice shows the effectiveness and reliability of results. The methodology developed in the article can be used to create information technologies and their application in automated control systems for complex projects.

A web-based personalized risk communication and decision-making tool for women with dense breasts: Design and methods of a randomized controlled trial within an integrated health care system.

PubMed

Knerr, Sarah; Wernli, Karen J; Leppig, Kathleen; Ehrlich, Kelly; Graham, Amanda L; Farrell, David; Evans, Chalanda; Luta, George; Schwartz, Marc D; O'Neill, Suzanne C

2017-05-01

Mammographic breast density is one of the strongest risk factors for breast cancer after age and family history. Mandatory breast density disclosure policies are increasing nationally without clear guidance on how to communicate density status to women. Coupling density disclosure with personalized risk counseling and decision support through a web-based tool may be an effective way to allow women to make informed, values-consistent risk management decisions without increasing distress. This paper describes the design and methods of Engaged, a prospective, randomized controlled trial examining the effect of online personalized risk counseling and decision support on risk management decisions in women with dense breasts and increased breast cancer risk. The trial is embedded in a large integrated health care system in the Pacific Northwest. A total of 1250 female health plan members aged 40-69 with a recent negative screening mammogram who are at increased risk for interval cancer based on their 5-year breast cancer risk and BI-RADS® breast density will be randomly assigned to access either a personalized web-based counseling and decision support tool or standard educational content. Primary outcomes will be assessed using electronic health record data (i.e., chemoprevention and breast MRI utilization) and telephone surveys (i.e., distress) at baseline, six weeks, and twelve months. Engaged will provide evidence about whether a web-based personalized risk counseling and decision support tool is an effective method for communicating with women about breast density and risk management. An effective intervention could be disseminated with minimal clinical burden to align with density disclosure mandates. Clinical Trials Registration Number:NCT03029286. Copyright © 2017 Elsevier Inc. All rights reserved.

Assessment of nutritional knowledge in female athletes susceptible to the Female Athlete Triad syndrome

PubMed Central

Raymond-Barker, Philippa; Petroczi, Andrea; Quested, Eleanor

2007-01-01

Background The study aimed to i) assess nutritional knowledge in female athletes susceptible to the Female Athlete Triad (FAT) syndrome and to compare with controls; and ii) to compare nutritional knowledge of those who were classified as being 'at risk' for developing FAT syndrome and those who are 'not at risk'. Methods In this study, participants completed General Nutritional Knowledge Questionnaire (GNKQ), the Eating Attitude Test (EAT-26) and survey measures of training/physical activity, menstrual and skeletal injury history. The sample consisted of 48 regional endurance athletes, 11 trampoline gymnasts and 32 untrained controls. Based on proxy measures for the FAT components, participants were classified being 'at risk' or 'not at risk' and nutrition knowledge scores were compared for the two groups. Formal education related to nutrition was considered. Results A considerably higher percentage of athletes were classified 'at risk' of menstrual dysfunction than controls (28.8% and 9.4%, respectively) and a higher percentage scored at or above the cutoff value of 20 on the EAT-26 test among athletes than controls (10.2% and 3.1%, respectively). 8.5% of athletes were classified 'at risk' for bone mineral density in contrast to none from the control group. Nutrition knowledge and eating attitude appeared to be independent for both athletes and controls. GNKQ scores of athletes were higher than controls but the differences between the knowledge of 'at risk' and 'not at risk' athletes and controls were inconsequential. Formal education in nutrition or closely related subjects does not have an influence on nutrition knowledge or on being classified as 'at risk' or 'not at risk'. Conclusion The lack of difference in nutrition knowledge between 'at risk' and 'not at risk' athletes suggests that lack of information is not accountable for restricted eating associated with the Female Athlete Triad. PMID:17900347

Adolescent Nutrition and Physical Fitness. Selected Indicators. Findings for 9th-12th Grade Students from the 1993 North Carolina Youth Risk Behavior Survey.

ERIC Educational Resources Information Center

Mikow, Victoria A.

A survey of 2,439 high school students (the 1993 Youth Risk Behavior Survey) in North Carolina found that students present a mixed picture of healthy and risky physical, nutritional, and weight management practices. The survey examined perception of body weight; weight control by gender; method of weight control; consumption of fruit or fruit…

76 FR 29767 - Preventive Controls for Registered Human Food and Animal Food/Feed Facilities; Request for Comments

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-23

... associated with specific types of food or specific methods of manufacturing, processing, packing, or holding... specific methods of manufacturing, processing, packing, or holding food. In particular, we welcome input on... controls (e.g., procedures and practices utilized to minimize the risk of contamination) for human food and...

Human Papilloma Virus in Head and Neck Squamous Cell Cancer

PubMed Central

Asvadi Kermani, I; Seifi, SH; Dolatkhah, R; Sakhinia, E; Dastgiri, S; Ebrahimi, A; Lotfy, A; Esmaeili, HA; G, Mohammadi; M, Naderpour; SH, Hajalipour; Haggi A, Asghari; M, Nadri

2012-01-01

Background Epidemiologic and molecular evidences have established a strong link between high risk types of Human Papilloma Virus and a subgroup of Head and Neck Squamous Cell Carcinomas (HNSCC). We evaluated the frequency of HPV positivity in HNSCC and its relationship to demographic and some risk factor variables in an open case- control study. Methods Fourteen recently diagnosed patients with squamous cell cancer of oropharynx, hypopharynx and larynx aged 18-50 years were examined from 2008-2010 in Tabriz, Iran. HPV DNA was extracted from paraffin-embedded blocks of each patient's sample for PCR evaluation. Saliva samples of 94 control cancer-free subjects were collected for DNA analysis. Multivariable logistic regression method was used to calculate odds ratio for case-control comparisons. Results High risk HPV was detected in 6(42.8%) patients, and 6(5.3%) control subjects which was statistically significant (p<0.0001). HPV-18 was the most frequent type both in the cases and controls. HPV-16 DNA was detected in two patients of the case group, but it was not detected in any of the controls. The relation between demographic and risk factor variables was not statistically significant. Conclusion HPV infection has a significant impact on HNSCC. Despite HPV-16 stronger impact, HPV-18 is more likely to cause malignant degeneration in such cancers amongst some communities. It is vital to introduce and conduct immunization schedules in health care systems to protect communities to some extent. PMID:25780535

Young Adult Cannabis Users Report Greater Propensity for Risk-Taking Only in Non-Monetary Domains

PubMed Central

Gilman, Jodi M.; Calderon, Vanessa; Curran, Max T.; Evins, A. Eden

2014-01-01

BACKGROUND Though substance use is often associated with elevated risk-taking in real-world scenarios, many risk-taking tasks in experimental psychology using financial gambles fail to find significant differences between individuals with substance use disorders and healthy controls. We assessed whether participants using marijuana would show a greater propensity for risk-taking in distinct domains including, but not limited to, financial risk-taking. METHODS In the current study, we assessed risk-taking in young adult (age 18–25) regular marijuana users and in non-using control participants using a domain-specific risk-taking self-report scale (DOSPERT) encompassing five domains of risk-taking (social, financial, recreational, health/safety, and ethical). We also measured behavioral risk-taking using a laboratory monetary risk-taking task. RESULTS Marijuana users and controls reported significant differences on the social, health/safety, and ethical risk-taking scales, but no differences in the propensity to take recreational or financial risks. Complementing the self-report finding, there were no differences between marijuana users and controls in their performance on the laboratory risk-taking task. CONCLUSIONS These findings suggest that financial risk-taking may be less sensitive than other domains of risk-taking in assessing differences in risky behavior between those who use marijuana and those who do not. In order to more consistently determine whether increased risk-taking is a factor in substance use, it may be necessary to use both monetary risk-taking tasks and complementary assessments of non-monetary-based risk-taking measures. PMID:25577478

Risk of Substance Use Disorders in Adolescents with Bipolar Disorder

ERIC Educational Resources Information Center

Wilens, Timothy E.; Biederman, Joseph; Kwon, Anne; Ditterline, Jeffrey; Forkner, Peter; Moore, Hadley; Swezey, Allison; Snyder, Lindsey; Henin, Aude; Wozniak, Janet; Faraone, Stephen V.

2004-01-01

Objective: Previous work in adults and youths has suggested that juvenile onset bipolar disorder (BPD) is associated with an elevated risk of substance use disorders (SUD). Considering the public health importance of this issue, the authors now report on a controlled study of adolescents with and without BPD to evaluate the risk of SUD. Method:…

A Case-Control Study Estimating Accident Risk for Alcohol, Medicines and Illegal Drugs

PubMed Central

Kuypers, Kim Paula Colette; Legrand, Sara-Ann; Ramaekers, Johannes Gerardus; Verstraete, Alain Gaston

2012-01-01

Background The aim of the present study was to assess the risk of having a traffic accident after using alcohol, single drugs, or a combination, and to determine the concentrations at which this risk is significantly increased. Methods A population-based case-control study was carried out, collecting whole blood samples of both cases and controls, in which a number of drugs were detected. The risk of having an accident when under the influence of drugs was estimated using logistic regression adjusting for gender, age and time period of accident (cases)/sampling (controls). The main outcome measures were odds ratio (OR) for accident risk associated with single and multiple drug use. In total, 337 cases (negative: 176; positive: 161) and 2726 controls (negative: 2425; positive: 301) were included in the study. Results Main findings were that 1) alcohol in general (all the concentrations together) caused an elevated crash risk; 2) cannabis in general also caused an increase in accident risk; at a cut-off of 2 ng/mL THC the risk of having an accident was four times the risk associated with the lowest THC concentrations; 3) when ranking the adjusted OR from lowest to highest risk, alcohol alone or in combination with other drugs was related to a very elevated crash risk, with the highest risk for stimulants combined with sedatives. Conclusion The study demonstrated a concentration-dependent crash risk for THC positive drivers. Alcohol and alcohol-drug combinations are by far the most prevalent substances in drivers and subsequently pose the largest risk in traffic, both in terms of risk and scope. PMID:22952694

Accelerated Monte Carlo Simulation for Safety Analysis of the Advanced Airspace Concept

NASA Technical Reports Server (NTRS)

Thipphavong, David

2010-01-01

Safe separation of aircraft is a primary objective of any air traffic control system. An accelerated Monte Carlo approach was developed to assess the level of safety provided by a proposed next-generation air traffic control system. It combines features of fault tree and standard Monte Carlo methods. It runs more than one order of magnitude faster than the standard Monte Carlo method while providing risk estimates that only differ by about 10%. It also preserves component-level model fidelity that is difficult to maintain using the standard fault tree method. This balance of speed and fidelity allows sensitivity analysis to be completed in days instead of weeks or months with the standard Monte Carlo method. Results indicate that risk estimates are sensitive to transponder, pilot visual avoidance, and conflict detection failure probabilities.

Malaria Risk Mapping for Control in the Republic of Sudan

PubMed Central

Noor, Abdisalan M.; ElMardi, Khalid A.; Abdelgader, Tarig M.; Patil, Anand P.; Amine, Ahmed A. A.; Bakhiet, Sahar; Mukhtar, Maowia M.; Snow, Robert W.

2012-01-01

Evidence shows that malaria risk maps are rarely tailored to address national control program ambitions. Here, we generate a malaria risk map adapted for malaria control in Sudan. Community Plasmodium falciparum parasite rate (PfPR) data from 2000 to 2010 were assembled and were standardized to 2–10 years of age (PfPR2–10). Space-time Bayesian geostatistical methods were used to generate a map of malaria risk for 2010. Surfaces of aridity, urbanization, irrigation schemes, and refugee camps were combined with the PfPR2–10 map to tailor the epidemiological stratification for appropriate intervention design. In 2010, a majority of the geographical area of the Sudan had risk of < 1% PfPR2–10. Areas of meso- and hyperendemic risk were located in the south. About 80% of Sudan's population in 2011 was in the areas in the desert, urban centers, or where risk was < 1% PfPR2–10. Aggregated data suggest reducing risks in some high transmission areas since the 1960s. PMID:23033400

Management of Occupational Exposure to Engineered Nanoparticles Through a Chance-Constrained Nonlinear Programming Approach

PubMed Central

Chen, Zhi; Yuan, Yuan; Zhang, Shu-Shen; Chen, Yu; Yang, Feng-Lin

2013-01-01

Critical environmental and human health concerns are associated with the rapidly growing fields of nanotechnology and manufactured nanomaterials (MNMs). The main risk arises from occupational exposure via chronic inhalation of nanoparticles. This research presents a chance-constrained nonlinear programming (CCNLP) optimization approach, which is developed to maximize the nanaomaterial production and minimize the risks of workplace exposure to MNMs. The CCNLP method integrates nonlinear programming (NLP) and chance-constrained programming (CCP), and handles uncertainties associated with both the nanomaterial production and workplace exposure control. The CCNLP method was examined through a single-walled carbon nanotube (SWNT) manufacturing process. The study results provide optimal production strategies and alternatives. It reveal that a high control measure guarantees that environmental health and safety (EHS) standards regulations are met, while a lower control level leads to increased risk of violating EHS regulations. The CCNLP optimization approach is a decision support tool for the optimization of the increasing MNMS manufacturing with workplace safety constraints under uncertainties. PMID:23531490

Management of occupational exposure to engineered nanoparticles through a chance-constrained nonlinear programming approach.

PubMed

Chen, Zhi; Yuan, Yuan; Zhang, Shu-Shen; Chen, Yu; Yang, Feng-Lin

2013-03-26

Critical environmental and human health concerns are associated with the rapidly growing fields of nanotechnology and manufactured nanomaterials (MNMs). The main risk arises from occupational exposure via chronic inhalation of nanoparticles. This research presents a chance-constrained nonlinear programming (CCNLP) optimization approach, which is developed to maximize the nanaomaterial production and minimize the risks of workplace exposure to MNMs. The CCNLP method integrates nonlinear programming (NLP) and chance-constrained programming (CCP), and handles uncertainties associated with both the nanomaterial production and workplace exposure control. The CCNLP method was examined through a single-walled carbon nanotube (SWNT) manufacturing process. The study results provide optimal production strategies and alternatives. It reveal that a high control measure guarantees that environmental health and safety (EHS) standards regulations are met, while a lower control level leads to increased risk of violating EHS regulations. The CCNLP optimization approach is a decision support tool for the optimization of the increasing MNMS manufacturing with workplace safety constraints under uncertainties.

Long-term psychosocial work environment and cardiovascular mortality among Swedish men.

PubMed Central

Johnson, J V; Stewart, W; Hall, E M; Fredlund, P; Theorell, T

1996-01-01

OBJECTIVES. This study examined the effect of cumulative exposure to work organization--psychological demands, work control, and social support on prospectively measured cardiovascular disease mortality risk. METHODS. The source population was a national sample of 12517 subjects selected from the Swedish male population by Statistics Sweden in annual surveys between 1977 and 1981. Over a 14-year follow-up period, 521 deaths from cardiovascular disease were identified. A nested case-control design was used. Work environment exposure scores were assigned to cases and controls by linking lifetime job histories with a job exposure matrix. RESULTS. Conditional logistic regression analysis was used in examining cardiovascular mortality risk in relation to work exposure after adjustment for age, year last employed, smoking, exercise, education, social class, nationality, and physical job demands. In the final multi-variable analysis, workers with low work control had a relative risk of 1.83 (95% confidence interval [CI] = 1.19, 2.82) for cardiovascular mortality. Workers with combined exposure to low control and low support had a relative risk of 2.62 (95% CI=1.22, 5.61). CONCLUSIONS. These results indicate that long-term exposure to low work control is a risk factor for cardiovascular disease mortality. PMID:8604756

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

PubMed

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

2012-08-01

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

Effects of knowledge and internal locus of control in groups of health care workers judging likelihood of pathogen transfer.

PubMed

McLaughlin, Anne Collins; Walsh, Fran; Bryant, Michelle

2013-08-01

A study was conducted to measure the effects of attitudes and beliefs on the risk judgments of health care workers. Lack of hand hygiene compliance is a worldwide issue in health care, contributing to infections, fatalities, and increased health care costs. Human factors methods are a promising solution to the problem of compliance, although thus far, the concentration has been on process and engineering methods, such as the design of no-touch sinks. Factors internal to the health care worker, such as their attitudes and beliefs about hand hygiene, have received less attention. For this study, three groups of health care workers completed measures of attitudes, control beliefs, and hand hygiene knowledge. They then provided risk judgments of touching various surfaces via a factorial survey. Attitudes, knowledge, control beliefs, and surface type all predicted the risk judgments of the sample of health care workers, with differences between professional groups. Health care workers perceive less risk when touching surfaces,which may explain historically low rates of hand hygiene compliance after surface contact. Although more research is needed to directly connect risk judgments to failures of hand hygiene, the current results can inform interventions targeting the internal attitudes and beliefs of health care workers.

Proton pump inhibitors and the risk of pneumonia: a comparison of cohort and self-controlled case series designs

PubMed Central

2013-01-01

Background To compare the results of a new-user cohort study design and the self-controlled case series (SCCS) design using the risk of hospitalisation for pneumonia in those dispensed proton pump inhibitors compared to those unexposed as a case study. Methods The Australian Government Department of Veterans’ Affairs administrative claims database was used. Exposure to proton pump inhibitors and hospitalisations for pneumonia were identified over a 4 year study period 01 Jul 2007 -30 Jun 2011. The same inclusion and exclusion criteria were applied to both studies, however, the SCCS study included subjects with a least one hospitalisation for pneumonia. Results There were 105,467 subjects included in the cohort study and 6775 in the SCCS. Both studies showed an increased risk of hospitalisations for pneumonia in the three defined risk periods following initiation of proton pump inhibitors compared to baseline. With the highest risk in the first 1 to 7 days (Cohort RR, 3.24; 95% CI (2.50, 4.19): SCCS: RR, 3.07; 95% CI (2.69, 3.50)). Conclusions This study has shown that the self-controlled case series method produces similar risk estimates to a new-users cohort study design when applied to the association of proton pump inhibitors and pneumonia. Exposure to a proton pump inhibitor increases the likelihood of being admitted to hospital for pneumonia, with the risk highest in the first week of treatment. PMID:23800078

Feasibility of reusing time-matched controls in an overlapping cohort.

PubMed

Delcoigne, Bénédicte; Hagenbuch, Niels; Schelin, Maria Ec; Salim, Agus; Lindström, Linda S; Bergh, Jonas; Czene, Kamila; Reilly, Marie

2018-06-01

The methods developed for secondary analysis of nested case-control data have been illustrated only in simplified settings in a common cohort and have not found their way into biostatistical practice. This paper demonstrates the feasibility of reusing prior nested case-control data in a realistic setting where a new outcome is available in an overlapping cohort where no new controls were gathered and where all data have been anonymised. Using basic information about the background cohort and sampling criteria, the new cases and prior data are "aligned" to identify the common underlying study base. With this study base, a Kaplan-Meier table of the prior outcome extracts the risk sets required to calculate the weights to assign to the controls to remove the sampling bias. A weighted Cox regression, implemented in standard statistical software, provides unbiased hazard ratios. Using the method to compare cases of contralateral breast cancer to available controls from a prior study of metastases, we identified a multifocal tumor as a risk factor that has not been reported previously. We examine the sensitivity of the method to an imperfect weighting scheme and discuss its merits and pitfalls to provide guidance for its use in medical research studies.

A prospective study of musculoskeletal outcomes among manufacturing workers: II. Effects of psychosocial stress and work organization factors.

PubMed

Gerr, Fredric; Fethke, Nathan B; Anton, Dan; Merlino, Linda; Rosecrance, John; Marcus, Michele; Jones, Michael P

2014-02-01

The aim of this study was to characterize associations between psychosocial and work organizational risk factors and upper-extremity musculoskeletal symptoms and disorders. Methodological limitations of previous studies of psychosocial and work organizational risk factors and musculoskeletal outcomes have produced inconsistent associations. In this prospective epidemiologic study of 386 workers, questionnaires to assess decision latitude ("control") and psychological job demands ("demand") were administered to study participants and were used to classify them into job strain "quadrants". Measures of job stress and job change were collected during each week of follow-up. Incident hand/arm and neck/shoulder symptoms and disorders were ascertained weekly. Associations between exposure measures and musculoskeletal outcomes were estimated with proportional hazard methods. When compared to the low-demand/high-control job strain referent category, large increases in risk of hand/arm disorders were observed for both high-demand/high-control (hazard ratio [HR] = 4.49, 95% confidence interval [CI] = [1.23, 16.4]) and high-demand/low-control job strain categories (HR = 5.18,95% CI = [1.39, 19.4]). Similar associations were observed for hand/arm symptoms. A strong association was also observed between the low-demand/low-control job strain category and neck/shoulder disorders (HR = 6.46, 95% CI = [1.46, 28.6]). Statistically significant associations were also observed between weekly stress level and weekly job change and several musculoskeletal outcomes. Associations between psychosocial risk factors and work organizational factors and musculoskeletal outcomes were large and in the hypothesized direction. Prevention of occupational musculoskeletal disorders may require attention to psychosocial and work organizational factors in addition to physical factors. Methods to control adverse effects of psychosocial and work organizational risk factors should be explored.

Prevalence of and Risk Factors for Multidrug-Resistant Acinetobacter baumannii Colonization Among High-Risk Nursing Home Residents

PubMed Central

Mody, Lona; Gibson, Kristen E.; Horcher, Amanda; Prenovost, Katherine; McNamara, Sara E.; Foxman, Betsy; Kaye, Keith S.; Bradley, Suzanne

2015-01-01

OBJECTIVE To characterize the epidemiology of multidrug-resistant (MDR) Acinetobacter baumannii colonization in high-risk nursing home (NH) residents. DESIGN Nested case-control study within a multicenter prospective intervention trial. SETTING Four NHs in Southeast Michigan. PARTICIPANTS Case patients and control subjects were NH residents with an indwelling device (urinary catheter and/or feeding tube) selected from the control arm of the Targeted Infection Prevention study. Cases were residents colonized with MDR (resistant to ≥3 classes of antibiotics) A. baumannii; controls were never colonized with MDR A. baumannii. METHODS For active surveillance cultures, specimens from the nares, oropharynx, groin, perianal area, wounds, and device insertion site(s) were collected upon study enrollment, day 14, and monthly thereafter. A. baumannii strains and their susceptibilities were identified using standard microbiologic methods. RESULTS Of 168 NH residents, 25 (15%) were colonized with MDR A. baumannii. Compared with the 143 controls, cases were more functionally disabled (Physical Self-Maintenance Score >24; odds ratio, 5.1 [95% CI, 1.8–14.9]; P < .004), colonized with Proteus mirabilis (5.8 [1.9–17.9]; P < .003), and diabetic (3.4 [1.2–9.9]; P < .03). Most cases (22 [88%]) were colonized with multiple antibiotic-resistant organisms and 16 (64%) exhibited co-colonization with at least one other resistant gram-negative bacteria. CONCLUSION Functional disability, P. mirabilis colonization, and diabetes mellitus are important risk factors for colonization with MDR A. baumannii in high-risk NH residents. A. baumannii exhibits widespread antibiotic resistance and a preference to colonize with other antibiotic-resistant organisms, meriting enhanced attention and improved infection control practices in these residents. PMID:26072936

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

Balance Training Reduces Falls Risk in Older Individuals With Type 2 Diabetes

PubMed Central

Morrison, Steven; Colberg, Sheri R.; Mariano, Mira; Parson, Henri K.; Vinik, Arthur I.

2010-01-01

OBJECTIVE This study assessed the effects of balance/strength training on falls risk and posture in older individuals with type 2 diabetes. RESEARCH DESIGN AND METHODS Sixteen individuals with type 2 diabetes and 21 age-matched control subjects (aged 50–75 years) participated. Postural stability and falls risk was assessed before and after a 6-week exercise program. RESULTS Diabetic individuals had significantly higher falls risk score compared with control subjects. The diabetic group also exhibited evidence of mild-to-moderate neuropathy, slower reaction times, and increased postural sway. Following exercise, the diabetic group showed significant improvements in leg strength, faster reaction times, decreased sway, and, consequently, reduced falls risk. CONCLUSIONS Older individuals with diabetes had impaired balance, slower reactions, and consequently a higher falls risk than age-matched control subjects. However, all these variables improved after resistance/balance training. Together these results demonstrate that structured exercise has wide-spread positive effects on physiological function for older individuals with type 2 diabetes. PMID:20097781

Overview of Risk Management for Engineered Nanomaterials

NASA Astrophysics Data System (ADS)

Schulte, P. A.; Geraci, C. L.; Hodson, L. L.; Zumwalde, R. D.; Kuempel, E. D.; Murashov, V.; Martinez, K. F.; Heidel, D. S.

2013-04-01

Occupational exposure to engineered nanomaterials (ENMs) is considered a new and challenging occurrence. Preliminary information from laboratory studies indicates that workers exposed to some kinds of ENMs could be at risk of adverse health effects. To protect the nanomaterial workforce, a precautionary risk management approach is warranted and given the newness of ENMs and emergence of nanotechnology, a naturalistic view of risk management is useful. Employers have the primary responsibility for providing a safe and healthy workplace. This is achieved by identifying and managing risks which include recognition of hazards, assessing exposures, characterizing actual risk, and implementing measures to control those risks. Following traditional risk management models for nanomaterials is challenging because of uncertainties about the nature of hazards, issues in exposure assessment, questions about appropriate control methods, and lack of occupational exposure limits (OELs) or nano-specific regulations. In the absence of OELs specific for nanomaterials, a precautionary approach has been recommended in many countries. The precautionary approach entails minimizing exposures by using engineering controls and personal protective equipment (PPE). Generally, risk management utilizes the hierarchy of controls. Ideally, risk management for nanomaterials should be part of an enterprise-wide risk management program or system and this should include both risk control and a medical surveillance program that assesses the frequency of adverse effects among groups of workers exposed to nanomaterials. In some cases, the medical surveillance could include medical screening of individual workers to detect early signs of work-related illnesses. All medical surveillance should be used to assess the effectiveness of risk management; however, medical surveillance should be considered as a second line of defense to ensure that implemented risk management practices are effective.

Using spatial information about recurrence risk for robust optimization of dose-painting prescription functions

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

Bender, Edward T.

Purpose: To develop a robust method for deriving dose-painting prescription functions using spatial information about the risk for disease recurrence. Methods: Spatial distributions of radiobiological model parameters are derived from distributions of recurrence risk after uniform irradiation. These model parameters are then used to derive optimal dose-painting prescription functions given a constant mean biologically effective dose. Results: An estimate for the optimal dose distribution can be derived based on spatial information about recurrence risk. Dose painting based on imaging markers that are moderately or poorly correlated with recurrence risk are predicted to potentially result in inferior disease control when comparedmore » the same mean biologically effective dose delivered uniformly. A robust optimization approach may partially mitigate this issue. Conclusions: The methods described here can be used to derive an estimate for a robust, patient-specific prescription function for use in dose painting. Two approximate scaling relationships were observed: First, the optimal choice for the maximum dose differential when using either a linear or two-compartment prescription function is proportional to R, where R is the Pearson correlation coefficient between a given imaging marker and recurrence risk after uniform irradiation. Second, the predicted maximum possible gain in tumor control probability for any robust optimization technique is nearly proportional to the square of R.« less

Induced Abortions and the Risk of Preeclampsia Among Nulliparous Women

PubMed Central

Parker, Samantha E.; Gissler, Mika; Ananth, Cande V.; Werler, Martha M.

2015-01-01

Induced abortion (IA) has been associated with a lower risk of preeclampsia among nulliparous women, but it remains unclear whether this association differs by method (either surgical or medical) or timing of IA. We performed a nested case-control study of 12,650 preeclampsia cases and 50,600 matched control deliveries identified in the Medical Birth Register of Finland from 1996 to 2010. Data on number, method, and timing of IAs were obtained through a linkage with the Registry of Induced Abortions. Odds ratios and 95% confidence intervals were calculated. Overall, prior IA was associated with a lower risk of preeclampsia, with odds ratios of 0.9 (95% confidence interval (CI): 0.9, 1.0) for 1 prior IA and 0.7 (95% CI: 0.5, 1.0) for 3 or more IAs. Differences in the associations between IA and preeclampsia by timing and method of IA were small, with odds ratios of 0.8 (95% CI: 0.6, 1.1) for late (≥12 gestation weeks) surgical abortion and 0.9 (95% CI: 0.7, 1.2) for late medical abortion. There was no association between IA in combination with a history of spontaneous abortion and risk of preeclampsia. In conclusion, prior IA only was associated with a slight reduction in the risk of preeclampsia. PMID:26377957

Association of meat intake and meat-derived mutagen exposure with the risk of colorectal polyps by histologic type

PubMed Central

Fu, Zhenming; Shrubsole, Martha J.; Smalley, Walter E.; Wu, Huiyun; Chen, Zhi; Shyr, Yu; Ness, Reid M.; Zheng, Wei

2011-01-01

Background The association of meat intake and meat-derived mutagens with colorectal tumor risk remains unclear. We evaluated this hypothesis in a large colonoscopy-based case-control study. Methods Included in the study were 2,543 polyp patients [(1,881 with adenomas, and 622 with hyperplastic polyp (HPP)] and 3,764 polyp-free controls. Surveys obtained information about meat intake by cooking methods and doneness levels plus other suspected or known risk factors for colorectal tumors. Unconditional logistic regression was used to derive odds ratios (ORs) after adjusting for potential confounders. Results High intake of red meat and processed meat (P-trend < 0.05), particularly red meat cooked using high-temperature cooking methods (P-trend ≤ 0.01), was associated with an elevated risk for colorectal polyps. A significant positive association between exposures to meat-derived heterocyclic amines and risk of polyps was found for both adenomas and hyperplastic polyps. Furthermore, the positive association with red-meat intake and heterocyclic amine exposure was stronger for multiple adenomas than single adenoma and serrated than non-serrated adenomas. Conclusion This study supports a role for red meat and meat-derived mutagen exposure in the development of colorectal tumor. PMID:21803984

Development and validation of a melanoma risk score based on pooled data from 16 case-control studies

PubMed Central

Davies, John R; Chang, Yu-mei; Bishop, D Timothy; Armstrong, Bruce K; Bataille, Veronique; Bergman, Wilma; Berwick, Marianne; Bracci, Paige M; Elwood, J Mark; Ernstoff, Marc S; Green, Adele; Gruis, Nelleke A; Holly, Elizabeth A; Ingvar, Christian; Kanetsky, Peter A; Karagas, Margaret R; Lee, Tim K; Le Marchand, Loïc; Mackie, Rona M; Olsson, Håkan; Østerlind, Anne; Rebbeck, Timothy R; Reich, Kristian; Sasieni, Peter; Siskind, Victor; Swerdlow, Anthony J; Titus, Linda; Zens, Michael S; Ziegler, Andreas; Gallagher, Richard P.; Barrett, Jennifer H; Newton-Bishop, Julia

2015-01-01

Background We report the development of a cutaneous melanoma risk algorithm based upon 7 factors; hair colour, skin type, family history, freckling, nevus count, number of large nevi and history of sunburn, intended to form the basis of a self-assessment webtool for the general public. Methods Predicted odds of melanoma were estimated by analysing a pooled dataset from 16 case-control studies using logistic random coefficients models. Risk categories were defined based on the distribution of the predicted odds in the controls from these studies. Imputation was used to estimate missing data in the pooled datasets. The 30th, 60th and 90th centiles were used to distribute individuals into four risk groups for their age, sex and geographic location. Cross-validation was used to test the robustness of the thresholds for each group by leaving out each study one by one. Performance of the model was assessed in an independent UK case-control study dataset. Results Cross-validation confirmed the robustness of the threshold estimates. Cases and controls were well discriminated in the independent dataset (area under the curve 0.75, 95% CI 0.73-0.78). 29% of cases were in the highest risk group compared with 7% of controls, and 43% of controls were in the lowest risk group compared with 13% of cases. Conclusion We have identified a composite score representing an estimate of relative risk and successfully validated this score in an independent dataset. Impact This score may be a useful tool to inform members of the public about their melanoma risk. PMID:25713022

Benchmarking Distance Control and Virtual Drilling for Lateral Skull Base Surgery.

PubMed

Voormolen, Eduard H J; Diederen, Sander; van Stralen, Marijn; Woerdeman, Peter A; Noordmans, Herke Jan; Viergever, Max A; Regli, Luca; Robe, Pierre A; Berkelbach van der Sprenkel, Jan Willem

2018-01-01

Novel audiovisual feedback methods were developed to improve image guidance during skull base surgery by providing audiovisual warnings when the drill tip enters a protective perimeter set at a distance around anatomic structures ("distance control") and visualizing bone drilling ("virtual drilling"). To benchmark the drill damage risk reduction provided by distance control, to quantify the accuracy of virtual drilling, and to investigate whether the proposed feedback methods are clinically feasible. In a simulated surgical scenario using human cadavers, 12 unexperienced users (medical students) drilled 12 mastoidectomies. Users were divided into a control group using standard image guidance and 3 groups using distance control with protective perimeters of 1, 2, or 3 mm. Damage to critical structures (sigmoid sinus, semicircular canals, facial nerve) was assessed. Neurosurgeons performed another 6 mastoidectomy/trans-labyrinthine and retro-labyrinthine approaches. Virtual errors as compared with real postoperative drill cavities were calculated. In a clinical setting, 3 patients received lateral skull base surgery with the proposed feedback methods. Users drilling with distance control protective perimeters of 3 mm did not damage structures, whereas the groups using smaller protective perimeters and the control group injured structures. Virtual drilling maximum cavity underestimations and overestimations were 2.8 ± 0.1 and 3.3 ± 0.4 mm, respectively. Feedback methods functioned properly in the clinical setting. Distance control reduced the risks of drill damage proportional to the protective perimeter distance. Errors in virtual drilling reflect spatial errors of the image guidance system. These feedback methods are clinically feasible. Copyright © 2017 Elsevier Inc. All rights reserved.

Effects of a Brief Early Start Denver Model (ESDM)-Based Parent Intervention on Toddlers at Risk for Autism Spectrum Disorders: A Randomized Controlled Trial

ERIC Educational Resources Information Center

Rogers, Sally J.; Estes, Annette; Lord, Catherine; Vismara, Laurie; Winter, Jamie; Fitzpatrick, Annette; Guo, Mengye; Dawson, Geraldine

2012-01-01

Objective: This study was carried out to examine the efficacy of a 12-week, low-intensity (1-hour/wk of therapist contact), parent-delivered intervention for toddlers at risk for autism spectrum disorders (ASD) aged 14 to 24 months and their families. Method: A randomized controlled trial involving 98 children and families was carried out in three…

How effective are strategies for non-communicable disease prevention and control in a high risk population in a developing country? Isfahan Healthy Heart Programme

PubMed Central

Baghaei, Abdolmehdi; Rabiei, Katayoun; Gharipour, Mojgan; Tavasoli, Ali Akbar; Shirani, Shahin; Bahonar, Ahamad; Davarpanah, Amir Hossein; Ramezani, Mohammad Arash; Kelishadi, Roya

2010-01-01

Introduction The Isfahan Healthy Heart Programme (IHHP) is a community-based programme for non-communicable diseases prevention and control using both a population and high risk approach in Iran. This study demonstrated the efficacy of IHHP interventional strategies to improve lifestyle behaviours in a population at risk for developing cardiovascular diseases. Material and methods Healthy Lifestyle for NCDs High Risk Population is one of ten projects of IHHP. High risk individuals were defined as those who have at least one risk factor for developing coronary artery disease (CAD). Changes of behavioural indicators have been compared between two areas with a survey after 5 years of intervention. Results Among high risk individuals in the intervention and reference areas, 77.8% and 82.5% had at least one major risk factor for CAD. The prevalence of major risk factors for CAD (except cigarette smoking) was decreased in both intervention and reference areas during 5 years of intervention and the pattern of diet and physical activity was improved. Conclusions Interventional activities in IHHP targeting the high risk population seem to be effective in improving lifestyle behaviour, increasing awareness and control of risk factors of the high risk population. PMID:22371716

Family history and perceptions about risk and prevention for chronic diseases in primary care: A report from the Family Healthware™ Impact Trial

PubMed Central

Acheson, Louise S.; Wang, Catharine; Zyzanski, Stephen J.; Lynn, Audrey; Ruffin, Mack T.; Gramling, Robert; Rubinstein, Wendy S.; O'Neill, Suzanne M.; Nease, Donald E.

2014-01-01

Purpose To determine whether family medical history as a risk factor for six common diseases is related to patients' perceptions of risk, worry, and control over getting these diseases. Methods We used data from the cluster-randomized, controlled Family Healthware™ Impact Trial (FHITr). At baseline, healthy primary care patients reported their perceptions about coronary heart disease, stroke, diabetes, and breast, ovarian, and colon cancers. Immediately afterward, intervention group participants used Family Healthware™ to record family medical history; this web-based tool stratified familial disease risks. Multivariate and multilevel regression analyses measured the association between familial risk and patient perceptions for each disease, controlling for personal health and demographics. Results For the 2330 participants who used Family Healthware™ immediately after providing baseline data, perceived risk and worry for each disease were strongly associated with family history risk, adjusting for personal risk factors. The magnitude of the effect of family history on perceived risk ranged from 0.35 standard deviation for ovarian cancer to 1.12 standard deviations for colon cancer. Family history was not related to perceived control over developing diseases. Risk perceptions seemed optimistically biased, with 48–79% of participants with increased familial risk for diseases reporting that they were at average risk or below. Conclusions Participants' ratings of their risk for developing common diseases, before feedback on familial risk, parallels but is often lower than their calculated risk based on family history. Having a family history of a disease increases its salience and does not change one's perceived ability to prevent the disease. PMID:20216073

Design of the BRISC study: a multicentre controlled clinical trial to optimize the communication of breast cancer risks in genetic counselling.

PubMed

Ockhuysen-Vermey, Caroline F; Henneman, Lidewij; van Asperen, Christi J; Oosterwijk, Jan C; Menko, Fred H; Timmermans, Daniëlle R M

2008-10-03

Understanding risks is considered to be crucial for informed decision-making. Inaccurate risk perception is a common finding in women with a family history of breast cancer attending genetic counseling. As yet, it is unclear how risks should best be communicated in clinical practice. This study protocol describes the design and methods of the BRISC (Breast cancer RISk Communication) study evaluating the effect of different formats of risk communication on the counsellee's risk perception, psychological well-being and decision-making regarding preventive options for breast cancer. The BRISC study is designed as a pre-post-test controlled group intervention trial with repeated measurements using questionnaires. The intervention-an additional risk consultation-consists of one of 5 conditions that differ in the way counsellee's breast cancer risk is communicated: 1) lifetime risk in numerical format (natural frequencies, i.e. X out of 100), 2) lifetime risk in both numerical format and graphical format (population figures), 3) lifetime risk and age-related risk in numerical format, 4) lifetime risk and age-related risk in both numerical format and graphical format, and 5) lifetime risk in percentages. Condition 6 is the control condition in which no intervention is given (usual care). Participants are unaffected women with a family history of breast cancer attending one of three participating clinical genetic centres in the Netherlands. The BRISC study allows for an evaluation of the effects of different formats of communicating breast cancer risks to counsellees. The results can be used to optimize risk communication in order to improve informed decision-making among women with a family history of breast cancer. They may also be useful for risk communication in other health-related services. Current Controlled Trials ISRCTN14566836.

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

PubMed

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

2018-05-01

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

Young People's Risk of Suicide Attempts after Contact with a Psychiatric Department--A Nested Case-Control Design Using Danish Register Data

ERIC Educational Resources Information Center

Christiansen, Erik; Larsen, Kim Juul

2012-01-01

Background: There seems to be an increased risk of children and adolescents committing or attempting suicide after contact with a psychiatric department. Children and adolescents living in families with low socio-economic status (SES) might have an especially increased suicide attempt risk. Methods: A complete extraction of Danish register data…

A Randomized Controlled Trial of a Couple Relationship and Coparenting Program (Couple CARE for Parents) for High- and Low-Risk New Parents

ERIC Educational Resources Information Center

Petch, Jemima F.; Halford, W. Kim; Creedy, Debra K.; Gamble, Jenny

2012-01-01

Objective: This study evaluated the effectiveness of couple relationship education in assisting couples to sustain relationship functioning and parenting sensitivity, and whether benefits were moderated by risk of maladjustment in the transition to parenthood ("risk"). Method: Two hundred fifty couples expecting their first child were assessed on…

Stratospheric controlled perturbation experiment: a small-scale experiment to improve understanding of the risks of solar geoengineering

PubMed Central

Dykema, John A.; Keith, David W.; Anderson, James G.; Weisenstein, Debra

2014-01-01

Although solar radiation management (SRM) through stratospheric aerosol methods has the potential to mitigate impacts of climate change, our current knowledge of stratospheric processes suggests that these methods may entail significant risks. In addition to the risks associated with current knowledge, the possibility of ‘unknown unknowns’ exists that could significantly alter the risk assessment relative to our current understanding. While laboratory experimentation can improve the current state of knowledge and atmospheric models can assess large-scale climate response, they cannot capture possible unknown chemistry or represent the full range of interactive atmospheric chemical physics. Small-scale, in situ experimentation under well-regulated circumstances can begin to remove some of these uncertainties. This experiment—provisionally titled the stratospheric controlled perturbation experiment—is under development and will only proceed with transparent and predominantly governmental funding and independent risk assessment. We describe the scientific and technical foundation for performing, under external oversight, small-scale experiments to quantify the risks posed by SRM to activation of halogen species and subsequent erosion of stratospheric ozone. The paper's scope includes selection of the measurement platform, relevant aspects of stratospheric meteorology, operational considerations and instrument design and engineering. PMID:25404681

Stratospheric controlled perturbation experiment: a small-scale experiment to improve understanding of the risks of solar geoengineering.

PubMed

Dykema, John A; Keith, David W; Anderson, James G; Weisenstein, Debra

2014-12-28

Although solar radiation management (SRM) through stratospheric aerosol methods has the potential to mitigate impacts of climate change, our current knowledge of stratospheric processes suggests that these methods may entail significant risks. In addition to the risks associated with current knowledge, the possibility of 'unknown unknowns' exists that could significantly alter the risk assessment relative to our current understanding. While laboratory experimentation can improve the current state of knowledge and atmospheric models can assess large-scale climate response, they cannot capture possible unknown chemistry or represent the full range of interactive atmospheric chemical physics. Small-scale, in situ experimentation under well-regulated circumstances can begin to remove some of these uncertainties. This experiment-provisionally titled the stratospheric controlled perturbation experiment-is under development and will only proceed with transparent and predominantly governmental funding and independent risk assessment. We describe the scientific and technical foundation for performing, under external oversight, small-scale experiments to quantify the risks posed by SRM to activation of halogen species and subsequent erosion of stratospheric ozone. The paper's scope includes selection of the measurement platform, relevant aspects of stratospheric meteorology, operational considerations and instrument design and engineering.

Leucocytes telomere length and breast cancer risk/ susceptibility: A case-control study

PubMed Central

Pavanello, Sofia; Varesco, Liliana; Gismondi, Viviana; Bruzzi, Paolo

2018-01-01

Background Telomere length in peripheral blood leukocytes (PBL-TL) was proposed as a biomarker of cancer risk. Recent scientific evidence suggested PBL-TL plays a diverse role in different cancers. Inconsistent results were obtained on PBL-TL in relation to breast cancer risk and specifically to the presence of BRCA1 and BRCA2 mutations. The aim of the present case-control study was to analyse the correlation between family history of breast cancer or presence of a BRCA mutation and PBL-TL in the hypothesis that TL is a modifier of cancer risk. Methods PBL-TL was measured using the real-time quantitative PCR method in DNA for 142 cases and 239 controls. All the women enrolled were characterized for cancer family history. A subgroup of 48 women were classified for the presence of a BRCA mutation. PBL-TL were summarized as means and standard deviations, and compared by standard analysis of variance. A multivariable Generalised Linear Model was fitted to the data with PBL-TL as the dependent variable, case/control status and presence of a BRCA/VUS mutation as factors, and age in 4 strata as a covariate. Results Age was significantly associated with decreasing PBL-TL in controls (p = 0.01), but not in BC cases. The telomere length is shorter in cases than in controls after adjusting for age. No effect on PBL-TL of BMI, smoke nor of the most common risk factors for breast cancer was observed. No association between PBL-TL and family history was detected both in BC cases and controls. In the multivariate model, no association was observed between BRCA mutation and decreased PBL-TL. A statistically significant interaction (p = 0.031) between case-control status and a BRCA-mutation/VUS was observed, but no effect was detected for the interaction of cancer status and BRCA or VUS. Conclusion Our study fails to provide support to the hypothesis that PBL-TL is associated with the risk of hereditary BC, or that is a marker of inherited mutations in BRCA genes. PMID:29782524

Can an educational application increase risk perception accuracy amongst patients attending a high-risk breast cancer clinic?

PubMed

Keohane, D; Lehane, E; Rutherford, E; Livingstone, V; Kelly, L; Kaimkhani, S; O'Connell, F; Redmond, H P; Corrigan, M A

2017-04-01

To design, develop and test the effect of an educational initiative to improve risk perception amongst patients attending a high-risk breast cancer clinic. This was achieved through three objectives - 1. identifying an optimal method of presenting risk data, 2. designing and building a risk application, and 3. testing the ability of the application to successfully modify patients perceived risk of cancer. A mobile application was developed for this project using best practice methods for displaying risk information. Patients (n = 84) were randomly allocated into two groups - 'Control' or 'Treatment'. Both groups underwent standard risk counseling while the application was employed in the 'Treatment' group. The patients were surveyed before their session, immediately after and six weeks later. Increases in accuracy were seen in both groups with larger increases demonstrated in the 'Treatment' group with 'Personal 10 Year Risk' statistically significant ('Control' group increase from 21% to 48% vs the 'Treatment' group increase from 33% to 71% - p = 0.003). This project demonstrated trends towards improved risk perception, however mixed logistic regression was unable to show a 30% difference between groups. Numerical literacy and understanding of risk were identified as issues amongst the general population. Overestimating risk remains high amongst attendees. Using mobile applications to convey risk information to patients is a new and evolving area with a corresponding paucity of data. We have demonstrated its potential and emphasised the importance of designing how this information is communicated to patients in order to make it understandable and meaningful. Copyright © 2017 Elsevier Ltd. All rights reserved.

Estimating relative risks for common outcome using PROC NLP.

PubMed

Yu, Binbing; Wang, Zhuoqiao

2008-05-01

In cross-sectional or cohort studies with binary outcomes, it is biologically interpretable and of interest to estimate the relative risk or prevalence ratio, especially when the response rates are not rare. Several methods have been used to estimate the relative risk, among which the log-binomial models yield the maximum likelihood estimate (MLE) of the parameters. Because of restrictions on the parameter space, the log-binomial models often run into convergence problems. Some remedies, e.g., the Poisson and Cox regressions, have been proposed. However, these methods may give out-of-bound predicted response probabilities. In this paper, a new computation method using the SAS Nonlinear Programming (NLP) procedure is proposed to find the MLEs. The proposed NLP method was compared to the COPY method, a modified method to fit the log-binomial model. Issues in the implementation are discussed. For illustration, both methods were applied to data on the prevalence of microalbuminuria (micro-protein leakage into urine) for kidney disease patients from the Diabetes Control and Complications Trial. The sample SAS macro for calculating relative risk is provided in the appendix.

Integrated risk management

NASA Technical Reports Server (NTRS)

Hunsucker, J. L.

1993-01-01

The purpose of this report is to first present a basis or foundation for the building of an integrated risk management plan and them to present the plan. The integration referred to is across both the temporal and the hierarchical dimensions. Complexity, consequence, and credibility seem to be driving the need for the consideration of risk. Reduction of personal bias and reproducibility of the decision making process seem to be driving the consideration of a formal risk plan. While risk can be used as either a selection tool or a control tool, this paper concentrates on the selection usage. Risk relies on stated purpose. The tightness of the definition of purpose and success is directly reflected in the definition and control of risk. Much of a risk management plan could be designed by the answers to the questions of why, what, who, when, and where. However, any plan must provide the following information about a threat or risk: likelihood, consequence, predictability, reliability, and reproducibility. While the environment at NASA is seen as warm, but not hot, for the introduction of a risk program, some encouragement is seen if the following problems are addressed: no champion, no commitment of resource, confused definitions, lack of direction and focus, a hard sell, NASA culture, many choices of assessment methods, and cost. The plan is designed to follow the normal method of doing work and is structured to follow either the work break down structure or a functional structure very well. The parts of the plan include: defining purpose and success, initial threat assessment, initial risk assessment, reconciling threats and parameters, putting part of the information down and factoring the information back into the decision process as it comes back up, and developing inferences. Two major suggestions are presented. One is to build an office of risk management to be used as a resource by managers in doing the risk process. Another is to form a pilot program to try out the details in the plan and modify the method where needed.

Spatial analysis on human brucellosis incidence in mainland China: 2004–2010

PubMed Central

Zhang, Junhui; Yin, Fei; Zhang, Tao; Yang, Chao; Zhang, Xingyu; Feng, Zijian; Li, Xiaosong

2014-01-01

Objectives China has experienced a sharply increasing rate of human brucellosis in recent years. Effective spatial monitoring of human brucellosis incidence is very important for successful implementation of control and prevention programmes. The purpose of this paper is to apply exploratory spatial data analysis (ESDA) methods and the empirical Bayes (EB) smoothing technique to monitor county-level incidence rates for human brucellosis in mainland China from 2004 to 2010 by examining spatial patterns. Methods ESDA methods were used to characterise spatial patterns of EB smoothed incidence rates for human brucellosis based on county-level data obtained from the China Information System for Disease Control and Prevention (CISDCP) in mainland China from 2004 to 2010. Results EB smoothed incidence rates for human brucellosis were spatially dependent during 2004–2010. The local Moran test identified significantly high-risk clusters of human brucellosis (all p values <0.01), which persisted during the 7-year study period. High-risk counties were centred in the Inner Mongolia Autonomous Region and other Northern provinces (ie, Hebei, Shanxi, Jilin and Heilongjiang provinces) around the border with the Inner Mongolia Autonomous Region where animal husbandry was highly developed. The number of high-risk counties increased from 25 in 2004 to 54 in 2010. Conclusions ESDA methods and the EB smoothing technique can assist public health officials in identifying high-risk areas. Allocating more resources to high-risk areas is an effective way to reduce human brucellosis incidence. PMID:24713215

Hazard Identification and Risk Assessment in Water Treatment Plant considering Environmental Health and Safety Practice

NASA Astrophysics Data System (ADS)

Falakh, Fajrul; Setiani, Onny

2018-02-01

Water Treatment Plant (WTP) is an important infrastructure to ensure human health and the environment. In its development, aspects of environmental safety and health are of concern. This paper case study was conducted at the Water Treatment Plant Company in Semarang, Central Java, Indonesia. Hazard identification and risk assessment is one part of the occupational safety and health program at the risk management stage. The purpose of this study was to identify potential hazards using hazard identification methods and risk assessment methods. Risk assessment is done using criteria of severity and probability of accident. The results obtained from this risk assessment are 22 potential hazards present in the water purification process. Extreme categories that exist in the risk assessment are leakage of chlorine and industrial fires. Chlorine and fire leakage gets the highest value because its impact threatens many things, such as industrial disasters that could endanger human life and the environment. Control measures undertaken to avoid potential hazards are to apply the use of personal protective equipment, but management will also be better managed in accordance with hazard control hazards, occupational safety and health programs such as issuing work permits, emergency response training is required, Very useful in overcoming potential hazards that have been determined.

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

PubMed Central

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

2015-01-01

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

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

PubMed

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

2015-01-01

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

The rare TREM2 R47H variant exerts only a modest effect on Alzheimer disease risk

PubMed Central

Hooli, Basavaraj V.; Parrado, Antonio R.; Mullin, Kristina; Yip, Wai-Ki; Liu, Tian; Roehr, Johannes T.; Qiao, Dandi; Jessen, Frank; Peters, Oliver; Becker, Tim; Ramirez, Alfredo; Lange, Christoph; Bertram, Lars

2014-01-01

Objectives: Recently, 2 independent studies reported that a rare missense variant, rs75932628 (R47H), in exon 2 of the gene encoding the “triggering receptor expressed on myeloid cells 2” (TREM2) significantly increases the risk of Alzheimer disease (AD) with an effect size comparable to that of the APOE ε4 allele. Methods: In this study, we attempted to replicate the association between rs75932628 and AD risk by directly genotyping rs75932628 in 2 independent Caucasian family cohorts consisting of 927 families (with 1,777 affected and 1,235 unaffected) and in 2 Caucasian case-control cohorts composed of 1,314 cases and 1,609 controls. In addition, we imputed genotypes in 3 independent Caucasian case-control cohorts containing 1,906 cases and 1,503 controls. Results: Meta-analysis of the 2 family-based and the 5 case-control cohorts yielded a p value of 0.0029, while the overall summary estimate (using case-control data only) resulted in an odds ratio of 1.67 (95% confidence interval 0.95–2.92) for the association between the TREM2 R47H and increased AD risk. Conclusions: While our results serve to confirm the association between R47H and risk of AD, the observed effect on risk was substantially smaller than that previously reported. PMID:25186855

PARENTS’ UNDERSTANDING OF INFORMATION REGARDING THEIR CHILD’S POSTOPERATIVE PAIN MANAGEMENT

PubMed Central

Tait, Alan R.; Voepel-Lewis, Terri; Snyder, Robin M.; Malviya, Shobha

2009-01-01

Objectives Unlike information provided for research, information disclosed to patients for treatment or procedures is largely unregulated and, as such, there is likely considerable variability in the type and amount of disclosure. This study was designed to examine the nature of information provided to parents regarding options for postoperative pain control and their understanding thereof. Methods 187 parents of children scheduled to undergo a surgical procedure requiring inpatient postoperative pain control completed questionnaires that elicited information regarding their perceptions and understanding of, and satisfaction with, information regarding postoperative pain management. Results Results showed that there was considerable variability in the content and amount of information provided to parents based on the method of postoperative pain control provided. Parents whose child received Patient Controlled Analgesia (PCA) were given significantly (P< 0.025) more information on the risks and benefits compared to those receiving Nurse Controlled or intravenous-prn (NCA or IV) analgesia. Approximately one third of parents had no understanding of the risks associated with postoperative pain management. Parents who received pain information preoperatively and who were given information regarding the risks and benefits had improved understanding compared to parents who received no or minimal information (P< 0.001). Furthermore, information that was deemed unclear or insufficient resulted in decreased parental understanding. Discussion These results demonstrate the variability in the type and amount of information provided to parents regarding their child’s postoperative pain control and reinforce the importance of clear and full disclosure of pain information, particularly with respect to the risks and benefits. PMID:18716495

Empirical mode decomposition processing to improve multifocal-visual-evoked-potential signal analysis in multiple sclerosis

PubMed Central

2018-01-01

Objective To study the performance of multifocal-visual-evoked-potential (mfVEP) signals filtered using empirical mode decomposition (EMD) in discriminating, based on amplitude, between control and multiple sclerosis (MS) patient groups, and to reduce variability in interocular latency in control subjects. Methods MfVEP signals were obtained from controls, clinically definitive MS and MS-risk progression patients (radiologically isolated syndrome (RIS) and clinically isolated syndrome (CIS)). The conventional method of processing mfVEPs consists of using a 1–35 Hz bandpass frequency filter (XDFT). The EMD algorithm was used to decompose the XDFT signals into several intrinsic mode functions (IMFs). This signal processing was assessed by computing the amplitudes and latencies of the XDFT and IMF signals (XEMD). The amplitudes from the full visual field and from ring 5 (9.8–15° eccentricity) were studied. The discrimination index was calculated between controls and patients. Interocular latency values were computed from the XDFT and XEMD signals in a control database to study variability. Results Using the amplitude of the mfVEP signals filtered with EMD (XEMD) obtains higher discrimination index values than the conventional method when control, MS-risk progression (RIS and CIS) and MS subjects are studied. The lowest variability in interocular latency computations from the control patient database was obtained by comparing the XEMD signals with the XDFT signals. Even better results (amplitude discrimination and latency variability) were obtained in ring 5 (9.8–15° eccentricity of the visual field). Conclusions Filtering mfVEP signals using the EMD algorithm will result in better identification of subjects at risk of developing MS and better accuracy in latency studies. This could be applied to assess visual cortex activity in MS diagnosis and evolution studies. PMID:29677200

A Randomized, Controlled Trial to Increase Discussion of Breast Cancer in Primary Care

PubMed Central

Kaplan, Celia P.; Livaudais-Toman, Jennifer; Tice, Jeffrey A.; Kerlikowske, Karla; Gregorich, Steven E.; Pérez-Stable, Eliseo J.; Pasick, Rena J.; Chen, Alice; Quinn, Jessica; Karliner, Leah S.

2014-01-01

Background Assessment and discussion of individual risk for breast cancer within the primary care setting are crucial to discussion of risk reduction and timely referral. Methods We conducted a randomized controlled trial of a multiethnic, multilingual sample of women ages 40 to 74 years from two primary care practices (one academic, one safety net) to test a breast cancer risk assessment and education intervention. Patients were randomly assigned to control or intervention group. All patients completed a baseline telephone survey and risk assessment (via telephone for controls, via tablet computer in clinic waiting room before visit for intervention). Intervention (BreastCARE) patients and their physicians received an individualized risk report to discuss during the visit. One-week follow-up telephone surveys with all patients assessed patient–physician discussion of family cancer history, personal breast cancer risk, high-risk clinics, and genetic counseling/testing. Results A total of 655 control and 580 intervention women completed the risk assessment and follow-up interview; 25% were high-risk by family history, Gail, or Breast Cancer Surveillance Consortium risk models. BreastCARE increased discussions of family cancer history [OR, 1.54; 95% confidence interval (CI), 1.25–1.91], personal breast cancer risk (OR, 4.15; 95% CI, 3.02–5.70), high-risk clinics (OR, 3.84; 95% CI, 2.13–6.95), and genetic counseling/testing (OR, 2.22; 95% CI, 1.34–3.68). Among high-risk women, all intervention effects were stronger. Conclusions An intervention combining an easy-to-use, quick risk assessment tool with patient-centered risk reports at the point of care can successfully promote discussion of breast cancer risk reduction between patients and primary care physicians, particularly for high-risk women. Impact Next steps include scaling and dissemination of BreastCARE with integration into electronic medical record systems. PMID:24762560

Case-control geographic clustering for residential histories accounting for risk factors and covariates

PubMed Central

2006-01-01

Background Methods for analyzing space-time variation in risk in case-control studies typically ignore residential mobility. We develop an approach for analyzing case-control data for mobile individuals and apply it to study bladder cancer in 11 counties in southeastern Michigan. At this time data collection is incomplete and no inferences should be drawn – we analyze these data to demonstrate the novel methods. Global, local and focused clustering of residential histories for 219 cases and 437 controls is quantified using time-dependent nearest neighbor relationships. Business address histories for 268 industries that release known or suspected bladder cancer carcinogens are analyzed. A logistic model accounting for smoking, gender, age, race and education specifies the probability of being a case, and is incorporated into the cluster randomization procedures. Sensitivity of clustering to definition of the proximity metric is assessed for 1 to 75 k nearest neighbors. Results Global clustering is partly explained by the covariates but remains statistically significant at 12 of the 14 levels of k considered. After accounting for the covariates 26 Local clusters are found in Lapeer, Ingham, Oakland and Jackson counties, with the clusters in Ingham and Oakland counties appearing in 1950 and persisting to the present. Statistically significant focused clusters are found about the business address histories of 22 industries located in Oakland (19 clusters), Ingham (2) and Jackson (1) counties. Clusters in central and southeastern Oakland County appear in the 1930's and persist to the present day. Conclusion These methods provide a systematic approach for evaluating a series of increasingly realistic alternative hypotheses regarding the sources of excess risk. So long as selection of cases and controls is population-based and not geographically biased, these tools can provide insights into geographic risk factors that were not specifically assessed in the case-control study design. PMID:16887016

Escherichia coli O157:H7 in beef cattle: on farm contamination and pre-slaughter control methods.

PubMed

Soon, J M; Chadd, S A; Baines, R N

2011-12-01

This paper addresses food safety in beef cattle production, with particular emphasis on factors that affect the prevalence of Escherichia coli O157:H7 in beef cattle and on control methods that have been investigated. Product recalls and foodborne diseases due to this organism continue to occur even though control measures have been under investigation for over 20 years. Most meatborne outbreaks are due to improper food handling practices and consumption of undercooked meat. However, the majority of pathogenic bacteria that can spread at slaughter by cross-contamination can be traced back to the farm rather than originating from the slaughter plant. This would ideally require the adoption of rigorous on-farm intervention strategies to mitigate risks at the farm level. On-farm strategies to control and reduce E. coli O157:H7 at the farm level will reduce the risk of carcass contamination at slaughter and processing facilities although they will not eliminate E. coli O157:H7. The most successful strategy for reducing the risk of contamination of beef and beef products will involve the implementation of both pre- and post-harvest measures.

Communication about environmental health risks: a systematic review.

PubMed

Fitzpatrick-Lewis, Donna; Yost, Jennifer; Ciliska, Donna; Krishnaratne, Shari

2010-11-01

Using the most effective methods and techniques for communicating risk to the public is critical. Understanding the impact that different types of risk communication have played in real and perceived public health risks can provide information about how messages, policies and programs can and should be communicated in order to be most effective. The purpose of this systematic review is to identify the effectiveness of communication strategies and factors that impact communication uptake related to environmental health risks. A systematic review of English articles using multiple databases with appropriate search terms. Data sources also included grey literature. Key organization websites and key journals were hand searched for relevant articles. Consultation with experts took place to locate any additional references.Articles had to meet relevance criteria for study design [randomized controlled trials, clinical controlled trials, cohort analytic, cohort, any pre-post, interrupted time series, mixed methods or any qualitative studies), participants (those in community-living, non-clinical populations), interventions (including, but not limited to, any community-based methods or tools such as Internet, telephone, media-based interventions or any combination thereof), and outcomes (reported measurable outcomes such as awareness, knowledge or attitudinal or behavioural change). Articles were assessed for quality and data was extracted using standardized tools by two independent reviewers. Articles were given an overall assessment of strong, moderate or weak quality. There were no strong or moderate studies. Meta-analysis was not appropriate to the data. Data for 24 articles were analyzed and reported in a narrative format. The findings suggest that a multi-media approach is more effective than any single media approach. Similarly, printed material that offers a combination of information types (i.e., text and diagrams) is a more effective than just a single type, such as all text. Findings also suggest that factors influencing response to risk communications are impacted by personal risk perception, previous personal experience with risk, sources of information and trust in those sources. No single method of message delivery is best. Risk communication strategies that incorporate the needs of the target audience(s) with a multi-faceted delivery method are most effective at reaching the audience.

Personality traits associated with genetic counselor compassion fatigue: the roles of dispositional optimism and locus of control.

PubMed

Injeyan, Marie C; Shuman, Cheryl; Shugar, Andrea; Chitayat, David; Atenafu, Eshetu G; Kaiser, Amy

2011-10-01

Compassion fatigue (CMF) arises as a consequence of secondary exposure to distress and can be elevated in some health practitioners. Locus of control and dispositional optimism are aspects of personality known to influence coping style. To investigate whether these personality traits influence CMF risk, we surveyed 355 genetic counselors about their CMF, locus of control orientation, and degree of dispositional optimism. Approximately half of respondents reported they experience CMF; 26.6% had considered leaving their job due to CMF symptoms. Mixed-method analyses revealed that genetic counselors having an external locus of control and low optimism were at highest risk for CMF. Those at highest risk experienced moderate-to-high burnout, low-to-moderate compassion satisfaction, and tended to rely on religion/spirituality when coping with stress. CMF risk was not influenced by years in practice, number of genetic counselor colleagues in the workplace, or completion of graduate training in this area. Recommendations for practice and education are outlined.

Trichomonas vaginalis infection and risk of advanced prostate cancer.

PubMed

Shui, Irene M; Kolb, Suzanne; Hanson, Christi; Sutcliffe, Siobhan; Rider, Jennifer R; Stanford, Janet L

2016-05-01

The epidemiologic evidence for an association of Trichomonas vaginalis (Tv) with overall prostate cancer is mixed, but some studies suggest Tv may increase risk of more aggressive disease. The aim of this study was to assess whether Tv serostatus is associated with advanced or fatal prostate cancer. A total of 146 men with advanced (metastatic or fatal) prostate cancer and 181 age-matched controls were selected from two prior population-based, case-control studies. Tv serostatus was determined with the same laboratory methods used in previous epidemiologic studies. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using multivariable logistic regression to compare Tv serostatus in prostate cancer cases and controls adjusted for potential confounders. The seroprevalence of Tv in controls was 23%. Tv serostatus was not associated with an increased risk of metastatic or fatal prostate cancer (ORs < 1). Our study does not support an increased risk of advanced or fatal prostate cancer in men seropositive for Tv. © 2016 Wiley Periodicals, Inc.

Expert ratings of job demand and job control as predictors of injury and musculoskeletal disorder risk in a manufacturing cohort

PubMed Central

Cantley, Linda F; Tessier-Sherman, Baylah; Slade, Martin D; Galusha, Deron; Cullen, Mark R

2016-01-01

Objective To examine associations between workplace injury and musculoskeletal disorder (MSD) risk and expert ratings of job-level psychosocial demand and job control, adjusting for job-level physical demand. Methods Among a cohort of 9260 aluminium manufacturing workers in jobs for which expert ratings of job-level physical and psychological demand and control were obtained during the 2 years following rating obtainment, multivariate mixed effects models were used to estimate relative risk (RR) of minor injury and minor MSD, serious injury and MSD, minor MSD only and serious MSD only by tertile of demand and control, adjusting for physical demand as well as other recognised risk factors. Results Compared with workers in jobs rated as having low psychological demand, workers in jobs with high psychological demand had 49% greater risk of serious injury and serious MSD requiring medical treatment, work restrictions or lost work time (RR=1.49; 95% CI 1.10 to 2.01). Workers in jobs rated as having low control displayed increased risk for minor injury and minor MSD (RR=1.45; 95% CI 1.12 to 1.87) compared with those in jobs rated as having high control. Conclusions Using expert ratings of job-level exposures, this study provides evidence that psychological job demand and job control contribute independently to injury and MSD risk in a blue-collar manufacturing cohort, and emphasises the importance of monitoring psychosocial workplace exposures in addition to physical workplace exposures to promote worker health and safety. PMID:26163544

Peer education for secondary stroke prevention in inner-city minorities: design and methods of the prevent recurrence of all inner-city strokes through education randomized controlled trial.

PubMed

Goldfinger, Judith Z; Kronish, Ian M; Fei, Kezhen; Graciani, Albert; Rosenfeld, Peri; Lorig, Kate; Horowitz, Carol R

2012-09-01

The highest risk for stroke is among survivors of strokes or transient ischemic attacks (TIA). However, use of proven-effective cardiovascular medications to control stroke risk is suboptimal, particularly among the Black and Latino populations disproportionately impacted by stroke. A partnership of Harlem and Bronx community representatives, stroke survivors, researchers, clinicians, outreach workers and patient educators used community-based participatory research to conceive and develop the Prevent Recurrence of All Inner-city Strokes through Education (PRAISE) trial. Using data from focus groups with stroke survivors, they tailored a peer-led, community-based chronic disease self-management program to address stroke risk factors. PRAISE will test, in a randomized controlled trial, whether this stroke education intervention improves blood pressure control and a composite outcome of blood pressure control, lipid control, and use of antithrombotic medications. Of the 582 survivors of stroke and TIA enrolled thus far, 81% are Black or Latino and 56% have an annual income less than $15,000. Many (33%) do not have blood pressures in the target range, and most (66%) do not have control of all three major stroke risk factors. Rates of stroke recurrence risk factors remain suboptimal in the high risk, urban, predominantly minority communities studied. With a community-partnered approach, PRAISE has recruited a large number of stroke and TIA survivors to date, and may prove successful in engaging those at highest risk for stroke and reducing disparities in stroke outcomes in inner-city communities. Copyright © 2012 Elsevier Inc. All rights reserved.

Tuberculosis Infection Control in Health-Care Facilities: Environmental Control and Personal Protection.

PubMed

Lee, Ji Yeon

2016-10-01

Transmission of tuberculosis (TB) is a recognized risk to patients and healthcare workers in healthcare settings. The literature review suggests that implementation of combination control measures reduces the risk of TB transmission. Guidelines suggest a three-level hierarchy of controls including administrative, environmental, and respiratory protection. Among environmental controls, installation of ventilation systems is a priority because ventilation reduces the number of infectious particles in the air. Natural ventilation is cost-effective but depends on climatic conditions. Supplemented intervention such as air-cleaning methods including high efficiency particulate air filtration and ultraviolet germicidal irradiation should be considered in areas where adequate ventilation is difficult to achieve. Personal protective equipment including particulate respirators provides additional benefit when administrative and environmental controls cannot assure protection.

Development of risk-based nanomaterial groups for occupational exposure control

NASA Astrophysics Data System (ADS)

Kuempel, E. D.; Castranova, V.; Geraci, C. L.; Schulte, P. A.

2012-09-01

Given the almost limitless variety of nanomaterials, it will be virtually impossible to assess the possible occupational health hazard of each nanomaterial individually. The development of science-based hazard and risk categories for nanomaterials is needed for decision-making about exposure control practices in the workplace. A possible strategy would be to select representative (benchmark) materials from various mode of action (MOA) classes, evaluate the hazard and develop risk estimates, and then apply a systematic comparison of new nanomaterials with the benchmark materials in the same MOA class. Poorly soluble particles are used here as an example to illustrate quantitative risk assessment methods for possible benchmark particles and occupational exposure control groups, given mode of action and relative toxicity. Linking such benchmark particles to specific exposure control bands would facilitate the translation of health hazard and quantitative risk information to the development of effective exposure control practices in the workplace. A key challenge is obtaining sufficient dose-response data, based on standard testing, to systematically evaluate the nanomaterials' physical-chemical factors influencing their biological activity. Categorization processes involve both science-based analyses and default assumptions in the absence of substance-specific information. Utilizing data and information from related materials may facilitate initial determinations of exposure control systems for nanomaterials.

Effectiveness of personalized face-to-face and telephone nursing counseling interventions for cardiovascular risk factors: a controlled clinical trial 1

PubMed Central

Vílchez Barboza, Vivian; Klijn, Tatiana Paravic; Salazar Molina, Alide; Sáez Carrillo, Katia Lorena

2016-01-01

Abstract Objective: to evaluate the effect and gender differences of an innovative intervention involving in-person and telephone nursing counseling to control cardiovascular risk factors (arterial hypertension, dyslipidemia, and overweight), improve health-related quality of life and strengthen self-efficacy and social support in persons using the municipal health centers' cardiovascular health program. Method: a randomized controlled clinical trial involving participants randomized into the intervention group who received traditional consultation plus personalized and telephone nursing counseling for 7 months (n = 53) and the control group (n = 56). The study followed the Consolidated Standards of Reporting Trials Statement. Results: women in the intervention group presented a significant increase in the physical and mental health components compared to the control group, with decreases in weight, abdominal circumference, total cholesterol, low-density lipoprotein cholesterol, and the atherogenic index. The effects attributable to the intervention in the men in the intervention group were increased physical and emotional roles and decreased systolic and diastolic pressure, waist circumference, total cholesterol, low-density lipoprotein cholesterol, atherogenic index, cardiovascular risk factor, and 10-year coronary risk. Conclusion: this intervention is an effective strategy for the control of three cardiovascular risk factors and the improvement of health-related quality of life. PMID:27508917

Vulnerabilities, Influences and Interaction Paths: Failure Data for Integrated System Risk Analysis

NASA Technical Reports Server (NTRS)

Malin, Jane T.; Fleming, Land

2006-01-01

We describe graph-based analysis methods for identifying and analyzing cross-subsystem interaction risks from subsystem connectivity information. By discovering external and remote influences that would be otherwise unexpected, these methods can support better communication among subsystem designers at points of potential conflict and to support design of more dependable and diagnosable systems. These methods identify hazard causes that can impact vulnerable functions or entities if propagated across interaction paths from the hazard source to the vulnerable target. The analysis can also assess combined impacts of And-Or trees of disabling influences. The analysis can use ratings of hazards and vulnerabilities to calculate cumulative measures of the severity and importance. Identification of cross-subsystem hazard-vulnerability pairs and propagation paths across subsystems will increase coverage of hazard and risk analysis and can indicate risk control and protection strategies.

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

Lack of association between NAT2 polymorphism and prostate cancer risk: a meta-analysis and trial sequential analysis

PubMed Central

Tang, Jingyuan; Xu, Lingyan; Xu, Haoxiang; Li, Ran; Han, Peng; Yang, Haiwei

2017-01-01

Previous studies have investigated the association between NAT2 polymorphism and the risk of prostate cancer (PCa). However, the findings from these studies remained inconsistent. Hence, we performed a meta-analysis to provide a more reliable conclusion about such associations. In the present meta-analysis, 13 independent case-control studies were included with a total of 14,469 PCa patients and 10,689 controls. All relevant studies published were searched in the databates PubMed, EMBASE, and Web of Science, till March 1st, 2017. We used the pooled odds ratios (ORs) with 95% confidence intervals (CIs) to evaluate the strength of the association between NAT2*4 allele and susceptibility to PCa. Subgroup analysis was carried out by ethnicity, source of controls and genotyping method. What's more, we also performed trial sequential analysis (TSA) to reduce the risk of type I error and evaluate whether the evidence of the results was firm. Firstly, our results indicated that NAT2*4 allele was not associated with PCa susceptibility (OR = 1.00, 95% CI= 0.95–1.05; P = 0.100). However, after excluding two studies for its heterogeneity and publication bias, no significant relationship was also detected between NAT2*4 allele and the increased risk of PCa, in fixed-effect model (OR = 0.99, 95% CI= 0.94–1.04; P = 0.451). Meanwhile, no significant increased risk of PCa was found in the subgroup analyses by ethnicity, source of controls and genotyping method. Moreover, TSA demonstrated that such association was confirmed in the present study. Therefore, this meta-analysis suggested that no significant association between NAT2 polymorphism and the risk of PCa was found. PMID:28915684

A quantitative risk assessment model to evaluate effective border control measures for rabies prevention.

PubMed

Weng, Hsin-Yi; Wu, Pei-I; Yang, Ping-Cheng; Tsai, Yi-Lun; Chang, Chao-Chin

2010-01-01

Border control is the primary method to prevent rabies emergence. This study developed a quantitative risk model incorporating stochastic processes to evaluate whether border control measures could efficiently prevent rabies introduction through importation of cats and dogs using Taiwan as an example. Both legal importation and illegal smuggling were investigated. The impacts of reduced quarantine and/or waiting period on the risk of rabies introduction were also evaluated. The results showed that Taiwan's current animal importation policy could effectively prevent rabies introduction through legal importation of cats and dogs. The median risk of a rabid animal to penetrate current border control measures and enter Taiwan was 5.33 x 10(-8) (95th percentile: 3.20 x 10(-7)). However, illegal smuggling may pose Taiwan to the great risk of rabies emergence. Reduction of quarantine and/or waiting period would affect the risk differently, depending on the applied assumptions, such as increased vaccination coverage, enforced custom checking, and/or change in number of legal importations. Although the changes in the estimated risk under the assumed alternatives were not substantial except for completely abolishing quarantine, the consequences of rabies introduction may yet be considered to be significant in a rabies-free area. Therefore, a comprehensive benefit-cost analysis needs to be conducted before recommending these alternative measures.

Associations of tea and coffee consumption with prostate cancer risk

PubMed Central

Geybels, Milan S.; Neuhouser, Marian L.; Stanford, Janet L.

2013-01-01

Purpose: Tea and coffee contain bioactive compounds and both beverages have recently been associated with a reduced risk of prostate cancer (PCa). Methods: We studied associations of tea and coffee consumption with PCa risk in a population-based case-control study from King County, Washington, US. Prostate cancer cases were diagnosed in 2002-2005 and matched to controls by five-year age groups. Logistic regression was used to generate odds ratios (ORs) and 95% confidence intervals (CIs). Results: Among controls, 19% and 58% consumed at least one cup per day of tea and coffee, respectively. The analysis of tea included 892 cases and 863 controls and tea consumption was associated with a reduced overall PCa risk with an adjusted OR of 0.63 (95% CI: 0.45, 0.90; P for trend = 0.02) for men in the highest compared to lowest category of tea intake (≥2 cups/day versus ≤1 cup/week). Risk estimates did not vary substantially by Gleason grade or disease stage. Coffee consumption was not associated with risk of overall PCa or PCa in subgroups defined by tumor grade or stage. Conclusions: Our results contribute further evidence that tea consumption may be a modifiable exposure that reduces PCa risk. PMID:23412806

Comparison of Paper-and-Pencil versus Web Administration of the Youth Risk Behavior Survey (YRBS): Risk Behavior Prevalence Estimates

ERIC Educational Resources Information Center

Eaton, Danice K.; Brener, Nancy D.; Kann, Laura; Denniston, Maxine M.; McManus, Tim; Kyle, Tonja M.; Roberts, Alice M.; Flint, Katherine H.; Ross, James G.

2010-01-01

The authors examined whether paper-and-pencil and Web surveys administered in the school setting yield equivalent risk behavior prevalence estimates. Data were from a methods study conducted by the Centers for Disease Control and Prevention (CDC) in spring 2008. Intact classes of 9th- or 10th-grade students were assigned randomly to complete a…

Amoeba-related health risk in drinking water systems: could monitoring of amoebae be a complementary approach to current quality control strategies?

PubMed

Codony, Francesc; Pérez, Leonardo Martín; Adrados, Bárbara; Agustí, Gemma; Fittipaldi, Mariana; Morató, Jordi

2012-01-01

Culture-based methods for fecal indicator microorganisms are the standard protocol to assess potential health risk from drinking water systems. However, these traditional fecal indicators are inappropriate surrogates for disinfection-resistant fecal pathogens and the indigenous pathogens that grow in drinking water systems. There is now a range of molecular-based methods, such as quantitative PCR, which allow detection of a variety of pathogens and alternative indicators. Hence, in addition to targeting total Escherichia coli (i.e., dead and alive) for the detection of fecal pollution, various amoebae may be suitable to indicate the potential presence of pathogenic amoeba-resisting microorganisms, such as Legionellae. Therefore, monitoring amoeba levels by quantitative PCR could be a useful tool for directly and indirectly evaluating health risk and could also be a complementary approach to current microbial quality control strategies for drinking water systems.

Machine learning derived risk prediction of anorexia nervosa.

PubMed

Guo, Yiran; Wei, Zhi; Keating, Brendan J; Hakonarson, Hakon

2016-01-20

Anorexia nervosa (AN) is a complex psychiatric disease with a moderate to strong genetic contribution. In addition to conventional genome wide association (GWA) studies, researchers have been using machine learning methods in conjunction with genomic data to predict risk of diseases in which genetics play an important role. In this study, we collected whole genome genotyping data on 3940 AN cases and 9266 controls from the Genetic Consortium for Anorexia Nervosa (GCAN), the Wellcome Trust Case Control Consortium 3 (WTCCC3), Price Foundation Collaborative Group and the Children's Hospital of Philadelphia (CHOP), and applied machine learning methods for predicting AN disease risk. The prediction performance is measured by area under the receiver operating characteristic curve (AUC), indicating how well the model distinguishes cases from unaffected control subjects. Logistic regression model with the lasso penalty technique generated an AUC of 0.693, while Support Vector Machines and Gradient Boosted Trees reached AUC's of 0.691 and 0.623, respectively. Using different sample sizes, our results suggest that larger datasets are required to optimize the machine learning models and achieve higher AUC values. To our knowledge, this is the first attempt to assess AN risk based on genome wide genotype level data. Future integration of genomic, environmental and family-based information is likely to improve the AN risk evaluation process, eventually benefitting AN patients and families in the clinical setting.

Controlling the Radon Threat Needn't Be Another Costly Nightmare.

ERIC Educational Resources Information Center

Freije, Matthew R.

1989-01-01

After a study of 3,000 classrooms in 130 schools in 16 states, the Environmental Protection Agency urged all schools to conduct tests for radon. Explains a 6-step screening test, methods of reducing radon concentrations, and how the risk from radon exposure compares with other risks. (MLF)

Rural Residence and Hispanic Ethnicity: Doubly Disadvantaged for Diabetes?

ERIC Educational Resources Information Center

Koopman, Richelle J.; Mainous, Arch G.; Geesey, Mark E.

2006-01-01

Context: Hispanics are at increased risk for diabetes, while rural residents have historically had decreased access to care. Purpose: To determine whether living in a rural area and being Hispanic confers special risks for diagnosis and control of diabetes. Methods: We analyzed the Third National Health and Nutrition Examination Survey…

Liver transplant patients have a similar risk of progression as sporadic patients with branch duct intraductal papillary mucinous neoplasms

PubMed Central

Lennon, Anne Marie; Victor, David; Zaheer, Atif; Ostovaneh, Mohammad Reza; Jeh, Jessica; Law, Joanna K.; Rezaee, Neda; Molin, Marco Dal; Ahn, Young Joon; Wu, Wenchuan; Khashab, Mouen A.; Girotra, Mohit; Ahuja, Nita; Makary, Martin A.; Weiss, Matthew J.; Hirose, Kenzo; Goggins, Michael; Hruban, Ralph H.; Cameron, Andrew; Wolfgang, Christopher L.; Singh, Vikesh K.; Gurakar, Ahmet

2015-01-01

Background Intraductal papillary mucinous neoplasms (IPMNs) have malignant potential, and can progress from low- to high-grade dysplasia to invasive adenocarcinoma. The management of patients with IPMNs is dependent on their risk of malignant progression, with surgical resection recommended for patients with branch duct-IPMN (BD-IPMN) who develop high-risk features. There is increasing evidence that liver transplant patients are at increased risk of extra-hepatic malignancy. However there are few data regarding the risk of progression of BD-IPMNs in liver transplant recipients. The aim of this study was to determine if liver transplant recipients with BD-IPMNs are at higher risk of developing high-risk features than patients with BD-IPMNs who did not receive a transplant. Methods Consecutive patients who underwent a liver transplant with BD-IPMNs were included. Patients with BD-IPMNs with no history of immunosuppression were used as controls. Progression of the BD-IPMNs was defined as development of a high-risk feature (jaundice, dilated main pancreatic duct, mural nodule, cytology suspicious or diagnostic for malignancy, cyst diameter ≥3cm). Results Twenty three liver transplant patients with BD-IPMN were compared with 274 control patients. The median length of follow-up was 53.7 and 24 months in liver transplant and control groups respectively. Four (17.4%) liver transplant patients and 45 (16.4%) controls developed high-risk features (p=0.99). In multivariate analysis, progression of BD-IPMNs was associated with age at diagnosis but not with liver transplantation. Conclusion There was no statistically significant difference in the risk of developing high-risk features between the liver transplant and control groups. PMID:25155689

[Study of lung cancer risk in the electroplating industry in Lombardy based on the OCCAM method].

PubMed

Panizza, C; Bai, E; Oddone, E; Scaburri, Alessandra; Massari, Stefania; Modonesi, C; Crosignani, P

2011-01-01

The OCCAM method consists of case-control studies aimed at estimating occupational risks by cancer site, by area and by economic sector, using available archives to identify cases and controls; for exposure definition each subject is assigned to the category code of the economic sector or company where he/she worked the longest, obtained by automatic link with the Social Security Institute (INPS) files. The reference category (unexposed) consists of service industry workers. The economic sector is given by the ATECO category that INPS assigns to each firm. In the Lombardy Region, lung cancer risk evaluated for the "metal treatment" industry as a whole was 1.32 (90% CI 1.33-3.10, 67 cases) for males and 1.33 (90% CI 0.51-3.59, 10 cases) for females. The aim of the study was to estimate lung cancer risk among metal electroplating workers only. The metal electroplating firms were identified according to the detailed description of production, data which was also contained in INPS files, instead of using the "metal treatment" ATECO code. Lung cancer risk was evaluated using 2001-2008 incident cases identified from hospital discharge records of residents in the Lombardy Region. Controls were a sample from National Health Service files. For the group of firms identified as metal electroplating industries the risk was 2.03 (90% CI 1.69-8.32, 18 cases) for males and 3.75 (90% CI 1.38-9.03, 4 cases) for females. Focusing on the true electroplating firms increased the risk estimates. Even though these risk were due to past exposures, case histories and recent acute effects indicate that, at least in some factories, a carcinogenic hazard still exists.

Ensemble Flow Forecasts for Risk Based Reservoir Operations of Lake Mendocino in Mendocino County, California

NASA Astrophysics Data System (ADS)

Delaney, C.; Hartman, R. K.; Mendoza, J.; Evans, K. M.; Evett, S.

2016-12-01

Forecast informed reservoir operations (FIRO) is a methodology that incorporates short to mid-range precipitation or flow forecasts to inform the flood operations of reservoirs. Previous research and modeling for flood control reservoirs has shown that FIRO can reduce flood risk and increase water supply for many reservoirs. The risk-based method of FIRO presents a unique approach that incorporates flow forecasts made by NOAA's California-Nevada River Forecast Center (CNRFC) to model and assess risk of meeting or exceeding identified management targets or thresholds. Forecasted risk is evaluated against set risk tolerances to set reservoir flood releases. A water management model was developed for Lake Mendocino, a 116,500 acre-foot reservoir located near Ukiah, California. Lake Mendocino is a dual use reservoir, which is owned and operated for flood control by the United State Army Corps of Engineers and is operated by the Sonoma County Water Agency for water supply. Due to recent changes in the operations of an upstream hydroelectric facility, this reservoir has been plagued with water supply reliability issues since 2007. FIRO is applied to Lake Mendocino by simulating daily hydrologic conditions from 1985 to 2010 in the Upper Russian River from Lake Mendocino to the City of Healdsburg approximately 50 miles downstream. The risk-based method is simulated using a 15-day, 61 member streamflow hindcast by the CNRFC. Model simulation results of risk-based flood operations demonstrate a 23% increase in average end of water year (September 30) storage levels over current operations. Model results show no increase in occurrence of flood damages for points downstream of Lake Mendocino. This investigation demonstrates that FIRO may be a viable flood control operations approach for Lake Mendocino and warrants further investigation through additional modeling and analysis.

Presence of DQ2.2 Associated with DQ2.5 Increases the Risk for Celiac Disease

PubMed Central

Almeida, Lucas Malta; Gandolfi, Lenora; Pratesi, Riccardo; Uenishi, Rosa Harumi; de Almeida, Fernanda Coutinho; Selleski, Nicole

2016-01-01

Background. Celiac disease (CD) is a genetically determined immune-mediated disorder in which gluten immunogenic peptides are presented to CD4 T cells by HLA-DQ2.5, DQ8, DQ2.2, and their combinations. Our aim is to establish a risk gradient for celiac disease based on HLA-DQ profile in a brazilian representative population and the relevance of DQ2.2 in celiac disease development. Materials and Methods. 237 celiac patients and 237 controls (both groups with 164 females and 73 males) were included. All samples were tested for the presence of predisposing HLA-DQ alleles using the PCR-SSP method. Results were considered significant when p < 0.05. Disease risk was expressed as 1 : N for each HLA-DQ category described at this study. Results. DQ2.5 and/or DQ8 were detected in 224 celiac patients (94.5%) and 84 controls (35.4%). Eight celiac patients (3.4%) and 38 controls (16%) disclosed only DQ2.2. Even though DQ2.2 (β2/β2 or β2/x) showed a low CD risk of 1 : 251 and 1 : 550, respectively, the genotype DQ2.5/DQ2.2 (β2/β2) showed high CD risk of 1 : 10 (p < 0.0001). The disease risk gradient ranged from 1 : 3014 to 1 : 7. Conclusion. Our study allowed the determination of a risk gradient for celiac disease development in at-risk population, showing that DQ2.2 variant was relevant when associated with DQ2.5. PMID:28042478

Evaluation of Contamination Inspection and Analysis Methods through Modeling System Performance

NASA Technical Reports Server (NTRS)

Seasly, Elaine; Dever, Jason; Stuban, Steven M. F.

2016-01-01

Contamination is usually identified as a risk on the risk register for sensitive space systems hardware. Despite detailed, time-consuming, and costly contamination control efforts during assembly, integration, and test of space systems, contaminants are still found during visual inspections of hardware. Improved methods are needed to gather information during systems integration to catch potential contamination issues earlier and manage contamination risks better. This research explores evaluation of contamination inspection and analysis methods to determine optical system sensitivity to minimum detectable molecular contamination levels based on IEST-STD-CC1246E non-volatile residue (NVR) cleanliness levels. Potential future degradation of the system is modeled given chosen modules representative of optical elements in an optical system, minimum detectable molecular contamination levels for a chosen inspection and analysis method, and determining the effect of contamination on the system. By modeling system performance based on when molecular contamination is detected during systems integration and at what cleanliness level, the decision maker can perform trades amongst different inspection and analysis methods and determine if a planned method is adequate to meet system requirements and manage contamination risk.

Assessment of contamination and misclassification biases in a randomized controlled trial of a social network peer education intervention to reduce HIV risk behaviors among drug users and risk partners in Philadelphia, PA and Chiang Mai, Thailand.

PubMed

Simmons, Nicole; Donnell, Deborah; Ou, San-San; Celentano, David D; Aramrattana, Apinun; Davis-Vogel, Annet; Metzger, David; Latkin, Carl

2015-10-01

Controlled trials of HIV prevention and care interventions are susceptible to contamination. In a randomized controlled trial of a social network peer education intervention among people who inject drugs and their risk partners in Philadelphia, PA and Chiang Mai, Thailand, we tested a contamination measure based on recall of intervention terms. We assessed the recall of test, negative and positive control terms among intervention and control arm participants and compared the relative odds of recall of test versus negative control terms between study arms. The contamination measures showed good discriminant ability among participants in Chiang Mai. In Philadelphia there was no evidence of contamination and little evidence of diffusion. In Chiang Mai there was strong evidence of diffusion and contamination. Network structure and peer education in Chiang Mai likely led to contamination. Recall of intervention materials can be a useful method to detect contamination in experimental interventions.

Evidence-based risk communication: a systematic review.

PubMed

Zipkin, Daniella A; Umscheid, Craig A; Keating, Nancy L; Allen, Elizabeth; Aung, KoKo; Beyth, Rebecca; Kaatz, Scott; Mann, Devin M; Sussman, Jeremy B; Korenstein, Deborah; Schardt, Connie; Nagi, Avishek; Sloane, Richard; Feldstein, David A

2014-08-19

Effective communication of risks and benefits to patients is critical for shared decision making. To review the comparative effectiveness of methods of communicating probabilistic information to patients that maximize their cognitive and behavioral outcomes. PubMed (1966 to March 2014) and CINAHL, EMBASE, and the Cochrane Central Register of Controlled Trials (1966 to December 2011) using several keywords and structured terms. Prospective or cross-sectional studies that recruited patients or healthy volunteers and compared any method of communicating probabilistic information with another method. Two independent reviewers extracted study characteristics and assessed risk of bias. Eighty-four articles, representing 91 unique studies, evaluated various methods of numerical and visual risk display across several risk scenarios and with diverse outcome measures. Studies showed that visual aids (icon arrays and bar graphs) improved patients' understanding and satisfaction. Presentations including absolute risk reductions were better than those including relative risk reductions for maximizing accuracy and seemed less likely than presentations with relative risk reductions to influence decisions to accept therapy. The presentation of numbers needed to treat reduced understanding. Comparative effects of presentations of frequencies (such as 1 in 5) versus event rates (percentages, such as 20%) were inconclusive. Most studies were small and highly variable in terms of setting, context, and methods of administering interventions. Visual aids and absolute risk formats can improve patients' understanding of probabilistic information, whereas numbers needed to treat can lessen their understanding. Due to study heterogeneity, the superiority of any single method for conveying probabilistic information is not established, but there are several good options to help clinicians communicate with patients. None.

75 FR 30077 - Advisory Committee On Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee On Digital I&C...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-28

... Subcommittee On Digital I&C Systems The ACRS Subcommittee on Digital Instrumentation and Control (DI&C) Systems... the area of Digital Instrumentation and Control (DI&C) Probabilistic Risk Assessment (PRA). Topics... software reliability methods (QSRMs), NUREG/CR--6997, ``Modeling a Digital Feedwater Control System Using...

Pest Control in the School Environment: Adopting Integrated Pest Management.

ERIC Educational Resources Information Center

Environmental Protection Agency, Washington, DC. Office of Pesticide Programs.

As the public becomes more aware of the health and environmental risks pesticides may pose, its interest in seeking the use of equally effective alternative pest control methods increases. School administrators and other persons who have pest control decision-making responsibilities for school buildings and grounds can use this guide to become…

Approach to risk identification in undifferentiated mental disorders

PubMed Central

Silveira, José; Rockman, Patricia; Fulford, Casey; Hunter, Jon

2016-01-01

Abstract Objective To provide primary care physicians with a novel approach to risk identification and related clinical decision making in the management of undifferentiated mental disorders. Sources of information We conducted a review of the literature in PubMed, CINAHL, PsycINFO, and Google Scholar using the search terms diagnostic uncertainty, diagnosis, risk identification, risk assessment/methods, risk, risk factors, risk management/methods, cognitive biases and psychiatry, decision making, mental disorders/diagnosis, clinical competence, evidence-based medicine, interviews as topic, psychiatry/education, psychiatry/methods, documentation/methods, forensic psychiatry/education, forensic psychiatry/methods, mental disorders/classification, mental disorders/psychology, violence/prevention and control, and violence/psychology. Main message Mental disorders are a large component of practice in primary care and often present in an undifferentiated manner, remaining so for prolonged periods. The challenging search for a diagnosis can divert attention from risk identification, as diagnosis is commonly presumed to be necessary before treatment can begin. This might inadvertently contribute to preventable adverse events. Focusing on salient aspects of the patient presentation related to risk should be prioritized. This article presents a novel approach to organizing patient information to assist risk identification and decision making in the management of patients with undifferentiated mental disorders. Conclusion A structured approach can help physicians to manage the clinical uncertainty common to risk identification in patients with mental disorders and cope with the common anxiety and cognitive biases that affect priorities in risk-related decision making. By focusing on risk, functional impairments, and related symptoms using a novel framework, physicians can meet their patients’ immediate needs while continuing the search for diagnostic clarity and long-term treatment. PMID:27965330

Approach to risk identification in undifferentiated mental disorders.

PubMed

Silveira, José; Rockman, Patricia; Fulford, Casey; Hunter, Jon

2016-12-01

To provide primary care physicians with a novel approach to risk identification and related clinical decision making in the management of undifferentiated mental disorders. We conducted a review of the literature in PubMed, CINAHL, PsycINFO, and Google Scholar using the search terms diagnostic uncertainty, diagnosis, risk identification, risk assessment/methods, risk, risk factors, risk management/methods, cognitive biases and psychiatry, decision making, mental disorders/diagnosis, clinical competence, evidence-based medicine, interviews as topic, psychiatry/education, psychiatry/methods, documentation/methods, forensic psychiatry/education, forensic psychiatry/methods, mental disorders/classification, mental disorders/psychology, violence/prevention and control, and violence/psychology. Mental disorders are a large component of practice in primary care and often present in an undifferentiated manner, remaining so for prolonged periods. The challenging search for a diagnosis can divert attention from risk identification, as diagnosis is commonly presumed to be necessary before treatment can begin. This might inadvertently contribute to preventable adverse events. Focusing on salient aspects of the patient presentation related to risk should be prioritized. This article presents a novel approach to organizing patient information to assist risk identification and decision making in the management of patients with undifferentiated mental disorders. A structured approach can help physicians to manage the clinical uncertainty common to risk identification in patients with mental disorders and cope with the common anxiety and cognitive biases that affect priorities in risk-related decision making. By focusing on risk, functional impairments, and related symptoms using a novel framework, physicians can meet their patients' immediate needs while continuing the search for diagnostic clarity and long-term treatment. Copyright© the College of Family Physicians of Canada.

Estimated Reduction in Cancer Risk due to PAH Exposures If Source Control Measures during the 2008 Beijing Olympics Were Sustained

PubMed Central

Jia, Yuling; Stone, Dave; Wang, Wentao; Schrlau, Jill; Tao, Shu; Massey Simonich, Staci L.

2011-01-01

Background The 2008 Beijing Olympic Games provided a unique case study to investigate the effect of source control measures on the reduction in air pollution, and associated inhalation cancer risk, in a Chinese megacity. Objectives We measured 17 carcinogenic polycyclic aromatic hydrocarbons (PAHs) and estimated the lifetime excess inhalation cancer risk during different periods of the Beijing Olympic Games, to assess the effectiveness of source control measures in reducing PAH-induced inhalation cancer risks. Methods PAH concentrations were measured in samples of particulate matter ≤ 2.5 μm in aerodynamic diameter (PM2.5) collected during the Beijing Olympic Games, and the associated inhalation cancer risks were estimated using a point-estimate approach based on relative potency factors. Results We estimated the number of lifetime excess cancer cases due to exposure to the 17 carcinogenic PAHs [12 priority pollutant PAHs and five high-molecular-weight (302 Da) PAHs (MW 302 PAHs)] to range from 6.5 to 518 per million people for the source control period concentrations and from 12.2 to 964 per million people for the nonsource control period concentrations. This would correspond to a 46% reduction in estimated inhalation cancer risk due to source control measures, if these measures were sustained over time. Benzo[b]fluoranthene, dibenz[a,h]anthracene, benzo[a]pyrene, and dibenzo[a,l]pyrene were the most carcinogenic PAH species evaluated. Total excess inhalation cancer risk would be underestimated by 23% if we did not include the five MW 302 PAHs in the risk calculation. Conclusions Source control measures, such as those imposed during the 2008 Beijing Olympics, can significantly reduce the inhalation cancer risk associated with PAH exposure in Chinese megacities similar to Beijing. MW 302 PAHs are a significant contributor to the estimated overall inhalation cancer risk. PMID:21632310

A Statistical Testing Approach for Quantifying Software Reliability; Application to an Example System

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

Chu, Tsong-Lun; Varuttamaseni, Athi; Baek, Joo-Seok

The U.S. Nuclear Regulatory Commission (NRC) encourages the use of probabilistic risk assessment (PRA) technology in all regulatory matters, to the extent supported by the state-of-the-art in PRA methods and data. Although much has been accomplished in the area of risk-informed regulation, risk assessment for digital systems has not been fully developed. The NRC established a plan for research on digital systems to identify and develop methods, analytical tools, and regulatory guidance for (1) including models of digital systems in the PRAs of nuclear power plants (NPPs), and (2) incorporating digital systems in the NRC's risk-informed licensing and oversight activities.more » Under NRC's sponsorship, Brookhaven National Laboratory (BNL) explored approaches for addressing the failures of digital instrumentation and control (I and C) systems in the current NPP PRA framework. Specific areas investigated included PRA modeling digital hardware, development of a philosophical basis for defining software failure, and identification of desirable attributes of quantitative software reliability methods. Based on the earlier research, statistical testing is considered a promising method for quantifying software reliability. This paper describes a statistical software testing approach for quantifying software reliability and applies it to the loop-operating control system (LOCS) of an experimental loop of the Advanced Test Reactor (ATR) at Idaho National Laboratory (INL).« less

From differences in means between cases and controls to risk stratification: a business plan for biomarker development.

PubMed

Wentzensen, Nicolas; Wacholder, Sholom

2013-02-01

Researchers developing biomarkers for early detection can determine the potential for clinical benefit at early stages of development. We provide the theoretical background showing the quantitative connection between biomarker levels in cases and controls and clinically meaningful risk measures, as well as a spreadsheet for researchers to use in their own research. We provide researchers with tools to decide whether a test is useful, whether it needs technical improvement, whether it may work only in specific populations, or whether any further development is futile. The methods described here apply to any method that aims to estimate risk of disease based on biomarkers, clinical tests, genetics, environment, or behavior. Many efforts go into futile biomarker development and premature clinical testing. In many instances, predictions for translational success or failure can be made early, simply based on critical analysis of case–control data. Our article presents well-established theory in a form that can be appreciated by biomarker researchers. Furthermore, we provide an interactive spreadsheet that links biomarker performance with specific disease characteristics to evaluate the promise of biomarker candidates at an early stage.

Electric and hybrid vehicles environmental control subsystem study

NASA Technical Reports Server (NTRS)

1981-01-01

An environmental control subsystem (ECS) in the passenger compartment of electric and hybrid vehicles is studied. Various methods of obtaining the desired temperature control for the battery pack is also studied. The functional requirements of ECS equipment is defined. Following categorization by methodology, technology availability and risk, all viable ECS concepts are evaluated. Each is assessed independently for benefits versus risk, as well as for its feasibility to short, intermediate and long term product development. Selection of the preferred concept is made against these requirements, as well as the study's major goal of providing safe, highly efficient and thermally confortable ECS equipment.

Maneuver Planning for Conjunction Risk Mitigation with Ground-track Control Requirements

NASA Technical Reports Server (NTRS)

McKinley, David

2008-01-01

The planning of conjunction Risk Mitigation Maneuvers (RMM) in the presence of ground-track control requirements is analyzed. Past RMM planning efforts on the Aqua, Aura, and Terra spacecraft have demonstrated that only small maneuvers are available when ground-track control requirements are maintained. Assuming small maneuvers, analytical expressions for the effect of a given maneuver on conjunction geometry are derived. The analytical expressions are used to generate a large trade space for initial RMM design. This trade space represents a significant improvement in initial maneuver planning over existing methods that employ high fidelity maneuver models and propagation.

Diabetes, glycemic control, and urinary incontinence in women

PubMed Central

Wang, Rui; Lefevre, Roger; Hacker, Michele R.; Golen, Toni H.

2015-01-01

OBJECTIVES To estimate the association between urinary incontinence and glycemic control in women ages 20 to 85. METHODS We included 7,270 women from the 2005–2010 National Health and Nutrition Examination Survey, stratified into three groups of glycemic control defined by hemoglobin A1c (HbA1c): i) those below the diagnostic threshold (HbA1c<6.5%), ii) those with relatively controlled diabetes (HbA1c 6.5–8.5%), and iii) those with poorly controlled diabetes (HbA1c>8.5%) to allow for a different relationship between glycemic control and urinary incontinence within each group. The primary outcomes were the presence of any, only stress, only urgency, and mixed urinary incontinence. We calculated adjusted risk ratios using Poisson regressions with robust variance estimates. RESULTS The survey-weighted prevalence was 52.9% for any, 27.2% for only stress, 9.9% for only urgency, and 15.8% for mixed urinary incontinence. Among women with relatively controlled diabetes, each one-unit increase in HbA1c was associated with a 13% (95% CI: 1.03–1.25) increase for any urinary incontinence and a 34% (95% CI 1.06–1.69) increase in risk for only stress incontinence but was not significantly associated with only urgency and mixed incontinence. Other risk factors included body mass index, hormone replacement therapy, smoking, and physical activity. CONCLUSIONS Worsening glycemic control is associated with an increased risk for stress incontinence for women with relatively controlled diabetes. For those either below the diagnostic threshold or with poorly controlled diabetes, the risk may be driven by other factors. Further prospective investigation of HbA1c as a modifiable risk factor may motivate measures to improve continence in women with diabetes. PMID:26313496

Dietary patterns derived with multiple methods from food diaries and breast cancer risk in the UK Dietary Cohort Consortium

PubMed Central

Pot, Gerda K; Stephen, Alison M; Dahm, Christina C; Key, Timothy J; Cairns, Benjamin J; Burley, Victoria J; Cade, Janet E; Greenwood, Darren C; Keogh, Ruth H; Bhaniani, Amit; McTaggart, Alison; Lentjes, Marleen AH; Mishra, Gita; Brunner, Eric J; Khaw, Kay Tee

2015-01-01

Background/ Objectives In spite of several studies relating dietary patterns to breast cancer risk, evidence so far remains inconsistent. This study aimed to investigate associations of dietary patterns derived with three different methods with breast cancer risk. Subjects/ Methods The Mediterranean Diet Score (MDS), principal components analyses (PCA) and reduced rank regression (RRR) were used to derive dietary patterns in a case-control study of 610 breast cancer cases and 1891 matched controls within 4 UK cohort studies. Dietary intakes were collected prospectively using 4-to 7-day food diaries and resulting food consumption data were grouped into 42 food groups. Conditional logistic regression models were used to estimate odds ratios (ORs) for associations between pattern scores and breast cancer risk adjusting for relevant covariates. A separate model was fitted for post-menopausal women only. Results The MDS was not associated with breast cancer risk (OR comparing 1st tertile with 3rd 1.20 (95% CI 0.92; 1.56)), nor the first PCA-derived dietary pattern, explaining 2.7% of variation of diet and characterized by cheese, crisps and savoury snacks, legumes, nuts and seeds (OR 1.18 (95% CI 0.91; 1.53)). The first RRR-derived pattern, a ‘high-alcohol’ pattern, was associated with a higher risk of breast cancer (OR 1.27; 95% CI 1.00; 1.62), which was most pronounced in post-menopausal women (OR 1.46 (95% CI 1.08; 1.98). Conclusions A ‘high-alcohol’ dietary pattern derived with RRR was associated with an increased breast cancer risk; no evidence of associations of other dietary patterns with breast cancer risk was observed in this study. PMID:25052230

Cost effective malaria risk control using remote sensing and environmental data

NASA Astrophysics Data System (ADS)

Rahman, Md. Z.; Roytman, Leonid; Kadik, Abdel Hamid

2012-06-01

Malaria transmission in many part of the world specifically in Bangladesh and southern African countries is unstable and epidemic. An estimate of over a million cases is reported annually. Malaria is heterogeneous, potentially due to variations in ecological settings, socio-economic status, land cover, and agricultural practices. Malaria control only relies on treatment and supply of bed networks. Drug resistance to these diseases is widespread. Vector control is minimal. Malaria control in those countries faces many formidable challenges such as inadequate accessibility to effective treatment, lack of trained manpower, inaccessibility of endemic areas, poverty, lack of education, poor health infrastructure and low health budgets. Health facilities for malaria management are limited, surveillance is inadequate, and vector control is insufficient. Control can only be successful if the right methods are used at the right time in the right place. This paper aims to improve malaria control by developing malaria risk maps and risk models using satellite remote sensing data by identifying, assessing, and mapping determinants of malaria associated with environmental, socio-economic, malaria control, and agricultural factors.

How well are malaria maps used to design and finance malaria control in Africa?

PubMed

Omumbo, Judy A; Noor, Abdisalan M; Fall, Ibrahima S; Snow, Robert W

2013-01-01

Rational decision making on malaria control depends on an understanding of the epidemiological risks and control measures. National Malaria Control Programmes across Africa have access to a range of state-of-the-art malaria risk mapping products that might serve their decision-making needs. The use of cartography in planning malaria control has never been methodically reviewed. An audit of the risk maps used by NMCPs in 47 malaria endemic countries in Africa was undertaken by examining the most recent national malaria strategies, monitoring and evaluation plans, malaria programme reviews and applications submitted to the Global Fund. The types of maps presented and how they have been used to define priorities for investment and control was investigated. 91% of endemic countries in Africa have defined malaria risk at sub-national levels using at least one risk map. The range of risk maps varies from maps based on suitability of climate for transmission; predicted malaria seasons and temperature/altitude limitations, to representations of clinical data and modelled parasite prevalence. The choice of maps is influenced by the source of the information. Maps developed using national data through in-country research partnerships have greater utility than more readily accessible web-based options developed without inputs from national control programmes. Although almost all countries have stratification maps, only a few use them to guide decisions on the selection of interventions allocation of resources for malaria control. The way information on the epidemiology of malaria is presented and used needs to be addressed to ensure evidence-based added value in planning control. The science on modelled impact of interventions must be integrated into new mapping products to allow a translation of risk into rational decision making for malaria control. As overseas and domestic funding diminishes, strategic planning will be necessary to guide appropriate financing for malaria control.

Using genetic prediction from known complex disease Loci to guide the design of next-generation sequencing experiments.

PubMed

Jostins, Luke; Levine, Adam P; Barrett, Jeffrey C

2013-01-01

A central focus of complex disease genetics after genome-wide association studies (GWAS) is to identify low frequency and rare risk variants, which may account for an important fraction of disease heritability unexplained by GWAS. A profusion of studies using next-generation sequencing are seeking such risk alleles. We describe how already-known complex trait loci (largely from GWAS) can be used to guide the design of these new studies by selecting cases, controls, or families who are most likely to harbor undiscovered risk alleles. We show that genetic risk prediction can select unrelated cases from large cohorts who are enriched for unknown risk factors, or multiply-affected families that are more likely to harbor high-penetrance risk alleles. We derive the frequency of an undiscovered risk allele in selected cases and controls, and show how this relates to the variance explained by the risk score, the disease prevalence and the population frequency of the risk allele. We also describe a new method for informing the design of sequencing studies using genetic risk prediction in large partially-genotyped families using an extension of the Inside-Outside algorithm for inference on trees. We explore several study design scenarios using both simulated and real data, and show that in many cases genetic risk prediction can provide significant increases in power to detect low-frequency and rare risk alleles. The same approach can also be used to aid discovery of non-genetic risk factors, suggesting possible future utility of genetic risk prediction in conventional epidemiology. Software implementing the methods in this paper is available in the R package Mangrove.

A novel method for assessing risks to pollinators from plant protection products using honeybees as a model species.

PubMed

Barmaz, Stefania; Potts, Simon G; Vighi, Marco

2010-10-01

Pollination is one of the most important ecosystem services in agroecosystems and supports food production. Pollinators are potentially at risk being exposed to pesticides and the main route of exposure is direct contact, in some cases ingestion, of contaminated materials such as pollen, nectar, flowers and foliage. To date there are no suitable methods for predicting pesticide exposure for pollinators, therefore official procedures to assess pesticide risk are based on a Hazard Quotient. Here we develop a procedure to assess exposure and risk for pollinators based on the foraging behaviour of honeybees (Apis mellifera) and using this species as indicator representative of pollinating insects. The method was applied in 13 European field sites with different climatic, landscape and land use characteristics. The level of risk during the crop growing season was evaluated as a function of the active ingredients used and application regime. Risk levels were primarily determined by the agronomic practices employed (i.e. crop type, pest control method, pesticide use), and there was a clear temporal partitioning of risks through time. Generally the risk was higher in sites cultivated with permanent crops, such as vineyard and olive, than in annual crops, such as cereals and oil seed rape. The greatest level of risk is generally found at the beginning of the growing season for annual crops and later in June-July for permanent crops.

Associations between heavy episodic drinking and alcohol related injuries: a case control study

PubMed Central

2013-01-01

Background Alcohol is a significant risk factor for injuries. This study addresses 1) whether the risk of alcohol related injury increases with frequency of heavy episodic drinking (HED) in a linear fashion, and 2) whether a small group of high risk drinkers accounts for the majority of alcohol related injuries. Methods We applied a case – control design. Cases were BAC positive injured patients (n = 534) and controls were respondents to a general population survey in Norway (n = 1947). Age and gender adjusted association between self-reported past year HED frequency and alcohol related injury risk was estimated in logistic regression models for all alcohol related injuries and for violence injuries and accident injuries separately. Results An increase in HED was associated with an increase in risk of alcohol related injury, resembling a linear risk function. The small fraction of high risk drinkers (6.6%) accounted for 41.6% of all alcohol related injuries, thus lending support to the validity of the prevention paradox. Conclusion There is a strong relationship between frequency of heavy episodic drinking and risk of alcohol related injuries, yet the majority of alcohol related injuries are found among drinkers who are not in the high risk group. PMID:24228707

Pregnancy-related maternal risk factors of attention-deficit hyperactivity disorder: a case-control study.

PubMed

Amiri, Shahrokh; Malek, Ayyoub; Sadegfard, Majid; Abdi, Salman

2012-01-01

Background. The etiology of attention-deficit hyperactivity disorder (ADHD) is complex.This study was conducted to evaluate the pregnancy-related maternal risk factors of ADHD. Methods. 164 ADHD children attending to Child and Adolescent Psychiatric Clinics compared with 166 normal children selected in a random-cluster method from primary schools. ADHD rating scale and clinical interview based on Schedule for Affective disorders and Schizophrenia for School-Aged Children (K-SADS) were used to diagnose ADHD cases and to select the control group. Results. The mean maternal age at pregnancy, duration of pregnancy, and the mean paternal age were alike in two groups. The ADHD children's mothers compared with those of control group had higher frequencies of somatic diseases, psychiatric disorders, and alcohol and cigarette exposure during the pregnancies (P < 0.01). Also birth by cesarean section was more common among mothers of ADHD children (P < 0.001). These factors plus trauma to the abdomen during pregnancy were significantly predictors of ADHD in children. Conclusions. Some pregnancy-related maternal factors may be considered as environmental risk factors for ADHD. Each of these factors considered in our study as a risk factor needs to be tested and confirmed through next methodologically appropriate researches in this field.

Estimating the Time to Benefit for Preventive Drugs with the Statistical Process Control Method: An Example with Alendronate.

PubMed

van de Glind, Esther M M; Willems, Hanna C; Eslami, Saeid; Abu-Hanna, Ameen; Lems, Willem F; Hooft, Lotty; de Rooij, Sophia E; Black, Dennis M; van Munster, Barbara C

2016-05-01

For physicians dealing with patients with a limited life expectancy, knowing the time to benefit (TTB) of preventive medication is essential to support treatment decisions. The aim of this study was to investigate the usefulness of statistical process control (SPC) for determining the TTB in relation to fracture risk with alendronate versus placebo in postmenopausal women. We performed a post hoc analysis of the Fracture Intervention Trial (FIT), a randomized, controlled trial that investigated the effect of alendronate versus placebo on fracture risk in postmenopausal women. We used SPC, a statistical method used for monitoring processes for quality control, to determine if and when the intervention group benefited significantly more than the control group. SPC discriminated between the normal variations over time in the numbers of fractures in both groups and the variations that were attributable to alendronate. The TTB was defined as the time point from which the cumulative difference in the number of clinical fractures remained greater than the upper control limit on the SPC chart. For the total group, the TTB was defined as 11 months. For patients aged ≥70 years, the TTB was 8 months [absolute risk reduction (ARR) = 1.4%]; for patients aged <70 years, it was 19 months (ARR = 0.7%). SPC is a clear and understandable graphical method to determine the TTB. Its main advantage is that there is no need to define a prespecified time point, as is the case in traditional survival analyses. Prescribing alendronate to patients who are aged ≥70 years is useful because the TTB shows that they will benefit after 8 months. Investigators should report the TTB to simplify clinical decision making.

Papilloma Virus Infected Northeastern Thai Women

PubMed

Phuthong, Sophida; Settheetham-Ishida, Wannapa; Natphopsuk, Sitakan; Ishida, Takafumi

2018-02-26

Objective: We aimed to investigate any association between a genetic polymorphism of the detoxification GSTP1 gene and risk of cervical cancer in northeastern Thailand. Materials and Methods: Genotyping of GSTP1 was performed for 198 squamous cell cervical cancer (SCCA) patients and 198 age-matched healthy controls with the PCR-RFLP method. Results: The respective frequencies of the G allele were 0.33 and 0.26 in the controls and cases, the difference being significant (OR = 0.69 [95% CI: 0.50-0.95, p=0.0192]). Among women infected with high-risk types of HPV, being a heterozygous carrier was associated with a reduced risk of cervical cancer (adjusted OR = 0.32 [95% CI: 0.12-0.91, p=0.031]). Similarly, a decreased risk was observed in heterozygous women with a non-smoking partner (adjusted OR = 0.27 [95% CI: 0.09-0.83, p=0.023]). Conclusions: GSTP1 polymorphism could influence susceptibility to cervical cancer among northeast Thai women; either as a independent factor or in combination with high-risk HPV infection. Dual-testing of HPV and the GSTP1 might prove an effective screening tool for cervical cancer. Creative Commons Attribution License

Impact of a primary care based intervention on breast cancer knowledge, risk perception and concern: A randomized, controlled trial

PubMed Central

Livaudais-Toman, Jennifer; Karliner, Leah S.; Tice, Jeffrey A.; Kerlikowske, Karla; Gregorich, Steven; Pérez-Stable, Eliseo J.; Pasick, Rena J.; Chen, Alice; Quinn, Jessica; Kaplan, Celia P.

2015-01-01

Purpose To estimate the effects of a tablet-based, breast cancer risk education intervention for use in primary care settings (BreastCARE) on patients' breast cancer knowledge, risk perception and concern. Methods From June 2011–August 2012, we enrolled women from two clinics, aged 40–74 years with no personal breast cancer history, and randomized them to the BreastCARE intervention group or to the control group. All patients completed a baseline telephone survey and risk assessment (via telephone for controls, via tablet computer in clinic waiting room prior to visit for intervention). All women were categorized as high or average risk based on the Referral Screening Tool, the Gail model or the Breast Cancer Surveillance Consortium model. Intervention patients and their physicians received an individualized risk report to discuss during the visit. All women completed a follow-up telephone survey 1–2 weeks after risk assessment. Post-test comparisons estimated differences at follow-up in breast cancer knowledge, risk perception and concern. Results 580 intervention and 655 control women completed follow-up interviews. Mean age was 56 years (SD = 9). At follow-up, 73% of controls and 71% of intervention women correctly perceived their breast cancer risk and 22% of controls and 24% of intervention women were very concerned about breast cancer. Intervention patients had greater knowledge (≥75% correct answers) of breast cancer risk factors at follow-up (24% vs. 16%; p = 0.002). In multivariable analysis, there were no differences in correct risk perception or concern, but intervention patients had greater knowledge ([OR] = 1.62; 95% [CI] = 1.19–2.23). Conclusions A simple, practical intervention involving physicians at the point of care can improve knowledge of breast cancer without increasing concern. Trial Registration ClinicalTrials.gov identifier NCT01830933. PMID:26476466

Market analyses of livestock trade networks to inform the prevention of joint economic and epidemiological risks.

PubMed

Moslonka-Lefebvre, Mathieu; Gilligan, Christopher A; Monod, Hervé; Belloc, Catherine; Ezanno, Pauline; Filipe, João A N; Vergu, Elisabeta

2016-03-01

Conventional epidemiological studies of infections spreading through trade networks, e.g., via livestock movements, generally show that central large-size holdings (hubs) should be preferentially surveyed and controlled in order to reduce epidemic spread. However, epidemiological strategies alone may not be economically optimal when costs of control are factored in together with risks of market disruption from targeting core holdings in a supply chain. Using extensive data on animal movements in supply chains for cattle and swine in France, we introduce a method to identify effective strategies for preventing outbreaks with limited budgets while minimizing the risk of market disruptions. Our method involves the categorization of holdings based on position along the supply chain and degree of market share. Our analyses suggest that trade has a higher risk of propagating epidemics through cattle networks, which are dominated by exchanges involving wholesalers, than for swine. We assess the effectiveness of contrasting interventions from the perspectives of regulators and the market, using percolation analysis. We show that preferentially targeting minor, non-central agents can outperform targeting of hubs when the costs to stakeholders and the risks of market disturbance are considered. Our study highlights the importance of assessing joint economic-epidemiological risks in networks underlying pathogen propagation and trade. © 2016 The Authors.

Market analyses of livestock trade networks to inform the prevention of joint economic and epidemiological risks

PubMed Central

Gilligan, Christopher A.; Belloc, Catherine; Filipe, João A. N.; Vergu, Elisabeta

2016-01-01

Conventional epidemiological studies of infections spreading through trade networks, e.g. via livestock movements, generally show that central large-size holdings (hubs) should be preferentially surveyed and controlled in order to reduce epidemic spread. However, epidemiological strategies alone may not be economically optimal when costs of control are factored in together with risks of market disruption from targeting core holdings in a supply chain. Using extensive data on animal movements in supply chains for cattle and swine in France, we introduce a method to identify effective strategies for preventing outbreaks with limited budgets while minimizing the risk of market disruptions. Our method involves the categorization of holdings based on position along the supply chain and degree of market share. Our analyses suggest that trade has a higher risk of propagating epidemics through cattle networks, which are dominated by exchanges involving wholesalers, than for swine. We assess the effectiveness of contrasting interventions from the perspectives of regulators and the market, using percolation analysis. We show that preferentially targeting minor, non-central agents can outperform targeting of hubs when the costs to stakeholders and the risks of market disturbance are considered. Our study highlights the importance of assessing joint economic–epidemiological risks in networks underlying pathogen propagation and trade. PMID:26984191

Cost effective management of space venture risks

NASA Technical Reports Server (NTRS)

Giuntini, Ronald E.; Storm, Richard E.

1986-01-01

The development of a model for the cost-effective management of space venture risks is discussed. The risk assessment and control program of insurance companies is examined. A simplified system development cycle which consists of a conceptual design phase, a preliminary design phase, a final design phase, a construction phase, and a system operations and maintenance phase is described. The model incorporates insurance safety risk methods and reliability engineering, and testing practices used in the development of large aerospace and defense systems.

Use-related risk analysis for medical devices based on improved FMEA.

PubMed

Liu, Long; Shuai, Ma; Wang, Zhu; Li, Ping

2012-01-01

In order to effectively analyze and control use-related risk of medical devices, quantitative methodologies must be applied. Failure Mode and Effects Analysis (FMEA) is a proactive technique for error detection and risk reduction. In this article, an improved FMEA based on Fuzzy Mathematics and Grey Relational Theory is developed to better carry out user-related risk analysis for medical devices. As an example, the analysis process using this improved FMEA method for a certain medical device (C-arm X-ray machine) is described.

What can formal methods offer to digital flight control systems design

NASA Technical Reports Server (NTRS)

Good, Donald I.

1990-01-01

Formal methods research begins to produce methods which will enable mathematic modeling of the physical behavior of digital hardware and software systems. The development of these methods directly supports the NASA mission of increasing the scope and effectiveness of flight system modeling capabilities. The conventional, continuous mathematics that is used extensively in modeling flight systems is not adequate for accurate modeling of digital systems. Therefore, the current practice of digital flight control system design has not had the benefits of extensive mathematical modeling which are common in other parts of flight system engineering. Formal methods research shows that by using discrete mathematics, very accurate modeling of digital systems is possible. These discrete modeling methods will bring the traditional benefits of modeling to digital hardware and hardware design. Sound reasoning about accurate mathematical models of flight control systems can be an important part of reducing risk of unsafe flight control.

Using a geographical information system to plan a malaria control programme in South Africa.

PubMed Central

Booman, M.; Durrheim, D. N.; La Grange, K.; Martin, C.; Mabuza, A. M.; Zitha, A.; Mbokazi, F. M.; Fraser, C.; Sharp, B. L.

2000-01-01

INTRODUCTION: Sustainable control of malaria in sub-Saharan Africa is jeopardized by dwindling public health resources resulting from competing health priorities that include an overwhelming acquired immunodeficiency syndrome (AIDS) epidemic. In Mpumalanga province, South Africa, rational planning has historically been hampered by a case surveillance system for malaria that only provided estimates of risk at the magisterial district level (a subdivision of a province). METHODS: To better map control programme activities to their geographical location, the malaria notification system was overhauled and a geographical information system implemented. The introduction of a simplified notification form used only for malaria and a carefully monitored notification system provided the good quality data necessary to support an effective geographical information system. RESULTS: The geographical information system displays data on malaria cases at a village or town level and has proved valuable in stratifying malaria risk within those magisterial districts at highest risk, Barberton and Nkomazi. The conspicuous west-to-east gradient, in which the risk rises sharply towards the Mozambican border (relative risk = 4.12, 95% confidence interval = 3.88-4.46 when the malaria risk within 5 km of the border was compared with the remaining areas in these two districts), allowed development of a targeted approach to control. DISCUSSION: The geographical information system for malaria was enormously valuable in enabling malaria risk at town and village level to be shown. Matching malaria control measures to specific strata of endemic malaria has provided the opportunity for more efficient malaria control in Mpumalanga province. PMID:11196490

Construction risk assessment of deep foundation pit in metro station based on G-COWA method

NASA Astrophysics Data System (ADS)

You, Weibao; Wang, Jianbo; Zhang, Wei; Liu, Fangmeng; Yang, Diying

2018-05-01

In order to get an accurate understanding of the construction safety of deep foundation pit in metro station and reduce the probability and loss of risk occurrence, a risk assessment method based on G-COWA is proposed. Firstly, relying on the specific engineering examples and the construction characteristics of deep foundation pit, an evaluation index system based on the five factors of “human, management, technology, material and environment” is established. Secondly, the C-OWA operator is introduced to realize the evaluation index empowerment and weaken the negative influence of expert subjective preference. The gray cluster analysis and fuzzy comprehensive evaluation method are combined to construct the construction risk assessment model of deep foundation pit, which can effectively solve the uncertainties. Finally, the model is applied to the actual project of deep foundation pit of Qingdao Metro North Station, determine its construction risk rating is “medium”, evaluate the model is feasible and reasonable. And then corresponding control measures are put forward and useful reference are provided.

An optimization-based approach for facility energy management with uncertainties, and, Power portfolio optimization in deregulated electricity markets with risk management

NASA Astrophysics Data System (ADS)

Xu, Jun

Topic 1. An Optimization-Based Approach for Facility Energy Management with Uncertainties. Effective energy management for facilities is becoming increasingly important in view of the rising energy costs, the government mandate on the reduction of energy consumption, and the human comfort requirements. This part of dissertation presents a daily energy management formulation and the corresponding solution methodology for HVAC systems. The problem is to minimize the energy and demand costs through the control of HVAC units while satisfying human comfort, system dynamics, load limit constraints, and other requirements. The problem is difficult in view of the fact that the system is nonlinear, time-varying, building-dependent, and uncertain; and that the direct control of a large number of HVAC components is difficult. In this work, HVAC setpoints are the control variables developed on top of a Direct Digital Control (DDC) system. A method that combines Lagrangian relaxation, neural networks, stochastic dynamic programming, and heuristics is developed to predict the system dynamics and uncontrollable load, and to optimize the setpoints. Numerical testing and prototype implementation results show that our method can effectively reduce total costs, manage uncertainties, and shed the load, is computationally efficient. Furthermore, it is significantly better than existing methods. Topic 2. Power Portfolio Optimization in Deregulated Electricity Markets with Risk Management. In a deregulated electric power system, multiple markets of different time scales exist with various power supply instruments. A load serving entity (LSE) has multiple choices from these instruments to meet its load obligations. In view of the large amount of power involved, the complex market structure, risks in such volatile markets, stringent constraints to be satisfied, and the long time horizon, a power portfolio optimization problem is of critical importance but difficulty for an LSE to serve the load, maximize its profit, and manage risks. In this topic, a mid-term power portfolio optimization problem with risk management is presented. Key instruments are considered, risk terms based on semi-variances of spot market transactions are introduced, and penalties on load obligation violations are added to the objective function to improve algorithm convergence and constraint satisfaction. To overcome the inseparability of the resulting problem, a surrogate optimization framework is developed enabling a decomposition and coordination approach. Numerical testing results show that our method effectively provides decisions for various instruments to maximize profit, manage risks, and is computationally efficient.

A community-based, case-control study of childhood stroke risk associated with congenital heart disease

PubMed Central

Fox, Christine K.; Sidney, Stephen; Fullerton, Heather J.

2014-01-01

Background and Purpose A better understanding of the stroke risk factors in children with congenital heart disease (CHD) could inform stroke prevention strategies. We analyzed pediatric stroke associated with CHD in a large community-based, case-control study. Methods From 2.5 million children (< 20 years) enrolled in a Northern California integrated healthcare plan, we identified ischemic and hemorrhagic strokes and randomly selected age and facility-matched stroke-free controls (3 per case). We determined exposure to CHD (diagnosed prior to stroke) and used conditional logistic regression to analyze stroke risk. Results CHD was identified in 15/412 cases (4%) versus 7/1,236 controls (0.6%). Children (28 days – 20 years) with CHD had 19-fold (Odds Ratio [OR] 19; 95% Confidence Interval [CI] 4.2, 83) increased stroke risk compared to controls. History of CHD surgery was associated with >30-fold increased risk of stroke (OR 31; CI 4, 241 compared to controls). After excluding peri-operative strokes, a history of CHD surgery still increased childhood stroke risk (OR 13; CI 1.5, 114). The majority of children with stroke and CHD were outpatient at the time of stroke, and almost half the cases who underwent cardiac surgery had their stroke >5 years after the most recent procedure. An estimated 7% of ischemic and 2% of hemorrhagic childhood strokes in the population were attributable to CHD. Conclusions CHD is an important childhood stroke risk factor. Children who undergo CHD surgery remain at elevated risk outside of the peri-operative period, and would benefit from optimized long-term stroke prevention strategies. PMID:25516197

Evolution of poor reporting and inadequate methods over time in 20 920 randomised controlled trials included in Cochrane reviews: research on research study.

PubMed

Dechartres, Agnes; Trinquart, Ludovic; Atal, Ignacio; Moher, David; Dickersin, Kay; Boutron, Isabelle; Perrodeau, Elodie; Altman, Douglas G; Ravaud, Philippe

2017-06-08

Objective  To examine how poor reporting and inadequate methods for key methodological features in randomised controlled trials (RCTs) have changed over the past three decades. Design  Mapping of trials included in Cochrane reviews. Data sources  Data from RCTs included in all Cochrane reviews published between March 2011 and September 2014 reporting an evaluation of the Cochrane risk of bias items: sequence generation, allocation concealment, blinding, and incomplete outcome data. Data extraction  For each RCT, we extracted consensus on risk of bias made by the review authors and identified the primary reference to extract publication year and journal. We matched journal names with Journal Citation Reports to get 2014 impact factors. Main outcomes measures  We considered the proportions of trials rated by review authors at unclear and high risk of bias as surrogates for poor reporting and inadequate methods, respectively. Results  We analysed 20 920 RCTs (from 2001 reviews) published in 3136 journals. The proportion of trials with unclear risk of bias was 48.7% for sequence generation and 57.5% for allocation concealment; the proportion of those with high risk of bias was 4.0% and 7.2%, respectively. For blinding and incomplete outcome data, 30.6% and 24.7% of trials were at unclear risk and 33.1% and 17.1% were at high risk, respectively. Higher journal impact factor was associated with a lower proportion of trials at unclear or high risk of bias. The proportion of trials at unclear risk of bias decreased over time, especially for sequence generation, which fell from 69.1% in 1986-1990 to 31.2% in 2011-14 and for allocation concealment (70.1% to 44.6%). After excluding trials at unclear risk of bias, use of inadequate methods also decreased over time: from 14.8% to 4.6% for sequence generation and from 32.7% to 11.6% for allocation concealment. Conclusions  Poor reporting and inadequate methods have decreased over time, especially for sequence generation and allocation concealment. But more could be done, especially in lower impact factor journals. 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 application of quality risk management to the bacterial endotoxins test: use of hazard analysis and critical control points.

PubMed

Annalaura, Carducci; Giulia, Davini; Stefano, Ceccanti

2013-01-01

Risk analysis is widely used in the pharmaceutical industry to manage production processes, validation activities, training, and other activities. Several methods of risk analysis are available (for example, failure mode and effects analysis, fault tree analysis), and one or more should be chosen and adapted to the specific field where they will be applied. Among the methods available, hazard analysis and critical control points (HACCP) is a methodology that has been applied since the 1960s, and whose areas of application have expanded over time from food to the pharmaceutical industry. It can be easily and successfully applied to several processes because its main feature is the identification, assessment, and control of hazards. It can be also integrated with other tools, such as fishbone diagram and flowcharting. The aim of this article is to show how HACCP can be used to manage an analytical process, propose how to conduct the necessary steps, and provide data templates necessary to document and useful to follow current good manufacturing practices. In the quality control process, risk analysis is a useful tool for enhancing the uniformity of technical choices and their documented rationale. Accordingly, it allows for more effective and economical laboratory management, is capable of increasing the reliability of analytical results, and enables auditors and authorities to better understand choices that have been made. The aim of this article is to show how hazard analysis and critical control points can be used to manage bacterial endotoxins testing and other analytical processes in a formal, clear, and detailed manner.

Characterizing mammographic images by using generic texture features

PubMed Central

2012-01-01

Introduction Although mammographic density is an established risk factor for breast cancer, its use is limited in clinical practice because of a lack of automated and standardized measurement methods. The aims of this study were to evaluate a variety of automated texture features in mammograms as risk factors for breast cancer and to compare them with the percentage mammographic density (PMD) by using a case-control study design. Methods A case-control study including 864 cases and 418 controls was analyzed automatically. Four hundred seventy features were explored as possible risk factors for breast cancer. These included statistical features, moment-based features, spectral-energy features, and form-based features. An elaborate variable selection process using logistic regression analyses was performed to identify those features that were associated with case-control status. In addition, PMD was assessed and included in the regression model. Results Of the 470 image-analysis features explored, 46 remained in the final logistic regression model. An area under the curve of 0.79, with an odds ratio per standard deviation change of 2.88 (95% CI, 2.28 to 3.65), was obtained with validation data. Adding the PMD did not improve the final model. Conclusions Using texture features to predict the risk of breast cancer appears feasible. PMD did not show any additional value in this study. With regard to the features assessed, most of the analysis tools appeared to reflect mammographic density, although some features did not correlate with PMD. It remains to be investigated in larger case-control studies whether these features can contribute to increased prediction accuracy. PMID:22490545

Exposure assessment and risk management of engineered nanoparticles: Investigation in semiconductor wafer processing

NASA Astrophysics Data System (ADS)

Shepard, Michele N.

Engineered nanomaterials (ENMs) are currently used in hundreds of commercial products and industrial processes, with more applications being investigated. Nanomaterials have unique properties that differ from bulk materials. While these properties may enable technological advancements, the potential risks of ENMs to people and the environment are not yet fully understood. Certain low solubility nanoparticles are more toxic than their bulk material, such that existing occupational exposure limits may not be sufficiently protective for workers. Risk assessments are currently challenging due to gaps in data on the numerous emerging materials and applications as well as method uncertainties and limitations. Chemical mechanical planarization (CMP) processes with engineered nanoparticle abrasives are used for research and commercial manufacturing applications in the semiconductor and related industries. Despite growing use, no published studies addressed occupational exposures to nanoparticles associated with CMP or risk assessment and management practices for these scenarios. Additional studies are needed to evaluate potential sources of workplace exposure or emission, as well as to help test and refine assessment methods. This research was conducted to: identify the lifecycle stages and potential exposure sources for ENMs in CMP processes; characterize worker exposure; determine recommended engineering controls and compare risk assessment models. The study included workplace air and surface sampling and an evaluation of qualitative risk banding approaches. Exposure assessment results indicated the potential for worker contact with ENMs on workplace surfaces but did not identify nanoparticles readily dispersed in air during work tasks. Some increases in respirable particle concentrations were identified, but not consistently. Measured aerosol concentrations by number and mass were well below current reference values for poorly soluble low toxicity nanoparticles. From application and evaluation of qualitative risk assessment approaches, differences in control banding models and results were identified, although output generally agreed with conclusions from air sampling as to whether an upgrade in site engineering controls was recommended. This research helped to improve understanding of potential worker exposures to ENMs in CMP processes, as well as the methods for risk assessment and management of metal oxide nanoparticles in occupational environments.

The Official Control beyond the Official Control. How To Plan And Schedule Controls Starting From Risk Assessment Along The Agro-Food Supply Chain.

PubMed

Panunzio, M F; Caporizzi, R; Lagravinese, D; Conversano, M

2015-01-01

Every year the Italian Ministry of Health, on the basis of regional data, draws up the "Report on Official Controls" to be submitted to the Parliament. The report contains abundant data, diagrams and charts and illustrates the number and type of official controls (OC) performed by the pertinent Bodies (Ministry of Health, Regional and Local Health Authorities) over the previous year on Food Business Operators (FBO), in accordance with the EC Regulation 882/2004. The trend - which has consolidated over the years - relates to the multiplicity of OC and shows a decrease of such controls compared to an increase in "non-conformities". OC frequency is established by the Regional Authorities on the basis of the categorisation of both a "generic risk" for companies calculated taking into account the probability of occurrence of a "non-conformity", and a "specific" risk, assessed on the basis of the results of the OC actually performed on a given "Operatore del Settore Alimentare" (Food Sector Operator, in Italian: OSA). Thus, categorisation (i.e. the probability of occurrence of non-conformities) is the main driver of the OC scheduling and planning process. We have been asking ourselves whether the current OC planning/scheduling method is still suitable for ensuring food safety in the face of internalisation of the food supply chain. As a matter of fact, food safety is now becoming increasingly variable due to the globalization of consumption where "farm to fork", rather than "border to fork", food safety must be ensured. On the basis of these considerations, a different OC planning /scheduling method is being proposed based on the assessment of risks and the estimation of the occurrence of the same along the agro-food chain.

Internal relationship between symptomatic venous thromboembolism and risk factors: up-regulation of integrin β1, β2 and β3 levels

PubMed Central

Duan, Qianglin; Wang, Lemin; Yang, Fan; Li, Jue; Song, Yanli; Gong, Zhu; Li, Guiyuan; Song, Haoming; Zhang, Xiaoyu; Shen, Zugang; Dart, Anthony

2015-01-01

Background: To compare different expression of core proteins among venous thromboembolism (VTE) and those with risk factor groups and analyze the relative risk for VTE after integrating integrin β1, β2 and β3 expression. Methods: A total of 1006 subjects were recruited and divided into VTE group, risk factor groups and control (non- risk factor) group. Flow cytometry was performed to detect the expression of integrin β1, β2 and β3. The relative risk for VTE was evaluated with independent, parallel and serial methods. Results: The expression of integrin β1 increased markedly in VTE patients, and those with risk factors (acute infection, malignancy, and autoimmune diseases), respectively (P < 0.001 or 0.01). The expression of integrin β1 in trauma/surgery group was not significantly different with control group (P > 0.05). The expression of integrin β2 or β3 significantly increased in VTE group, but that in risk factor groups was not significantly increased (P > 0.05). Multivariate analysis revealed the trauma/surgery groups had no significantly increased risk for VTE. Conclusions: VTE group patients have significantly increased expression of integrin β1, β2 and β3, and risk factor groups (acute infection, malignancy and autoimmune disease) have significantly increased expression of integrin β1. The significant increase in integrin β2, β3 expression is a marker differentiating of VTE group patients with other risk factor groups. Trauma/surgery group has no increased expression of integrin β1, β2 and β3 as other risk factors. Thus, that trauma/surgery may be not the “true” risk factor for VTE. PMID:26045901

Adverse Effects of Heavy Prenatal Maternal Smoking on Attentional Control in Children with ADHD

ERIC Educational Resources Information Center

Motlagh, Maria G.; Sukhodolsky, Denis G.; Landeros-Weisenberger, Angeli; Katsovich, Liliya; Thompson, Nancy; Scahill, Lawrence; King, Robert A.; Peterson, Bradley S.; Schultz, Robert T.; Leckman, James F.

2011-01-01

Objective: Exposure to heavy maternal cigarette smoking in pregnancy and severe maternal psychosocial stress during pregnancy appear to be important risk factors for the development of ADHD. This study aimed to determine whether these perinatal risk factors were associated with neuropsychological deficits commonly seen in ADHD. Method: We examined…

49 CFR Appendix D to Part 172 - Rail Risk Analysis Factors

Code of Federal Regulations, 2012 CFR

2012-10-01

... nature of the rail system, each carrier must select and document the analysis method/model used and identify the routes to be analyzed. D. The safety and security risk analysis must consider current data and... curvature; 7. Presence or absence of signals and train control systems along the route (“dark” versus...

COST EFFECTIVE CONTROL OF HEXAVALENT CHROMIUM AIR EMISSIONS FROM FUNCTIONAL CHROMIUM ELECTROPLATING

EPA Science Inventory

This paper will summrize thie pollution prevention (p2) method to control stack emissions from hard chromium plating operations performed by the USEPA's National Risk Management Research Laboratory (NRMRL) over the last four years. During literature research and user surveys, it...

Effect of systematic ergonomic hazard identification and control implementation on musculoskeletal disorder and injury risk

PubMed Central

Cantley, Linda F; Taiwo, Oyebode A; Galusha, Deron; Barbour, Russell; Slade, Martin D; Tessier-Sherman, Baylah; Cullen, Mark R

2014-01-01

Objectives This study aimed to examine the effect of an ergonomic hazard control (HC) initiative, undertaken as part of a company ergonomics standard, on worker injury risk. Methods Using the company's ergonomic hazards database to identify jobs with and without ergonomic HC implementation and linking to individual job and injury histories, injury risk among person-jobs with HC implementation (the HC group) was compared to those without HC (NoHC group) using random coefficient models. Further analysis of the HC group was conducted to determine the effect of additional ergonomic hazards controlled on injury risk. Results Among 123jobs at 17 plant locations, 347 ergonomic hazards were quantitatively identified during the study period. HC were implemented for 204 quantified ergonomic hazards in 84 jobs, impacting 10 385 persons (12 967 person-jobs). No HC were implemented for quantified ergonomic hazards in the remaining 39 jobs affecting 4155 persons (5046 person-jobs). Adjusting for age, sex, plant origin, and year to control for any temporal trend in injury risk, the relative risk (RR) for musculoskeletal disorder (MSD) was 0.85 and the RR for any injury or MSD was 0.92 in the HC compared to NoHC group. Among the HC group, each ergonomic hazard controlled was associated with risk reduction for MSD and acute injury outcomes (RR 0.93). Conclusion Systematic ergonomic HC through participatory ergonomics, as part of a mandatory company ergonomics standard, is associated with MSD and injury risk reduction among workers in jobs with HC implemented. PMID:24142048

Risk Assessment Using the Three Dimensions of Probability (Likelihood), Severity, and Level of Control

NASA Technical Reports Server (NTRS)

Watson, Clifford

2010-01-01

Traditional hazard analysis techniques utilize a two-dimensional representation of the results determined by relative likelihood and severity of the residual risk. These matrices present a quick-look at the Likelihood (Y-axis) and Severity (X-axis) of the probable outcome of a hazardous event. A three-dimensional method, described herein, utilizes the traditional X and Y axes, while adding a new, third dimension, shown as the Z-axis, and referred to as the Level of Control. The elements of the Z-axis are modifications of the Hazard Elimination and Control steps (also known as the Hazard Reduction Precedence Sequence). These steps are: 1. Eliminate risk through design. 2. Substitute less risky materials for more hazardous materials. 3. Install safety devices. 4. Install caution and warning devices. 5. Develop administrative controls (to include special procedures and training.) 6. Provide protective clothing and equipment. When added to the twodimensional models, the level of control adds a visual representation of the risk associated with the hazardous condition, creating a tall-pole for the least-well-controlled failure while establishing the relative likelihood and severity of all causes and effects for an identified hazard. Computer modeling of the analytical results, using spreadsheets and threedimensional charting gives a visual confirmation of the relationship between causes and their controls

Risk Assessment Using the Three Dimensions of Probability (Likelihood), Severity, and Level of Control

NASA Technical Reports Server (NTRS)

Watson, Clifford C.

2011-01-01

Traditional hazard analysis techniques utilize a two-dimensional representation of the results determined by relative likelihood and severity of the residual risk. These matrices present a quick-look at the Likelihood (Y-axis) and Severity (X-axis) of the probable outcome of a hazardous event. A three-dimensional method, described herein, utilizes the traditional X and Y axes, while adding a new, third dimension, shown as the Z-axis, and referred to as the Level of Control. The elements of the Z-axis are modifications of the Hazard Elimination and Control steps (also known as the Hazard Reduction Precedence Sequence). These steps are: 1. Eliminate risk through design. 2. Substitute less risky materials for more hazardous materials. 3. Install safety devices. 4. Install caution and warning devices. 5. Develop administrative controls (to include special procedures and training.) 6. Provide protective clothing and equipment. When added to the two-dimensional models, the level of control adds a visual representation of the risk associated with the hazardous condition, creating a tall-pole for the least-well-controlled failure while establishing the relative likelihood and severity of all causes and effects for an identified hazard. Computer modeling of the analytical results, using spreadsheets and three-dimensional charting gives a visual confirmation of the relationship between causes and their controls.

Risk Presentation Using the Three Dimensions of Likelihood, Severity, and Level of Control

NASA Technical Reports Server (NTRS)

Watson, Clifford

2010-01-01

Traditional hazard analysis techniques utilize a two-dimensional representation of the results determined by relative likelihood and severity of the residual risk. These matrices present a quick-look at the Likelihood (Y-axis) and Severity (X-axis) of the probable outcome of a hazardous event. A three-dimensional method, described herein, utilizes the traditional X and Y axes, while adding a new, third dimension, shown as the Z-axis, and referred to as the Level of Control. The elements of the Z-axis are modifications of the Hazard Elimination and Control steps (also known as the Hazard Reduction Precedence Sequence). These steps are: 1. Eliminate risk through design. 2. Substitute less risky materials for more hazardous materials. 3. Install safety devices. 4. Install caution and warning devices. 5. Develop administrative controls (to include special procedures and training.) 6. Provide protective clothing and equipment. When added to the two-dimensional models, the level of control adds a visual representation of the risk associated with the hazardous condition, creating a tall-pole for the leastwell-controlled failure while establishing the relative likelihood and severity of all causes and effects for an identified hazard. Computer modeling of the analytical results, using spreadsheets and three-dimensional charting gives a visual confirmation of the relationship between causes and their controls.

Risk of lung cancer associated with six types of chlorinated solvents: results from two case-control studies in Montreal, Canada

EPA Science Inventory

Methods: Two case-control studies of occupation and lung cancer were conducted in Montreal, including 2,016 cases and 2,001 population controls. Occupational exposure to a host of agents was evaluated using a combination of subject-reported job history and expert assessment. We e...

Factors associated with suicide: Case-control study in South Tyrol.

PubMed

Giupponi, Giancarlo; Innamorati, Marco; Baldessarini, Ross J; De Leo, Diego; de Giovannelli, Francesca; Pycha, Roger; Conca, Andreas; Girardi, Paolo; Pompili, Maurizio

2018-01-01

As suicide is related to many factors in addition to psychiatric illness, broad and comprehensive risk-assessment for risk of suicide is required. This study aimed to differentiate nondiagnostic risk factors among suicides versus comparable psychiatric patients without suicidal behavior. We carried out a pilot, case-control comparison of 131 cases of suicide in South Tyrol matched for age and sex with 131 psychiatric controls, using psychological autopsy methods to evaluate differences in clinically assessed demographic, social, and clinical factors, using bivariate conditional Odds Risk comparisons followed by conditional regression modeling controlled for ethnicity. Based on multivariable conditional regression modeling, suicides were significantly more likely to have experienced risk factors, ranking as: [a] family history of suicide or attempt≥[b] recent interpersonal stressors≥[c] childhood traumatic events≥[d] lack of recent clinician contacts≥[e] previous suicide attempt≥[f] non-Italian ethnicity, but did not differ in education, marital status, living situation, or employment, nor by psychiatric or substance-abuse diagnoses. Both recent and early factors were associated with suicide, including lack of recent clinical care, non-Italian cultural subgroup-membership, familial suicidal behavior, and recent interpersonal distress. Copyright © 2017 Elsevier Inc. All rights reserved.

Quantifying prognosis with risk predictions.

PubMed

Pace, Nathan L; Eberhart, Leopold H J; Kranke, Peter R

2012-01-01

Prognosis is a forecast, based on present observations in a patient, of their probable outcome from disease, surgery and so on. Research methods for the development of risk probabilities may not be familiar to some anaesthesiologists. We briefly describe methods for identifying risk factors and risk scores. A probability prediction rule assigns a risk probability to a patient for the occurrence of a specific event. Probability reflects the continuum between absolute certainty (Pi = 1) and certified impossibility (Pi = 0). Biomarkers and clinical covariates that modify risk are known as risk factors. The Pi as modified by risk factors can be estimated by identifying the risk factors and their weighting; these are usually obtained by stepwise logistic regression. The accuracy of probabilistic predictors can be separated into the concepts of 'overall performance', 'discrimination' and 'calibration'. Overall performance is the mathematical distance between predictions and outcomes. Discrimination is the ability of the predictor to rank order observations with different outcomes. Calibration is the correctness of prediction probabilities on an absolute scale. Statistical methods include the Brier score, coefficient of determination (Nagelkerke R2), C-statistic and regression calibration. External validation is the comparison of the actual outcomes to the predicted outcomes in a new and independent patient sample. External validation uses the statistical methods of overall performance, discrimination and calibration and is uniformly recommended before acceptance of the prediction model. Evidence from randomised controlled clinical trials should be obtained to show the effectiveness of risk scores for altering patient management and patient outcomes.

Farm-level risk factors for Fasciola hepatica infection in Danish dairy cattle as evaluated by two diagnostic methods.

PubMed

Takeuchi-Storm, Nao; Denwood, Matthew; Hansen, Tina Vicky Alstrup; Halasa, Tariq; Rattenborg, Erik; Boes, Jaap; Enemark, Heidi Larsen; Thamsborg, Stig Milan

2017-11-09

The prevalence of bovine fasciolosis in Denmark is increasing but appropriate guidelines for control are currently lacking. In order to help develop a control strategy for liver fluke, a risk factor study of farm management factors was conducted and the utility of bulk tank milk (BTM ELISA) as a tool for diagnosis in Danish dairy cattle farms was assessed. This case-control study aimed to identify farm-level risk factors for fasciolosis in Danish dairy farms (> 50 animals slaughtered in 2013) using two diagnostic methods: recordings of liver condemnation at slaughter, and farm-level Fasciola hepatica antibody levels in BTM. A case farm was defined as having a minimum of 3 incidents of liver condemnation due to liver fluke at slaughter (in any age group) during 2013, and control farms were located within 10 km of at least one case farm and had no history of liver condemnation due to liver fluke during 2011-2013. The selected farmers were interviewed over telephone about grazing and control practices, and BTM from these farms was collected and analysed by ELISA in 2014. The final complete dataset consisting of 131 case and 63 control farms was analysed using logistic regression. Heifers grazing on wet pastures, dry cows grazing on wet pastures, herd size, breed and concurrent beef cattle production were identified as risk factors associated with being classified as a case farm. With the categorised BTM ELISA result as the response variable, heifers grazing on wet pastures, dry cows grazing on wet pastures, and purchase of cows were identified as risk factors. Within the case and control groups, 74.8 and 12.7% of farms were positive for fasciolosis on BTM ELISA, respectively. The differences are likely to be related to the detection limit of the farm-level prevalence by the BTM ELISA test, time span between slaughter data and BTM, and the relatively low sensitivity of liver inspection at slaughter. Control of bovine fasciolosis in Denmark should target heifers and dry cows through grazing management and appropriate anthelmintic treatment, and BTM ELISA can be a useful diagnostic tool for fasciolosis in Danish dairy farms.

Risk factors for unintentional poisoning in children aged 1–3 years in NSW Australia: a case–control study

PubMed Central

2013-01-01

Background Unintentional poisoning in young children is an important public health issue. Age pattern studies have demonstrated that children aged 1–3 years have the highest levels of poisoning risk among children aged 0–4 years, yet little research has been conducted regarding risk factors specific to this three-year age group and the methodologies employed varied greatly. The purpose of the current study is to investigate a broad range of potential risk factors for unintentional poisoning in children aged 1–3 years using appropriate methodologies. Methods Four groups of children, one case group (children who had experienced a poisoning event) and three control groups (children who had been ‘injured’, ‘sick’ or who were ‘healthy’), and their mothers (mother-child dyads) were enrolled into a case–control study. All mother-child dyads participated in a 1.5-hour child developmental screening and observation, with mothers responding to a series of questionnaires at home. Data were analysed as three case–control pairs with multivariate analyses used to control for age and sex differences between child cases and controls. Results Five risk factors were included in the final multivariate models for one or more case–control pairs. All three models found that children whose mothers used more positive control in their interactions during a structured task had higher odds of poisoning. Two models showed that maternal psychiatric distress increased poisoning risk (poisoning-injury and poisoning-healthy). Individual models identified the following variables as risk factors: less proximal maternal supervision during risk taking activities (poisoning-injury), medicinal substances stored in more accessible locations in bathrooms (poisoning-sick) and lower total parenting stress (poisoning-healthy). Conclusions The findings of this study indicate that the nature of the caregiver-child relationship and caregiver attributes play an important role in influencing poisoning risk. Further research is warranted to explore the link between caregiver-child relationships and unintentional poisoning risk. Caregiver education should focus on the benefits of close interaction with their child as a prevention measure. PMID:23705679

Closed-loop and robust control of quantum systems.

PubMed

Chen, Chunlin; Wang, Lin-Cheng; Wang, Yuanlong

2013-01-01

For most practical quantum control systems, it is important and difficult to attain robustness and reliability due to unavoidable uncertainties in the system dynamics or models. Three kinds of typical approaches (e.g., closed-loop learning control, feedback control, and robust control) have been proved to be effective to solve these problems. This work presents a self-contained survey on the closed-loop and robust control of quantum systems, as well as a brief introduction to a selection of basic theories and methods in this research area, to provide interested readers with a general idea for further studies. In the area of closed-loop learning control of quantum systems, we survey and introduce such learning control methods as gradient-based methods, genetic algorithms (GA), and reinforcement learning (RL) methods from a unified point of view of exploring the quantum control landscapes. For the feedback control approach, the paper surveys three control strategies including Lyapunov control, measurement-based control, and coherent-feedback control. Then such topics in the field of quantum robust control as H(∞) control, sliding mode control, quantum risk-sensitive control, and quantum ensemble control are reviewed. The paper concludes with a perspective of future research directions that are likely to attract more attention.

[Consensus on objectives and action guidelines on low density lipoproteins-cholesterol control in very high risk cardiovascular patients].

PubMed

Galve, Enrique; Guijarro-Herraiz, Carlos; Masana-Marin, Luis; Cordero-Fort, Alberto

2016-01-01

Cardiovascular disease is the leading cause of death in developed countries. Among cardiovascular disease risk factors one of the most relevant is low-density lipoprotein-associated cholesterol (LDL-c), but there is controversy about the methods used to control it. The aim was to obtain an expert opinion to clarify the most relevant issues regarding the control of dyslipidemia in very high cardiovascular risk patients. A survey with 55 items, stratified into 4 blocks: LDL-c as a therapeutic target, therapeutic goals, causes of the failure to achieve LDL-c goals, and recommendations to optimize their achievement, was addressed to 41 specialists (Cardiology and Internal Medicine) using the Delphi method to achieve professional consensus criteria. A high consensus was reached among all items, in line with the European recommendations. The panelists considered that the goal of 70mg/dl for LDL-c for high cardiovascular disease risk (mainly vascular disease, diabetes mellitus, and renal failure), using combined treatment when necessary. Lack of adherence and therapeutic inertia were considered the main reasons for treatment failure. The Spanish experts show an elevated consensus with the European recommendations, confirming the LDL-c control target of <70mg/dl. The simplification of the guidelines and the combined treatment may favor an improvement the achievement of lipid target goals. Copyright © 2015 Sociedad Española de Arteriosclerosis. Published by Elsevier España. All rights reserved.

Modeling and E-M estimation of haplotype-specific relative risks from genotype data for a case-control study of unrelated individuals.

PubMed

Stram, Daniel O; Leigh Pearce, Celeste; Bretsky, Phillip; Freedman, Matthew; Hirschhorn, Joel N; Altshuler, David; Kolonel, Laurence N; Henderson, Brian E; Thomas, Duncan C

2003-01-01

The US National Cancer Institute has recently sponsored the formation of a Cohort Consortium (http://2002.cancer.gov/scpgenes.htm) to facilitate the pooling of data on very large numbers of people, concerning the effects of genes and environment on cancer incidence. One likely goal of these efforts will be generate a large population-based case-control series for which a number of candidate genes will be investigated using SNP haplotype as well as genotype analysis. The goal of this paper is to outline the issues involved in choosing a method of estimating haplotype-specific risk estimates for such data that is technically appropriate and yet attractive to epidemiologists who are already comfortable with odds ratios and logistic regression. Our interest is to develop and evaluate extensions of methods, based on haplotype imputation, that have been recently described (Schaid et al., Am J Hum Genet, 2002, and Zaykin et al., Hum Hered, 2002) as providing score tests of the null hypothesis of no effect of SNP haplotypes upon risk, which may be used for more complex tasks, such as providing confidence intervals, and tests of equivalence of haplotype-specific risks in two or more separate populations. In order to do so we (1) develop a cohort approach towards odds ratio analysis by expanding the E-M algorithm to provide maximum likelihood estimates of haplotype-specific odds ratios as well as genotype frequencies; (2) show how to correct the cohort approach, to give essentially unbiased estimates for population-based or nested case-control studies by incorporating the probability of selection as a case or control into the likelihood, based on a simplified model of case and control selection, and (3) finally, in an example data set (CYP17 and breast cancer, from the Multiethnic Cohort Study) we compare likelihood-based confidence interval estimates from the two methods with each other, and with the use of the single-imputation approach of Zaykin et al. applied under both null and alternative hypotheses. We conclude that so long as haplotypes are well predicted by SNP genotypes (we use the Rh2 criteria of Stram et al. [1]) the differences between the three methods are very small and in particular that the single imputation method may be expected to work extremely well. Copyright 2003 S. Karger AG, Basel

A quantitative risk assessment model to evaluate effective border control measures for rabies prevention

PubMed Central

Weng, Hsin-Yi; Wu, Pei-I; Yang, Ping-Cheng; Tsai, Yi-Lun; Chang, Chao-Chin

2009-01-01

Border control is the primary method to prevent rabies emergence. This study developed a quantitative risk model incorporating stochastic processes to evaluate whether border control measures could efficiently prevent rabies introduction through importation of cats and dogs using Taiwan as an example. Both legal importation and illegal smuggling were investigated. The impacts of reduced quarantine and/or waiting period on the risk of rabies introduction were also evaluated. The results showed that Taiwan’s current animal importation policy could effectively prevent rabies introduction through legal importation of cats and dogs. The median risk of a rabid animal to penetrate current border control measures and enter Taiwan was 5.33 × 10−8 (95th percentile: 3.20 × 10−7). However, illegal smuggling may pose Taiwan to the great risk of rabies emergence. Reduction of quarantine and/or waiting period would affect the risk differently, depending on the applied assumptions, such as increased vaccination coverage, enforced custom checking, and/or change in number of legal importations. Although the changes in the estimated risk under the assumed alternatives were not substantial except for completely abolishing quarantine, the consequences of rabies introduction may yet be considered to be significant in a rabies-free area. Therefore, a comprehensive benefit-cost analysis needs to be conducted before recommending these alternative measures. PMID:19822125

[Using sequential indicator simulation method to define risk areas of soil heavy metals in farmland.

PubMed

Yang, Hao; Song, Ying Qiang; Hu, Yue Ming; Chen, Fei Xiang; Zhang, Rui

2018-05-01

The heavy metals in soil have serious impacts on safety, ecological environment and human health due to their toxicity and accumulation. It is necessary to efficiently identify the risk area of heavy metals in farmland soil, which is of important significance for environment protection, pollution warning and farmland risk control. We collected 204 samples and analyzed the contents of seven kinds of heavy metals (Cu, Zn, Pb, Cd, Cr, As, Hg) in Zengcheng District of Guangzhou, China. In order to overcame the problems of the data, including the limitation of abnormal values and skewness distribution and the smooth effect with the traditional kriging methods, we used sequential indicator simulation method (SISIM) to define the spatial distribution of heavy metals, and combined Hakanson index method to identify potential ecological risk area of heavy metals in farmland. The results showed that: (1) Based on the similar accuracy of spatial prediction of soil heavy metals, the SISIM had a better expression of detail rebuild than ordinary kriging in small scale area. Compared to indicator kriging, the SISIM had less error rate (4.9%-17.1%) in uncertainty evaluation of heavy-metal risk identification. The SISIM had less smooth effect and was more applicable to simulate the spatial uncertainty assessment of soil heavy metals and risk identification. (2) There was no pollution in Zengcheng's farmland. Moderate potential ecological risk was found in the southern part of study area due to enterprise production, human activities, and river sediments. This study combined the sequential indicator simulation with Hakanson risk index method, and effectively overcame the outlier information loss and smooth effect of traditional kriging method. It provided a new way to identify the soil heavy metal risk area of farmland in uneven sampling.

Mosquito Control Techniques Developed for the US Military

USDA-ARS?s Scientific Manuscript database

The USDA developed and field tested new techniques to reduce the risk to deployed military troops from vector-borne diseases. Some of the methods developed included (1) novel military personal protection methods, (2) barrier treatments of artificial materials and natural vegetation, and (3) ground a...

Field Monitoring of Drosophila suzukii and Associated Communities in South Eastern France as a Pre-Requisite for Classical Biological Control

PubMed Central

Kremmer, Laurent; Thaon, Marcel; Borowiec, Nicolas; David, Jean; Poirié, Marylène; Ris, Nicolas

2017-01-01

The spotted wing Drosophila, Drosophila suzukii (Ds), became a major economic pest for fruit production since its establishment in Europe and America. Among potential control methods, only classical biological control appears to be a mean of sustainably regulating Ds in both cultivated and natural habitats. In the frame of risk assessment, pre-release surveys were carried out in a restricted but highly heterogeneous area in the south-east of France using traps and deliberate field exposures of Ds and D. melanogaster larvae/pupae. Although Ds abundance varied according to sampling methods, it was found to be pervasive and to produce offspring and adults in most conditions (spatial and seasonal). Its main limits are some specific abiotic conditions (i.e., desiccation) as well as interspecific competition. Indeed, Ds mostly co-occurred with D. busckii and D. hydei, probably due to common phenology and/or ecological requirements. These two species thus deserve more attention for risk assessment. The main indigenous parasitoids collected belonged to two pupal species, Trichopria cf drosophilae and Pachycrepoideus vindemmiae, but their presence was observed late in the autumn and mainly in cultivated areas. Results are discussed in a comparison of the methodological approaches for monitoring Drosophilids and the benefits-risks assessment of classical biological control. PMID:29144440

An outbreak of vancomycin-resistant Enterococcus faecium in an acute care pediatric hospital: Lessons from environmental screening and a case-control study

PubMed Central

Drews, Steven J; Richardson, Susan E; Wray, Rick; Freeman, Renee; Goldman, Carol; Streitenberger, Laurie; Stevens, Derek; Goia, Cristina; Kovach, Danuta; Brophy, Jason; Matlow, Anne G

2008-01-01

BACKGROUND The present study describes a vancomycin-resistant enterococci (VRE) outbreak investigation and a case-control study to identify risk factors for VRE acquisition in a tertiary care pediatric hospital. OBJECTIVE To report an outbreak investigation and a case-control study to identify risk factors for VRE colonization or infection in hospitalized children. METHODS Screening for VRE cases was performed by culture or polymerase chain reaction. A case-control study of VRE-colonized patients was undertaken. Environmental screening was performed using standard culture and susceptibility methods, with pulsed-field gel electrophoresis to determine relationships between VRE isolates. Statistical analysis was performed using SAS version 9.0 (SAS Institute Inc, USA). RESULTS Thirty-four VRE-positive cases were identified on 10 wards between February 28, 2005, and May 27, 2005. Pulsed-field gel electrophoresis analysis confirmed a single outbreak strain that was also isolated from a video game found on one affected ward. Multivariate analysis identified cephalosporin use as the major risk factor for VRE colonization. CONCLUSIONS In the present study outbreak, VRE colonization was significantly associated with cephalosporin use. Because shared recreational items and environmental surfaces may be colonized by VRE, they warrant particular attention in housekeeping protocols, particularly in pediatric institutions. PMID:19412380

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

Estimating the health consequences of replacing cigarettes with nicotine inhalers

PubMed Central

Sumner, W

2003-01-01

Background: A fast acting, clean nicotine delivery system might substantially displace cigarettes. Public health consequences would depend on the subsequent prevalence of nicotine use, hazards of delivery systems, and intrinsic hazards of nicotine. Methods: A spreadsheet program, DEMANDS, estimates differences in expected mortality, adjusted for nicotine delivery system features and prevalence of nicotine use, by extending the data and methods of the SAMMEC 3 software from the US Centers for Disease Control and Prevention. The user estimates disease risks attributable to nicotine, other smoke components, and risk factors that coexist with smoking. The public health consequences of a widely used clean nicotine inhaler replacing cigarettes were compared to historical observations and public health goals, using four different risk attribution scenarios and nicotine use prevalence from 0–100%. Main outcome measures: Changes in years of potential life before age 85 (YPL85). Results: If nicotine accounts for less than a third of smokers' excess risk of SAMMEC diseases, as it most likely does, then even with very widespread use of clean nicotine DEMANDS predicts public health gains, relative to current tobacco use. Public health benefits accruing from a widely used clean nicotine inhaler probably equal or exceed the benefits of achieving Healthy People 2010 goals. Conclusions: Clean nicotine inhalers might improve public health as much as any feasible tobacco control effort. Although the relevant risk estimates are somewhat uncertain, partial nicotine deregulation deserves consideration as part of a broad tobacco control policy. PMID:12773720

Meat cooking habits and risk of colorectal cancer in Córdoba, Argentina.

PubMed

Navarro, Alicia; Muñoz, Sonia E; Lantieri, María J; del Pilar Diaz, María; Cristaldo, Patricia E; de Fabro, Sofía P; Eynard, Aldo R

2004-10-01

Colorectal cancer is the third cause of death among women and the fifth among men in Córdoba, Argentina. We previously reported colorectal cancer to be associated with a high intake of fatty meats and bovine viscera and inversely associated with dietary fiber intake. In this study, we investigated the role of method of cooking meat and preferences in browned surfaces in the risk of colorectal cancer. A case-control retrospective study was carried out by interviewing 296 patients and 597 control subjects with a food-frequency questionnaire. Meat consumption and preferred cooking procedures (boiled, roasted, barbecued, cooked in a flat iron-pan without fat, and fried) were investigated. Odds ratios and 95% confidence intervals were obtained by unconditional logistic regression analysis. Barbecuing was the cooking method preferred by men, whereas iron-pan cooking was favored by women; frying was the least favored method. Fatty beef, sausages, and bovine viscera were preferentially barbecued or boiled, whereas lean beef was mainly roasted, iron-pan cooked, or fried. Chicken was barbecued or roasted. The multivariate relative risks (adjusted by age, sex, social stratum, and total energy intake) for preferring darkly browned surfaces were significantly associated with an increased risk for all cooking procedures (odds ratio, 4.57; 95% confidence interval, 3.10 to 6.73). No associations were found for red roasted or for boiled meats. Increased risk seems to be related to cooking temperature and close contact of the food to the heating source, because higher risks were observed for heavily browned surfaces when meats were barbecued or iron-pan cooked.

Use of Influenza Risk Assessment Tool for Prepandemic Preparedness

PubMed Central

Trock, Susan C.

2018-01-01

In 2010, the Centers for Disease Control and Prevention began to develop an Influenza Risk Assessment Tool (IRAT) to methodically capture and assess information relating to influenza A viruses not currently circulating among humans. The IRAT uses a multiattribute, additive model to generate a summary risk score for each virus. Although the IRAT is not intended to predict the next pandemic influenza A virus, it has provided input into prepandemic preparedness decisions. PMID:29460739

STAT4 and the Risk of Rheumatoid Arthritis and Systemic Lupus Erythematosus

PubMed Central

Remmers, Elaine F.; Plenge, Robert M.; Lee, Annette T.; Graham, Robert R.; Hom, Geoffrey; Behrens, Timothy W.; de Bakker, Paul I.W.; Le, Julie M.; Lee, Hye-Soon; Batliwalla, Franak; Li, Wentian; Masters, Seth L.; Booty, Matthew G.; Carulli, John P.; Padyukov, Leonid; Alfredsson, Lars; Klareskog, Lars; Chen, Wei V.; Amos, Christopher I.; Criswell, Lindsey A.; Seldin, Michael F.; Kastner, Daniel L.

2009-01-01

BACKGROUND Rheumatoid arthritis is a chronic inflammatory disease with a substantial genetic component. Susceptibility to disease has been linked with a region on chromosome 2q. METHODS We tested single-nucleotide polymorphisms (SNPs) in and around 13 candidate genes within the previously linked chromosome 2q region for association with rheumatoid arthritis. We then performed fine mapping of the STAT1-STAT4 region in a total of 1620 case patients with established rheumatoid arthritis and 2635 controls, all from North America. Implicated SNPs were further tested in an independent case-control series of 1529 patients with early rheumatoid arthritis and 881 controls, all from Sweden, and in a total of 1039 case patients and 1248 controls from three series of patients with systemic lupus erythematosus. RESULTS A SNP haplotype in the third intron of STAT4 was associated with susceptibility to both rheumatoid arthritis and systemic lupus erythematosus. The minor alleles of the haplotype-defining SNPs were present in 27% of chromosomes of patients with established rheumatoid arthritis, as compared with 22% of those of controls (for the SNP rs7574865, P = 2.81×10-7; odds ratio for having the risk allele in chromosomes of patients vs. those of controls, 1.32). The association was replicated in Swedish patients with recent-onset rheumatoid arthritis (P = 0.02) and matched controls. The haplotype marked by rs7574865 was strongly associated with lupus, being present on 31% of chromosomes of case patients and 22% of those of controls (P = 1.87×10-9; odds ratio for having the risk allele in chromosomes of patients vs. those of controls, 1.55). Homozygosity of the risk allele, as compared with absence of the allele, was associated with a more than doubled risk for lupus and a 60% increased risk for rheumatoid arthritis. CONCLUSIONS A haplotype of STAT4 is associated with increased risk for both rheumatoid arthritis and systemic lupus erythematosus, suggesting a shared pathway for these illnesses. PMID:17804842

Applying spatial analysis tools in public health: an example using SaTScan to detect geographic targets for colorectal cancer screening interventions.

PubMed

Sherman, Recinda L; Henry, Kevin A; Tannenbaum, Stacey L; Feaster, Daniel J; Kobetz, Erin; Lee, David J

2014-03-20

Epidemiologists are gradually incorporating spatial analysis into health-related research as geocoded cases of disease become widely available and health-focused geospatial computer applications are developed. One health-focused application of spatial analysis is cluster detection. Using cluster detection to identify geographic areas with high-risk populations and then screening those populations for disease can improve cancer control. SaTScan is a free cluster-detection software application used by epidemiologists around the world to describe spatial clusters of infectious and chronic disease, as well as disease vectors and risk factors. The objectives of this article are to describe how spatial analysis can be used in cancer control to detect geographic areas in need of colorectal cancer screening intervention, identify issues commonly encountered by SaTScan users, detail how to select the appropriate methods for using SaTScan, and explain how method selection can affect results. As an example, we used various methods to detect areas in Florida where the population is at high risk for late-stage diagnosis of colorectal cancer. We found that much of our analysis was underpowered and that no single method detected all clusters of statistical or public health significance. However, all methods detected 1 area as high risk; this area is potentially a priority area for a screening intervention. Cluster detection can be incorporated into routine public health operations, but the challenge is to identify areas in which the burden of disease can be alleviated through public health intervention. Reliance on SaTScan's default settings does not always produce pertinent results.

Risk Factors Profile of Shoulder Dystocia in Oman: A Case Control Study

PubMed Central

Al-Khaduri, Maha M.; Abudraz, Rania Mohammed; Al-Farsi, Yahya M.

2014-01-01

Objective This study aimed to assess the risk factor profile of shoulder dystocia and associated neonatal complications in Oman, a developing Arab country. Methods A retrospective case-control study was conducted among 111 cases with dystocia and 111 controls, identified during 1994-2006 period in a tertiary care hospital in Oman. Controls were randomly selected among women who did not have dystocia, and were matched to cases on the day of delivery. Data related to potential risk factors, delivery, and obstetric complications were collected. Results Dystocia was significantly associated with older maternal age, higher parity, larger BMI, diabetes, and previous record of dystocia. In addition, dystocia was associated more with vacuum and forceps deliveries. Routine traction (51%) was the most used manoeuvre. Among dystocia cases, 13% were associated with fetal complications of which Erb’s Palsy was the most prevalent (79%). Conclusion Our finding of significant associations with risk factors lays out the ground to develop a predictability index for shoulder dystocia, which would help in making it preventable. Further p rospective studies are required to confirm the obtained results. PMID:25337307

[Type 2 diabetes mellitus and cardiovascular risk factors: is comprehensive treatment required?].

PubMed

Nadal, Josep Franch; Gutiérrez, Pedro Conthe

2013-09-01

Diabetes mellitus, especially type 2, is a metabolic disease involving the coexistence of several cardiovascular risk factors. Affected patients are therefore at high cardiovascular risk (2-3 times higher than that of men in the general population and 2-6 times higher than that of women). Cardiovascular disease is the main cause of death in the diabetic population, followed by cancer. Cardiovascular risk cannot be compared between diabetic patients and persons who have already shown one or more manifestations of cardiovascular disease (such as myocardial infarction). Single risk factors should be evaluated in combination with other risk factors and a person's cardiovascular risk should be individually assessed. Cardiovascular risk assessment in patients with diabetes through current calculations methods is complex because their ability to predict risk in individuals is very low. Studies such as that by Steno have demonstrated the validity of a comprehensive strategy to control all the risk factors present in persons with type 2 diabetes mellitus, which can reduce the development of micro- and macrovascular complications and mortality by almost 50%. The present article reviews each of the classical cardiovascular risk factors (hypertension, dyslipidemia, smoking, obesity, sedentariness) in relation to diabetes, as well as their recommended targets and the benefits of their control. In view of the above, a comprehensive approach is recommended to control the multiple risk factors that can coexist in persons with type 2 diabetes mellitus. Copyright © 2013 Elsevier España, S.L. All rights reserved.

Integration of DNA sample collection into a multi-site birth defects case-control study.

PubMed

Rasmussen, Sonja A; Lammer, Edward J; Shaw, Gary M; Finnell, Richard H; McGehee, Robert E; Gallagher, Margaret; Romitti, Paul A; Murray, Jeffrey C

2002-10-01

Advances in quantitative analysis and molecular genotyping have provided unprecedented opportunities to add biological sampling and genetic information to epidemiologic studies. The purpose of this article is to describe the incorporation of DNA sample collection into the National Birth Defects Prevention Study (NBDPS), an ongoing case-control study in an eight-state consortium with a primary goal to identify risk factors for birth defects. Babies with birth defects are identified through birth defects surveillance systems in the eight participating centers. Cases are infants with one or more of over 30 major birth defects. Controls are infants without defects from the same geographic area. Epidemiologic information is collected through an hour-long interview with mothers of both cases and controls. We added the collection of buccal cytobrush DNA samples for case-infants, control-infants, and their parents to this study. We describe here the methods by which the samples have been collected and processed, establishment of a centralized resource for DNA banking, and quality control, database management, access, informed consent, and confidentiality issues. Biological sampling and genetic analyses are important components to epidemiologic studies of birth defects aimed at identifying risk factors. The DNA specimens collected in this study can be used for detection of mutations, study of polymorphic variants that confer differential susceptibility to teratogens, and examination of interactions among genetic risk factors. Information on the methods used and issues faced by the NBDPS may be of value to others considering the addition of DNA sampling to epidemiologic studies.

Indoor tanning in businesses and homes and risk of melanoma and non-melanoma skin cancer in two US case-control studies

PubMed Central

Ferrucci, Leah M.; Vogel, Rachel Isaksson; Cartmel, Brenda; Lazovich, DeAnn; Mayne, Susan T.

2014-01-01

Background Indoor tanning increases skin cancer risk. Beyond early research describing melanoma and sun lamps, few recent reports describe where individuals indoor tan and whether skin cancer risk varies by location (business, home-based). Objective Assess where individuals tanned indoors and skin cancer risk by tanning device location. Methods Multivariate logistic regression in two US case-control studies of melanoma (1,161 cases, 1,083 controls, ages 25–59) and early-onset basal cell carcinoma (BCC) (375 cases, 382 controls, under age 40) conducted between 2004 and 2010. Results Most indoor tanners (86.4–95.1%), especially younger individuals, tanned exclusively in businesses. Persons who used indoor tanning exclusively in businesses were at increased risk of melanoma (OR=1.82, 95% CI=1.47–2.26) and BCC (OR=1.69, 95% CI=1.15–2.48) compared to non-users. Melanoma risk was also increased in the small number who reported tanning indoors only at home relative to non-users (OR=4.14, 95% CI=1.75–9.78); 67.6% used sun lamps. Limitations Self-reported tanning, potential recall bias. Conclusion Business only tanning, despite claims of “safe" tanning, was positively associated with a significant risk of melanoma and BCC. Home tanning was uncommon and mostly from sun lamps which were rarely used by younger participants. Regardless of location, indoor tanning was associated with increased risk of skin cancer. PMID:25062934

Short and Long Term Cardiovascular Risk, Metabolic Syndrome Prevalence and HIV in Tanzania: A Cross-Sectional Study

PubMed Central

Kingery, Justin R; Alfred, Yona; Smart, Luke R; Nash, Emily; Todd, Jim; Naguib, Mostafa R; Downs, Jennifer A; Kalluvya, Samuel; Kataraihya, Johannes B; Peck, Robert N

2016-01-01

Objective To compare short and long term cardiovascular disease (CVD) risk scores and prevalence of metabolic syndrome in HIV-infected adults receiving and not receiving antiretroviral therapy (ART) to HIV-negative controls. Methods A cross-sectional study including: 151 HIV-infected, ART-naive, 150 HIV-infected on ART and 153 HIV-negative adults. Traditional cardiovascular risk factors were determined by standard investigations. The primary outcome was ACC/AHA ASCVD Risk Estimator lifetime CVD risk score. Secondary outcomes were ASCVD 10-year risk, Framingham risk scores, statin indication and metabolic syndrome. Results Compared to HIV-negative controls, more HIV-infected adults on ART were classified as high lifetime CVD risk (34.7% vs 17.0%, p<0.001) although 10-year risk scores were similar, a trend which was similar across multiple CVD risk models. In addition, HIV-infected adults on ART had a higher prevalence of metabolic syndrome vs HIV-negative controls (21.3% vs 7.8%, p=0.008), with 2 common clusters of risk factors. More than one-quarter (28.7%) of HIV-infected Tanzanian adults on ART meet criteria for statin initiation. Conclusions HIV-infected ART-treated individuals have high lifetime cardiovascular risk, and this risk seems to develop rapidly in the first 3–4 years of ART as does the development of clusters of metabolic syndrome criteria. These data identify a new subgroup of low short-term/high lifetime risk HIV-infected individuals on ART who do not currently meet criteria for CVD risk factor modification but require further study. PMID:27105648

Advanced Guidance and Control Project for Reusable Launch Vehicles

NASA Technical Reports Server (NTRS)

Hanson, John M.

2000-01-01

The goals of this project are to significantly reduce the time and cost associated with guidance and control design for reusable launch vehicles, and to increase their safety and reliability. Success will lead to reduced cycle times during vehicle design and to reduced costs associated with flying to new orbits, with new payloads, and with modified vehicles. Success will also lead to more robustness to unforeseen circumstances in flight thereby enhancing safety and reducing risk. There are many guidance and control methods available that hold some promise for improvement in the desired areas. Investigators are developing a representative set of independent guidance and control methods for this project. These methods are being incorporated into a high-fidelity off is being conducted across a broad range of flight requirements. The guidance and control methods that perform the best will have demonstrated the desired qualities.

Construction of an Exome-Wide Risk Score for Schizophrenia Based on a Weighted Burden Test.

PubMed

Curtis, David

2018-01-01

Polygenic risk scores obtained as a weighted sum of associated variants can be used to explore association in additional data sets and to assign risk scores to individuals. The methods used to derive polygenic risk scores from common SNPs are not suitable for variants detected in whole exome sequencing studies. Rare variants, which may have major effects, are seen too infrequently to judge whether they are associated and may not be shared between training and test subjects. A method is proposed whereby variants are weighted according to their frequency, their annotations and the genes they affect. A weighted sum across all variants provides an individual risk score. Scores constructed in this way are used in a weighted burden test and are shown to be significantly different between schizophrenia cases and controls using a five-way cross-validation procedure. This approach represents a first attempt to summarise exome sequence variation into a summary risk score, which could be combined with risk scores from common variants and from environmental factors. It is hoped that the method could be developed further. © 2017 John Wiley & Sons Ltd/University College London.

Effect of Economic Assets on Sexual Risk-Taking Intentions Among Orphaned Adolescents in Uganda

PubMed Central

Han, Chang-Keun; Neilands, Torsten B.; Ismayilova, Leyla; Sperber, Elizabeth

2010-01-01

Objectives. We examined the effect of economic assets on sexual risk-taking intentions among school-going AIDS-orphaned adolescents in rural Uganda. Methods. AIDS-orphaned adolescents from 15 comparable schools were randomly assigned to control (n = 133) or treatment (n = 127) conditions. Treatment participants received child savings accounts, workshops, and mentorship. This economic intervention was in addition to the traditional care and support services for school-going orphaned adolescents (counseling and school supplies) provided to both treatment and control groups. Adolescents in the treatment condition were compared with adolescents in the control condition at baseline and at 10 months after the intervention. Results. After control for sociodemographic factors, child-caregiver/parental communication, and peer pressure, adolescents in the economic intervention group reported a significant reduction in sexual risk-taking intentions compared with adolescents in the control condition. Conclusions. The findings indicate that in Uganda, a country devastated by poverty and disease (including HIV/AIDS), having access to economic assets plays an important role in influencing adolescents' sexual risk-taking intentions. These findings have implications for the care and support of orphaned adolescents, especially in poor African countries devastated by poverty and sexually transmitted diseases. PMID:20075323

Modeling Freedom From Progression for Standard-Risk Medulloblastoma: A Mathematical Tumor Control Model With Multiple Modes of Failure

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

Brodin, N. Patrik, E-mail: nils.patrik.brodin@rh.dk; Niels Bohr Institute, University of Copenhagen, Copenhagen; Vogelius, Ivan R.

2013-10-01

Purpose: As pediatric medulloblastoma (MB) is a relatively rare disease, it is important to extract the maximum information from trials and cohort studies. Here, a framework was developed for modeling tumor control with multiple modes of failure and time-to-progression for standard-risk MB, using published pattern of failure data. Methods and Materials: Outcome data for standard-risk MB published after 1990 with pattern of relapse information were used to fit a tumor control dose-response model addressing failures in both the high-dose boost volume and the elective craniospinal volume. Estimates of 5-year event-free survival from 2 large randomized MB trials were used tomore » model the time-to-progression distribution. Uncertainty in freedom from progression (FFP) was estimated by Monte Carlo sampling over the statistical uncertainty in input data. Results: The estimated 5-year FFP (95% confidence intervals [CI]) for craniospinal doses of 15, 18, 24, and 36 Gy while maintaining 54 Gy to the posterior fossa was 77% (95% CI, 70%-81%), 78% (95% CI, 73%-81%), 79% (95% CI, 76%-82%), and 80% (95% CI, 77%-84%) respectively. The uncertainty in FFP was considerably larger for craniospinal doses below 18 Gy, reflecting the lack of data in the lower dose range. Conclusions: Estimates of tumor control and time-to-progression for standard-risk MB provides a data-driven setting for hypothesis generation or power calculations for prospective trials, taking the uncertainties into account. The presented methods can also be applied to incorporate further risk-stratification for example based on molecular biomarkers, when the necessary data become available.« less

[French recommendations on control measures to reduce the infectious risk in immunocompromised patients].

PubMed

Zahar, J-R; Jolivet, S; Adam, H; Dananché, C; Lizon, J; Alfandari, S; Boulestreau, H; Baghdadi, N; Bay, J-O; Bénéteau, A-M; Bougnoux, M-E; Brenier-Pinchart, M-P; Dalle, J-H; Fournier, S; Fuzibet, J-G; Kauffmann-Lacroix, C; Le Guinche, I; Lepelletier, D; Loukili, N; Lory, A; Morvan, M; Oumedaly, R; Ribaud, P; Rohrlich, P; Vanhems, P; Aho, S; Vanjak, D; Gangneux, J-P

2017-12-01

The increase use of immunosuppressive treatments in patients with solid cancer and/or inflammatory diseases requires revisiting our practices for the prevention of infectious risk in the care setting. A review of the literature by a multidisciplinary working group at the beginning of 2014 wished to answer the following 4 questions to improve healthcare immunocompromised patients: (I) How can we define immunocompromised patients with high, intermediate and low infectious risk, (II) which air treatment should be recommended for this specific population? (III) What additional precautions should be recommended for immunocompromised patients at risk for infection? (IV) Which global environmental control should be recommended? Based on data from the literature and using the GRADE method, we propose 15 recommendations that could help to reduce the risk of infection in these exposed populations. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Guidelines to birth control counselling of the physically handicapped.

PubMed Central

Szasz, G.; Miller, S.; Anderson, L.

1979-01-01

Birth control counselling of well motivated physically handicapped men and women is discussed in a series of suggested steps: (1) preappointment arrangements are made to ensure physical access to the office, and the partner or a helper may be invited to the visit; (2) the patient is encouraged to name the desired birth control method; (3) the patient's fertility is established from the history and the results of physical examination and laboratory tests; (4) methods of birth control are matched to the patient's physical and mental capabilities; (5) potential side effects of the proposed methods are considered in the light of the handicap; (6) a method is finally recommended that may be a trade-off, with ease of use balanced against efficacy, and living with side effects balanced against the risks of pregnancy; and (7) rechecks are necessary to ensure that the patient is using the method with skill and satisfaction. PMID:156579

Risk assessment of metals in road-deposited sediment along an urban-rural gradient.

PubMed

Zhao, Hongtao; Li, Xuyong

2013-03-01

We applied the traditional risk assessment methods originally designed for soils and river sediments to evaluation of risk associated with metals in road-deposited sediment (RDS) along an urban-rural gradient that included central urban (UCA), urban village (UVA), central suburban county (CSA), rural town (RTA), and rural village (RVA) areas in the Beijing metropolitan region. A new indicator RI(RDS) was developed which integrated the RDS characteristics of mobility, grain size and amount with the potential ecological risk index. The risk associated with metals in RDS in urban areas was generally higher than that in rural areas based on the assessment using traditional methods, but the risk was higher in urban and rural village areas than the areas with higher administration units based on the indicator RI(RDS). These findings implied that RDS characteristics variation with the urban-rural gradient must be considered in metal risk assessment and RDS washoff pollution control. Copyright © 2012 Elsevier Ltd. All rights reserved.

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

The Relationship between Smoking and Unhealthy Weight Control Behaviors among Korean Adolescents: The Tenth Korea Youth Risk Behavior Web-Based Survey, 2014

PubMed Central

Sim, Won Yong; Kang, Jae Heon; Park, Hyun Ah; Kim, Kyoung Woo; Hur, Yang Im; Shin, Koh Eun; Byeon, Gyeong Ran

2017-01-01

Background Adolescent smoking is positively related to weight control attempts, especially by unhealthy methods. The co-occurrence of smoking and unhealthy weight control behaviors may cause serious health problems in adolescents. This study examined the relationship of smoking with unhealthy weight control behaviors among Korean adolescents. Methods This cross-sectional study involved 31,090 students of grades 7 to 12, who had tried to reduce or maintain their weight during the 30 days prior to The Tenth Korea Youth Risk Behavior Web-based Survey, 2014. Data on height, weight, weight control methods, smoking, alcohol intake, living with one's family, and perceived economic status were obtained through self-report questionnaires. ‘Unhealthy weight control behaviors’ were subcategorized into ‘extreme weight control behaviors’ and ‘less extreme weight control behaviors.’ Results The smoking rates were 13.3%±0.4% in boys and 3.8%±0.2% in girls. Current smokers were more likely to engage in extreme weight control behaviors (odds ratio [OR], 1.47; 95% confidence interval [CI], 1.09 to 2.00 in boys, and OR, 2.05; 95% CI, 1.59 to 2.65 in girls) and less extreme weight control behaviors (OR, 1.23; 95% CI, 1.07 to 1.40 in boys, and OR, 1.47; 95% CI, 1.22 to 1.76 in girls) compared to non-smokers among both boys and girls. Conclusion Current smoking is independently related to a high likelihood of engaging in unhealthy weight control behaviors among Korean adolescents. This relationship is stronger for girls than for boys. Extreme weight control behaviors have a stronger relationship with current smoking than less extreme weight control behaviors. PMID:28197330

Quantification of mammographic masking risk with volumetric breast density maps: how to select women for supplemental screening

NASA Astrophysics Data System (ADS)

Holland, Katharina; van Gils, Carla H.; Wanders, Johanna OP; Mann, Ritse M.; Karssemeijer, Nico

2016-03-01

The sensitivity of mammograms is low for women with dense breasts, since cancers may be masked by dense tissue. In this study, we investigated methods to identify women with density patterns associated with a high masking risk. Risk measures are derived from volumetric breast density maps. We used the last negative screening mammograms of 93 women who subsequently presented with an interval cancer (IC), and, as controls, 930 randomly selected normal screening exams from women without cancer. Volumetric breast density maps were computed from the mammograms, which provide the dense tissue thickness at each location. These were used to compute absolute and percentage glandular tissue volume. We modeled the masking risk for each pixel location using the absolute and percentage dense tissue thickness and we investigated the effect of taking the cancer location probability distribution (CLPD) into account. For each method, we selected cases with the highest masking measure (by thresholding) and computed the fraction of ICs as a function of the fraction of controls selected. The latter can be interpreted as the negative supplemental screening rate (NSSR). Between the models, when incorporating CLPD, no significant differences were found. In general, the methods performed better when CLPD was included. At higher NSSRs some of the investigated masking measures had a significantly higher performance than volumetric breast density. These measures may therefore serve as an alternative to identify women with a high risk for a masked cancer.

Method for assessing coal-floor water-inrush risk based on the variable-weight model and unascertained measure theory

NASA Astrophysics Data System (ADS)

Wu, Qiang; Zhao, Dekang; Wang, Yang; Shen, Jianjun; Mu, Wenping; Liu, Honglei

2017-11-01

Water inrush from coal-seam floors greatly threatens mining safety in North China and is a complex process controlled by multiple factors. This study presents a mathematical assessment system for coal-floor water-inrush risk based on the variable-weight model (VWM) and unascertained measure theory (UMT). In contrast to the traditional constant-weight model (CWM), which assigns a fixed weight to each factor, the VWM varies with the factor-state value. The UMT employs the confidence principle, which is more effective in ordered partition problems than the maximum membership principle adopted in the former mathematical theory. The method is applied to the Datang Tashan Coal Mine in North China. First, eight main controlling factors are selected to construct the comprehensive evaluation index system. Subsequently, an incentive-penalty variable-weight model is built to calculate the variable weights of each factor. Then, the VWM-UMT model is established using the quantitative risk-grade divide of each factor according to the UMT. On this basis, the risk of coal-floor water inrush in Tashan Mine No. 8 is divided into five grades. For comparison, the CWM is also adopted for the risk assessment, and a differences distribution map is obtained between the two methods. Finally, the verification of water-inrush points indicates that the VWM-UMT model is powerful and more feasible and reasonable. The model has great potential and practical significance in future engineering applications.

Effects of antithyroid drugs on radioiodine treatment: systematic review and meta-analysis of randomised controlled trials.

PubMed

Walter, Martin A; Briel, Matthias; Christ-Crain, Mirjam; Bonnema, Steen J; Connell, John; Cooper, David S; Bucher, Heiner C; Müller-Brand, Jan; Müller, Beat

2007-03-10

To determine the effect of adjunctive antithyroid drugs on the risk of treatment failure, hypothyroidism, and adverse events after radioiodine treatment. Meta-analysis. Electronic databases (Cochrane central register of controlled trials, Medline, Embase) searched to August 2006 and contact with experts. Review methods Three reviewers independently assessed trial eligibility and quality. Pooled relative risks for treatment failure and hypothyroidism after radioiodine treatment with and without adjunctive antithyroid drugs were calculated with a random effects model. We identified 14 relevant randomised controlled trials with a total of 1306 participants. Adjunctive antithyroid medication was associated with an increased risk of treatment failure (relative risk 1.28, 95% confidence interval 1.07 to 1.52; P=0.006) and a reduced risk for hypothyroidism (0.68, 0.53 to 0.87; P=0.006) after radioiodine treatment. We found no difference in summary estimates for the different antithyroid drugs or for whether antithyroid drugs were given before or after radioiodine treatment. Antithyroid drugs potentially increase rates of failure and reduce rates of hypothyroidism if they are given in the week before or after radioiodine treatment, respectively.

Risk management algorithm for rear-side collision avoidance using a combined steering torque overlay and differential braking

NASA Astrophysics Data System (ADS)

Lee, Junyung; Yi, Kyongsu; Yoo, Hyunjae; Chong, Hyokjin; Ko, Bongchul

2015-06-01

This paper describes a risk management algorithm for rear-side collision avoidance. The proposed risk management algorithm consists of a supervisor and a coordinator. The supervisor is designed to monitor collision risks between the subject vehicle and approaching vehicle in the adjacent lane. An appropriate criterion of intervention, which satisfies high acceptance to drivers through the consideration of a realistic traffic, has been determined based on the analysis of the kinematics of the vehicles in longitudinal and lateral directions. In order to assist the driver actively and increase driver's safety, a coordinator is designed to combine lateral control using a steering torque overlay by motor-driven power steering and differential braking by vehicle stability control. In order to prevent the collision while limiting actuator's control inputs and vehicle dynamics to safe values for the assurance of the driver's comfort, the Lyapunov theory and linear matrix inequalities based optimisation methods have been used. The proposed risk management algorithm has been evaluated via simulation using CarSim and MATLAB/Simulink.

Evaluating and understanding fish health risks and their consequences in propagated and free-ranging fish populations

USGS Publications Warehouse

Moffitt, C.M.; Haukenes, A.H.; Williams, C.J.

2005-01-01

Fishery managers and resource conservationists are increasingly interested in understanding the fish health and disease risks of free-ranging fishes and whether propagated fishes or features and practices used at fish culture facilities pose a health risk to free-ranging populations. Disease agents are present in most both captive and all free-ranging fish populations, but the consequences and extent of infections in free-ranging populations are often difficult to measure, control, and understand. Sampling methods, protocols, and assay techniques developed to assess the health of captive populations are not as applicable for assessments of free-ranging fishes. The use of chemicals and therapeutics to control diseases and parasites in propagated fishes likely reduces the risk of introducing specific pathogens into the environment, but control measures may have localized effects on the environment surrounding fish culture facilities. To understand health risks of propagated and free ranging fishes, we must consider fish populations, culture facilities, fish releases, and their interactions within the greater geospatial features of the aquatic environment. ?? 2004 by the American Fisheries Society.

Meat consumption, cooking methods, mutagens, and risk of squamous cell carcinoma of the esophagus: a case-control study in Uruguay.

PubMed

De Stefani, Eduardo; Deneo-Pellegrini, Hugo; Ronco, Alvaro L; Boffetta, Paolo; Correa, Pelayo; Aune, Dagfinn; Mendilaharsu, María; Acosta, Gisele; Silva, Cecilia; Landó, Gabriel; Luaces, María E

2012-01-01

The role of meat in squamous cell carcinoma of the esophagus (ESCC) has been considered conflictive. For this reason, we decided to conduct a case-control study on meat consumption and ESCC. Data included 234 newly diagnosed and microscopically examined ESCC and 2,020 controls with conditions not related to tobacco smoking nor alcohol drinking and without changes in their diets. We studied total meat, red meat, beef, lamb, processed meat, poultry, fish, total white meat, liver, fried meat, barbecued meat, boiled meat, heterocyclic amines, nitrosodimethylamine, and benzo[a]pyrene in relation with the risk of ESCC. Red meat, lamb, and boiled meat were directly associated with the risk of ESCC, whereas total white meat, poultry, fish, and liver were mainly protective against this malignancy.

Influence of dorsolateral prefrontal cortex and ventral striatum on risk avoidance in addiction: a mediation analysis*

PubMed Central

Yamamoto, Dorothy J.; Woo, Choong-Wan; Wager, Tor D.; Regner, Michael F.; Tanabe, Jody

2015-01-01

Background Alterations in frontal and striatal function are hypothesized to underlie risky decision-making in drug users, but how these regions interact to affect behavior is incompletely understood. We used mediation analysis to investigate how prefrontal cortex and ventral striatum together influence risk avoidance in abstinent drug users. Method Thirty-seven abstinent substance-dependent individuals (SDI) and 43 controls underwent fMRI while performing a decision-making task involving risk and reward. Analyses of a priori regions-of-interest tested whether activity in dorsolateral prefrontal cortex (DLPFC) and ventral striatum (VST) explained group differences in risk avoidance. Whole-brain analysis was conducted to identify brain regions influencing the negative VST-risk avoidance relationship. Results Right DLPFC (RDLPFC) positively mediated the group-risk avoidance relationship (p < 0.05); RDLPFC activity was higher in SDI and predicted higher risk avoidance across groups, controlling for SDI vs. controls. Conversely, VST activity negatively influenced risk avoidance (p < 0.05); it was higher in SDI, and predicted lower risk avoidance. Whole-brain analysis revealed that, across group, RDLPFC and left temporal-parietal junction positively (p ≤ 0.001) while right thalamus and left middle frontal gyrus negatively (p < 0.005) mediated the VST activity-risk avoidance relationship. Conclusion RDLPFC activity mediated less risky decision-making while VST mediated more risky decision-making across drug users and controls. These results suggest a dual pathway underlying decision-making, which, if imbalanced, may adversely influence choices involving risk. Modeling contributions of multiple brain systems to behavior through mediation analysis could lead to a better understanding of mechanisms of behavior and suggest neuromodulatory treatments for addiction. PMID:25736619

Fast Track Randomized Controlled Trial to Prevent Externalizing Psychiatric Disorders: Findings from Grades 3 to 9

ERIC Educational Resources Information Center

Journal of the American Academy of Child & Adolescent Psychiatry, 2007

2007-01-01

Objective: This study tests the efficacy of the Fast Track Program in preventing antisocial behavior and psychiatric disorders among groups varying in initial risk. Method: Schools within four sites (Durham, NC; Nashville, TN; Seattle, WA; and rural central Pennsylvania) were selected as high-risk institutions based on neighborhood crime and…

Combining Primary Prevention and Risk Reduction Approaches in Sexual Assault Protection Programming

ERIC Educational Resources Information Center

Menning, Chadwick; Holtzman, Mellisa

2015-01-01

Objective: The object of this study is to extend prior evaluations of Elemental, a sexual assault protection program that combines primary prevention and risk reduction strategies within a single program. Participants and Methods: During 2012 and 2013, program group and control group students completed pretest, posttest, and 6-week and 6-month…

Ceratapion basicorne (Illiger) (Coleoptera: Curculionidae): laboratory and open field trials to assess its specificity as biocontrol agent of Centaurea solstitialis (Asteraceae: Cardueae)

USDA-ARS?s Scientific Manuscript database

Prospective biological control agents generally must be demonstrated to not pose risks to non-target plants. Laboratory experiments evaluating host plant specificity are the most common method of evaluating such risk; however, they are constrained by limitations of space and number of replicates, gi...

Chronic Disease Risks in Young Adults with Autism Spectrum Disorder: Forewarned Is Forearmed

ERIC Educational Resources Information Center

Tyler, Carl V.; Schramm, Sarah C.; Karafa, Matthew; Tang, Anne S.; Jain, Anil K.

2011-01-01

An emerging, cost-effective method to examine prevalent and future health risks of persons with disabilities is electronic health record (EHR) analysis. As an example, a case-control EHR analysis of adults with autism spectrum disorder receiving primary care through the Cleveland Clinic from 2005 to 2008 identified 108 adults with autism spectrum…

Associations between genetic polymorphisms of insulin-like growth factor axis genes and risk for age-related macular degeneration

USDA-ARS?s Scientific Manuscript database

Purpose: Our objective was to investigate if insulin-like growth factor (IGF) axis genes affect the risk for age-related macular degeneration (AMD). Methods: 864 Caucasian non-diabetic participants from the Age-Related Eye Disease Study (AREDS) Genetic Repository were used in this case control st...

ANALYTICAL METHODS NECESSARY TO IMPLEMENT RISK-BASED CRITERIA FOR CHEMICALS IN MUNICIPAL SLUDGE

EPA Science Inventory

The Ambient Water Quality Criteria that were promulgated by the U.S. Environmental Protection Agency in 1980 included water concentration levels which, for many pollutants, were so low as to be unmeasurable by standard analytical methods. Criteria for controlling toxics in munici...

COMPARISON OF GEOCODING METHODS USED IN CASE-CONTROL STUDY OF AIR QUALITY AND BIRTH DEFECTS

EPA Science Inventory

Introduction: Accurate geocoding of maternal residence is critical to the success of an ongoing case-control study of exposure to five criteria air pollutants and the risk of selected birth defects in seven Texas counties between 1997 and 2000. The geocoded maternal residence a...

Fast Foods, Sweets and Beverage Consumption and Risk of Colorectal Cancer: A Case-Control Study in Jordan

PubMed Central

Tayyem, Reema F; Bawadi, Hiba A; Shehadah, Ihab; Bani-Hani, Kamal E; Takruri, Hamed; Al-Jaberi, Tareq; Heath, Dennis D

2018-01-01

Background: The effects of consuming fast foods, sweets and beverages on the development of colorectal cancer (CRC) are unclear. The aim of this case-control study was to assess possible associations between the consumption of different fast foods, sweets and beverages and CRC risk in a Jordanian population. Methods: Two hundred and twenty diagnosed CRC cases and 281 controls were enrolled. Diet history was obtained using a validated quantitative questionnaire. Results: Consumption of some types of fast food, and particularly falafel, was associated with an increased risk of developing CRC. Elevated risk was found for potato and corn chips with an AOR of 4.36 (95%CI: 1.24-15.28) for daily consumption and 3.33 (95%CI: 1.00-11.11) for ≥5 servings/week. Consuming 1-2 or >5 servings per week of fried potatoes or 2-3 servings per week of chicken in sandwiches also increased the risk while exposure to fresh tomato juice and hot pepper sauce on a monthly basis appeared to exert a protective effect. Conclusions: Consumption of fried fast food items was significantly linked with an increased risk of developing CRC in Jordan. PMID:29374411

Suicide Risks among Adolescents and Young Adults in Rural China

PubMed Central

Zhao, Sibo; Zhang, Jie

2014-01-01

Background: In China, suicide is one of the major causes of death among adolescents and young adults aged 15 to 34 years. Aim: The current study examines how risk factors vary by age groups in rural China, referring to those aged 15 to 24 years and those aged 25 to 34 years. Method: A case-control psychological autopsy (PA) study is conducted in sixteen counties from three Chinese provinces, including 392 suicide cases and 416 community living controls in the sample. Results: In China, young adults aged 25 to 34 years have a higher risk for suicide than adolescents aged 15 to 24 years, and it holds true even controlling for relevant social factors. In addition, age-related factors such as education, marital status, whether having children, status in the family, physical health, and personal income all have varying degrees of impact on suicide risks for rural youth. Conclusions: This study shows that there are some age-related risk factors for suicide at certain life stages and emphasizes that young adults in rural China aged 25 to 34 years have an increased risk of suicide as a result of experiencing more psychological strains with age. PMID:25546276

Variable Lifting Index for Manual-Lifting Risk Assessment: A Preliminary Validation Study.

PubMed

Battevi, Natale; Pandolfi, Monica; Cortinovis, Ivan

2016-08-01

The aim of this study was to evaluate the efficacy of the new Variable Lifting Index (VLI) method, theoretically based on the Revised National Institute for Occupational Safety and Health [NIOSH] Lifting Equation (RNLE), in predicting the risk of acute low-back pain (LBP) in the past 12 months. A new risk variable termed the VLI for assessing variable manual lifting has been developed, but there has been no epidemiological study that evaluates the relationship between the VLI and LBP. A sample of 3,402 study participants from 16 companies in different industrial sectors was analyzed. Of the participants, 2,374 were in the risk exposure group involving manual materials handling (MMH), and 1,028 were in the control group without MMH. The VLI was calculated for each participant in the exposure group using a systematic approach. LBP information was collected by occupational physicians at the study sites. The risk of acute LBP was estimated by calculating the odds ratio (OR) between levels of the risk exposure and the control group using a logistic regression analysis. Both crude and adjusted ORs for body mass index, gender, and age were analyzed. Both crude and adjusted ORs showed a dose-response relationship. As the levels of VLI increased, the risk of LBP increased. This risk relationship existed when VLI was greater than 1. The VLI method can be used to assess the risk of acute LBP, although further studies are needed to confirm the outcome and to define better VLI categories. © 2016, Human Factors and Ergonomics Society.

Tuberculosis disease mapping in Kedah using standardized morbidity ratio

NASA Astrophysics Data System (ADS)

Diah, Ijlal Mohd; Aziz, Nazrina; Kasim, Maznah Mat

2017-10-01

This paper presents the results of relative risk estimation that applied to TB data in Kedah using the most common approach, Standardized Morbidity Ratio (SMR). Disease mapping has been recognized as one of the methods that can be used by government and public health in order to control diseases since it can give a clear picture of the risk areas. To get good disease mapping, relative risk estimation is an important issue that need to be considered. TB risk areas will be recognized through the map. From the result, Kulim shows the lowest risk areas of contracting TB while Kota Setar has the highest risk area.

The influence of mechanical vibration on local and central balance control.

PubMed

Ehsani, Hossein; Mohler, Jane; Marlinski, Vladimir; Rashedi, Ehsan; Toosizadeh, Nima

2018-04-11

Fall prevention has an indispensable role in enhancing life expectancy and quality of life among older adults. The first step to prevent falls is to devise reliable methods to identify individuals at high fall risk. The purpose of the current study was to assess alterations in local postural muscle and central sensory balance control mechanisms due to low-frequency externally applied vibration among elders at high fall risk, in comparison with healthy controls, as a potential tool for assessing fall risk. Three groups of participants were recruited: healthy young (n = 10; age = 23 ± 2 years), healthy elders (n = 10; age = 73 ± 3 years), and elders at high fall risk (n = 10; age = 84 ± 9 years). Eyes-open and eyes-closed upright standing balance performance was measured with no vibration, 30 Hz, and 40 Hz vibration of Gastrocnemius muscles. When vibratory stimulation was applied, changes in local-control performance manifested significant differences among the groups (p < 0.01). On average between conditions, we observed 97% and 92% less change among high fall risk participants when compared to healthy young and older adults, respectively. On the other hand, vibration-induced changes in the central-control performance were not significant between groups (p ≥ 0.19). Results suggest that local-control deficits are responsible for balance behavior alterations among elders at high fall risk and healthy individuals. This observation may be attributable to deterioration of short-latency reflexive loop in elders at high fall risk. On the other hand, we could not ascribe the balance alterations to problems related to central nervous system performance or long-latency responses. Copyright © 2018 Elsevier Ltd. All rights reserved.

Potential of household environmental resources and practices in eliminating residual malaria transmission: a case study of Tanzania, Burundi, Malawi and Liberia.

PubMed

Semakula, Henry M; Song, Guobao; Zhang, Shushen; Achuu, Simon P

2015-09-01

The increasing protection gaps of insecticide-treated nets and indoor-residual spraying methods against malaria have led to an emergence of residual transmission in sub-Saharan Africa and thus, supplementary strategies to control mosquitoes are urgently required. To assess household environmental resources and practices that increase or reduce malaria risk among children under-five years of age in order to identify those aspects that can be adopted to control residual transmission. Household environmental resources, practices and malaria test results were extracted from Malaria Indicators Survey datasets for Tanzania, Burundi, Malawi and Liberia with 16,747 children from 11,469 households utilised in the analysis. Logistic regressions were performed to quantify the contribution of each factor to malaria occurrence. Cattle rearing reduced malaria risk between 26%-49% while rearing goats increased the risk between 26%-32%. All piped-water systems reduced malaria risk between 30%-87% (Tanzania), 48%-95% (Burundi), 67%-77% (Malawi) and 58%-73 (Liberia). Flush toilets reduced malaria risk between 47%-96%. Protected-wells increased malaria risk between 19%-44%. Interestingly, boreholes increased malaria risk between 19%-75%. Charcoal use reduced malaria risk between 11%-49%. Vector control options for tackling mosquitoes were revealed based on their risk levels. These included cattle rearing, installation of piped-water systems and flush toilets as well as use of smokeless fuels.

Integrating Phylodynamics and Epidemiology to Estimate Transmission Diversity in Viral Epidemics

PubMed Central

Magiorkinis, Gkikas; Sypsa, Vana; Magiorkinis, Emmanouil; Paraskevis, Dimitrios; Katsoulidou, Antigoni; Belshaw, Robert; Fraser, Christophe; Pybus, Oliver George; Hatzakis, Angelos

2013-01-01

The epidemiology of chronic viral infections, such as those caused by Hepatitis C Virus (HCV) and Human Immunodeficiency Virus (HIV), is affected by the risk group structure of the infected population. Risk groups are defined by each of their members having acquired infection through a specific behavior. However, risk group definitions say little about the transmission potential of each infected individual. Variation in the number of secondary infections is extremely difficult to estimate for HCV and HIV but crucial in the design of efficient control interventions. Here we describe a novel method that combines epidemiological and population genetic approaches to estimate the variation in transmissibility of rapidly-evolving viral epidemics. We evaluate this method using a nationwide HCV epidemic and for the first time co-estimate viral generation times and superspreading events from a combination of molecular and epidemiological data. We anticipate that this integrated approach will form the basis of powerful tools for describing the transmission dynamics of chronic viral diseases, and for evaluating control strategies directed against them. PMID:23382662

Early Adolescent Relationship Predictors of Emerging Adult Outcomes: Youth with and without Type 1 Diabetes

PubMed Central

Helgeson, Vicki S.; Palladino, Dianne K.; Reynolds, Kerry A.; Becker, Dorothy; Escobar, Oscar; Siminerio, Linda

2013-01-01

Background Emerging adulthood is a high-risk period for mental health problems and risk behaviors for youth generally and for physical health problems among those with type 1 diabetes. Purpose To examine whether adolescents’ relationships with parents and friends predict health and risk behaviors during emerging adulthood. Method Youth with and without diabetes were enrolled at average age 12 and followed for 7 years. Parent and friend relationship variables, measured during adolescence, were used to predict emerging adulthood outcomes: depression, risk behavior, and, for those with diabetes, diabetes outcomes. Results Parent relationship quality predicted decreased depressive symptoms and, for those with diabetes, decreased alcohol use. Parent control predicted increased smoking, reduced college attendance, and, for control participants, increased depressive symptoms. For those with diabetes, parent control predicted decreased depressive symptoms and better self-care. Friend relationship variables predicted few outcomes. Conclusions Adolescent parent relationships remain an important influence on emerging adults’ lives. PMID:24178509

Behavioral and Neurodevelopmental Precursors to Binge-Type Eating Disorders: Support for the Role of Negative Valence Systems

PubMed Central

Vannucci, Anna; Nelson, Eric E.; Bongiorno, Diana M.; Pine, Daniel S.; Yanovski, Jack A.; Tanofsky-Kraff, Marian

2015-01-01

Background Pediatric loss-of-control eating is a robust behavioral precursor to binge-type eating disorders. Elucidating precursors to loss-of-control eating and binge-type eating disorders may refine developmental risk models of eating disorders and inform interventions. Method We review evidence within constructs of the Negative Valence Systems (NVS)-domain, as specified by the Research Domain Criteria framework. Based on published studies, we propose an integrated NVS model of binge-type eating disorder risk. Results Data implicate altered corticolimbic functioning, neuroendocrine dysregulation, and self-reported negative affect as possible risk-factors. However, neuroimaging and physiological data in children and adolescents are sparse, and most prospective studies are limited to self-report measures. Conclusions We discuss a broad NVS framework for conceptualizing early risk for binge-type eating disorders. Future neural and behavioral research on the developmental trajectory of loss-of-control and binge-type eating disorders is required. PMID:26040923

Risk Factors for premature birth in a hospital 1

PubMed Central

Ahumada-Barrios, Margarita E.; Alvarado, German F.

2016-01-01

Abstract Objective: to determine the risk factors for premature birth. Methods: retrospective case-control study of 600 pregnant women assisted in a hospital, with 298 pregnant women in the case group (who gave birth prematurely <37 weeks) and 302 pregnant women who gave birth to a full-term newborn in the control group. Stata software version 12.2 was used. The Chi-square test was used in bivariate analysis and logistic regression was used in multivariate analysis, from which Odds Ratios (OR) and Confidence Intervals (CI) of 95% were derived. Results: risk factors associated with premature birth were current twin pregnancy (adjusted OR= 2.4; p= 0.02), inadequate prenatal care (< 6 controls) (adjusted OR= 3.2; p <0.001), absent prenatal care (adjusted OR= 3.0; p <0.001), history of premature birth (adjusted OR= 3.7; p <0.001) and preeclampsia (adjusted OR= 1.9; p= 0.005). Conclusion: history of premature birth, preeclampsia, not receiving prenatal care and receiving inadequate prenatal care were risk factors for premature birth. PMID:27463110

Lower Hippocampal Volume Predicts Decrements in Lane Control among Drivers with Amnestic MCI

PubMed Central

Griffith, H Randall; Okonkwo, Ozioma C; Stewart, Christopher C; Stoeckel, Luke E; den Hollander, Jan A; Elgin, Jennifer M; Harrell, Lindy E; Brockington, John C; Clark, David G; Ball, Karlene K; Owsley, Cynthia; Marson, Daniel C; Wadley, Virginia G

2014-01-01

Objectives There are few methods to discern driving risks in patients with early dementia and Mild Cognitive Impairment (MCI). We aimed to determine whether structural MRI of the hippocampus – a biomarker of probable Alzheimer pathology and a measure of disease severity in those affected – is linked to objective ratings of on-road driving performance in older adults with and without amnestic MCI. Methods 49 consensus-diagnosed participants from an Alzheimer's Disease Research Center (15 diagnosed with amnestic MCI and 34 demographically similar controls) underwent structural MRI and on-road driving assessments. Results Mild atrophy of the left hippocampus was associated with less-than-optimal ratings in lane control but not with other discrete driving skills. Decrements in left hippocampal volume conferred higher risk for less-than-optimal lane control ratings in the MCI patients (B = −1.63, SE = .74, Wald = 4.85, P = .028), but not in controls (B = 0.13, SE = .415, Wald = 0.10, P = .752). The odds ratio (OR) and 95% confidence interval (CI) for below optimal lane control in the MCI group was 4.41 (1.18, 16.36), which was attenuated to 3.46 (0.88, 13.60) after accounting for the contribution of left hippocampal volume. Conclusion These findings suggest that there may be a link between hippocampal atrophy and difficulties with lane control in persons with amnestic MCI. Further study appears warranted to better discern patterns of brain atrophy in MCI and AD and whether these could be early markers of clinically meaningful driving risk. PMID:24212246

Can we (actually) assess global risk?

NASA Astrophysics Data System (ADS)

Di Baldassarre, Giuliano

2013-04-01

The evaluation of the dynamic interactions of the different components of global risk (e.g. hazard, exposure, vulnerability or resilience) is one of the main challenges in risk assessment and management. In state-of-the-art approaches for the analysis of risk, natural and socio-economic systems are typically treated separately by using different methods. In flood risk studies, for instance, physical scientists typically focus on the study of the probability of flooding (i.e. hazard), while social scientists mainly examine the exposure, vulnerability or resilience to flooding. However, these different components are deeply interconnected. Changes in flood hazard might trigger changes in vulnerability, and vice versa. A typical example of these interactions is the so-called "levee effect", whereby heightening levees to reduce the probability of flooding often leads to increase the potential adverse consequences of flooding as people often perceive that flood risk was completely eliminated once the levee was raised. These interconnections between the different components of risk remain largely unexplored and poorly understood. This lack of knowledge is of serious concern as it limits our ability to plan appropriate risk prevention measures. To design flood control structures, for example, state-of-the-art models can indeed provide quantitative assessments of the corresponding risk reduction associated to the lower probability of flooding. Nevertheless, current methods cannot estimate how, and to what extent, such a reduction might trigger a future increase of the potential adverse consequences of flooding (the aforementioned "levee effect"). Neither can they evaluate how the latter might (in turn) lead to the requirement of additional flood control structures. Thus, while many progresses have been made in the static assessment of flood risk, more inter-disciplinary research is required for the development of methods for dynamic risk assessment, which is very much needed in a rapidly changing world. This presentation will discuss these challenges and describe a few initial attempts aiming to better understand the interactions between the different components of flood risk with reference to diverse case studies in Europe, Central America, and Africa.

Effectiveness of an HIV/STD Risk-Reduction Intervention for Adolescents When Implemented by Community-Based Organizations: A Cluster-Randomized Controlled Trial

PubMed Central

Jemmott, Loretta S.; Fong, Geoffrey T.; Morales, Knashawn H.

2010-01-01

Objectives. We evaluated the effectiveness of an HIV/STD risk-reduction intervention when implemented by community-based organizations (CBOs). Methods. In a cluster-randomized controlled trial, 86 CBOs that served African American adolescents aged 13 to 18 years were randomized to implement either an HIV/STD risk-reduction intervention whose efficacy has been demonstrated or a health-promotion control intervention. CBOs agreed to implement 6 intervention groups, a random half of which completed 3-, 6-, and 12-month follow-up assessments. The primary outcome was consistent condom use in the 3 months prior to each follow-up assessment, averaged over the follow-up assessments. Results. Participants were 1707 adolescents, 863 in HIV/STD-intervention CBOs and 844 in control-intervention CBOs. HIV/STD-intervention participants were more likely to report consistent condom use (odds ratio [OR] = 1.39; 95% confidence interval [CI] = 1.06, 1.84) than were control-intervention participants. HIV/STD-intervention participants also reported a greater proportion of condom-protected intercourse (β = 0.06; 95% CI = 0.00, 0.12) than did the control group. Conclusions. This is the first large, randomized intervention trial to demonstrate that CBOs can successfully implement an HIV/STD risk-reduction intervention whose efficacy has been established. PMID:20167903

An updated review of case-control studies of lung cancer and indoor radon-Is indoor radon the risk factor for lung cancer?

PubMed

Sheen, Seungsoo; Lee, Keu Sung; Chung, Wou Young; Nam, Saeil; Kang, Dae Ryong

2016-01-01

Lung cancer is a leading cause of cancer-related death in the world. Smoking is definitely the most important risk factor for lung cancer. Radon ((222)Rn) is a natural gas produced from radium ((226)Ra) in the decay series of uranium ((238)U). Radon exposure is the second most common cause of lung cancer and the first risk factor for lung cancer in never-smokers. Case-control studies have provided epidemiological evidence of the causative relationship between indoor radon exposure and lung cancer. Twenty-four case-control study papers were found by our search strategy from the PubMed database. Among them, seven studies showed that indoor radon has a statistically significant association with lung cancer. The studies performed in radon-prone areas showed a more positive association between radon and lung cancer. Reviewed papers had inconsistent results on the dose-response relationship between indoor radon and lung cancer risk. Further refined case-control studies will be required to evaluate the relationship between radon and lung cancer. Sufficient study sample size, proper interview methods, valid and precise indoor radon measurement, wide range of indoor radon, and appropriate control of confounders such as smoking status should be considered in further case-control studies.

The SOBANE strategy for the management of risk, as applied to whole-body or hand-arm vibration.

PubMed

Malchaire, J; Piette, A

2006-06-01

The objective was to develop a coherent set of methods to be used effectively in industry to prevent and manage the risks associated with exposure to vibration, by coordinating the progressive intervention of the workers, their management, the occupational health and safety (OHS) professionals and the experts. The methods were developed separately for the exposure to whole-body and hand-arm vibration. The SOBANE strategy of risk prevention includes four levels of intervention: level 1, Screening; level 2, Observation; level 3, Analysis and; level 4, Expertise. The methods making it possible to apply this strategy were developed for 14 types of risk factors. The article presents the methods specific to the prevention of the risks associated with the exposure to vibration. The strategy is similar to those published for the risks associated with exposure to noise, heat and musculoskeletal disorders. It explicitly recognizes the qualifications of the workers and their management with regard to the work situation and shares the principle that measuring the exposure of the workers is not necessarily the first step in order to improve these situations. It attempts to optimize the recourse to the competences of the OHS professionals and the experts, in order to come more rapidly, effectively and economically to practical control measures.

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

Diagnosis before treatment: Identifying dairy farmers' determinants for the adoption of sustainable practices in gastrointestinal nematode control.

PubMed

Vande Velde, F; Claerebout, E; Cauberghe, V; Hudders, L; Van Loo, H; Vercruysse, J; Charlier, J

2015-09-15

Anthelmintic resistance is emerging in dairy cattle and this can result in a lack of effective control and production losses. Therefore, sustainable control strategies, such as targeted treatments (TT) and targeted selected treatments (TST), should be adopted by the industry. TT and TST approaches require the use of diagnostic methods to take informed treatment decisions. To understand the factors affecting the farmers' intention to adopt diagnostic methods before implementing anthelmintic drugs ('adoption intention'), a cross-sectional survey was carried out in dairy farms in Belgium (Flanders). A framework was constructed to predict adoption intentions based on two fundamental theories in the field of behavioural psychology and health psychology: the Theory of Planned Behaviour and the Health Belief Model. In the tested model, adoption intentions were predicted based on attitudes towards anthelminthics, attitudes towards diagnostic methods, subjective norms, behavioural control and perceived risk. Structural equation modelling was used for analyses. The model fitted the data well and explained 46% of the variance in adoption intention of diagnostics. The factors 'attitude towards diagnostic methods' and 'subjective norm'; i.e. the influence of significant others, had the strongest, positive influence on adoption intention of diagnostic methods. 'Perceived behavioural control' had a weak, positive effect on intention. Further, 'attitude towards the use of anthelmintic drugs' had a negative effect on adoption intention of the diagnostic methods. This implicates an effect of current behaviour on future adoption, which should be considered in future research. Factors measuring risk perception of anthelmintic resistance; perceived severity and perceived susceptibility, had no effect on the adoption intention of diagnostic methods. The threat of anthelmintic resistance is perceived to be low for dairy herds. The study further did not find any differences in the effects of the predictors for young stock and adult dairy cows. The results of this study can be used to develop communication strategies to advertise sustainable nematode control on dairy farms. Copyright © 2015 Elsevier B.V. All rights reserved.

Seismic, structural, and individual factors associated with earthquake related injury

PubMed Central

Peek-Asa, C; Ramirez, M; Seligson, H; Shoaf, K

2003-01-01

Background: Earthquakes cause thousands of deaths worldwide every year, and systematic study of the causes of these deaths can lead to their prevention. Few studies have examined how multiple types of risk factors are related to physical injury during an earthquake. Methods: A population based case-control study was conducted to examine how individual characteristics, building characteristics, and seismic features of the 1994 Northridge, California, earthquake contributed to physical injury. Cases included fatal and hospital-admitted injuries caused by the earthquake. Controls were drawn from a population based phone survey of county residents. Cases were individually matched to two sets of controls: one matched by age and gender and one matched by location at the time of the earthquake. Results: Individuals over age 65 had 2.9 times the risk of injury as younger people (95% confidence interval (CI) 1.2 to 7.4) and women had a 2.4 times greater risk than men (95% CI 1.2 to 5.1). Location in multiple unit residential and commercial structures each led to increased injury risk compared with single unit residential structures, but the exact estimate varied depending on the control group used. With every increase in ground motion of 10%g, injury risk increased 2.2 times (95% CI 1.6 to 3.3). Conclusions: Controlling for other factors, it was found that individual, building, and seismic characteristics were independently predictive of increased injury risk. Prevention and preparedness efforts should focus on each of these as potential points of intervention. PMID:12642562

Intensive glycaemic control for patients with type 2 diabetes: systematic review with meta-analysis and trial sequential analysis of randomised clinical trials.

PubMed

Hemmingsen, Bianca; Lund, Søren S; Gluud, Christian; Vaag, Allan; Almdal, Thomas; Hemmingsen, Christina; Wetterslev, Jørn

2011-11-24

To assess the effect of targeting intensive glycaemic control versus conventional glycaemic control on all cause mortality and cardiovascular mortality, non-fatal myocardial infarction, microvascular complications, and severe hypoglycaemia in patients with type 2 diabetes. Systematic review with meta-analyses and trial sequential analyses of randomised trials. Cochrane Library, Medline, Embase, Science Citation Index Expanded, LILACS, and CINAHL to December 2010; hand search of reference lists and conference proceedings; contacts with authors, relevant pharmaceutical companies, and the US Food and Drug Administration. Randomised clinical trials comparing targeted intensive glycaemic control with conventional glycaemic control in patients with type 2 diabetes. Published and unpublished trials in all languages were included, irrespective of predefined outcomes. Two reviewers independently assessed studies for inclusion and extracted data related to study methods, interventions, outcomes, risk of bias, and adverse events. Risk ratios with 95% confidence intervals were estimated with fixed and random effects models. Fourteen clinical trials that randomised 28,614 participants with type 2 diabetes (15,269 to intensive control and 13,345 to conventional control) were included. Intensive glycaemic control did not significantly affect the relative risks of all cause (1.02, 95% confidence interval 0.91 to 1.13; 28,359 participants, 12 trials) or cardiovascular mortality (1.11, 0.92 to 1.35; 28,359 participants, 12 trials). Trial sequential analyses rejected a relative risk reduction above 10% for all cause mortality and showed insufficient data on cardiovascular mortality. The risk of non-fatal myocardial infarction may be reduced (relative risk 0.85, 0.76 to 0.95; P=0.004; 28,111 participants, 8 trials), but this finding was not confirmed in trial sequential analysis. Intensive glycaemic control showed a reduction of the relative risks for the composite microvascular outcome (0.88, 0.79 to 0.97; P=0.01; 25,600 participants, 3 trials) and retinopathy (0.80, 0.67 to 0.94; P=0.009; 10,793 participants, 7 trials), but trial sequential analyses showed that sufficient evidence had not yet been reached. The estimate of an effect on the risk of nephropathy (relative risk 0.83, 0.64 to 1.06; 27,769 participants, 8 trials) was not statistically significant. The risk of severe hypoglycaemia was significantly increased when intensive glycaemic control was targeted (relative risk 2.39, 1.71 to 3.34; 27,844 participants, 9 trials); trial sequential analysis supported a 30% increased relative risk of severe hypoglycaemia. Intensive glycaemic control does not seem to reduce all cause mortality in patients with type 2 diabetes. Data available from randomised clinical trials remain insufficient to prove or refute a relative risk reduction for cardiovascular mortality, non-fatal myocardial infarction, composite microvascular complications, or retinopathy at a magnitude of 10%. Intensive glycaemic control increases the relative risk of severe hypoglycaemia by 30%.

Comparison of 3 Methods for Identifying Dietary Patterns Associated With Risk of Disease

PubMed Central

DiBello, Julia R.; Kraft, Peter; McGarvey, Stephen T.; Goldberg, Robert; Campos, Hannia

2008-01-01

Reduced rank regression and partial least-squares regression (PLS) are proposed alternatives to principal component analysis (PCA). Using all 3 methods, the authors derived dietary patterns in Costa Rican data collected on 3,574 cases and controls in 1994–2004 and related the resulting patterns to risk of first incident myocardial infarction. Four dietary patterns associated with myocardial infarction were identified. Factor 1, characterized by high intakes of lean chicken, vegetables, fruit, and polyunsaturated oil, was generated by all 3 dietary pattern methods and was associated with a significantly decreased adjusted risk of myocardial infarction (28%–46%, depending on the method used). PCA and PLS also each yielded a pattern associated with a significantly decreased risk of myocardial infarction (31% and 23%, respectively); this pattern was characterized by moderate intake of alcohol and polyunsaturated oil and low intake of high-fat dairy products. The fourth factor derived from PCA was significantly associated with a 38% increased risk of myocardial infarction and was characterized by high intakes of coffee and palm oil. Contrary to previous studies, the authors found PCA and PLS to produce more patterns associated with cardiovascular disease than reduced rank regression. The most effective method for deriving dietary patterns related to disease may vary depending on the study goals. PMID:18945692

The grey matter correlates of impaired decision-making in multiple sclerosis

PubMed Central

Muhlert, Nils; Sethi, Varun; Cipolotti, Lisa; Haroon, Hamied; Parker, Geoff J M; Yousry, Tarek; Wheeler-Kingshott, Claudia; Miller, David; Ron, Maria; Chard, Declan

2015-01-01

Objective People with multiple sclerosis (MS) have difficulties with decision-making but it is unclear if this is due to changes in impulsivity, risk taking, deliberation or risk adjustment, and how this relates to brain pathology. Methods We assessed these aspects of decision-making in 105 people with MS and 43 healthy controls. We used a novel diffusion MRI method, diffusion orientational complexity (DOC), as an index of grey matter pathology in regions associated with decision-making and also measured grey matter tissue volumes and white matter lesion volumes. Results People with MS showed less adjustment to risk and slower decision-making than controls. Moreover, impaired decision-making correlated with reduced executive function, memory and processing speed. Decision-making impairments were most prevalent in people with secondary progressive MS. They were seen in patients with cognitive impairment and those without cognitive impairment. On diffusion MRI, people with MS showed DOC changes in all regions except the occipital cortex, relative to controls. Risk adjustment correlated with DOC in the hippocampi and deliberation time with DOC in the medial prefrontal, middle frontal gyrus, anterior cingulate and caudate parcellations and with white matter lesion volumes. Conclusions These data clarify the features of decision-making deficits in MS, and provide the first evidence that they relate to grey and white matter abnormalities seen using MRI. PMID:25006208

Use of Organic Nitrates and the Risk of Hip Fracture: A Population-Based Case-Control Study

PubMed Central

Pouwels, Sander; Lalmohamed, Arief; van Staa, Tjeerd; Cooper, Cyrus; Souverein, Patrick; Leufkens, Hubertus G.; Rejnmark, Lars; de Boer, Anthonius; Vestergaard, Peter; de Vries, Frank

2010-01-01

Context: Use of organic nitrates has been associated with increased bone mineral density. Moreover, a large Danish case-control study reported a decreased fracture risk. However, the association with duration of nitrate use, dose frequency, and impact of discontinuation has not been extensively studied. Objective: Our objective was to evaluate the association between organic nitrates and hip fracture risk. Methods: A case-control study was conducted using the Dutch PHARMO Record Linkage System (1991–2002, n = 6,763 hip fracture cases and 26,341 controls). Cases had their first admission for hip fracture, whereas controls had not sustained any fracture after enrollment. Current users of organic nitrates were patients who had received a prescription within 90 d before the index date. The analyses were adjusted for disease and drug history. Results: Current use of nitrates was not associated with a decreased risk of hip fracture [adjusted odds ratio (OR) = 0.93; 95% confidence interval (CI) = 0.83–1.04]. Those who used as-needed medication only had a lower risk of hip fracture (adjusted OR = 0.83; 95% CI = 0.63–1.08) compared with users of maintenance medication only (adjusted OR = 1.17; 95% CI = 0.97–1.40). No association was found between duration of nitrate use and fracture risk. Conclusions: Our overall analyses showed that risk of a hip fracture was significantly lower among users of as-needed organic nitrates, when compared with users of maintenance medication. Our analyses of hip fracture risks with duration of use did not further support a beneficial effect of organic nitrates on hip fracture, although residual confounding may have masked beneficial effects. PMID:20130070

Occupational Exposures and Chronic Kidney Disease: Possible associations with endotoxin and ultrafine particles

PubMed Central

Sponholtz, Todd R.; Sandler, Dale P.; Parks, Christine G.; Applebaum, Katie M.

2015-01-01

Background Chronic kidney disease (CKD) carries a high public health burden yet there is limited research on occupational factors, which are examined in this retrospective case-control study. Methods Newly diagnosed cases of CKD (n=547) and controls (n=508) from North Carolina provided detailed work histories in telephone interviews. Unconditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Results There was heterogeneity in the association of CKD and agricultural work, with crop production associated with increased risk and work with livestock associated with decreased risk. Work with cutting/cooling/lubricating oils was associated with a reduced risk. CKD risk was increased for working in dusty conditions. Conclusions CKD risk was reduced in subjects with occupational exposures previously reported to involve endotoxin exposure. Further, exposure to dusty conditions was consistently associated with increased risk of glomerulonephritis across industry, suggesting that research on CKD and ultrafine particulates is needed. PMID:26572099

Early Initiation of Substance Use and Subsequent Risk Factors Related to Suicide among Urban High School Students

PubMed Central

Cho, Hyunsan; Hallfors, Denise Dion; Iritani, Bonita J.

2013-01-01

Objective To examine the association between onset of substance use and risk factors related to suicide. Method 1,252 adolescents in two urban school districts completed surveys as part of a large, randomized controlled prevention effectiveness trial. Risk factors measured included depressive symptoms, suicide ideation, suicide ideation specifically with alcohol and/or drug use, endorsement of suicide as a personal option, and suicide attempt. Results In our final multivariate models that controlled for current substance use and demographic characteristics, we found that earlier onset of hard drug use among boys was associated with all five suicide risk factors. In comparison, among girls, earlier onset of regular cigarette smoking, getting drunk, and hard drug use was associated with some of suicide risk factors. Conclusions The findings confirm the importance of screening for substance use in early adolescence. The association between early substance use and suicide risk factors differed by gender; both research and intervention efforts need to incorporate gender differences. PMID:17210230

Chemical exposure reduction: Factors impacting on South African herbicide sprayers' personal protective equipment compliance and high risk work practices.

PubMed

Andrade-Rivas, Federico; Rother, Hanna-Andrea

2015-10-01

The high exposure risks of workers to herbicides in low- and middle-income countries is an important public health concern because of the potential resulting negative impacts on workers' health. This study investigated workers' personal protective equipment (PPE) compliance as a risk mitigation measure; particularly workers who apply herbicides for Working for Water (WfW) - a South African invasive alien vegetation control programme. The study aim was to understand workers' low PPE compliance by analysing their risk perceptions of herbicide use, working conditions and socio-cultural context. Research methods included ethnographic observations, informal interviews, visual media, questionnaires and a focus group. Study results indicated that low PPE compliance persists despite workers' awareness of herbicide exposure risks and as a result of the influence from workers' socio-cultural context (i.e. gender dynamics and social status), herbicide risk perceptions and working conditions (i.e. environmental and logistical). Interestingly, teams comprised of mostly women had the highest compliance rate. These findings highlighted that given the complexity of PPE compliance, especially in countries with several economic and social constraints, exposure reduction interventions should not rely solely on PPE use promotion. Instead, other control strategies requiring less worker input for effectiveness should be implemented, such as elimination and substitution of highly hazardous pesticides, and altering application methods. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

Telehealthcare for chronic obstructive pulmonary disease: Cochrane Review and meta-analysis

PubMed Central

McLean, Susannah; Nurmatov, Ulugbek; Liu, Joseph LY; Pagliari, Claudia; Car, Josip; Sheikh, Aziz

2012-01-01

Background Chronic obstructive pulmonary disease (COPD) is common. Telehealthcare, involving personalised health care over a distance, is seen as having the potential to improve care for people with COPD. Aim To systematically review the effectiveness of telehealthcare interventions in COPD to improve clinical and process outcomes. Design and setting Cochrane Systematic Review of randomised controlled trials. Methods The study involved searching the Cochrane Airways Group Register of Trials, which is derived from the Cochrane Central Register of Controlled Trials, MEDLINE®, embase™, and CINAHL®, as well as searching registers of ongoing and unpublished trials. Randomised controlled trials comparing a telehealthcare intervention with a control intervention in people with a clinical diagnosis of COPD were identified. The main outcomes of interest were quality of life and risk of emergency department visit, hospitalisation, and death. Two authors independently selected trials for inclusion and extracted data. Study quality was assessed using the Cochrane Collaboration’s risk of bias method. Meta-analysis was undertaken using fixed effect and/or random effects modelling. Results Ten randomised controlled trials were included. Telehealthcare did not improve COPD quality of life: mean difference –6.57 (95% confidence interval [CI] = –13.62 to 0.48). However, there was a significant reduction in the odds ratios (ORs) of emergency department attendance (OR = 0.27; 95% CI = 0.11 to 0.66) and hospitalisation (OR = 0.46; 95% CI = 0.33 to 0.65). There was a non-significant change in the OR of death (OR = 1.05; 95% CI = 0.63 to 1.75). Conclusion In COPD, telehealthcare interventions can significantly reduce the risk of emergency department attendance and hospitalisation, but has little effect on the risk of death. PMID:23211177

Spatial point analysis based on dengue surveys at household level in central Brazil

PubMed Central

Siqueira-Junior, João B; Maciel, Ivan J; Barcellos, Christovam; Souza, Wayner V; Carvalho, Marilia S; Nascimento, Nazareth E; Oliveira, Renato M; Morais-Neto, Otaliba; Martelli, Celina MT

2008-01-01

Background Dengue virus (DENV) affects nonimunne human populations in tropical and subtropical regions. In the Americas, dengue has drastically increased in the last two decades and Brazil is considered one of the most affected countries. The high frequency of asymptomatic infection makes difficult to estimate prevalence of infection using registered cases and to locate high risk intra-urban area at population level. The goal of this spatial point analysis was to identify potential high-risk intra-urban areas of dengue, using data collected at household level from surveys. Methods Two household surveys took place in the city of Goiania (~1.1 million population), Central Brazil in the year 2001 and 2002. First survey screened 1,586 asymptomatic individuals older than 5 years of age. Second survey 2,906 asymptomatic volunteers, same age-groups, were selected by multistage sampling (census tracts; blocks; households) using available digital maps. Sera from participants were tested by dengue virus-specific IgM/IgG by EIA. A Generalized Additive Model (GAM) was used to detect the spatial varying risk over the region. Initially without any fixed covariates, to depict the overall risk map, followed by a model including the main covariates and the year, where the resulting maps show the risk associated with living place, controlled for the individual risk factors. This method has the advantage to generate smoothed risk factors maps, adjusted by socio-demographic covariates. Results The prevalence of antibody against dengue infection was 37.3% (95%CI [35.5–39.1]) in the year 2002; 7.8% increase in one-year interval. The spatial variation in risk of dengue infection significantly changed when comparing 2001 with 2002, (ORadjusted = 1.35; p < 0.001), while controlling for potential confounders using GAM model. Also increasing age and low education levels were associated with dengue infection. Conclusion This study showed spatial heterogeneity in the risk areas of dengue when using a spatial multivariate approach in a short time interval. Data from household surveys pointed out that low prevalence areas in 2001 surveys shifted to high-risk area in consecutive year. This mapping of dengue risks should give insights for control interventions in urban areas. PMID:18937868

Association between RTEL1, PHLDB1, and TREH Polymorphisms and Glioblastoma Risk: A Case-Control Study

PubMed Central

Yang, Bo; Heng, Liang; Du, Shuli; Yang, Hua; Jin, Tianbo; Lang, Hongjuan; Li, Shanqu

2015-01-01

Background Glioblastoma (GBM) is a highly invasive, aggressive, and incurable brain tumor. Genetic factors play important roles in GBM risk. The aim of this study was to elucidate the influence of gene polymorphism on GBM susceptibility. Material/Methods In this case-control study, we included 72 GBM patients and 320 healthy controls to analyze the association between 29 single-nucleotide polymorphisms and GBM cancer risk in the Chinese Han population. The single-nucleotide polymorphisms were determined by Sequenom MassARRAY RS1000 and statistical analysis was performed using SPSS software and SNPStats software. Results Using the χ2 test, we found that rs2297440 and rs6010620 in RTEL1 increased risk of GBM. In the recessive model, we also found that the genotypes “CC” of rs2297440 and “GG” of rs6010620 in RTEL1 significantly increased GBM risk. The variant TT genotype of TREH rs17748 and the variant TT genotype of PHLDB1 rs498872 decreased GBM risk in the recessive model. We also found that the TREH rs17748 variant C allele showed an increased risk in males in the dominant model. Conclusions Our results suggest a significant association between the RETL1, TREH, and PHLDB1 genes and GBM development in the Han Chinese population. PMID:26156397

Alcohol and cigarette use among Warsaw adolescents: Factors associated with risk and resilience

PubMed Central

Pisarska, Agnieszka; Eisman, Andria; Ostaszewski, Krzysztof; Zimmerman, Marc A.

2016-01-01

Background Youth in Poland are at notable risk for substance use. Guided by resiliency theory, we examine if developmental risk and promotive factors are associated with substance abuse risk. Objectives We examined the association between adolescent cigarette and alcohol use and related risk and promotive factors including maternal support, neighbours’ informal social control, friends’ acceptance of substance use, and alcohol and cigarette use by nonparental adults. Method Data were collected from a random sample of 13–14-year old students attending Warsaw middle schools (N=3029). We used hierarchical regression models and examined compensatory and protective models of resilience, controlling for sociodemograhic factors. Results Our results indicated that friends’ acceptance of substance use and perceived drug use among nonparental adults was associated with increased risk cigarette and alcohol use among youth. We found that maternal support moderated the relationship between friends’ acceptance of substance use and cigarette use (protective model of resilience). Thus, maternal support buffered the negative effects of friends’ acceptance of use on youths’ cigarette use. Neighbor’s informal social control and maternal support were associated with reduced risk of alcohol use (compensatory model of resilience). Conclusion Collectively, results of the study support compensatory and protective models of resilience in a large representative sample of Warsaw adolescents. PMID:27223142

Relation between diagnosis of atheromatous plaque from orthopantomographs and cardiovascular risk factors. A study of cases and control subjects

PubMed Central

Gutierrez-Bonet, Carmen; Leco-Berrocal, Isabel; Fernández-Cáliz, Fernando; Martínez-González, José-María

2016-01-01

Background In recent years the use of orthopantomography has been proposed as a low-cost, reliable and non-invasive diagnostic medium for detecting atheromatous plaque. The purpose of this study was to correlate the presence of carotid calcifications (atheroma) in orthopantomographs with specific risk factors for cerebrovascular accidents (previous cerebrovascular accidents, arterial hypertension, and diabetes). Material and Methods The methods used in this observational study of cases and control subjects followed STROBE (Strengthening the Reporting of Observational studies in Epidemiology) recommendations. The study analyzed a total of 1,602 panoramic radiographs taken for dental diagnostic purposes between January 2010 and February 2014. The main variables analyzed were the incidence of atheromatous plaque and other cardiovascular risk factors. Epidat 3.1 statistical software was used to determine minimum sample sizes and the results were analyzed using PASW (Predictive Analytics Software) Statistics 10.0.0. Results For all the variables analyzed, the correlation between radiographic detection of atheromatous plaque and the presence of cardiovascular disease risk factors was found to be statistically significant (RR>1.5). Conclusions The presence of cardiovascular risk factors is related to the incidence of radiopaque lesions at the carotid artery bifurcation, indicating the presence of atheromatous plaque. Key words:Orthopantomography, atheromatous plaque, cerebrovascular accident, diabetes, arterial hypertension. PMID:26595828

Protective and risk factors in amateur equestrians and description of injury patterns: A retrospective data analysis and a case - control survey

PubMed Central

2011-01-01

Background In Switzerland there are about 150,000 equestrians. Horse related injuries, including head and spinal injuries, are frequently treated at our level I trauma centre. Objectives To analyse injury patterns, protective factors, and risk factors related to horse riding, and to define groups of safer riders and those at greater risk Methods We present a retrospective and a case-control survey at conducted a tertiary trauma centre in Bern, Switzerland. Injured equestrians from July 2000 - June 2006 were retrospectively classified by injury pattern and neurological symptoms. Injured equestrians from July-December 2008 were prospectively collected using a questionnaire with 17 variables. The same questionnaire was applied in non-injured controls. Multiple logistic regression was performed, and combined risk factors were calculated using inference trees. Results Retrospective survey A total of 528 injuries occured in 365 patients. The injury pattern revealed as follows: extremities (32%: upper 17%, lower 15%), head (24%), spine (14%), thorax (9%), face (9%), pelvis (7%) and abdomen (2%). Two injuries were fatal. One case resulted in quadriplegia, one in paraplegia. Case-control survey 61 patients and 102 controls (patients: 72% female, 28% male; controls: 63% female, 37% male) were included. Falls were most frequent (65%), followed by horse kicks (19%) and horse bites (2%). Variables statistically significant for the controls were: Older age (p = 0.015), male gender (p = 0.04) and holding a diploma in horse riding (p = 0.004). Inference trees revealed typical groups less and more likely to suffer injury. Conclusions Experience with riding and having passed a diploma in horse riding seem to be protective factors. Educational levels and injury risk should be graded within an educational level-injury risk index. PMID:21294862

Functional Logistic Regression Approach to Detecting Gene by Longitudinal Environmental Exposure Interaction in a Case-Control Study

PubMed Central

Wei, Peng; Tang, Hongwei; Li, Donghui

2014-01-01

Most complex human diseases are likely the consequence of the joint actions of genetic and environmental factors. Identification of gene-environment (GxE) interactions not only contributes to a better understanding of the disease mechanisms, but also improves disease risk prediction and targeted intervention. In contrast to the large number of genetic susceptibility loci discovered by genome-wide association studies, there have been very few successes in identifying GxE interactions which may be partly due to limited statistical power and inaccurately measured exposures. While existing statistical methods only consider interactions between genes and static environmental exposures, many environmental/lifestyle factors, such as air pollution and diet, change over time, and cannot be accurately captured at one measurement time point or by simply categorizing into static exposure categories. There is a dearth of statistical methods for detecting gene by time-varying environmental exposure interactions. Here we propose a powerful functional logistic regression (FLR) approach to model the time-varying effect of longitudinal environmental exposure and its interaction with genetic factors on disease risk. Capitalizing on the powerful functional data analysis framework, our proposed FLR model is capable of accommodating longitudinal exposures measured at irregular time points and contaminated by measurement errors, commonly encountered in observational studies. We use extensive simulations to show that the proposed method can control the Type I error and is more powerful than alternative ad hoc methods. We demonstrate the utility of this new method using data from a case-control study of pancreatic cancer to identify the windows of vulnerability of lifetime body mass index on the risk of pancreatic cancer as well as genes which may modify this association. PMID:25219575

Functional logistic regression approach to detecting gene by longitudinal environmental exposure interaction in a case-control study.

PubMed

Wei, Peng; Tang, Hongwei; Li, Donghui

2014-11-01

Most complex human diseases are likely the consequence of the joint actions of genetic and environmental factors. Identification of gene-environment (G × E) interactions not only contributes to a better understanding of the disease mechanisms, but also improves disease risk prediction and targeted intervention. In contrast to the large number of genetic susceptibility loci discovered by genome-wide association studies, there have been very few successes in identifying G × E interactions, which may be partly due to limited statistical power and inaccurately measured exposures. Although existing statistical methods only consider interactions between genes and static environmental exposures, many environmental/lifestyle factors, such as air pollution and diet, change over time, and cannot be accurately captured at one measurement time point or by simply categorizing into static exposure categories. There is a dearth of statistical methods for detecting gene by time-varying environmental exposure interactions. Here, we propose a powerful functional logistic regression (FLR) approach to model the time-varying effect of longitudinal environmental exposure and its interaction with genetic factors on disease risk. Capitalizing on the powerful functional data analysis framework, our proposed FLR model is capable of accommodating longitudinal exposures measured at irregular time points and contaminated by measurement errors, commonly encountered in observational studies. We use extensive simulations to show that the proposed method can control the Type I error and is more powerful than alternative ad hoc methods. We demonstrate the utility of this new method using data from a case-control study of pancreatic cancer to identify the windows of vulnerability of lifetime body mass index on the risk of pancreatic cancer as well as genes that may modify this association. © 2014 Wiley Periodicals, Inc.

Review of methods to prevent and reduce the risk of Lyme disease.

PubMed

Lindsay, L R; Ogden, N H; Schofield, S W

2015-06-04

Cases of Lyme disease and areas with self-sustaining populations of vector ticks are increasing in Canada. This trend is expected to continue. Preventing Lyme disease will therefore become relevant to an increasing number of Canadians. To summarize methods for reducing the risk of tick bites and preventing transmission once a tick is feeding. A literature search was conducted to identify methods to reduce the risk of tick bites and the abundance of vector ticks, as well as the risk of becoming infected with the Lyme disease pathogen, Borrelia burgdorferi (BB), if bitten by a vector tick. Current approaches to reducing the risk of tick bites or preventing infection with BB once bitten are largely reliant on the individual. They include use of topical repellents, use of protective clothing, avoidance of risk areas and removing ticks soon (ideally within a day) after they attach. These methods are efficacious, but constrained by user adherence. Other approaches such as landscape modification or the use of acaricides to control ticks, have shown promise in other countries, but have not been widely adopted in Canada. Lyme disease will continue to present a threat in Canada. In additional to the existing interventions for prevention of tick bites and Lyme disease, there is a need for new tools to help reduce the risk of Lyme disease to Canadians.

An optimization method for condition based maintenance of aircraft fleet considering prognostics uncertainty.

PubMed

Feng, Qiang; Chen, Yiran; Sun, Bo; Li, Songjie

2014-01-01

An optimization method for condition based maintenance (CBM) of aircraft fleet considering prognostics uncertainty is proposed. The CBM and dispatch process of aircraft fleet is analyzed first, and the alternative strategy sets for single aircraft are given. Then, the optimization problem of fleet CBM with lower maintenance cost and dispatch risk is translated to the combinatorial optimization problem of single aircraft strategy. Remain useful life (RUL) distribution of the key line replaceable Module (LRM) has been transformed into the failure probability of the aircraft and the fleet health status matrix is established. And the calculation method of the costs and risks for mission based on health status matrix and maintenance matrix is given. Further, an optimization method for fleet dispatch and CBM under acceptable risk is proposed based on an improved genetic algorithm. Finally, a fleet of 10 aircrafts is studied to verify the proposed method. The results shows that it could realize optimization and control of the aircraft fleet oriented to mission success.

An Optimization Method for Condition Based Maintenance of Aircraft Fleet Considering Prognostics Uncertainty

PubMed Central

Chen, Yiran; Sun, Bo; Li, Songjie

2014-01-01

An optimization method for condition based maintenance (CBM) of aircraft fleet considering prognostics uncertainty is proposed. The CBM and dispatch process of aircraft fleet is analyzed first, and the alternative strategy sets for single aircraft are given. Then, the optimization problem of fleet CBM with lower maintenance cost and dispatch risk is translated to the combinatorial optimization problem of single aircraft strategy. Remain useful life (RUL) distribution of the key line replaceable Module (LRM) has been transformed into the failure probability of the aircraft and the fleet health status matrix is established. And the calculation method of the costs and risks for mission based on health status matrix and maintenance matrix is given. Further, an optimization method for fleet dispatch and CBM under acceptable risk is proposed based on an improved genetic algorithm. Finally, a fleet of 10 aircrafts is studied to verify the proposed method. The results shows that it could realize optimization and control of the aircraft fleet oriented to mission success. PMID:24892046

Quantifying women's stated benefit-risk trade-off preferences for IBS treatment outcomes.

PubMed

Johnson, F Reed; Hauber, A Brett; Ozdemir, Semra; Lynd, Larry

2010-01-01

The Food and Drug Administration, currently, is exploring quantitative benefit-risk methods to support regulatory decision-making. A scientifically valid method for assessing patients' benefit-risk trade-off preferences is needed to compare risks and benefits in a common metric. The study aims to quantify the maximum acceptable risk (MAR) of treatment-related adverse events (AEs) that women with diarrhea-predominant irritable bowel syndrome (IBS) are willing to accept in exchange for symptom relief. A stated-choice survey was used to elicit trade-off preferences among constructed treatment profiles, each defined by symptom severity and treatment-related AEs. Symptom attributes included frequency of abdominal pain and discomfort, frequency of diarrhea, and frequency of urgency. AE attributes included frequency of mild-to-moderate constipation and the risk of four possible serious AEs. A Web-enabled survey was administered to 589 female US residents at least 18 years of age with a self-reported diagnosis of diarrhea-predominant IBS. Preference weights and MAR were estimated using mixed-logit methods. SUBJECTS were willing to accept higher risks of serious AEs in return for treatments offering better symptom control. For an improvement from the lowest to the highest of four benefit levels, subjects were willing to tolerate a 2.65% increase in impacted-bowel risk, but only a 1.34% increase in perforated-bowel risk. Variation in MARs across AE types is consistent with the relative seriousness of the AEs. Stated-preference methods offer a scientifically valid approach to quantifying benefit-risk trade-off preferences that can be used to inform regulatory decision-making.

Adolescents and oral contraceptives.

PubMed

Sanfilippo, J S

1991-01-01

Oral contraceptive (OC) options for adolescents are provides. Clarification for those desiring a birth control method is necessary and the benefits of decreased acne and dysmenorrhea with low dose OCs should be stressed along with the importance of compliance. A community effort is suggested to communicate the sexual and contraceptive alternatives, including abstinence and outercourse (sexual stimulation to orgasm without intercourse). Attention is given to concerns associated with teenage sexual activity, prevention of adolescent pregnancy, contraceptive options for the adolescent patient, adolescent attitudes toward birth control OCs, management of the adolescent OC user, manipulation of steroid components of OCs to respond to adolescent concerns, and other hormonal contraceptive options such as minipills or abstinence. The text is supplemented with tables: the % of US women by single years of age for 1971, 1976, 1979, and 1982; comparative pregnancy and abortion rates for the US and 5 other countries; federal cost for teen childbearing; adolescent nonhormonal contraceptive methods (advantages, disadvantages, and retail cost); checklist to identify those at risk for noncompliance with OCs; hormonal side effects of OCs; risks from OCs to adolescents; and benefits of OCs. Concern about adolescent pregnancy dates back to Aristotle. A modern profile shows girls form single-parent families are sexually active at an earlier age, adolescent mothers produce offspring who repeat the cycle, victims of sexual abuse are more likely to be sexually active, and teenagers in foster care are 4 times more likely to be sexually active and 8 times more likely to become pregnant. Prevention involves a multifaceted approach. OCs are the most appropriate contraceptive choice for adolescents. Frequency of intercourse is closely associated with OC use after approximately 15 months of unprotected sexual activity. At risk for noncompliance variables are scales of personality development (autonomy, self-esteem, locus of control), life expectations (marriage, college, career), dating behavior, age at 1st intercourse, perceived risk for becoming pregnant, personal attributes (sex, birth control, acquisition of birth control, pregnancy, parents' and peers' feelings toward sex and birth control), and previous experiences with birth control.

Multi-angle Indicators System of Non-point Pollution Source Assessment in Rural Areas: A Case Study Near Taihu Lake

NASA Astrophysics Data System (ADS)

Huang, Lei; Ban, Jie; Han, Yu Ting; Yang, Jie; Bi, Jun

2013-04-01

This study aims to identify key environmental risk sources contributing to water eutrophication and to suggest certain risk management strategies for rural areas. The multi-angle indicators included in the risk source assessment system were non-point source pollution, deficient waste treatment, and public awareness of environmental risk, which combined psychometric paradigm methods, the contingent valuation method, and personal interviews to describe the environmental sensitivity of local residents. Total risk values of different villages near Taihu Lake were calculated in the case study, which resulted in a geographic risk map showing which village was the critical risk source of Taihu eutrophication. The increased application of phosphorus (P) and nitrogen (N), loss vulnerability of pollutant, and a lack of environmental risk awareness led to more serious non-point pollution, especially in rural China. Interesting results revealed by the quotient between the scores of objective risk sources and subjective risk sources showed what should be improved for each study village. More environmental investments, control of agricultural activities, and promotion of environmental education are critical considerations for rural environmental management. These findings are helpful for developing targeted and effective risk management strategies in rural areas.

Health-seeking behavior and transmission dynamics in the control of influenza infection among different age groups

PubMed Central

You, Shu-Han; Chen, Szu-Chieh; Liao, Chung-Min

2018-01-01

Background It has been found that health-seeking behavior has a certain impact on influenza infection. However, behaviors with/without risk perception on the control of influenza transmission among age groups have not been well quantified. Objectives The purpose of this study was to assess to what extent, under scenarios of with/without control and preventive/protective behaviors, the age-specific network-driven risk perception influences influenza infection. Materials and methods A behavior-influenza model was used to estimate the spread rate of age-specific risk perception in response to an influenza outbreak. A network-based information model was used to assess the effect of network-driven risk perception information transmission on influenza infection. A probabilistic risk model was used to assess the infection risk effect of risk perception with a health behavior change. Results The age-specific overlapping percentage was estimated to be 40%–43%, 55%–60%, and 19%–35% for child, teenage and adult, and elderly age groups, respectively. Individuals perceive the preventive behavior to improve risk perception information transmission among teenage and adult and elderly age groups, but not in the child age group. The population with perceived health behaviors could not effectively decrease the percentage of infection risk in the child age group, whereas for the elderly age group, the percentage of decrease in infection risk was more significant, with a 97.5th percentile estimate of 97%. Conclusion The present integrated behavior-infection model can help health authorities in communicating health messages for an intertwined belief network in which health-seeking behavior plays a key role in controlling influenza infection. PMID:29563814

Stomach Cancer Risk After Treatment for Hodgkin Lymphoma

PubMed Central

Morton, Lindsay M.; Dores, Graça M.; Curtis, Rochelle E.; Lynch, Charles F.; Stovall, Marilyn; Hall, Per; Gilbert, Ethel S.; Hodgson, David C.; Storm, Hans H.; Johannesen, Tom Børge; Smith, Susan A.; Weathers, Rita E.; Andersson, Michael; Fossa, Sophie D.; Hauptmann, Michael; Holowaty, Eric J.; Joensuu, Heikki; Kaijser, Magnus; Kleinerman, Ruth A.; Langmark, Frøydis; Pukkala, Eero; Vaalavirta, Leila; van den Belt-Dusebout, Alexandra W.; Fraumeni, Joseph F.; Travis, Lois B.; Aleman, Berthe M.; van Leeuwen, Flora E.

2013-01-01

Purpose Treatment-related stomach cancer is an important cause of morbidity and mortality among the growing number of Hodgkin lymphoma (HL) survivors, but risks associated with specific HL treatments are unclear. Patients and Methods We conducted an international case-control study of stomach cancer nested in a cohort of 19,882 HL survivors diagnosed from 1953 to 2003, including 89 cases and 190 matched controls. For each patient, we quantified cumulative doses of specific alkylating agents (AAs) and reconstructed radiation dose to the stomach tumor location. Results Stomach cancer risk increased with increasing radiation dose to the stomach (Ptrend < .001) and with increasing number of AA-containing chemotherapy cycles (Ptrend = .02). Patients who received both radiation to the stomach ≥ 25 Gy and high-dose procarbazine (≥ 5,600 mg/m2) had strikingly elevated stomach cancer risk (25 cases, two controls; odds ratio [OR], 77.5; 95% CI, 14.7 to 1452) compared with those who received radiation < 25 Gy and procarbazine < 5,600 mg/m2 (Pinteraction < .001). Risk was also elevated (OR, 2.8; 95% CI, 1.3 to 6.4) among patients who received radiation to the stomach ≥ 25 Gy but procarbazine < 5,600 mg/m2; however, no procarbazine-related risk was evident with radiation < 25 Gy. Treatment with dacarbazine also increased stomach cancer risk (12 cases, nine controls; OR, 8.8; 95% CI, 2.1 to 46.6), after adjustment for radiation and procarbazine doses. Conclusion Patients with HL who received subdiaphragmatic radiotherapy had dose-dependent increased risk of stomach cancer, with marked risks for patients who also received chemotherapy containing high-dose procarbazine. For current patients, risks and benefits of exposure to both procarbazine and subdiaphragmatic radiotherapy should be weighed carefully. For patients treated previously, GI symptoms should be evaluated promptly. PMID:23980092

Role of Radiation Dose in the Risk of Secondary Leukemia After a Solid Tumor in Childhood Treated Between 1980 and 1999

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

Allard, Aurore; Haddy, Nadia; Le Deley, Marie-Cecile

2010-12-01

Purpose: The purpose of this study was to estimate the risk of secondary leukemia as a function of radiation dose, taking into account heterogeneous radiation dose distribution. Methods and Materials: We analyzed a case-control study that investigated the risk of secondary leukemia and myelodysplasia after a solid tumor in childhood; it included 61 patients with leukemia matched with 196 controls. Complete clinical, chemotherapy, and radiotherapy histories were recorded for each patient in the study. Average radiation dose to each of seven bone marrow components for each patient was incorporated into the models, and corresponding risks were summed up. Conditional maximummore » likelihood methods were used to estimate risk parameters. Results: Whatever the model, we failed to evidence a role for the radiation dose to active bone marrow in the risk of later leukemia, myelodysplasia, or myeloproliferative syndrome, when adjusting for epipodophyllotoxin and anthracycline doses. This result was confirmed when fitting models that included total dose of radiation delivered during radiotherapy, when fitting models taking into account dose per fraction, and when restricting the analysis to acute myeloid leukemia. Conclusions: In contrast to results found in similar studies that included children treated before the use of epipodophyllotoxins, this study failed to show a role for radiotherapy in the risk of secondary leukemia after childhood cancer in children treated between 1980 and 1999. This discrepancy was probably due to a competitive mechanism between these two carcinogens.« less

Use of risk projection models to estimate mortality and incidence from radiation-induced breast cancer in screening programs

NASA Astrophysics Data System (ADS)

Ramos, M.; Ferrer, S.; Villaescusa, J. I.; Verdú, G.; Salas, M. D.; Cuevas, M. D.

2005-02-01

The authors report on a method to calculate radiological risks, applicable to breast screening programs and other controlled medical exposures to ionizing radiation. In particular, it has been applied to make a risk assessment in the Valencian Breast Cancer Early Detection Program (VBCEDP) in Spain. This method is based on a parametric approach, through Markov processes, of hazard functions for radio-induced breast cancer incidence and mortality, with mean glandular breast dose, attained age and age-at-exposure as covariates. Excess relative risk functions of breast cancer mortality have been obtained from two different case-control studies exposed to ionizing radiation, with different follow-up time: the Canadian Fluoroscopy Cohort Study (1950-1987) and the Life Span Study (1950-1985 and 1950-1990), whereas relative risk functions for incidence have been obtained from the Life Span Study (1958-1993), the Massachusetts tuberculosis cohorts (1926-1985 and 1970-1985), the New York post-partum mastitis patients (1930-1981) and the Swedish benign breast disease cohort (1958-1987). Relative risks from these cohorts have been transported to the target population undergoing screening in the Valencian Community, a region in Spain with about four and a half million inhabitants. The SCREENRISK software has been developed to estimate radiological detriments in breast screening. Some hypotheses corresponding to different screening conditions have been considered in order to estimate the total risk associated with a woman who takes part in all screening rounds. In the case of the VBCEDP, the total radio-induced risk probability for fatal breast cancer is in a range between [5 × 10-6, 6 × 10-4] versus the natural rate of dying from breast cancer in the Valencian Community which is 9.2 × 10-3. The results show that these indicators could be included in quality control tests and could be adequate for making comparisons between several screening programs.

Evidence That Breast Tissue Stiffness Is Associated with Risk of Breast Cancer

PubMed Central

Boyd, Norman F.; Li, Qing; Melnichouk, Olga; Huszti, Ella; Martin, Lisa J.; Gunasekara, Anoma; Mawdsley, Gord; Yaffe, Martin J.; Minkin, Salomon

2014-01-01

Background Evidence from animal models shows that tissue stiffness increases the invasion and progression of cancers, including mammary cancer. We here use measurements of the volume and the projected area of the compressed breast during mammography to derive estimates of breast tissue stiffness and examine the relationship of stiffness to risk of breast cancer. Methods Mammograms were used to measure the volume and projected areas of total and radiologically dense breast tissue in the unaffected breasts of 362 women with newly diagnosed breast cancer (cases) and 656 women of the same age who did not have breast cancer (controls). Measures of breast tissue volume and the projected area of the compressed breast during mammography were used to calculate the deformation of the breast during compression and, with the recorded compression force, to estimate the stiffness of breast tissue. Stiffness was compared in cases and controls, and associations with breast cancer risk examined after adjustment for other risk factors. Results After adjustment for percent mammographic density by area measurements, and other risk factors, our estimate of breast tissue stiffness was significantly associated with breast cancer (odds ratio = 1.21, 95% confidence interval = 1.03, 1.43, p = 0.02) and improved breast cancer risk prediction in models with percent mammographic density, by both area and volume measurements. Conclusion An estimate of breast tissue stiffness was associated with breast cancer risk and improved risk prediction based on mammographic measures and other risk factors. Stiffness may provide an additional mechanism by which breast tissue composition is associated with risk of breast cancer and merits examination using more direct methods of measurement. PMID:25010427

Meat-cooking mutagens and risk of renal cell carcinoma

PubMed Central

Daniel, C R; Schwartz, K L; Colt, J S; Dong, L M; Ruterbusch, J J; Purdue, M P; Cross, A J; Rothman, N; Davis, F G; Wacholder, S; Graubard, B I; Chow, W H; Sinha, R

2011-01-01

Background: High-temperature cooked meat contains two families of carcinogens, heterocyclic amines (HCAs) and polycyclic aromatic hydrocarbons (PAHs). Given the kidneys' role in metabolism and urinary excretion of these compounds, we investigated meat-derived mutagens, as well as meat intake and cooking methods, in a population-based case–control study conducted in metropolitan Detroit and Chicago. Methods: Newly diagnosed, histologically confirmed adenocarcinoma of the renal parenchyma (renal cell carcinoma (RCC)) cases (n=1192) were frequency matched on age, sex, and race to controls (n=1175). The interviewer-administered Diet History Questionnaire (DHQ) included queries for meat-cooking methods and doneness with photographic aids. Levels of meat mutagens were estimated using the DHQ in conjunction with the CHARRED database. Results: The risk of RCC increased with intake of barbecued meat (Ptrend=0.04) and the PAH, benzo(a)pyrene (BaP) (multivariable-adjusted odds ratio and 95% confidence interval, highest vs lowest quartile: 1.50 (1.14, 1.95), Ptrend=0.001). With increasing BaP intake, the risk of RCC was more than twofold in African Americans and current smokers (Pinteraction<0.05). We found no association for HCAs or overall meat intake. Conclusion: BaP intake, a PAH in barbecued meat, was positively associated with RCC. These biologically plausible findings advocate further epidemiological investigation into dietary intake of BaP and risk of RCC. PMID:21897389

Occupational asphalt is not associated with head and neck cancer

PubMed Central

Fogleman, E. V.; Eliot, M.; Michaud, D. S.; Nelson, H. H.; McClean, M. D.

2015-01-01

Background Epidemiologic studies that evaluate the relationship between occupational asphalt exposure and head and neck cancer have had a limited ability to control for known risk factors such as smoking, alcohol and human papillomavirus (HPV). Aims To better elucidate this relationship by including known risk factors in a large case–control study of head and neck squamous cell carcinoma (HNSCC) from the greater Boston area. Methods We analysed the relationship between occupational asphalt exposure and HNSCC among men in the Greater Boston area of Massachusetts. Analyses were conducted using unconditional multivariable logistic regression, performed with adjustments for age, race, education, smoking, alcohol consumption and HPV serology. Results There were 753 cases and 913 controls. No associations between HNSCC and occupational asphalt exposure (neither among ever-exposed nor by occupational duration) were observed for exposures in any occupation or those restricted to the construction industry. We also observed no associations in subgroup analyses of never-smokers and ever-smokers. Adjusting for known risk factors further reduced the estimated effect of asphalt exposure on HNSCC risk. Conclusions We found no evidence for an association between occupational asphalt exposure and HNSCC. The null findings from this well-controlled analysis could suggest that the risk estimates stemming from occupational cohort studies may be overestimated due to uncontrolled confounding and enhance the literature available for weighing cancer risk from occupational exposure to bitumen. PMID:26272381

Multiple risk factors related to familial predisposition to anterior cruciate ligament injury: fraternal twin sisters with anterior cruciate ligament ruptures

PubMed Central

Hewett, T E; Lynch, T R; Myer, G D; Ford, K R; Gwin, R C; Heidt, R S

2014-01-01

Objective A multifactorial combination of predictors may increase anterior cruciate ligament (ACL) injury risk in athletes. The objective of this twin study was to examine these risk factors to identify commonalities in risk factors that predisposed female fraternal twins to ACL injury. Methods Female twins in high-risk sports were prospectively measured prior to an injury for neuromuscular control using three-dimensional motion analysis during landing, hamstrings and quadriceps muscular strength on a dynamometer and joint laxity using a modified Beighton–Horan index and a Compu-KT arthrometer. Intraoperative measures of femoral intercondylar notch width were recorded during ACL reconstruction. Results Abduction angles were increased at one knee in both of the twin sister athletes relative to uninjured controls at initial contact and at maximum displacement during landing. The twin female athletes that went on to ACL injury also demonstrated decreased peak knee flexion motion at both knees than uninjured females during landing. The twin athletes also had increased joint laxity and decreased hamstrings to quadriceps (H/Q) torque ratios compared to controls. Femoral intercondylar notch widths were also below the control mean in the twin siblings. Conclusions Prescreened mature female twins that subsequently experienced ACL injury demonstrated multiple potential risk factors including: increased knee abduction angles, decreased knee flexion angles, increased general joint laxity, decreased H/Q ratios and femoral intercondylar notch width. PMID:19158132

Reducing Risk Behaviors Linked to Noncommunicable Diseases in Mongolia: A Randomized Controlled Trial

PubMed Central

Wang, Wei; Riedel, Marion; Witte, Susan S.

2013-01-01

Objectives. We tested the efficacy of a 6-session, evidence-based health promotion intervention aimed at reducing noncommunicable disease (NCD) risk behaviors. Methods. Two hundred male and female factory workers in Ulaanbaatar, Mongolia were randomly assigned to groups receiving either the health promotion intervention or a time-matched financial literacy control intervention. Results. The health promotion intervention increased daily fruit and vegetable intake and physical activity, increased readiness for NCD risk behavior reduction and health promotion knowledge, and reduced the number of daily alcoholic drinks and diabetes symptoms 3 months after the intervention. Conclusions. The findings support the efficacy of the intervention to reduce risk behaviors associated with NCDs. Dissemination of the intervention may improve productivity, reduce costs of health services, and better the quality of life for Mongolians. PMID:23865647

Development of a community-based intervention for the control of Chagas disease based on peridomestic animal management: an eco-bio-social perspective

PubMed Central

De Urioste-Stone, Sandra M.; Pennington, Pamela M.; Pellecer, Elizabeth; Aguilar, Teresa M.; Samayoa, Gabriela; Perdomo, Hugo D.; Enríquez, Hugo; Juárez, José G.

2015-01-01

Background Integrated vector management strategies depend on local eco-bio-social conditions, community participation, political will and inter-sectorial partnership. Previously identified risk factors for persistent Triatoma dimidiata infestation include the presence of rodents and chickens, tiled roofs, dirt floors, partial wall plastering and dog density. Methods A community-based intervention was developed and implemented based on cyclical stakeholder and situational analyses. Intervention implementation and evaluation combined participatory action research and cluster randomized pre-test post-test experimental designs. The intervention included modified insecticide application, education regarding Chagas disease and risk factors, and participatory rodent control. Results At final evaluation there was no significant difference in post-test triatomine infestation between intervention and control, keeping pre-test rodent and triatomine infestations constant. Knowledge levels regarding Chagas disease and prevention practices including rodent control, chicken management and health service access increased significantly only in intervention communities. The odds of nymph infection and rat infestation were 8.3 and 1.9-fold higher in control compared to intervention communities, respectively. Conclusion Vector control measures without reservoir control are insufficient to reduce transmission risk in areas with persistent triatomine infestation. This integrated vector management program can complement house improvement initiatives by prioritizing households with risk factors such as tiled roofs. Requirement for active participation and multi-sectorial coordination poses implementation challenges. PMID:25604767

The Association Between the Genetic Variants of the NOTCH3 Gene and Ischemic Stroke Risk.

PubMed

Yuan, Xiaoling; Dong, Zifeng

2016-10-22

BACKGROUND Ischemic stroke (IS) is a leading cause of disability and death and NOTCH3 as a gene related with cardiac-cerebral vascular disease plays a vital role in IS development. However, the reports about the effect of genetic variants in NOTCH3 gene on IS are still few. MATERIAL AND METHODS In order to explore the association between NOTCH3 polymorphisms and IS, 134 patients with IS and 115 controls were enrolled in this case-control study. Polymerase chain reaction was used to do the genotyping of polymorphisms. The χ² test was performed to evaluate Hardy-Weinberg equilibrium (HWE) in the control group and calculate odds ratio (OR) with corresponding 95% confidence interval (CI) which represented the association intensity of NOTCH3 gene polymorphisms and IS risk. RESULTS The genotype frequencies in the control group all confirmed to HWE. TT genotype of 381C>T was associated significantly with IS risk (OR=2.441, 95%CI=1.021-5.837). TC, CC mutant genotypes of 1735T>C had higher frequencies in cases than controls and the difference was significant (P=0.013, 0.041); further, its C allele also increased 0.722 times risk in the case group than controls (OR=1.722, 95%CI=1.166-2.541). CONCLUSIONS NOTCH3 381C>T and 1735T>C polymorphisms were associated with IS and might be the risk factors for IS development, but not NOTCH3 605C>T polymorphism.

Incorporating concepts of inequality and inequity into health benefits analysis

PubMed Central

Levy, Jonathan I; Chemerynski, Susan M; Tuchmann, Jessica L

2006-01-01

Background Although environmental policy decisions are often based in part on both risk assessment information and environmental justice concerns, formalized approaches for addressing inequality or inequity when estimating the health benefits of pollution control have been lacking. Inequality indicators that fulfill basic axioms and agree with relevant definitions and concepts in health benefits analysis and environmental justice analysis can allow for quantitative examination of efficiency-equality tradeoffs in pollution control policies. Methods To develop appropriate inequality indicators for health benefits analysis, we provide relevant definitions from the fields of risk assessment and environmental justice and consider the implications. We evaluate axioms proposed in past studies of inequality indicators and develop additional axioms relevant to this context. We survey the literature on previous applications of inequality indicators and evaluate five candidate indicators in reference to our proposed axioms. We present an illustrative pollution control example to determine whether our selected indicators provide interpretable information. Results and Conclusions We conclude that an inequality indicator for health benefits analysis should not decrease when risk is transferred from a low-risk to high-risk person, and that it should decrease when risk is transferred from a high-risk to low-risk person (Pigou-Dalton transfer principle), and that it should be able to have total inequality divided into its constituent parts (subgroup decomposability). We additionally propose that an ideal indicator should avoid value judgments about the relative importance of transfers at different percentiles of the risk distribution, incorporate health risk with evidence about differential susceptibility, include baseline distributions of risk, use appropriate geographic resolution and scope, and consider multiple competing policy alternatives. Given these criteria, we select the Atkinson index as the single indicator most appropriate for health benefits analysis, with other indicators useful for sensitivity analysis. Our illustrative pollution control example demonstrates how these indices can help a policy maker determine control strategies that are dominated from an efficiency and equality standpoint, those that are dominated for some but not all societal viewpoints on inequality averseness, and those that are on the optimal efficiency-equality frontier, allowing for more informed pollution control policies. PMID:16569243

Closed-Loop and Robust Control of Quantum Systems

PubMed Central

Wang, Lin-Cheng

2013-01-01

For most practical quantum control systems, it is important and difficult to attain robustness and reliability due to unavoidable uncertainties in the system dynamics or models. Three kinds of typical approaches (e.g., closed-loop learning control, feedback control, and robust control) have been proved to be effective to solve these problems. This work presents a self-contained survey on the closed-loop and robust control of quantum systems, as well as a brief introduction to a selection of basic theories and methods in this research area, to provide interested readers with a general idea for further studies. In the area of closed-loop learning control of quantum systems, we survey and introduce such learning control methods as gradient-based methods, genetic algorithms (GA), and reinforcement learning (RL) methods from a unified point of view of exploring the quantum control landscapes. For the feedback control approach, the paper surveys three control strategies including Lyapunov control, measurement-based control, and coherent-feedback control. Then such topics in the field of quantum robust control as H ∞ control, sliding mode control, quantum risk-sensitive control, and quantum ensemble control are reviewed. The paper concludes with a perspective of future research directions that are likely to attract more attention. PMID:23997680

Identification and Prediction of Group-Based Glycemic Control Trajectories during the Transition to Adolescence

PubMed Central

Rohan, Jennifer M.; Rausch, Joseph R.; Pendley, Jennifer Shroff; Delamater, Alan M.; Dolan, Lawrence; Reeves, Grafton; Drotar, Dennis

2014-01-01

Objective To identify trajectories of glycemic control over a period of three years in a pediatric sample of youth diagnosed with type 1 diabetes transitioning to adolescence. A second aim was to examine a set of modifiable individual and family-level baseline predictors of glycemic control group membership. Methods This multisite, prospective study included 239 children and adolescents (ages 9–11 years at baseline) diagnosed with type 1 diabetes and their caregivers. Glycemic control was based on hemoglobin A1c (HbA1c) collected at six month intervals over a period of three years. Predictors of glycemic control membership included baseline global executive functioning, diabetes self-management, diabetes-specific family conflict, blood glucose monitoring frequency, and relevant individual and family level covariates. Results Group-based trajectory analyses were used to describe patterns of glycemic control from baseline to 36 months and three trajectories were identified: low risk (42.9%), elevated risk (44.6%), and high risk (12.1%) subgroups. Baseline maternal-reported family conflict, blood glucose monitoring frequency, and gender were significant predictors of glycemic control group membership. Higher levels of baseline family conflict, lower frequency of blood glucose monitoring, and female gender were associated with elevated and high risk group membership. Conclusions These findings underscore the importance of examining trajectories of HbA1c across time. These results suggest that problematic trajectories of glycemic control are evident during the transition to adolescence. Furthermore, there are modifiable individual and family-level characteristics that predict group membership and hence could be targeted in interventions to ensure adequate glycemic control is maintained over time and that risks for diabetes-related complications are reduced. PMID:24274797

Quantification of increased flood risk due to global climate change for urban river management planning.

PubMed

Morita, M

2011-01-01

Global climate change is expected to affect future rainfall patterns. These changes should be taken into account when assessing future flooding risks. This study presents a method for quantifying the increase in flood risk caused by global climate change for use in urban flood risk management. Flood risk in this context is defined as the product of flood damage potential and the probability of its occurrence. The study uses a geographic information system-based flood damage prediction model to calculate the flood damage caused by design storms with different return periods. Estimation of the monetary damages these storms produce and their return periods are precursors to flood risk calculations. The design storms are developed from modified intensity-duration-frequency relationships generated by simulations of global climate change scenarios (e.g. CGCM2A2). The risk assessment method is applied to the Kanda River basin in Tokyo, Japan. The assessment provides insights not only into the flood risk cost increase due to global warming, and the impact that increase may have on flood control infrastructure planning.

Association Between Zolpidem Use and Glaucoma Risk: A Taiwanese Population-Based Case-Control Study

PubMed Central

Ho, Yi-Hao; Chang, Yue-Cune; Huang, Wei-Cheng; Chen, Hsin-Yi; Lin, Che-Chen; Sung, Fung-Chang

2015-01-01

Background To date, the relationship between zolpidem use and subsequent risk of glaucoma in a Taiwanese population has not been assessed. Methods We used data from the National Health Insurance system to investigate whether zolpidem use was related to glaucoma risk. A 1:4 matched case-control study was conducted. The cases were patients newly diagnosed with glaucoma from 2001 to 2010. The controls were randomly selected non-glaucoma subjects matched by sex and age (±5 years). Zolpidem exposure and/or the average dosage of zolpidem used (mg/year) were evaluated. Medical comorbidities were considered as confounding factors. Multiple logistic regression models were used to evaluate the potential risk of zolpidem exposure on glaucoma with/without adjustment for the effects of confounding variables. Results The exposure rate of zolpidem use in the glaucoma group was significantly higher than that of the control group (2.8% vs. 2.0%, P < 0.0001). The adjusted odds ratio (OR) of the risk of glaucoma for those with zolpidem use vs. those without was 1.19 (95% confidence interval [CI], 1.02–1.38). Compared to non-zolpidem users, zolpidem users with an average dose of more than 200 mg/year had significantly increased risk of glaucoma (OR 1.31, 95% CI 1.03–1.68). Conclusions This study suggests that the use of zolpidem might increase the risk of subsequent glaucoma. Further confirmatory studies are recommended to clarify this important issue. PMID:25720944

Association Between Zolpidem Use and Glaucoma Risk: A Taiwanese Population-Based Case-Control Study.

PubMed

Ho, Yi-Hao; Chang, Yue-Cune; Huang, Wei-Cheng; Chen, Hsin-Yi; Lin, Che-Chen; Sung, Fung-Chang

2014-08-23

Background: To date, the relationship between zolpidem use and subsequent risk of glaucoma in a Taiwanese population has not been assessed.Methods: We used data from the National Health Insurance system to investigate whether zolpidem use was related to glaucoma risk. A 1:4 matched case-control study was conducted. The cases were patients newly diagnosed with glaucoma from 2001 to 2010. The controls were randomly selected non-glaucoma subjects matched by sex and age (±5 years). Zolpidem exposure and/or the average dosage of zolpidem used (mg/year) were evaluated. Medical comorbidities were considered as confounding factors. Multiple logistic regression models were used to evaluate the potential risk of zolpidem exposure on glaucoma with/without adjustment for the effects of confounding variables.Results: The exposure rate of zolpidem use in the glaucoma group was significantly higher than that of the control group (2.8% vs. 2.0%, P < 0.0001). The adjusted odds ratio (OR) of the risk of glaucoma for those with zolpidem use vs. those without was 1.19 (95% confidence interval [CI], 1.02-1.38). Compared to non-zolpidem users, zolpidem users with an average dose of more than 200 mg/year had significantly increased risk of glaucoma (OR 1.31, 95% CI 1.03-1.68).Conclusions: This study suggests that the use of zolpidem might increase the risk of subsequent glaucoma. Further confirmatory studies are recommended to clarify this important issue.

Socio-economic status and lifestyle factors are associated with achalasia risk: A population-based case-control study

PubMed Central

Coleman, Helen G; Gray, Ronan T; Lau, Kar W; McCaughey, Conall; Coyle, Peter V; Murray, Liam J; Johnston, Brian T

2016-01-01

AIM: To evaluate the association between various lifestyle factors and achalasia risk. METHODS: A population-based case-control study was conducted in Northern Ireland, including n = 151 achalasia cases and n = 117 age- and sex-matched controls. Lifestyle factors were assessed via a face-to-face structured interview. The association between achalasia and lifestyle factors was assessed by unconditional logistic regression, to produce odds ratios (OR) and 95% confidence interval (CI). RESULTS: Individuals who had low-class occupations were at the highest risk of achalasia (OR = 1.88, 95%CI: 1.02-3.45), inferring that high-class occupation holders have a reduced risk of achalasia. A history of foreign travel, a lifestyle factor linked to upper socio-economic class, was also associated with a reduced risk of achalasia (OR = 0.59, 95%CI: 0.35-0.99). Smoking and alcohol consumption carried significantly reduced risks of achalasia, even after adjustment for socio-economic status. The presence of pets in the house was associated with a two-fold increased risk of achalasia (OR = 2.00, 95%CI: 1.17-3.42). No childhood household factors were associated with achalasia risk. CONCLUSION: Achalasia is a disease of inequality, and individuals from low socio-economic backgrounds are at highest risk. This does not appear to be due to corresponding alcohol and smoking behaviours. An observed positive association between pet ownership and achalasia risk suggests an interaction between endotoxin and viral infection exposure in achalasia aetiology. PMID:27099443

Multivariate generalized multifactor dimensionality reduction to detect gene-gene interactions

PubMed Central

2013-01-01

Background Recently, one of the greatest challenges in genome-wide association studies is to detect gene-gene and/or gene-environment interactions for common complex human diseases. Ritchie et al. (2001) proposed multifactor dimensionality reduction (MDR) method for interaction analysis. MDR is a combinatorial approach to reduce multi-locus genotypes into high-risk and low-risk groups. Although MDR has been widely used for case-control studies with binary phenotypes, several extensions have been proposed. One of these methods, a generalized MDR (GMDR) proposed by Lou et al. (2007), allows adjusting for covariates and applying to both dichotomous and continuous phenotypes. GMDR uses the residual score of a generalized linear model of phenotypes to assign either high-risk or low-risk group, while MDR uses the ratio of cases to controls. Methods In this study, we propose multivariate GMDR, an extension of GMDR for multivariate phenotypes. Jointly analysing correlated multivariate phenotypes may have more power to detect susceptible genes and gene-gene interactions. We construct generalized estimating equations (GEE) with multivariate phenotypes to extend generalized linear models. Using the score vectors from GEE we discriminate high-risk from low-risk groups. We applied the multivariate GMDR method to the blood pressure data of the 7,546 subjects from the Korean Association Resource study: systolic blood pressure (SBP) and diastolic blood pressure (DBP). We compare the results of multivariate GMDR for SBP and DBP to the results from separate univariate GMDR for SBP and DBP, respectively. We also applied the multivariate GMDR method to the repeatedly measured hypertension status from 5,466 subjects and compared its result with those of univariate GMDR at each time point. Results Results from the univariate GMDR and multivariate GMDR in two-locus model with both blood pressures and hypertension phenotypes indicate best combinations of SNPs whose interaction has significant association with risk for high blood pressures or hypertension. Although the test balanced accuracy (BA) of multivariate analysis was not always greater than that of univariate analysis, the multivariate BAs were more stable with smaller standard deviations. Conclusions In this study, we have developed multivariate GMDR method using GEE approach. It is useful to use multivariate GMDR with correlated multiple phenotypes of interests. PMID:24565370

The @RISK Study: Risk communication for patients with type 2 diabetes: design of a randomised controlled trial.

PubMed

Welschen, Laura M C; Bot, Sandra D M; Dekker, Jacqueline M; Timmermans, Daniëlle R M; van der Weijden, Trudy; Nijpels, Giel

2010-08-05

Patients with type 2 diabetes mellitus (T2DM) have an increased risk to develop severe diabetes related complications, especially cardiovascular disease (CVD). The risk to develop CVD can be estimated by means of risk formulas. However, patients have difficulties to understand the outcomes of these formulas. As a result, they may not recognize the importance of changing lifestyle and taking medication in time. Therefore, it is important to develop risk communication methods, that will improve the patients' understanding of risks associated with having diabetes, which enables them to make informed choices about their diabetes care.The aim of this study is to investigate the effects of an intervention focussed on the communication of the absolute 10-year risk to develop CVD on risk perception, attitude and intention to change lifestyle behaviour in patients with T2DM. The conceptual framework of the intervention is based on the Theory of Planned Behaviour and the Self-regulation Theory. A randomised controlled trial will be performed in the Diabetes Care System West-Friesland (DCS), a managed care system. Newly referred T2DM patients of the DCS, younger than 75 years will be eligible for the study. The intervention group will be exposed to risk communication on CVD, on top of standard managed care of the DCS. This intervention consists of a simple explanation on the causes and consequences of CVD, and possibilities for prevention. The probabilities of CVD in 10 year will be explained in natural frequencies and visualised by a population diagram. The control group will receive standard managed care. The primary outcome is appropriateness of risk perception. Secondary outcomes are attitude and intention to change lifestyle behaviour and illness perception. Differences between baseline and follow-up (2 and 12 weeks) between groups will be analysed according to the intention-to-treat principle. The study was powered on 120 patients in each group. This innovative risk communication method based on two behavioural theories might improve patient's appropriateness of risk perception and attitude concerning lifestyle change. With a better understanding of their CVD risk, patients will be able to make informed choices concerning diabetes care. The trial is registered as NTR1556 in the Dutch Trial Register.

Cigarette Smoking and the Risk of Barrett's Esophagus

PubMed Central

Kubo, Ai; Levin, T.R.; Block, Gladys; Rumore, Gregory; Quesenberry, Charles P.; Buffler, Patricia; Corley, Douglas A.

2008-01-01

Introduction We examined the association between smoking and the risk of Barrett's esophagus (BE), a metaplastic precursor to esophageal adenocarcinoma. Methods We conducted a case-control study within the Kaiser Permanente Northern California population. Patients with a new diagnosis of BE (n=320) were matched to persons with gastroesophageal reflux disease (GERD) (n=316) and to population controls (n=317). Information was collected using validated questionnaires from direct in-person interviews and electronic databases. Analyses used multivariate unconditional logistic regression that controlled for age, gender, race and education. Results Ever smoking status, smoking intensity (pack-years), and smoking cessation were not associated with the risk of BE. Stratified analyses suggested that ever smoking may be associated with an increased risk of BE among some groups (compared to population controls): persons with long-segment Barrett's esophagus (odds ratio [OR]=1.72, 95% confidence interval [CI] 1.12-2.63); subjects without GERD symptoms (OR=3.98, 95% CI 1.58-10.0); obese subjects (OR=3.38, 95%CI 1.46-7.82); and persons with a large abdominal circumference (OR=3.02, 95%CI (1.18-2.75)). Conclusion Smoking was not a strong or consistent risk factor for BE in a large community-based study, although associations may be present in some population subgroups. PMID:18853262

Payload Safety: Risk and Characteristic-Based Control of Engineered Nanomaterials

NASA Astrophysics Data System (ADS)

Abou, Seraphin Chally; Saad, Maarouf

2013-09-01

In the last decade progress has been made to assist organizations that are developing payloads intended for flight on the International Space Station (ISS) and/or Space Shuttle. Collaboration programs for comprehensive risk assessment have been initiated between the U.S. and the European Union to generate requirements and data needed to comply with payloads safety and to perform risk assessment and controls guidance. Yet, substantial research gaps remain, as do challenges in the translation of these research findings to control for exposure to nanoscale material payloads, and the health effects. Since nanomaterial structures are different from traditional molecules, some standard material properties can change at size of 50nm or less. Changes in material properties at this scale challenge our understanding of hazards posed by nanomaterial payloads in the ISS realistic exposure conditions, and our ability to anticipate, evaluate, and control potential health issues, and safety. The research question addressed in this framework is: what kind of descriptors can be developed for nanomaterial payloads risks assessment? Methods proposed incorporate elements of characteristic- based risk an alysis: (1) to enable characterization of anthropogenic nanomaterials which can result in incidental from natural nanoparticles; and (2) to better understand safety attributes in terms of human health impacts from exposure to varying types of engineered nanomaterials.

[Delimitation of urban growth boundary based on ecological suitability and risk control: A case of Taibai Lake New District in Jining City, Shandong, China.

PubMed

Liu, Yan Xu; Peng, Jian; Sun, Mao Long; Yang, Yang

2016-08-01

Urban growth boundary, with full consideration of regional ecological constraints, can effectively control the unordered urban sprawl. Thus, urban growth boundary is a significant planning concept integrating regional ecological protection and urban construction. Finding the preferential position for urban construction, as well as controlling the ecological risk, has always been the core content of urban growth boundary delimitation. This study selected Taibai Lake New District in Jining City as a case area, and analyzed the scenario of ecological suitability by ordered weighted ave-raging algorithm. Surface temperature retrieval and rain flooding simulation were used to identify the spatial ecological risk. In the result of ecological suitability, the suitable construction zone accounted for 25.3% of the total area, the unsuitable construction zone accounted for 20.4%, and the other area was in the limit construction zone. Excluding the ecological risk control region, the flexible urban growth boundary covered 2975 hm 2 in near term, and covered 6754 hm 2 in long term. The final inflexible urban growth boundary covered 9405 hm 2 . As a new method, the scenario algorithms of ordered weighted averaging and ecological risk modeling could provide effective support in urban growth boundary identification.

Detecting space-time cancer clusters using residential histories

NASA Astrophysics Data System (ADS)

Jacquez, Geoffrey M.; Meliker, Jaymie R.

2007-04-01

Methods for analyzing geographic clusters of disease typically ignore the space-time variability inherent in epidemiologic datasets, do not adequately account for known risk factors (e.g., smoking and education) or covariates (e.g., age, gender, and race), and do not permit investigation of the latency window between exposure and disease. Our research group recently developed Q-statistics for evaluating space-time clustering in cancer case-control studies with residential histories. This technique relies on time-dependent nearest neighbor relationships to examine clustering at any moment in the life-course of the residential histories of cases relative to that of controls. In addition, in place of the widely used null hypothesis of spatial randomness, each individual's probability of being a case is instead based on his/her risk factors and covariates. Case-control clusters will be presented using residential histories of 220 bladder cancer cases and 440 controls in Michigan. In preliminary analyses of this dataset, smoking, age, gender, race and education were sufficient to explain the majority of the clustering of residential histories of the cases. Clusters of unexplained risk, however, were identified surrounding the business address histories of 10 industries that emit known or suspected bladder cancer carcinogens. The clustering of 5 of these industries began in the 1970's and persisted through the 1990's. This systematic approach for evaluating space-time clustering has the potential to generate novel hypotheses about environmental risk factors. These methods may be extended to detect differences in space-time patterns of any two groups of people, making them valuable for security intelligence and surveillance operations.

Environmental Tobacco Smoke and Adult-Onset Asthma: A Population-Based Incident Case–Control Study

PubMed Central

Jaakkola, Maritta S.; Piipari, Ritva; Jaakkola, Niina; Jaakkola, Jouni J. K.

2003-01-01

Objectives. The authors assessed the effects of environmental tobacco smoke (ETS) on the development of asthma in adults. Methods. In the Pirkanmaa district of South Finland, all 21- to 63-year-old adults with new cases of asthma diagnosed during a 2.5-year period (n = 521 case patients, out of 441 000 inhabitants) and a random sample of control subjects from the source population (932 control subjects) participated in a population-based incident case–control study. Results. Risk of asthma was related to workplace ETS exposure (adjusted odds ratio [OR] = 2.16; 95% confidence interval [CI] = 1.26, 3.72) and home exposure (OR = 4.77; 95% CI = 1.29, 17.7) in the past year. Cumulative ETS exposure over a lifetime at work and at home increased the risk. Conclusions. This study indicates for the first time that both cumulative lifetime and recent ETS exposures increase the risk of adult-onset asthma. PMID:14652334

Polymorphisms of genes coding for ghrelin and its receptor in relation to colorectal cancer risk: a two-step gene-wide case-control study

PubMed Central

2010-01-01

Background Ghrelin, an endogenous ligand for the growth hormone secretagogue receptor (GHSR), has two major functions: the stimulation of the growth hormone production and the stimulation of food intake. Accumulating evidence also indicates a role of ghrelin in cancer development. Methods We conducted a case-control study to examine the association of common genetic variants in the genes coding for ghrelin (GHRL) and its receptor (GHSR) with colorectal cancer risk. Pairwise tagging was used to select the 11 polymorphisms included in the study. The selected polymorphisms were genotyped in 680 cases and 593 controls from the Czech Republic. Results We found two SNPs associated with lower risk of colorectal cancer, namely SNPs rs27647 and rs35683. We replicated the two hits, in additional 569 cases and 726 controls from Germany. Conclusion A joint analysis of the two populations indicated that the T allele of rs27647 SNP exerted a protective borderline effect (Ptrend = 0.004). PMID:20920174

Are Balance Problems Connected to Reading Speed or the Familial Risk of Dyslexia?

ERIC Educational Resources Information Center

Viholainen, Helena; Aro, Mikko; Ahonen, Timo; Crawford, Susan; Cantell, Marja; Kooistra, Libbe

2011-01-01

Aim: The aim of this study was to examine the connection between balance problems and reading speed in children with and without a familial risk of dyslexia by controlling for the effects of attention, hyperactivity, and cognitive and motor functioning. Method: The prevalence of balance problems was studied in 94 children (48 females, 46 males)…

Effectiveness of a Lifestyle Intervention Program among Persons at High Risk for Cardiovascular Disease and Diabetes in a Rural Community

ERIC Educational Resources Information Center

Vadheim, Liane M.; Brewer, Kari A.; Kassner, Darcy R.; Vanderwood, Karl K.; Hall, Taryn O.; Butcher, Marcene K.; Helgerson, Steven D.; Harwell, Todd S.

2010-01-01

Purpose: To evaluate the feasibility of translating the Diabetes Prevention Program (DPP) lifestyle intervention into practice in a rural community. Methods: In 2008, the Montana Diabetes Control Program worked collaboratively with Holy Rosary Healthcare to implement an adapted group-based DPP lifestyle intervention. Adults at high risk for…

The rearing environment and risk for drug abuse: a Swedish national high-risk adopted and not adopted co-sibling control study

PubMed Central

Kendler, K. S.; Ohlsson, H.; Sundquist, K.; Sundquist, J.

2016-01-01

Background Although drug abuse (DA) is strongly familial, with important genetic influences, we need to know more about the role of rearing environment in the risk for DA. To address this question, we utilized a high-risk adopted and non-adopted co-sibling control design. Method High-risk offspring had one or more biological parents registered for DA, alcohol use disorders or criminal behavior. Using Swedish registries, we identified 1161 high-risk full-sibships and 3085 high-risk half-sibships containing at least one member who was adopted-away and one member who was not. Registration for DA was via national criminal, medical and pharmacy registers. In Sweden, adoptive families are screened to provide high-quality rearing environment for adoptees. Results Controlling for parental age at birth and gender (and, in half-siblings, high-risk status of the other parent), risk for DA was substantially lower in the full- and half-siblings who were adopted v. not adopted [hazard ratios and 95% confidence intervals: 0.55 (0.45–0·69) and 0.55 (95% CI 0.48–0.63), respectively]. The protective effect of adoption on risk for DA was significantly stronger in the full- and half-sibling pairs with very high familial liability (two high-risk parents) and significantly weaker when the adoptive family was broken by death or divorce, or contained a high-risk parent. Conclusions In both full- and half-sibling pairs, we found replicated evidence that rearing environment strongly impacts on risk for DA. High-quality rearing environments can substantively reduce risk for DA in those at high genetic risk. PMID:26753502

Electrophysiological evaluation of Wolff-Parkinson-White Syndrome

PubMed Central

Brembilla-Perrot, Beatrice

2002-01-01

Sudden death might complicate the follow-up of symptomatic patients with the Wolff-Parkinson-White syndrome (WPW) and might be the first event in patients with asymptomatic WPW. The risk of sudden death is increased in some clinical situations. Generally, the noninvasive studies are unable to predict the risk of sudden death correctly . The electrophysiological study is the best means to detect the risk of sudden death and to evaluate the nature of symptoms. Methods used to define the prognosis of WPW are well-defined. At first the maximal rate of conduction through the accessory pathway is evaluated; programmed atrial stimulation using 1 and 2 extrastimuli delivered at different cycle lengths is then used to determine the accessory pathway refractory period and to induce a supraventricular tachycardia. These methods should be performed in the control state and repeated in adrenergic situations either during exercise test or more simply during a perfusion of small doses of isoproterenol. The induction of an atrial fibrillation with rapid conduction through the accessory pathway (> 240/min in control state, > 300/min after isoproterenol) is the sign of a form of WPW at risk of sudden death. PMID:16951730

Healthcare workers' challenges in the implementation of tuberculosis infection prevention and control measures in Mozambique.

PubMed

Brouwer, Miranda; Coelho, Eliana; Mosse, Carla das Dores; Brondi, Luciana; Winterton, Laura; van Leth, Frank

2014-01-01

Healthcare Workers (HCWs) have a higher frequency of TB exposure than the general population and have therefore an occupational TB risk that infection prevention and control (IPC) measures aim to reduce. HCWs are crucial in the implementation of these measures. The objective of the study was to investigate Mozambican HCWs' perceptions of their occupational TB risk and the measures they report using to reduce this risk. In addition, we explored the challenges HCWs encounter while using these TBIPC measures. Focus group discussion. Analysis according content method. Four categories of HCWs: auxiliary workers, medical (doctors and clinical officers), nurses and TB program staff. HCWs are aware of their occupational TB risk and use various measures to reduce their risk of infection. HCWs find it challenging to employ measures that minimize such risks and a lack of clear guidelines contributes to these challenges. HCWs' and patient behavior further complicate the use of TBIPC measures. HCWs in Mozambique perceive a high occupational risk of TB infection. They report several challenges using measures to reduce this risk such as shortage of material, lack of clear guidelines, insufficient motivation and inadequate training. Robust training with motivational approaches, alongside supervision and support for HCWs could improve implementation of TBIPC measures. Healthcare management should address the areas for improvement that are beyond the individual HCW's control.

Accounting for competing risks in randomized controlled trials: a review and recommendations for improvement.

PubMed

Austin, Peter C; Fine, Jason P

2017-04-15

In studies with survival or time-to-event outcomes, a competing risk is an event whose occurrence precludes the occurrence of the primary event of interest. Specialized statistical methods must be used to analyze survival data in the presence of competing risks. We conducted a review of randomized controlled trials with survival outcomes that were published in high-impact general medical journals. Of 40 studies that we identified, 31 (77.5%) were potentially susceptible to competing risks. However, in the majority of these studies, the potential presence of competing risks was not accounted for in the statistical analyses that were described. Of the 31 studies potentially susceptible to competing risks, 24 (77.4%) reported the results of a Kaplan-Meier survival analysis, while only five (16.1%) reported using cumulative incidence functions to estimate the incidence of the outcome over time in the presence of competing risks. The former approach will tend to result in an overestimate of the incidence of the outcome over time, while the latter approach will result in unbiased estimation of the incidence of the primary outcome over time. We provide recommendations on the analysis and reporting of randomized controlled trials with survival outcomes in the presence of competing risks. © 2017 The Authors. Statistics in Medicine published by John Wiley & Sons Ltd. © 2017 The Authors. Statistics in Medicine published by John Wiley & Sons Ltd.

Accounting for competing risks in randomized controlled trials: a review and recommendations for improvement

PubMed Central

Fine, Jason P.

2017-01-01

In studies with survival or time‐to‐event outcomes, a competing risk is an event whose occurrence precludes the occurrence of the primary event of interest. Specialized statistical methods must be used to analyze survival data in the presence of competing risks. We conducted a review of randomized controlled trials with survival outcomes that were published in high‐impact general medical journals. Of 40 studies that we identified, 31 (77.5%) were potentially susceptible to competing risks. However, in the majority of these studies, the potential presence of competing risks was not accounted for in the statistical analyses that were described. Of the 31 studies potentially susceptible to competing risks, 24 (77.4%) reported the results of a Kaplan–Meier survival analysis, while only five (16.1%) reported using cumulative incidence functions to estimate the incidence of the outcome over time in the presence of competing risks. The former approach will tend to result in an overestimate of the incidence of the outcome over time, while the latter approach will result in unbiased estimation of the incidence of the primary outcome over time. We provide recommendations on the analysis and reporting of randomized controlled trials with survival outcomes in the presence of competing risks. © 2017 The Authors. Statistics in Medicine published by John Wiley & Sons Ltd. PMID:28102550

Measurement of whole-body vibration exposure from speed control humps

NASA Astrophysics Data System (ADS)

Khorshid, E.; Alkalby, F.; Kamal, H.

2007-07-01

The main objective of speed control humps is to introduce shocks and high vibration levels when a car passes over them if its speed is higher than the allowable limit. Hump geometry is a major factor in altering the level of these shocks and specifying the speed limit. However, there is no study of the relationship between whole body vibration due to passing over a speed control hump and lower back pain or occupational diseases. In this study, an experimental investigation is conducted to evaluate health risks associated with different geometry speed control humps. Vibration levels and shocks are measured by a seat pad accelerometer placed under the driver's seat to evaluate hazard risks on the human body's lower back. The assessment is based on two standard methods of measuring whole body vibration: the British standard BS 6841 and the new ISO/DIS standard 2631-5. These methods are used to assess the effects of vehicle type, passenger location in the vehicle, vehicle speed, and speed control hump geometry. It was found that circular speed control humps currently installed on many public roads should be modified in order to eliminate hazards. Two newly designed speed humps were proved to be less hazardous than circular speed control humps.

Relative risk estimation of Chikungunya disease in Malaysia: An analysis based on Poisson-gamma model

NASA Astrophysics Data System (ADS)

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

2015-05-01

Disease mapping is a method to display the geographical distribution of disease occurrence, which generally involves the usage and interpretation of a map to show the incidence of certain diseases. Relative risk (RR) estimation is one of the most important issues in disease mapping. This paper begins by providing a brief overview of Chikungunya disease. This is followed by a review of the classical model used in disease mapping, based on the standardized morbidity ratio (SMR), which we then apply to our Chikungunya data. We then fit an extension of the classical model, which we refer to as a Poisson-Gamma model, when prior distributions for the relative risks are assumed known. Both results are displayed and compared using maps and we reveal a smoother map with fewer extremes values of estimated relative risk. The extensions of this paper will consider other methods that are relevant to overcome the drawbacks of the existing methods, in order to inform and direct government strategy for monitoring and controlling Chikungunya disease.

Environmental risk analysis of oil handling facilities in port areas. Application to Tarragona harbor (NE Spain).

PubMed

Valdor, Paloma F; Gómez, Aina G; Puente, Araceli

2015-01-15

Diffuse pollution from oil spills is a widespread problem in port areas (as a result of fuel supply, navigation and loading/unloading activities). This article presents a method to assess the environmental risk of oil handling facilities in port areas. The method is based on (i) identification of environmental hazards, (ii) characterization of meteorological and oceanographic conditions, (iii) characterization of environmental risk scenarios, and (iv) assessment of environmental risk. The procedure has been tested by application to the Tarragona harbor. The results show that the method is capable of representing (i) specific local pollution cases (i.e., discriminating between products and quantities released by a discharge source), (ii) oceanographic and meteorological conditions (selecting a representative subset data), and (iii) potentially affected areas in probabilistic terms. Accordingly, it can inform the design of monitoring plans to study and control the environmental impact of these facilities, as well as the design of contingency plans. Copyright © 2014 Elsevier Ltd. All rights reserved.

Quantitative cancer risk assessment for occupational exposures to asphalt fumes during built-up roofing asphalt (BURA) operations.

PubMed

Rhomberg, Lorenz R; Mayfield, David B; Goodman, Julie E; Butler, Eric L; Nascarella, Marc A; Williams, Daniel R

2015-01-01

The International Agency for Research on Cancer qualitatively characterized occupational exposure to oxidized bitumen emissions during roofing as probably carcinogenic to humans (Group 2A). We examine chemistry, exposure, epidemiology and animal toxicity data to explore quantitative risks for roofing workers applying built-up roofing asphalt (BURA). Epidemiology studies do not consistently report elevated risks, and generally do not have sufficient exposure information or adequately control for confounders, precluding their use for dose-response analysis. Dermal carcinogenicity bioassays using mice report increased tumor incidence with single high doses. In order to quantify potential cancer risks, we develop time-to-tumor model methods [consistent with U.S. Environmental Protection Agency (EPA) dose-response analysis and mixtures guidelines] using the dose-time-response shape of concurrent exposures to benzo[a]pyrene (B[a]P) as concurrent controls (which had several exposure levels) to infer presumed parallel dose-time-response curves for BURA-fume condensate. We compare EPA relative potency factor approaches, based on observed relative potency of BURA to B[a]P in similar experiments, and direct observation of the inferred BURA dose-time-response (scaled to humans) as means for characterizing a dermal unit risk factor. We apply similar approaches to limited data on asphalt-fume inhalation and respiratory cancers in rats. We also develop a method for adjusting potency estimates for asphalts that vary in composition using measured fluorescence. Overall, the various methods indicate that cancer risks to roofers from both dermal and inhalation exposure to BURA are within a range typically deemed acceptable within regulatory frameworks. The approaches developed may be useful in assessing carcinogenic potency of other complex mixtures of polycyclic aromatic compounds.

[Efficiency of combined methods of hemorroid treatment using hal-rar and laser destruction].

PubMed

Rodoman, G V; Kornev, L V; Shalaeva, T I; Malushenko, R N

2017-01-01

To develop the combined method of treatment of hemorrhoids with arterial ligation under Doppler control and laser destruction of internal and external hemorrhoids. The study included 100 patients with chronic hemorrhoids stage II and III. Combined method of HAL-laser was used in study group, HAL RAR-technique in control group 1 and closed hemorrhoidectomy with linear stapler in control group 2. Сomparative evaluation of results in both groups was performed. Combined method overcomes the drawbacks of traditional surgical treatment and limitations in external components elimination which are inherent for HAL-RAR. Moreover, it has a higher efficiency in treating of hemorrhoids stage II-III compared with HAL-RAR and is equally safe and well tolerable for patients. This method does not increase the risk of recurrence, reduces incidence of complications and time of disability.

Black Carp: Biological synopsis and risk assessment of an introduced fish

USGS Publications Warehouse

Nico, L.G.; Williams, J.D.; Jelks, H.L.

2005-01-01

Major subjects addressed are (1) taxonomy, description, and distinguishing characteristics of the species; (2) native distribution; (3) biology and natural history, with emphasis on diet and reproduction; (4) history of the species in world aquaculture; (5) history of introduction within and outside the United States; (6) use as a biological control control agent, including a review of digenetic trematodes and snail-borne parasites of special concern and methods used for control; (7) alternatives to the use of black carp; (8) environmental tolerance and potential geographic range; and (9) risks associated with its introduction. The book also includes substantial information on the other Chinese carp species, including bighead carp, silver carp, and grass carp.

Is using multiple imputation better than complete case analysis for estimating a prevalence (risk) difference in randomized controlled trials when binary outcome observations are missing?

PubMed

Mukaka, Mavuto; White, Sarah A; Terlouw, Dianne J; Mwapasa, Victor; Kalilani-Phiri, Linda; Faragher, E Brian

2016-07-22

Missing outcomes can seriously impair the ability to make correct inferences from randomized controlled trials (RCTs). Complete case (CC) analysis is commonly used, but it reduces sample size and is perceived to lead to reduced statistical efficiency of estimates while increasing the potential for bias. As multiple imputation (MI) methods preserve sample size, they are generally viewed as the preferred analytical approach. We examined this assumption, comparing the performance of CC and MI methods to determine risk difference (RD) estimates in the presence of missing binary outcomes. We conducted simulation studies of 5000 simulated data sets with 50 imputations of RCTs with one primary follow-up endpoint at different underlying levels of RD (3-25 %) and missing outcomes (5-30 %). For missing at random (MAR) or missing completely at random (MCAR) outcomes, CC method estimates generally remained unbiased and achieved precision similar to or better than MI methods, and high statistical coverage. Missing not at random (MNAR) scenarios yielded invalid inferences with both methods. Effect size estimate bias was reduced in MI methods by always including group membership even if this was unrelated to missingness. Surprisingly, under MAR and MCAR conditions in the assessed scenarios, MI offered no statistical advantage over CC methods. While MI must inherently accompany CC methods for intention-to-treat analyses, these findings endorse CC methods for per protocol risk difference analyses in these conditions. These findings provide an argument for the use of the CC approach to always complement MI analyses, with the usual caveat that the validity of the mechanism for missingness be thoroughly discussed. More importantly, researchers should strive to collect as much data as possible.

Application of quality risk management to set viable environmental monitoring frequencies in biotechnology processing and support areas.

PubMed

Sandle, Tim

2012-01-01

Environmental monitoring programs are essential for pharmaceutical facilities in order to assess the level of environmental control. For biotechnology facilities there is little advice as to the frequency at which viable environmental monitoring should be conducted. This paper outlines an approach, based on the principles of quality risk management, for the development of a framework from which monitoring frequencies can be determined. This involved the identification of common hazards and the evaluation those hazards in terms of the severity of contamination and the probability of contamination occurring. These elements of risk were evaluated for different cleanrooms and the relative risks ranked. Once the risk scores were calculated, the methods for detecting risks within the cleanrooms were assessed. Risk filtering was then used to group different cleanrooms based on their relative risks and detection methods against predetermined monitoring frequencies. Through use of case study examples, the paper presents the model and describes how appropriate frequencies for the environmental monitoring of cleanrooms can be set. Cleanrooms in which biotechnology pharmaceutical processing takes place are subject to environmental monitoring. The frequency at which such monitoring should be performed can be difficult to determine. This paper uses quality risk assessment methods to construct a framework for determining monitoring frequencies and illustrates the suitability of the framework through a case study.

Altered Intrinsic Functional Brain Architecture in Children at Familial Risk of Major Depression

PubMed Central

Chai, Xiaoqian J.; Hirshfeld-Becker, Dina; Biederman, Joseph; Uchida, Mai; Doehrmann, Oliver; Leonard, Julia; Salvatore, John; Kenworthy, Tara; Brown, Ariel; Kagan, Elana; de los Angeles, Carlo; Gabrieli, John D.E.; Whitfield-Gabrieli, Susan

2015-01-01

Background Neuroimaging studies of patients with major depression have revealed abnormal intrinsic functional connectivity measured during the resting state in multiple, distributed networks. However, it is unclear whether these findings reflect the state of major depression or reflect trait neurobiological underpinnings of risk for major depression. Methods We compared resting-state functional connectivity, measured with functional magnetic resonance imaging (fMRI), between unaffected children of parents who had documented histories of major depression (at-risk, n = 27; 8–14 years of age) and age-matched children of parents with no lifetime history of depression (controls, n = 16). Results At-risk children exhibited hyperconnectivity between the default mode network (DMN) and subgenual anterior cingulate cortex (sgACC) / orbital frontal cortex (OFC), and the magnitude of connectivity positively correlated with individual symptom scores. At-risk children also exhibited (1) hypoconnectivity within the cognitive control network, which also lacked the typical anticorrelation with the DMN; (2) hypoconnectivity between left dorsolateral prefrontal cortex (DLPFC) and sgACC; and (3) hyperconnectivity between the right amygdala and right inferior frontal gyrus, a key region for top-down modulation of emotion. Classification between at-risk children and controls based on resting-state connectivity yielded high accuracy with high sensitivity and specificity that was superior to clinical rating scales. Conclusions Children at familial risk for depression exhibited atypical functional connectivity in the default-mode, cognitive-control, and affective networks. Such task-independent functional brain measures of risk for depression in children could be used to promote early intervention to reduce the likelihood of developing depression. PMID:26826874

Fuzzy Comprehensive Evaluation-Based Disaster Risk Assessment of Desertification in Horqin Sand Land, China

PubMed Central

Wang, Yongfang; Zhang, Jiquan; Guo, Enliang; Sun, Zhongyi

2015-01-01

Desertification is a typical disaster risk event in which human settlements and living environments are destroyed. Desertification Disaster Risk Assessment can control and prevent the occurrence and development of desertification disasters and reduce their adverse influence on human society. This study presents the methodology and procedure for risk assessment and zoning of desertification disasters in Horqin Sand Land. Based on natural disaster risk theory and the desertification disaster formation mechanism, the Desertification Disaster Risk Index (DDRI) combined hazard, exposure, vulnerability and restorability factors and was developed mainly by using multi-source data and the fuzzy comprehensive evaluation method. The results showed that high risk and middle risk areas account for 28% and 23% of the study area, respectively. They are distributed with an “S” type in the study area. Low risk and very low risk areas account for 21% and 10% of the study area, respectively. They are distributed in the west-central and southwestern parts. Very high risk areas account for 18% of the study area and are distributed in the northeastern parts. The results can be used to know the desertification disaster risk level. It has important theoretical and practical significance to prevention and control of desertification in Horqin Sand Land and even in Northern China. PMID:25654772

Fuzzy comprehensive evaluation-based disaster risk assessment of desertification in Horqin Sand Land, China.

PubMed

Wang, Yongfang; Zhang, Jiquan; Guo, Enliang; Sun, Zhongyi

2015-02-03

Desertification is a typical disaster risk event in which human settlements and living environments are destroyed. Desertification Disaster Risk Assessment can control and prevent the occurrence and development of desertification disasters and reduce their adverse influence on human society. This study presents the methodology and procedure for risk assessment and zoning of desertification disasters in Horqin Sand Land. Based on natural disaster risk theory and the desertification disaster formation mechanism, the Desertification Disaster Risk Index (DDRI) combined hazard, exposure, vulnerability and restorability factors and was developed mainly by using multi-source data and the fuzzy comprehensive evaluation method. The results showed that high risk and middle risk areas account for 28% and 23% of the study area, respectively. They are distributed with an "S" type in the study area. Low risk and very low risk areas account for 21% and 10% of the study area, respectively. They are distributed in the west-central and southwestern parts. Very high risk areas account for 18% of the study area and are distributed in the northeastern parts. The results can be used to know the desertification disaster risk level. It has important theoretical and practical significance to prevention and control of desertification in Horqin Sand Land and even in Northern China.

A novel approach to simulate gene-environment interactions in complex diseases.

PubMed

Amato, Roberto; Pinelli, Michele; D'Andrea, Daniel; Miele, Gennaro; Nicodemi, Mario; Raiconi, Giancarlo; Cocozza, Sergio

2010-01-05

Complex diseases are multifactorial traits caused by both genetic and environmental factors. They represent the major part of human diseases and include those with largest prevalence and mortality (cancer, heart disease, obesity, etc.). Despite a large amount of information that has been collected about both genetic and environmental risk factors, there are few examples of studies on their interactions in epidemiological literature. One reason can be the incomplete knowledge of the power of statistical methods designed to search for risk factors and their interactions in these data sets. An improvement in this direction would lead to a better understanding and description of gene-environment interactions. To this aim, a possible strategy is to challenge the different statistical methods against data sets where the underlying phenomenon is completely known and fully controllable, for example simulated ones. We present a mathematical approach that models gene-environment interactions. By this method it is possible to generate simulated populations having gene-environment interactions of any form, involving any number of genetic and environmental factors and also allowing non-linear interactions as epistasis. In particular, we implemented a simple version of this model in a Gene-Environment iNteraction Simulator (GENS), a tool designed to simulate case-control data sets where a one gene-one environment interaction influences the disease risk. The main aim has been to allow the input of population characteristics by using standard epidemiological measures and to implement constraints to make the simulator behaviour biologically meaningful. By the multi-logistic model implemented in GENS it is possible to simulate case-control samples of complex disease where gene-environment interactions influence the disease risk. The user has full control of the main characteristics of the simulated population and a Monte Carlo process allows random variability. A knowledge-based approach reduces the complexity of the mathematical model by using reasonable biological constraints and makes the simulation more understandable in biological terms. Simulated data sets can be used for the assessment of novel statistical methods or for the evaluation of the statistical power when designing a study.

How to study the aetiology of burn injury: the epidemiological approach.

PubMed

Bouter, L M; Knipschild, P G; van Rijn, J L; Meertens, R M

1989-06-01

Effective prevention of burn injury should be based on sound aetiological knowledge. This article deals with epidemiological methods to study the incidence of burn injury as a function of its risk factors. Central methodological issues are comparability of baseline prognosis, comparability of measurements (of effects in cohort studies and of risk factors in case-control studies), and comparability of external circumstances. These principles are clarified with a number of fictitious examples of risk factors for burn injury. It is explained that in preventive trials comparability may be achieved by randomization, blinding and placebo intervention. The main tools in non-experimental studies are deliberate selection and multivariate analysis. Special attention is given to the definition of the source population and to reducing measurement incomparability in case-control studies. Some well-designed case-control studies following these principles might bring effective prevention of burn injury some steps nearer.

Risk factors of breast cancer among women in eastern India: a tertiary hospital based case control study.

PubMed

Das, Soumen; Sen, Santanu; Mukherjee, Anindya; Chakraborty, Debadatta; Mondal, Pankaj Kumar

2012-01-01

Breast cancer is one of the most common cancers of women in India with high fatality rate. Over a 1 year study period 105 consecutive biopsy or fine needle aspiration cytology confirmed breast cancer patients were interviewed by direct questionnaire method regarding risk factors attending Surgery and Radiotherapy OPD of Medical College Kolkata, West Bengal while taking other 105 patients attending Surgery Department for some other disease as controls. The data were compiled in MS Excel 2007 and analyzed by Epi info 3.5.1 software. Among the cases, rural residence, illiteracy and low socio-economic status was significantly higher than controls. Late onset of menarche, late onset of menopause, ever OCP usage, breast feeding for 1-2 years and age of 1st childbirth between 20-30 years were found to be significant protective factors. People should be made aware regarding the modifiable risk factors to prevent breast cancer.

A new in vitro bioassay system for discovery and quantitative evaluation of mosquito repellents

USDA-ARS?s Scientific Manuscript database

Mosquitoes are vectors of many pathogens that cause human diseases. Although prevention and control of immature stages is the best method to control mosquitoes, repellents play a significant role in reducing the risk of these diseases by preventing mosquito bites. The In vitro K & D bioassay system ...

CACTUS: Command and Control Training Using Knowledge-Based Simulations

ERIC Educational Resources Information Center

Hartley, Roger; Ravenscroft, Andrew; Williams, R. J.

2008-01-01

The CACTUS project was concerned with command and control training of large incidents where public order may be at risk, such as large demonstrations and marches. The training requirements and objectives of the project are first summarized justifying the use of knowledge-based computer methods to support and extend conventional training…

The influence of processing on the microbial risk associated with Rooibos (Aspalathus linearis) tea.

PubMed

Gouws, Pieter; Hartel, Toni; van Wyk, Rudean

2014-12-01

This review discusses the influence of processing on the microbial risk associated with Salmonella in Rooibos tea, the identification of Salmonella and preventative and control measures to control microbial contamination. Rooibos tea, like other plant products, naturally contains a high microbial load. Downstream processing steps of these products usually help in reducing any contaminants present. Due to the delicate flavour properties and nature of Rooibos, gentle processing techniques are necessary for the production of good quality tea. However, this has a major influence on the microbiological status of the product. The presence of Salmonella in Rooibos is poorly understood. The ubiquitous distribution of Salmonella in the natural environment and its prevalence in the global food chain, the physiological adaptability, virulence of the bacterial pathogen and its serious economic impact on the food industry, emphasises the need for continued awareness and stringent controls at all levels of food production. With the advances of technology and information at hand, the processing of Rooibos needs to be re-evaluated. Since the delicate nature of Rooibos prohibits the use of harsh methods to control Salmonella, alternative methods for the steam pasteurisation of Rooibos show great potential to control Salmonella in a fast, efficient and cost-effective manner. These alternative methods will significantly improve the microbiological quality of Rooibos and provide a product that is safe to consumers. © 2014 Society of Chemical Industry.

The Role of Neighborhood Environment and Risk of Intimate Partner Femicide in a Large Urban Area

PubMed Central

Frye, Victoria; Galea, Sandro; Tracy, Melissa; Bucciarelli, Angela; Putnam, Sara; Wilt, Susan

2008-01-01

Objectives. We evaluated the contribution of neighborhood-level factors indicative of social disorganization, including educational and occupational attainment, immigrant concentration, physical disorder, and social cohesion, to the likelihood of intimate partner femicide (IPF) while taking into account known neighborhood- and individual-level IPF risk factors. Methods. We used medical examiner data on 1861 femicide victims between 1990 and 1999 and archival information on 59 neighborhoods in New York City to conduct a multilevel case–control analysis. Results. After controlling for neighborhood-level income, we found that no neighborhood factors were significantly associated with IPF risk, as compared with risk of non–IPF and risk of femicide from unknown perpetrators, above and beyond the contributions of individual-level factors. The strongest predictors of IPF were foreign country of birth and young age. Conclusions. IPF victims were nearly twice as likely as non-IPF victims to be foreign born; by contrast, there was little neighborhood-level heterogeneity with respect to IPF risk. Further research is needed to identify neighborhood characteristics that uniquely influence risk of IPF to guide community-level interventions. PMID:18556618

Cannabis, tobacco and domestic fumes intake are associated with nasopharyngeal carcinoma in North Africa

PubMed Central

Feng, B-J; Khyatti, M; Ben-Ayoub, W; Dahmoul, S; Ayad, M; Maachi, F; Bedadra, W; Abdoun, M; Mesli, S; Bakkali, H; Jalbout, M; Hamdi-Cherif, M; Boualga, K; Bouaouina, N; Chouchane, L; Benider, A; Ben-Ayed, F; Goldgar, D E; Corbex, M

2009-01-01

Background: The lifestyle risk factors for nasopharyngeal carcinoma (NPC) in North Africa are not known. Methods: From 2002 to 2005, we interviewed 636 patients and 615 controls from Algeria, Morocco and Tunisia, frequency-matched by centre, age, sex, and childhood household type (urban/rural). Conditional logistic regression was used to evaluate the association of lifestyles with NPC risk, controlling for socioeconomic status and dietary risk factors. Results: Cigarette smoking and snuff (tobacco powder with additives) intake were significantly associated with differentiated NPC but not with undifferentiated carcinoma (UCNT), which is the major histological type of NPC in these populations. As demonstrated by a stratified permutation test and by conditional logistic regression, marijuana smoking significantly elevated NPC risk independently of cigarette smoking, suggesting dissimilar carcinogenic mechanisms between cannabis and tobacco. Domestic cooking fumes intake by using kanoun (compact charcoal oven) during childhood increased NPC risk, whereas exposure during adulthood had less effect. Neither alcohol nor shisha (water pipe) was associated with risk. Conclusion: Tobacco, cannabis and domestic cooking fumes intake are risk factors for NPC in western North Africa. PMID:19724280

Focusing on appraisals: how and why anger and fear influence driving risk perception.

PubMed

Lu, Jingyi; Xie, Xiaofei; Zhang, Ruogu

2013-06-01

The present research explores how and why anger and fear influence driving risk perception. Based on appraisal tendency framework, researchers hypothesized that anger and fear would influence driving risk perception in opposite directions due to their differences in appraisals. Study 1 showed that anger reduced risk perception, whereas fear increased it. In Studies 2, 3, and 4, the researchers adopted the paradigm of reappraisal to investigate the causes of the opposite effects found in Study 1. Consistent with our hypothesis, appraisals accounted for these effects: After reappraisals along the dimensions of certainty (Study 2), control (Study 3), and responsibility (Study 4), the different effects between anger and fear on driving risk perception diminished or disappeared. In addition, fearful or angry experience mediated the effects of reappraisals on driving risk perception. The findings highlight the necessity to differentiate anger and fear in road safety management. Additionally, the current research also provides feasible methods (e.g., certainty, control, or responsibility reappraisal) to intervene in driving risk perception, which is important for driving safety. Copyright © 2013 National Safety Council and Elsevier Ltd. All rights reserved.

[Security of the medicinal therapy: Cartography of risks a priori within service of orthopaedic surgery].

PubMed

Razurel, A; Bertrand, É; Deranlot, J; Benhamou, F; Tritz, T; Le Mercier, F; Hardy, P

2015-11-01

Security and quality of the Medicinal Therapy are one of the most important objectives of the April 6th, 2011 order. The objective is to realize this study of the risks incurred by patients related to management and security of medicinal therapy in order to establish a plan to reduce the risks of drug's dispensation. The method of the Preliminary Risk Analysis (PRA) has been implemented by a multidisciplinary group in a hospital service of orthopaedic surgery. The study focused on the dispensation phase of medicinal circuit. This analysis revealed 148 scenarii, 35 were criticality unacceptable. Fifty-four initial risk control actions were proposed and their stress levels to put them in place were evaluated. The main measures of risk management are: training, information, communication, computerization, automation, dual control, updating the documentation system, drug reconciliation and respect for Best Practices Hospitallers (BPH). Risk management requires a significant human and financial investment as well as, material resources and multidisciplinary expertise in order to offer the best solutions. Copyright © 2015 Académie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.

Risk Factors for Diverticulosis, Diverticulitis, Diverticular Perforation, and Bleeding: A Plea for More Subtle History Taking

PubMed Central

Böhm, Stephan K.

2015-01-01

Background Diverticulosis is a very common condition. Around 20% of diverticula carriers are believed to suffer from diverticular disease during their lifetime. This makes diverticular disease one of the clinically and economically most significant conditions in gastroenterology. The etiopathogenesis of diverticulosis and diverticular disease is not well understood. Epidemiological studies allowed to define risk factors for the development of diverticulosis and the different disease entities associated with it, in particular diverticulitis, perforation, and diverticular bleeding. Methods A comprehensive literature search was performed, and the current knowledge about risk factors for diverticulosis and associated conditions reviewed. Results Non-controllable risk factors like age, sex, and genetics, and controllable risk factors like foods, drinks, and physical activity were identified, as well as comorbidities and drugs which increase or decrease the risk of developing diverticula or of suffering from complications. In naming risk factors, it is of utmost importance to differentiate between diverticulosis and the different disease entities. Conclusion Risk factors for diverticulosis and diverticular disease may give a clue towards the possible etiopathogenesis of the conditions. More importantly, knowledge of comorbidities and particularly drugs conferring a risk for development of complicated disease is crucial for patient management. PMID:26989377

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

PubMed

Root, Robin

2008-01-01

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

Injury risk in runners using standard or motion control shoes: a randomised controlled trial with participant and assessor blinding.

PubMed

Malisoux, Laurent; Chambon, Nicolas; Delattre, Nicolas; Gueguen, Nils; Urhausen, Axel; Theisen, Daniel

2016-04-01

This randomised controlled trial investigated if the usage of running shoes with a motion control system modifies injury risk in regular leisure-time runners compared to standard shoes, and if this influence depends on foot morphology. Recreational runners (n=372) were given either the motion control or the standard version of a regular running shoe model and were followed up for 6 months regarding running activity and injury. Foot morphology was analysed using the Foot Posture Index method. Cox regression analyses were used to compare injury risk between the two groups, based on HRs and their 95% CIs, controlling for potential confounders. Stratified analyses were conducted to evaluate the effect of motion control system in runners with supinated, neutral and pronated feet. The overall injury risk was lower among the participants who had received motion control shoes (HR=0.55; 95% CI 0.36 to 0.85) compared to those receiving standard shoes. This positive effect was only observed in the stratum of runners with pronated feet (n=94; HR=0.34; 95% CI 0.13 to 0.84); there was no difference in runners with neutral (n=218; HR=0.78; 95% CI 0.44 to 1.37) or supinated feet (n=60; HR=0.59; 95% CI 0.20 to 1.73). Runners with pronated feet using standard shoes had a higher injury risk compared to those with neutral feet (HR=1.80; 95% CI 1.01 to 3.22). The overall injury risk was lower in participants who had received motion control shoes. Based on secondary analysis, those with pronated feet may benefit most from this shoe type. 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/

Glioma and occupational exposure in Sweden, a case-control study.

PubMed Central

Rodvall, Y; Ahlbom, A; Spännare, B; Nise, G

1996-01-01

OBJECTIVES: The aim of the study was to analyse whether any job titles, industrial codes, and certain occupational exposures were associated with an increased risk of glioma. METHODS: A population based case-control study of incident primary brain tumours in adults was carried out in Uppsala, Sweden in the period 1987-90. The study included 192 cases of glioma and 192 matched controls. It also included cases with other tumours of the central nervous system with matched controls. Information from all 343 controls was used in this study. Information was collected by means of a questionnaire that was sent to all subjects. An occupational hygienist reviewed the questionnaires for self reported exposures to substances and assessed whether these reported exposures were plausible or not in the corresponding occupation. RESULTS: The kappa coefficient for those classified by the two methods ranged between 0.46 and 0.88, and they were almost the same for cases and controls. For men exposed to solvents a relative risk (RR) of 2.6 (95% CI 1.3 to 5.2) was found. For men exposed to pesticides the RR was 1.8 (95% CI 0.6 to 5.1), and for plastic materials the RR was 3.6 (95% CI 1.0 to 12.4). For men employed in forestry and logging the RR was 2.2 (95% CI 0.9 to 5.3) and in basic metal industries 2.0 (95% CI 1.0 to 4.0). CONCLUSION: An increased risk of glioma was associated with use of solvents, pesticides, and plastic materials but this should be interpreted with some caution. PMID:8983463

Vegetarian diet as a risk factor for tuberculosis in immigrant south London Asians.

PubMed Central

Strachan, D. P.; Powell, K. J.; Thaker, A.; Millard, F. J.; Maxwell, J. D.

1995-01-01

BACKGROUND--In a previous retrospective study of tuberculosis in south London among Asian immigrants from the Indian subcontinent Hindu Asians were found to have a significantly increased risk for tuberculosis compared with Muslims. This finding has been further investigated by examining the role of socioeconomic and lifestyle variables, including diet, as risk factors for tuberculosis in Asian immigrants from the Indian subcontinent resident in south London. METHODS--Using a case-control study technique Asian immigrants from the Indian subcontinent diagnosed with tuberculosis during the past 10 years and two Asian control groups (community and outpatient clinic controls) from the Indian subcontinent were investigated. Cases and community controls were approached by letter. A structured questionnaire concerning a range of demographic, migration, socioeconomic, dietary, and health topics was administered by a single trained interviewer to subjects (56 cases and 100 controls) who agreed to participate. RESULTS--The results confirmed earlier findings that Hindu Asians had an increased risk of tuberculosis compared with Muslims. However, further analysis revealed that religion had no independent influence after adjustment for vegetarianism (common among Hindu Asians). Unadjusted odds ratios for tuberculosis among vegetarians were 2.7 (95% CI 1.1 to 6.4) using community controls, and 4.3 (95% CI 1.8 to 10.4) using clinic controls. There was a trend of increasing risk of tuberculosis with decreasing frequency of meat or fish consumption. Lactovegetarians had an 8.5 fold risk (95% CI 1.6 to 45.4) compared with daily meat/fish eaters. Adjustment for a range of other socioeconomic, migration, and lifestyle variables made little difference to the relative risks derived using either community or clinic controls. CONCLUSIONS--These results indicate that a vegetarian diet is an independent risk factor for tuberculosis in immigrant Asians. The mechanism is unexplained. However, vitamin D deficiency, common among vegetarian Asians in south London, is known to affect immunological competence. Decreased immunocompetence associated with a vegetarian diet might result in increased mycobacterial reactivation among Asians from the Indian subcontinent. PMID:7701458

Case–control and prospective studies of dietary α-linolenic acid intake and prostate cancer risk: a meta-analysis

PubMed Central

Carleton, Amanda J; Sievenpiper, John L; de Souza, Russell; McKeown-Eyssen, Gail; Jenkins, David J A

2013-01-01

Objective α-Linolenic acid (ALA) is considered to be a cardioprotective nutrient; however, some epidemiological studies have suggested that dietary ALA intake increases the risk of prostate cancer. The main objective was to conduct a systematic review and meta-analysis of case–control and prospective studies investigating the association between dietary ALA intake and prostate cancer risk. Design A systematic review and meta-analysis were conducted by searching MEDLINE and EMBASE for relevant prospective and case–control studies. Included studies We included all prospective cohort, case–control, nested case-cohort and nested case–control studies that investigated the effect of dietary ALA intake on the incidence (or diagnosis) of prostate cancer and provided relative risk (RR), HR or OR estimates. Primary outcome measure Data were pooled using the generic inverse variance method with a random effects model from studies that compared the highest ALA quantile with the lowest ALA quantile. Risk estimates were expressed as RR with 95% CIs. Heterogeneity was assessed by χ2 and quantified by I2. Results Data from five prospective and seven case–control studies were pooled. The overall RR estimate showed ALA intake to be positively but non-significantly associated with prostate cancer risk (1.08 (0.90 to 1.29), p=0.40; I2=85%), but the interpretation was complicated by evidence of heterogeneity not explained by study design. A weak, non-significant protective effect of ALA intake on prostate cancer risk in the prospective studies became significant (0.91 (0.83 to 0.99), p=0.02) without evidence of heterogeneity (I2=8%, p=0.35) on removal of one study during sensitivity analyses. Conclusions This analysis failed to confirm an association between dietary ALA intake and prostate cancer risk. Larger and longer observational and interventional studies are needed to define the role of ALA and prostate cancer. PMID:23674441

The relationship between helicobacter pylori infection and myocardial infarction

PubMed Central

Azarkar, Zohreh; Jafarnejad, Majid; Sharifzadeh, Gholamreza

2011-01-01

Background: Coronary Artery Disease is known as the main cause of death in industrialized countries. Relation between this disease and some infections such as Helicobacter pylori (H.pylori) has been shown in several studies. The purpose of this study was to dermine the relationship between Hypylori and mycardical infarctions. Methods: Seventy-three myocardial infarction patients and 78 individuals with no history of this disease were compared. Patients and control matched for age and sex person to person by the match method. Levels of serum IgA and IgG antibodies against H. pylori were measured by Elisa method. Also, cholesterol, triglyceride, LDL, HDL measured in both groups and data were compared between two groups in terms of relation with cardiac risk factors. Results: From 151 participants, 73 were patients and 78 were control subjects. The percentage of IgG positive cases against H. pylori was 57.5% in the case group and 32.1% in the control group (p=0.002, OR: 2.87 CI: 95%; 1.5-5.6). Meanwhile, there was no significant difference in IgA positive cases between the two groups (42.5% and 48.7% in the case and control groups, respectively) (p=0.44; OR: 0.78 95% CI; 0.41-1.48). The study showed 74.2% of cases in the case group and 45.2% in the control group were positive for both IgG and IgA (p=0.01; OR: 3.5 95% CI; 1.3-9.5). No significant differences were found between two groups in terms of relation between H. pylori related antibodies level and heart disease classic risk factors (smoking, hypertension,…), sex, and age, but between dyslipidemia and H. pylori related antibodies was significant differences in case group (p=0.05). Conclusion: According to the results, it seems there is a relation between H. pylori infection and myocardial infarction. Also, between dislipidemia and H. Pylori antibodies in case group were significant difference. Therefore, H. pylori can be a new risk factor for atherosclerosis or can be exacerbate effect of other risk factors. Proper diagnosis and treatment of these infections can be useful in prone patients. More studies with larger sample groups are needed to review the possible role of this pathogen as a heart disease risk factor. PMID:24024020

Cardiac autonomic neuropathy: Risk factors, diagnosis and treatment

PubMed Central

Serhiyenko, Victoria A; Serhiyenko, Alexandr A

2018-01-01

Cardiac autonomic neuropathy (CAN) is a serious complication of diabetes mellitus (DM) that is strongly associated with approximately five-fold increased risk of cardiovascular mortality. CAN manifests in a spectrum of things, ranging from resting tachycardia and fixed heart rate (HR) to development of “silent” myocardial infarction. Clinical correlates or risk markers for CAN are age, DM duration, glycemic control, hypertension, and dyslipidemia (DLP), development of other microvascular complications. Established risk factors for CAN are poor glycemic control in type 1 DM and a combination of hypertension, DLP, obesity, and unsatisfactory glycemic control in type 2 DM. Symptomatic manifestations of CAN include sinus tachycardia, exercise intolerance, orthostatic hypotension (OH), abnormal blood pressure (BP) regulation, dizziness, presyncope and syncope, intraoperative cardiovascular instability, asymptomatic myocardial ischemia and infarction. Methods of CAN assessment in clinical practice include assessment of symptoms and signs, cardiovascular reflex tests based on HR and BP, short-term electrocardiography (ECG), QT interval prolongation, HR variability (24 h, classic 24 h Holter ECG), ambulatory BP monitoring, HR turbulence, baroreflex sensitivity, muscle sympathetic nerve activity, catecholamine assessment and cardiovascular sympathetic tests, heart sympathetic imaging. Although it is common complication, the significance of CAN has not been fully appreciated and there are no unified treatment algorithms for today. Treatment is based on early diagnosis, life style changes, optimization of glycemic control and management of cardiovascular risk factors. Pathogenetic treatment of CAN includes: Balanced diet and physical activity; optimization of glycemic control; treatment of DLP; antioxidants, first of all α-lipoic acid (ALA), aldose reductase inhibitors, acetyl-L-carnitine; vitamins, first of all fat-soluble vitamin B1; correction of vascular endothelial dysfunction; prevention and treatment of thrombosis; in severe cases-treatment of OH. The promising methods include prescription of prostacyclin analogues, thromboxane A2 blockers and drugs that contribute into strengthening and/or normalization of Na+, K+-ATPase (phosphodiesterase inhibitor), ALA, dihomo-γ-linolenic acid (DGLA), ω-3 polyunsaturated fatty acids (ω-3 PUFAs), and the simultaneous prescription of ALA, ω-3 PUFAs and DGLA, but the future investigations are needed. Development of OH is associated with severe or advanced CAN and prescription of nonpharmacological and pharmacological, in the foreground midodrine and fludrocortisone acetate, treatment methods are necessary. PMID:29359025

Placental peptides metabolism and maternal factors as predictors of risk of gestational diabetes in pregnant women. A case-control study

PubMed Central

Fondjo, Linda Ahenkorah; Gmagna, Peter; Ghartey, Frank Naku; Awe, Martin Akilla

2017-01-01

Background Gestational diabetes is a risk factor for perinatal complications; include shoulder dystocia, birth injuries such as bone fractures and nerve palsies. It is associated with later development of type 2 diabetes, the risk of macrosomia and other long-term health effects of infants born to diabetic mothers. The study assesses placental peptides and maternal factors as potential predictors of gestational diabetes among pregnant women. Material and methods A total of 200 pregnant women were recruited for the study, 150 pregnant women without pre gestational diabetes including 50 women with low risk factors of diabetes as controls and 50 other pregnant women with pregestational diabetes as control. Fasting blood glucose and the lipid profile were determined by enzymatic methods using Envoy® 500 reagents (Vital Diagnostics, USA). Glycated haemoglobin was assessed using the Cation Exchange resin method. Leptin and the Human Placenta Lactogen were assayed using the Sandwich-ELISA technique. Beta chorionic gonadotrophin, insulin, progesterone and estradiol were determined using chemilumiscence imunoassay technique on MAGLUMI 600 analyzer. Anthropometry, including BMI and blood pressure were also measured. Results Fasting plasma glucose (FBG), insulin, insulin resistance, glycated haemoglobin and Human Placenta Lactogen(HPL)were significantly (p<0.0001) increased in the pregestational diabetic women whereas progesterone and estradiol were significantly decreased. In the second trimester however, there was no significant difference (p>0.05) in estradiol, insulin, insulin resistance and HPL between the pregnant women who developed gestational diabetes and those who did not. Leptin, progesterone and FBG were significantly increased in those who developed GDM. The risk of developing gestational diabetes increased with overweight (OR = 1.76, P = 0.370) and family history of diabetes (OR = 2.18, P = 0.282). Conclusion Leptin, progesterone, estradiol estimated in this study were increased in the gestational diabetes mellitus women and fairly predicted gestational diabetes in the non-diabetics pregnant women. Obesity, aging and family history of diabetes were strongly predictive of gestational diabetes. PMID:28732072

The effectiveness of a training method using self-modeling webcam photos for reducing musculoskeletal risk among office workers using computers.

PubMed

Taieb-Maimon, Meirav; Cwikel, Julie; Shapira, Bracha; Orenstein, Ido

2012-03-01

An intervention study was conducted to examine the effectiveness of an innovative self-modeling photo-training method for reducing musculoskeletal risk among office workers using computers. Sixty workers were randomly assigned to either: 1) a control group; 2) an office training group that received personal, ergonomic training and workstation adjustments or 3) a photo-training group that received both office training and an automatic frequent-feedback system that displayed on the computer screen a photo of the worker's current sitting posture together with the correct posture photo taken earlier during office training. Musculoskeletal risk was evaluated using the Rapid Upper Limb Assessment (RULA) method before, during and after the six weeks intervention. Both training methods provided effective short-term posture improvement; however, sustained improvement was only attained with the photo-training method. Both interventions had a greater effect on older workers and on workers suffering more musculoskeletal pain. The photo-training method had a greater positive effect on women than on men. Copyright © 2011 Elsevier Ltd and The Ergonomics Society. All rights reserved.

Geographic Region, Weather, Pilot Age and Air Carrier Crashes: a Case-Control Study

PubMed Central

Li, Guohua; Pressley, Joyce C.; Qiang, Yandong; Grabowski, Jurek G.; Baker, Susan P.; Rebok, George W.

2009-01-01

Background Information about risk factors of aviation crashes is crucial for developing effective intervention programs. Previous studies assessing factors associated with crash risk were conducted primarily in general aviation, air taxis and commuter air carriers. Methods A matched case-control design was used to examine the associations of geographic region, basic weather condition, and pilot age with the risk of air carrier (14 CFR Part 121) crash involvement. Cases (n=373) were air carrier crashes involving aircraft made by Boeing, McDonnell Douglas, and Airbus, recorded in the National Transportation Safety Board’s aviation crash database during 1983 through 2002, and controls (n=746) were air carrier incidents involving aircraft of the same three makes selected at random from the Federal Aviation Administration’s aviation incident database. Each case was matched with two controls on the calendar year when the index crash occurred. Conditional logistic regression was used for statistical analysis. Results With adjustment for basic weather condition, pilot age, and total flight time, the risk of air carrier crashes in Alaska was more than three times the risk for other regions [adjusted odds ratio (OR) 3.18, 95% confidence interval (CI) 1.35 – 7.49]. Instrument meteorological conditions were associated with an increased risk for air carrier crashes involving pilot error (adjusted OR 2.26, 95% CI 1.15 – 4.44) and a decreased risk for air carrier crashes without pilot error (adjusted OR 0.57, 95% CI 0.40 – 0.87). Neither pilot age nor total flight time was significantly associated with the risk of air carrier crashes. Conclusions The excess risk of air carrier crashes in Alaska and the effect of adverse weather on pilot-error crashes underscore the importance of environmental hazards in flight safety. PMID:19378910

Empirical performance of the self-controlled case series design: lessons for developing a risk identification and analysis system.

PubMed

Suchard, Marc A; Zorych, Ivan; Simpson, Shawn E; Schuemie, Martijn J; Ryan, Patrick B; Madigan, David

2013-10-01

The self-controlled case series (SCCS) offers potential as an statistical method for risk identification involving medical products from large-scale observational healthcare data. However, analytic design choices remain in encoding the longitudinal health records into the SCCS framework and its risk identification performance across real-world databases is unknown. To evaluate the performance of SCCS and its design choices as a tool for risk identification in observational healthcare data. We examined the risk identification performance of SCCS across five design choices using 399 drug-health outcome pairs in five real observational databases (four administrative claims and one electronic health records). In these databases, the pairs involve 165 positive controls and 234 negative controls. We also consider several synthetic databases with known relative risks between drug-outcome pairs. We evaluate risk identification performance through estimating the area under the receiver-operator characteristics curve (AUC) and bias and coverage probability in the synthetic examples. The SCCS achieves strong predictive performance. Twelve of the twenty health outcome-database scenarios return AUCs >0.75 across all drugs. Including all adverse events instead of just the first per patient and applying a multivariate adjustment for concomitant drug use are the most important design choices. However, the SCCS as applied here returns relative risk point-estimates biased towards the null value of 1 with low coverage probability. The SCCS recently extended to apply a multivariate adjustment for concomitant drug use offers promise as a statistical tool for risk identification in large-scale observational healthcare databases. Poor estimator calibration dampens enthusiasm, but on-going work should correct this short-coming.

Traumatic Stress Interacts With Bipolar Disorder Genetic Risk to Increase Risk for Suicide Attempts

PubMed Central

Wilcox, Holly C.; Fullerton, Janice M.; Glowinski, Anne L.; Benke, Kelly; Kamali, Masoud; Hulvershorn, Leslie A.; Stapp, Emma K.; Edenberg, Howard J.; Roberts, Gloria M.P.; Ghaziuddin, Neera; Fisher, Carrie; Brucksch, Christine; Frankland, Andrew; Toma, Claudio; Shaw, Alex D.; Kastelic, Elizabeth; Miller, Leslie; McInnis, Melvin G.; Mitchell, Philip B.; Nurnberger, John I.

2018-01-01

Objective Bipolar disorder (BD) is one of the most heritable psychiatric conditions and is associated with high suicide risk. To explore the reasons for this link, this study examined the interaction between traumatic stress and BD polygenic risk score in relation to suicidal ideation, suicide attempt, and nonsuicidal self-injury (NSSI) in adolescent and young adult offspring and relatives of persons with BD (BD-relatives) compared with adolescent and young adult offspring of individuals without psychiatric disorders (controls). Method Data were collected from 4 sites in the United States and 1 site in Australia from 2006 through 2012. Generalized estimating equation models were used to compare rates of ideation, attempts, and NSSI between BD-relatives (n = 307) and controls (n = 166) and to determine the contribution of demographic factors, traumatic stress exposure, lifetime mood or substance (alcohol/drug) use disorders, and BD polygenic risk score. Results After adjusting for demographic characteristics and mood and substance use disorders, BD-relatives were at increased risk for suicidal ideation and attempts but not for NSSI. Independent of BD-relative versus control status, demographic factors, or mood and substance use disorders, exposure to trauma within the past year (including bullying, sexual abuse, and domestic violence) was associated with suicide attempts (p = .014), and BD polygenic risk score was marginally associated with attempts (p = .061). Importantly, the interaction between BD polygenic risk score and traumatic event exposures was significantly associated with attempts, independent of demographics, relative versus control status, and mood and substance use disorders (p = .041). Conclusion BD-relatives are at increased risk for suicide attempts and ideation, especially if they are exposed to trauma and have evidence of increased genetic vulnerability. PMID:29173741

Statistical analyses in Swedish randomised trials on mammography screening and in other randomised trials on cancer screening: a systematic review

PubMed Central

Boniol, Mathieu; Smans, Michel; Sullivan, Richard; Boyle, Peter

2015-01-01

Objectives We compared calculations of relative risks of cancer death in Swedish mammography trials and in other cancer screening trials. Participants Men and women from 30 to 74 years of age. Setting Randomised trials on cancer screening. Design For each trial, we identified the intervention period, when screening was offered to screening groups and not to control groups, and the post-intervention period, when screening (or absence of screening) was the same in screening and control groups. We then examined which cancer deaths had been used for the computation of relative risk of cancer death. Main outcome measures Relative risk of cancer death. Results In 17 non-breast screening trials, deaths due to cancers diagnosed during the intervention and post-intervention periods were used for relative risk calculations. In the five Swedish trials, relative risk calculations used deaths due to breast cancers found during intervention periods, but deaths due to breast cancer found at first screening of control groups were added to these groups. After reallocation of the added breast cancer deaths to post-intervention periods of control groups, relative risks of 0.86 (0.76; 0.97) were obtained for cancers found during intervention periods and 0.83 (0.71; 0.97) for cancers found during post-intervention periods, indicating constant reduction in the risk of breast cancer death during follow-up, irrespective of screening. Conclusions The use of unconventional statistical methods in Swedish trials has led to overestimation of risk reduction in breast cancer death attributable to mammography screening. The constant risk reduction observed in screening groups was probably due to the trial design that optimised awareness and medical management of women allocated to screening groups. PMID:26152677

Case-control analysis in highway safety: Accounting for sites with multiple crashes.

PubMed

Gross, Frank

2013-12-01

There is an increased interest in the use of epidemiological methods in highway safety analysis. The case-control and cohort methods are commonly used in the epidemiological field to identify risk factors and quantify the risk or odds of disease given certain characteristics and factors related to an individual. This same concept can be applied to highway safety where the entity of interest is a roadway segment or intersection (rather than a person) and the risk factors of interest are the operational and geometric characteristics of a given roadway. One criticism of the use of these methods in highway safety is that they have not accounted for the difference between sites with single and multiple crashes. In the medical field, a disease either occurs or it does not; multiple occurrences are generally not an issue. In the highway safety field, it is necessary to evaluate the safety of a given site while accounting for multiple crashes. Otherwise, the analysis may underestimate the safety effects of a given factor. This paper explores the use of the case-control method in highway safety and two variations to account for sites with multiple crashes. Specifically, the paper presents two alternative methods for defining cases in a case-control study and compares the results in a case study. The first alternative defines a separate case for each crash in a given study period, thereby increasing the weight of the associated roadway characteristics in the analysis. The second alternative defines entire crash categories as cases (sites with one crash, sites with two crashes, etc.) and analyzes each group separately in comparison to sites with no crashes. The results are also compared to a "typical" case-control application, where the cases are simply defined as any entity that experiences at least one crash and controls are those entities without a crash in a given period. In a "typical" case-control design, the attributes associated with single-crash segments are weighted the same as the attributes of segments with multiple crashes. The results support the hypothesis that the "typical" case-control design may underestimate the safety effects of a given factor compared to methods that account for sites with multiple crashes. Compared to the first alternative case definition (where multiple crash segments represent multiple cases) the results from the "typical" case-control design are less pronounced (i.e., closer to unity). The second alternative (where case definitions are constructed for various crash categories and analyzed separately) provides further evidence that sites with single and multiple crashes should not be grouped together in a case-control analysis. This paper indicates a clear need to differentiate sites with single and multiple crashes in a case-control analysis. While the results suggest that sites with multiple crashes can be accounted for using a case-control design, further research is needed to determine the optimal method for addressing this issue. This paper provides a starting point for that research. Copyright © 2012 Elsevier Ltd. All rights reserved.

Methods to estimate the transfer of contaminants into recycling products - A case study from Austria.

PubMed

Knapp, Julika; Allesch, Astrid; Müller, Wolfgang; Bockreis, Anke

2017-11-01

Recycling of waste materials is desirable to reduce the consumption of limited primary resources, but also includes the risk of recycling unwanted, hazardous substances. In Austria, the legal framework demands secondary products must not present a higher risk than comparable products derived from primary resources. However, the act provides no definition on how to assess this risk potential. This paper describes the development of different quantitative and qualitative methods to estimate the transfer of contaminants in recycling processes. The quantitative methods comprise the comparison of concentrations of harmful substances in recycling products to corresponding primary products and to existing limit values. The developed evaluation matrix, which considers further aspects, allows for the assessment of the qualitative risk potential. The results show that, depending on the assessed waste fraction, particular contaminants can be critical. Their concentrations were higher than in comparable primary materials and did not comply with existing limit values. On the other hand, the results show that a long-term, well-established quality control system can assure compliance with the limit values. The results of the qualitative assessment obtained with the evaluation matrix support the results of the quantitative assessment. Therefore, the evaluation matrix can be suitable to quickly screen waste streams used for recycling to estimate their potential environmental and health risks. To prevent the transfer of contaminants into product cycles, improved data of relevant substances in secondary resources are necessary. In addition, regulations for material recycling are required to assure adequate quality control measures, including limit values. Copyright © 2017 Elsevier Ltd. All rights reserved.

Risk factors for the development of colorectal carcinoma: A case control study from South India

PubMed Central

Iswarya, Santhana Krishnan; Premarajan, Kariyarath Cheriyath; Kar, Sitanshu Sekhar; Kumar, Sathasivam Suresh; Kate, Vikram

2016-01-01

AIM: To study the association of colorectal carcinoma (CRC) with diet, smoking, alcohol, physical activity, body mass index, family history and diabetes. METHODS: All consecutive patients with CRC confirmed by histopathology diagnosis were included. Age (± 5 years) and gender matched controls were selected among the patients admitted in surgery ward for various conditions without any co-existing malignancy. Food frequency questionnaire (FFQ) was developed and validated after pretesting by investigator trained in data collection techniques. Cases and controls were interviewed ensuring privacy, in similar interview setting, with same duration of time for both cases and controls without any leading question. Biological variables like family history of CRC in first degree relatives, history of diabetes mellitus; behavioral factors like tobacco use both smoking and smokeless form, alcohol consumption and physical activity were recorded. Dietary details were recorded using a FFQ consisting 29 food items with seven categories. Analysis was done using appropriate statistical methods. RESULTS: Ninety-four histopathologically confirmed cases of CRC and equal number of age and gender matched controls treated over a period of two years were studied. Age distribution, mean age, male to female ratio, education level and socioeconomic status were similar in cases and controls. Intake of food items was categorized into tertile due to skewed distribution of subjects as per recommended cut off for consumption of food item. On univariate analysis red meat [OR = 7.4 (2.935-18.732)], egg [OR = 5.1 (2.26-11.36)], fish, fried food and oil consumption were found to be risk factors for CRC. On multivariate analysis red meat consumption of more than 2-3 times a month (OR = 5.4; 95%CI: 1.55-19.05) and egg consumption of more than 2-3 times a week (OR = 3.67; 95%CI: 1.23-9.35) were found to be independent risk factors for the development of CRC. CONCLUSION: Egg and red meat consumption found to be independent risk factors for CRC. Smoking, alcohol, physical activity and family history were not associated with increased risk. PMID:26909135

Chickenpox and Risk of Stroke: A Self-controlled Case Series Analysis

PubMed Central

Thomas, Sara L.; Minassian, Caroline; Ganesan, Vijeya; Langan, Sinéad M.; Smeeth, Liam

2014-01-01

Background. There is good evidence that respiratory and other infections that cause systemic inflammation can trigger strokes; however, the role of specific infections is unclear. Case reports have highlighted chickenpox as a possible risk factor for arterial ischemic stroke, particularly in children, but rigorous studies are needed to determine and quantify any increased risk. Methods. We used anonymized electronic health records totaling >100 million person-years of observation from 4 UK primary care databases to identify individuals who had documented clinical chickenpox and a stroke or transient ischemic attack (TIA). Self-controlled case series methods were used to quantify any increased risk of first stroke or TIA in the 0–6 and 7–12 months following chickenpox compared to other observed time periods. We analyzed data within each database, and performed meta-analyses to obtain summary age-adjusted incidence ratios (IRs) separately for adults and children. Results. Five hundred sixty eligible individuals (including 60 children) were identified who experienced chickenpox and a stroke or TIA during follow-up. Among children, there was a 4-fold increased risk of stroke in the 0–6 months after chickenpox (summary IR = 4.07; 95% confidence interval [CI], 1.96–8.45; I2 = 0%). Among adults, there was a less marked increased risk with moderate between-database heterogeneity (random-effects summary IR = 2.13; 95% CI, 1.05–4.36; I2 = 51%). There was no significant increased risk of stroke in the 7–12 months after chickenpox in children or adults, nor was there evidence of increased risk of TIA in either time period. Conclusions. Our study provides new evidence that children who experience chickenpox are at increased risk of stroke in the subsequent 6 months. PMID:24092802

Homocysteine Level and Risk of Abdominal Aortic Aneurysm: A Meta-Analysis

PubMed Central

Cao, Hui; Hu, Xinhua; Zhang, Qiang; Li, Jun; Wang, Junpeng; Shao, Yang; Liu, Bing; Xin, Shijie

2014-01-01

Objectives Previous studies have reported inconsistent findings regarding the association between elevated plasma homocysteine (Hcy) levels and abdominal aortic aneurysm (AAA). We investigated this association between Hcy levels in patients with AAA and unaffected controls by conducting a meta-analysis and systematic review. Methods We conducted a systematic literature search (up to August 2013) of the PubMed database and Embase. We selected observational studies that evaluated Hcy levels in subjects with AAA compared to unaffected controls. Criteria for inclusion were the assessment of baseline Hcy and risk of AAA as an outcome. The results were presented as odd ratio (OR) and corresponding 95% confidence intervals (CI) comparing AAA patients to the control subjects. Results 7 studies with 6,445 participants were identified and analyzed. Overall, elevated plasma Hcy was associated with an increased risk of AAA (3.29; 95% CI 1.66–6.51). The pooled adjusted OR from a random effect model of only men participants in the AAA compared with the control group was 2.36 (95% CI 0.63–8.82). Conclusion This meta-analysis and systematic review suggested that Hcy significantly increased the risk of AAA. PMID:24465733

Funding for malaria control 2006–2010: A comprehensive global assessment

PubMed Central

2012-01-01

Background The last decade has seen a dramatic increase in international and domestic funding for malaria control, coupled with important declines in malaria incidence and mortality in some regions of the world. As the ongoing climate of financial uncertainty places strains on investment in global health, there is an increasing need to audit the origin, recipients and geographical distribution of funding for malaria control relative to populations at risk of the disease. Methods A comprehensive review of malaria control funding from international donors, bilateral sources and national governments was undertaken to reconstruct total funding by country for each year 2006 to 2010. Regions at risk from Plasmodium falciparum and/or Plasmodium vivax transmission were identified using global risk maps for 2010 and funding was assessed relative to populations at risk. Those nations with unequal funding relative to a regional average were identified and potential explanations highlighted, such as differences in national policies, government inaction or donor neglect. Results US$8.9 billion was disbursed for malaria control and elimination programmes over the study period. Africa had the largest levels of funding per capita-at-risk, with most nations supported primarily by international aid. Countries of the Americas, in contrast, were supported typically through national government funding. Disbursements and government funding in Asia were far lower with a large variation in funding patterns. Nations with relatively high and low levels of funding are discussed. Conclusions Global funding for malaria control is substantially less than required. Inequity in funding is pronounced in some regions particularly when considering the distinct goals of malaria control and malaria elimination. Efforts to sustain and increase international investment in malaria control should be informed by evidence-based assessment of funding equity. PMID:22839432

Risk and protective factors for meningococcal disease in adolescents: matched cohort study

PubMed Central

Tully, Joanna; Viner, Russell M; Coen, Pietro G; Stuart, James M; Zambon, Maria; Peckham, Catherine; Booth, Clare; Klein, Nigel; Kaczmarski, Ed; Booy, Robert

2006-01-01

Objective To examine biological and social risk factors for meningococcal disease in adolescents. Design Prospective, population based, matched cohort study with controls matched for age and sex in 1:1 matching. Controls were sought from the general practitioner. Setting Six contiguous regions of England, which represent some 65% of the country's population. Participants 15-19 year olds with meningococcal disease recruited at hospital admission in six regions (representing 65% of the population of England) from January 1999 to June 2000, and their matched controls. Methods Blood samples and pernasal and throat swabs were taken from case patients at admission to hospital and from cases and matched controls at interview. Data on potential risk factors were gathered by confidential interview. Data were analysed by using univariate and multivariate conditional logistic regression. Results 144 case control pairs were recruited (74 male (51%); median age 17.6). 114 cases (79%) were confirmed microbiologically. Significant independent risk factors for meningococcal disease were history of preceding illness (matched odds ratio 2.9, 95% confidence interval 1.4 to 5.9), intimate kissing with multiple partners (3.7, 1.7 to 8.1), being a university student (3.4, 1.2 to 10) and preterm birth (3.7, 1.0 to 13.5). Religious observance (0.09, 0.02 to 0.6) and meningococcal vaccination (0.12, 0.04 to 0.4) were associated with protection. Conclusions Activities and events increasing risk for meningococcal disease in adolescence are different from in childhood. Students are at higher risk. Altering personal behaviours could moderate the risk. However, the development of further effective meningococcal vaccines remains a key public health priority. PMID:16473859

The Association between Major Depressive Disorder in Childhood and Risk Factors for Cardiovascular Disease in Adolescence

PubMed Central

Rottenberg, Jonathan; Yaroslavsky, Ilya; Carney, Robert M.; Freedland, Kenneth E.; George, Charles J.; Baji, Ildikó; Dochnal, Roberta; Gádoros, Júlia; Halas, Kitti; Kapornai, Krisztina; Kiss, Enikő; Osváth, Viola; Varga, Hedvig; Vetró, Ágnes; Kovacs, Maria

2014-01-01

Objective Depression in adults is associated with risk factors for cardiovascular disease (CVD). It is unclear, however, when the association between clinical depression and cardiac risk factors develops, or how early in life this association can be detected. Methods In an ongoing study of pediatric depression, we compared CVD risk factors, including smoking, obesity, physical activity level, sedentary behavior, and parental history of CVD, across three samples of adolescents: probands with established histories of childhood-onset major depressive disorder (MDD; N=210), never-depressed siblings of probands (N=195), and controls with no history of any major psychiatric disorder (N=161). Results When assessed during adolescence, 85% of the probands were not in a major depressive episode. Nevertheless, at that assessment, probands had a higher prevalence of regular smoking ([odds ratio [OR] 12.54, 95% confidence interval [CI] = 4.36–36.12) and were less physically active than controls (OR .59, CI = .43–.81) and siblings (OR .70, CI = .52–.94), and had a higher rate of obesity than did controls (OR 3.67, CI = 1.42–9.52). Parents of probands reported high rates of CVD (significantly higher than did parents of controls), including myocardial infarction and CVD-related hospitalization (ORs 1.62–4.36; CIs = 1.03–15.40). Differences in CVD risk factors between probands and controls were independent of parental CVD. Conclusions Major depression in childhood is associated with an unfavorable CVD risk profile in adolescence, and risks for pediatric depression and CVD may coincide in families. Effective prevention and treatment of childhood depression may be a means to reduce the incidence of adult CVD. PMID:24470130

Testing Mediators of Intervention Effects in Randomized Controlled Trials: An Evaluation of Three Depression Prevention Programs

ERIC Educational Resources Information Center

Stice, Eric; Rohde, Paul; Seeley, John R.; Gau, Jeff M.

2010-01-01

Objective: Evaluate a new 5-step method for testing mediators hypothesized to account for the effects of depression prevention programs. Method: In this indicated prevention trial, at-risk teens with elevated depressive symptoms were randomized to a group cognitive-behavioral (CB) intervention, group supportive expressive intervention, CB…

Haptoglobin Phenotype Modifies Serum Iron Levels and the Effect of Smoking on Parkinson Disease Risk

PubMed Central

Costa-Mallen, Paola; Zabetian, Cyrus P.; Agarwal, Pinky; Hu, Shu-Ching; Yearout, Dora; Samii, Ali; Leverenz, James B.; Roberts, John W.; Checkoway, Harvey

2015-01-01

Introduction Haptoglobin is a hemoglobin-binding protein that exists in three functionally different phenotypes, and haptoglobin phenotype 2-1 has previously been associated with Parkinson disease (PD) risk, with mechanisms not elucidated. Some evidence is emerging that low levels of serum iron may increase PD risk. In this study we investigated whether PD patients have lower serum iron and ferritin than controls, and whether this is dependent on haptoglobin phenotype. We also investigated the effect of Hp phenotype as a modifier of the effect of smoking on PD risk. Methods The study population consisted of 128 PD patients and 226 controls. Serum iron, ferritin, and haptoglobin phenotype were determined, and compared between PD cases and controls. Stratified analysis by haptoglobin phenotype was performed to determine effect of haptoglobin phenotype on serum iron parameter differences between PD cases and controls and to investigate its role in the protective effect of smoking on PD risk. Results PD cases had lower serum iron than controls (83.28 ug/100ml vs 94.00 ug/100 ml, p 0.006), and in particular among subjects with phenotype 2-1. The protective effect of smoking on PD risk resulted stronger in subjects with phenotype 1-1 and 2-2, and weakest among subjects with phenotype 2-1. Ferritin levels were higher in PD cases than controls among subjects of White ethnicity. Conclusions Our results report for the first time that the haptoglobin phenotype may be a contributor of iron levels abnormalities in PD patients. The mechanisms for these haptoglobin-phenotype specific effects will have to be further elucidated. PMID:26228081

Nonsteroidal Anti-Inflammatory Drug Use is Not Associated With Reduced Risk of Barrett's Esophagus

PubMed Central

Thrift, Aaron P.; Anderson, Lesley A.; Murray, Liam J.; Cook, Michael B.; Shaheen, Nicholas J.; Rubenstein, Joel H.; El-Serag, Hashem B.; Vaughan, Thomas L.; Schneider, Jennifer L.; Whiteman, David C.; Corley, Douglas A.

2016-01-01

OBJECTIVES Regular use of nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with a reduced risk of esophageal adenocarcinoma. Epidemiological studies examining the association between NSAID use and the risk of the precursor lesion, Barrett's esophagus, have been inconclusive. METHODS We analyzed pooled individual-level participant data from six case-control studies of Barrett's esophagus in the Barrett's and Esophageal Adenocarcinoma Consortium (BEACON). We compared medication use from 1474 patients with Barrett's esophagus separately with two control groups: 2256 population-based controls and 2018 gastroesophageal reflux disease (GERD) controls. Study-specific odds ratios (OR) and 95% confidence intervals (CI) were estimated using multivariable logistic regression models and were combined using a random effects meta-analytic model. RESULTS Regular (at least once weekly) use of any NSAIDs was not associated with the risk of Barrett's esophagus (vs. population-based controls, adjusted OR = 1.00, 95% CI = 0.76–1.32; I2=61%; vs. GERD controls, adjusted OR = 0.99, 95% CI = 0.82–1.19; I2=19%). Similar null findings were observed among individuals who took aspirin or non-aspirin NSAIDs. We also found no association with highest levels of frequency (at least daily use) and duration (≥5 years) of NSAID use. There was evidence of moderate between-study heterogeneity; however, associations with NSAID use remained non-significant in “leave-one-out” sensitivity analyses. CONCLUSIONS Use of NSAIDs was not associated with the risk of Barrett's esophagus. The previously reported inverse association between NSAID use and esophageal adenocarcinoma may be through reducing the risk of neoplastic progression in patients with Barrett's esophagus. PMID:27575711

Body Mass Index and Breast Cancer Risk among Thai Premenopausal Women: a Case-Control Study

PubMed Central

Chaveepojnkamjorn, Wisit; Thotong, Rungsinoppadol; Sativipawee, Pratana; Pitikultang, Supachai

2017-01-01

Background: Breast cancer (BC) is the leading malignancy in women with high incidence and mortality worldwide. Obesity is one of several established risk factors for chronic diseases including cancer. The objective of this research was to determine the association of body mass index (BMI) with BC among Thai premenopausal women (TPW). Materials and Methods: A case-control study was conducted among TPW attending the National Cancer Institute in Bangkok, with 257 cases and 257 controls in 2013-2014. Cases and controls were matched by age (± 5 years), residential area and duration of attending. Data were collected with a questionnaire comprising 2 parts: part 1 socio-demographic characteristics, and part 2 health risk behavior and reproductive factors and BMI. The obtained data were analyzed using descriptive and analytic statistics with a computerized statistical package. Results: The study participants were mainly 40-44 years old (60 %) with an average age of 39 years. The major type of BC was the invasive ductal carcinoma (91.8%). On univariate analysis, risk factors for BC among the TPW were family history of BC, history of benign breast tumors, younger age at menarche, parity, miscarriage, contraceptive use, passive smoking, multivitamin use, and BMI (p<0.05). Multivariable conditional logistic regression analysis, controlling for possible confounding factors, revealed that a BMI 25-29.9 and ≥ 30 kg/m2 increased the risk of BC by a factor of 2.09 and 2.37 times, respectively (OR=2.09, 95%CI =1.09-3.97; OR=2.37, 95%CI =1.24-10.06). Conclusions: A surveillance system of obesity should be conducted in cooperation with information regarding physical activities and weight control among TPW as an essential measure to reduce BC risk. PMID:29172285

Breast cancer, heterocyclic aromatic amines from meat and N-acetyltransferase 2 genotype.

PubMed

Delfino, R J; Sinha, R; Smith, C; West, J; White, E; Lin, H J; Liao, S Y; Gim, J S; Ma, H L; Butler, J; Anton-Culver, H

2000-04-01

Breast cancer risk has been hypothesized to increase with exposure to heterocyclic aromatic amines (HAAs) formed from cooking meat at high temperature. HAAs require enzymatic activation to bind to DNA and initiate carcinogenesis. N-acetyltransferase 2 (NAT2) enzyme activity may play a role, its rate determined by a polymorphic gene. We examined the effect of NAT2 genetic polymorphisms on breast cancer risk from exposure to meat by cooking method, doneness and estimated HAA [2-amino-1-methyl-6-phenylimidazole[4,5-b]pyridine (PhIP), 2-amino-3,8-dimethylimidazo[4,5-f]quinoxaline (MeIQx) and 2-amino-3,4,8-trimethylimidazo[4,5-f]quinoxaline (DiMeIQx)] intake. Women were recruited with suspicious breast masses and questionnaire data were collected prior to biopsy to blind subjects and interviewers to diagnoses. For 114 cases with breast cancer and 280 controls with benign breast disease, NAT2 genotype was determined using allele-specific PCR amplification to detect slow acetylator mutations. HAAs were estimated from interview data on meat type, cooking method and doneness, combined with a quantitative HAA database. Logistic regression models controlled for known risk factors, first including all controls, then 108 with no or low risk (normal breast or no hyperplasia) and finally 149 with high risk (hyperplasia, atypical hyperplasia, complex fibroadenomas). Meat effects were examined within NAT2 strata to assess interactions. We found no association between NAT2 and breast cancer. These Californian women ate more white than red meat (control median 46 versus 8 g/day). There were no significant associations of breast cancer with red meat for any doneness. White meat was significantly protective (>67 versus <26 g/day, OR 0.46, 95% CI 0.23-0.94, P for trend = 0.02), as was chicken, including well done, pan fried and barbecued chicken. MeIQx and DiMeIQx were not associated with breast cancer. A protective effect of PhIP was confounded after controlling for well done chicken. Results were unchanged using low or high risk controls or dropping 30 in situ cases. There was no interaction between NAT2 and HAAs. These findings do not support a role for HAAs from meat or NAT2 in the etiology of breast cancer. Further research is needed to explain the white meat association.

Risk assessment of hazardous release in air due to the chemical production of "P. Karaminchev" company in the town of Rousse.

PubMed

Diankova, M

1998-09-01

A health risk evaluation of the lifetime population risk has been made, by using the US EPA's method of risk assessment. Several main steps have been conducted: --a hazard identification, by means of emission analysis and mathematical modeling of air concentration dispersion; a dose-response evaluation and exposure assessment, and finally--a risk characterization. The health risk evaluation was conducted, using lifetime reference concentrations and doses. As risk descriptors were applied: --the individual exposure coefficient (IEC), the hazard quotient (HQ) and the margin of exposure (MOE)--for system toxicants, and the excess lifetime cancer risk (ELCR)--for carcinogens. The method that was used provides an upperbound estimate, including all possible exposures. The results showed, that the emissions of hydrogen chloride, phthalates (DOF), nitrogen oxides and most of the organic solvents, released from this chemical plant, are not a source of lifetime chronic health risk for the population of any of the six evaluated residential areas of Rousse. The rest of the hazardous emissions cause a slightly increased lifetime health risk, which is entirely in the so called 'controlled risk zone' the risk descriptors vary from 1.00 to 5.00. A number of actions have been prescribed to the plant's government, most of which were realized in the short term.

Intensive glycaemic control for patients with type 2 diabetes: systematic review with meta-analysis and trial sequential analysis of randomised clinical trials

PubMed Central

Lund, Søren S; Gluud, Christian; Vaag, Allan; Almdal, Thomas; Wetterslev, Jørn

2011-01-01

Objective To assess the effect of targeting intensive glycaemic control versus conventional glycaemic control on all cause mortality and cardiovascular mortality, non-fatal myocardial infarction, microvascular complications, and severe hypoglycaemia in patients with type 2 diabetes. Design Systematic review with meta-analyses and trial sequential analyses of randomised trials. Data sources Cochrane Library, Medline, Embase, Science Citation Index Expanded, LILACS, and CINAHL to December 2010; hand search of reference lists and conference proceedings; contacts with authors, relevant pharmaceutical companies, and the US Food and Drug Administration. Study selection Randomised clinical trials comparing targeted intensive glycaemic control with conventional glycaemic control in patients with type 2 diabetes. Published and unpublished trials in all languages were included, irrespective of predefined outcomes. Data extraction Two reviewers independently assessed studies for inclusion and extracted data related to study methods, interventions, outcomes, risk of bias, and adverse events. Risk ratios with 95% confidence intervals were estimated with fixed and random effects models. Results Fourteen clinical trials that randomised 28 614 participants with type 2 diabetes (15 269 to intensive control and 13 345 to conventional control) were included. Intensive glycaemic control did not significantly affect the relative risks of all cause (1.02, 95% confidence interval 0.91 to 1.13; 28 359 participants, 12 trials) or cardiovascular mortality (1.11, 0.92 to 1.35; 28 359 participants, 12 trials). Trial sequential analyses rejected a relative risk reduction above 10% for all cause mortality and showed insufficient data on cardiovascular mortality. The risk of non-fatal myocardial infarction may be reduced (relative risk 0.85, 0.76 to 0.95; P=0.004; 28 111 participants, 8 trials), but this finding was not confirmed in trial sequential analysis. Intensive glycaemic control showed a reduction of the relative risks for the composite microvascular outcome (0.88, 0.79 to 0.97; P=0.01; 25 600 participants, 3 trials) and retinopathy (0.80, 0.67 to 0.94; P=0.009; 10 793 participants, 7 trials), but trial sequential analyses showed that sufficient evidence had not yet been reached. The estimate of an effect on the risk of nephropathy (relative risk 0.83, 0.64 to 1.06; 27 769 participants, 8 trials) was not statistically significant. The risk of severe hypoglycaemia was significantly increased when intensive glycaemic control was targeted (relative risk 2.39, 1.71 to 3.34; 27 844 participants, 9 trials); trial sequential analysis supported a 30% increased relative risk of severe hypoglycaemia. Conclusion Intensive glycaemic control does not seem to reduce all cause mortality in patients with type 2 diabetes. Data available from randomised clinical trials remain insufficient to prove or refute a relative risk reduction for cardiovascular mortality, non-fatal myocardial infarction, composite microvascular complications, or retinopathy at a magnitude of 10%. Intensive glycaemic control increases the relative risk of severe hypoglycaemia by 30%. PMID:22115901

Utility of genetic and non-genetic risk factors in predicting coronary heart disease in Singaporean Chinese.

PubMed

Chang, Xuling; Salim, Agus; Dorajoo, Rajkumar; Han, Yi; Khor, Chiea-Chuen; van Dam, Rob M; Yuan, Jian-Min; Koh, Woon-Puay; Liu, Jianjun; Goh, Daniel Yt; Wang, Xu; Teo, Yik-Ying; Friedlander, Yechiel; Heng, Chew-Kiat

2017-01-01

Background Although numerous phenotype based equations for predicting risk of 'hard' coronary heart disease are available, data on the utility of genetic information for such risk prediction is lacking in Chinese populations. Design Case-control study nested within the Singapore Chinese Health Study. Methods A total of 1306 subjects comprising 836 men (267 incident cases and 569 controls) and 470 women (128 incident cases and 342 controls) were included. A Genetic Risk Score comprising 156 single nucleotide polymorphisms that have been robustly associated with coronary heart disease or its risk factors ( p < 5 × 10 -8 ) in at least two independent cohorts of genome-wide association studies was built. For each gender, three base models were used: recalibrated Adult Treatment Panel III (ATPIII) Model (M 1 ); ATP III model fitted using Singapore Chinese Health Study data (M 2 ) and M 3 : M 2 + C-reactive protein + creatinine. Results The Genetic Risk Score was significantly associated with incident 'hard' coronary heart disease ( p for men: 1.70 × 10 -10 -1.73 × 10 -9 ; p for women: 0.001). The inclusion of the Genetic Risk Score in the prediction models improved discrimination in both genders (c-statistics: 0.706-0.722 vs. 0.663-0.695 from base models for men; 0.788-0.790 vs. 0.765-0.773 for women). In addition, the inclusion of the Genetic Risk Score also improved risk classification with a net gain of cases being reclassified to higher risk categories (men: 12.4%-16.5%; women: 10.2% (M 3 )), while not significantly reducing the classification accuracy in controls. Conclusions The Genetic Risk Score is an independent predictor for incident 'hard' coronary heart disease in our ethnic Chinese population. Inclusion of genetic factors into coronary heart disease prediction models could significantly improve risk prediction performance.

Menstrual Cycle Control in Female Astronauts and the Associated Risk of Venous Thromboembolism

NASA Technical Reports Server (NTRS)

Jain, Varsha; Wotring, Virginia

2015-01-01

Venous thromboembolism (VTE) is a common and serious condition affecting approximately 1-2 per 1000 people in the USA every year. There have been no documented case reports of VTE in female astronauts during spaceflight in the published literature. Some female astronauts use hormonal contraception to control their menstrual cycles and it is currently unknown how this affects their risk of VTE. Current terrestrial risk prediction models do not account for the spaceflight environment and the physiological changes associated with it. We therefore aim to estimate a specific risk score for female astronauts who are taking hormonal contraception for menstrual cycle control, to deduce whether they are at an elevated risk of VTE. A systematic review of the literature was conducted in order to identify and quantify known terrestrial risk factors for VTE. Studies involving analogues for the female astronaut population were also reviewed, for example, military personnel who use the oral contraceptive pill for menstrual suppression. Well known terrestrial risk factors, for example, obesity or smoking would not be applicable to our study population as these candidates would have been excluded during astronaut selection processes. Other risk factors for VTE include hormonal therapy, lower limb paralysis, physical inactivity, hyperhomocysteinemia, low methylfolate levels and minor injuries, all of which potentially apply to crew members LSAH data will be assessed to identify which of these risk factors are applicable to our astronaut population. Using known terrestrial risk data, an overall estimated risk of VTE for female astronauts using menstrual cycle control methods will therefore be calculated. We predict this will be higher than the general population but not significantly higher requiring thromboprophylaxis. This study attempts to delineate what is assumed to be true of our astronaut population, for example, they are known to be a healthy fit cohort of individuals, and combine physiological impacts of spaceflight (cephalic fluid shifts, lower limb inactivity) to understand specific risks associated with hormonal contraception.

A review on the mechanism, risk evaluation, and prevention of coal spontaneous combustion in China.

PubMed

Kong, Biao; Li, Zenghua; Yang, Yongliang; Liu, Zhen; Yan, Daocheng

2017-10-01

In recent years, the ecology, security, and sustainable development of modern mines have become the theme of coal mine development worldwide. However, spontaneous combustion of coal under conditions of oxygen supply and automatic exothermic heating during coal mining lead to coalfield fires. Coal spontaneous combustion (CSC) causes huge economic losses and casualties, with the toxic and harmful gases produced during coal combustion not only polluting the working environment, but also causing great damage to the ecological environment. China is the world's largest coal producer and consumer; however, coal production in Chinese mines is seriously threatened by the CSC risk. Because deep underground mining methods are commonly adopted in Chinese coal mines, coupling disasters are frequent in these mines with the coalfield fires becoming increasingly serious. Therefore, in this study, we analyzed the development mechanism of CSC. The CSC risk assessment was performed from the aspects of prediction, detection, and determination of the "dangerous area" in a coal mine (i.e., the area most susceptible to fire hazards). A new geophysical method for CSC determination is proposed and analyzed. Furthermore, the main methods for CSC fire prevention and control and their advantages and disadvantages are analyzed. To eventually construct CSC prevention and control integration system, future developmental direction of CSC was given from five aspects. Our results can present a reference for the development of CSC fire prevention and control technology and promote the protection of ecological environment in China.

Inhalation Toxicity of Humidifier Disinfectants as a Risk Factor of Children’s Interstitial Lung Disease in Korea: A Case-Control Study

PubMed Central

Yu, Jinho; Lee, Eun; Jung, Young-Ho; Kim, Hyung-Young; Seo, Ju-Hee; Kwon, Geun-Yong; Park, Ji-Hyuk; Gwack, Jin; Youn, Seung-Ki; Kwon, Jun-Wook; Jun, Byung-Yool; Kim, Kyung Won; Ahn, Kangmo; Lee, Soo-Young; Park, June-Dong; Kwon, Ji-Won; Kim, Byoung-Ju; Lee, Moo-Song; Do, Kyung-Hyun; Jang, Se-Jin; Pyun, Bok-Yang; Hong, Soo-Jong

2013-01-01

Background The occurrence of numerous cases of interstitial lung disease in children (chILD) every spring in Korea starting in 2006 raised suspicion about a causal relationship with the use of humidifier disinfectants (HDs). The aim of this study was to evaluate the association between HD use and the risk of chILD. Methods This retrospective, 1∶3 matched case-control study consisted of 16 cases of chILD that had developed between 2010 and 2011. The three groups of parallel controls (patients with acute lobar pneumonia, asthma, and healthy children) were matched by age, gender, and index date. Indoor/outdoor environmental risk factors, including HD use, were investigated by asking the guardians to complete a questionnaire. Results The median age of the affected children (43.8% male) was 26 months (18.25–36.25). The chILD group did not differ significantly from the control groups with respect to socio-demographic and clinical variables. Indoor and outdoor environmental factors were not associated with a risk of chILD. However, the previous use of HDs (OR; 2.73. 95% CI; 1.41–5.90, P = 0.00) were independently associated with an increased risk. Conclusions This study showed that HDs, which are widely used in South Korea in the winter season, independently increased the risk of chILD in spring. Therefore, continuous monitoring and, if needed, changes in policy are essential to prevent and control pediatric diseases caused by toxic chemicals. PMID:23755124

Recommendations for dealing with waste contaminated with Ebola virus: a Hazard Analysis of Critical Control Points approach

PubMed Central

Edmunds, Kelly L; Elrahman, Samira Abd; Bell, Diana J; Brainard, Julii; Dervisevic, Samir; Fedha, Tsimbiri P; Few, Roger; Howard, Guy; Lake, Iain; Maes, Peter; Matofari, Joseph; Minnigh, Harvey; Mohamedani, Ahmed A; Montgomery, Maggie; Morter, Sarah; Muchiri, Edward; Mudau, Lutendo S; Mutua, Benedict M; Ndambuki, Julius M; Pond, Katherine; Sobsey, Mark D; van der Es, Mike; Zeitoun, Mark

2016-01-01

Abstract Objective To assess, within communities experiencing Ebola virus outbreaks, the risks associated with the disposal of human waste and to generate recommendations for mitigating such risks. Methods A team with expertise in the Hazard Analysis of Critical Control Points framework identified waste products from the care of individuals with Ebola virus disease and constructed, tested and confirmed flow diagrams showing the creation of such products. After listing potential hazards associated with each step in each flow diagram, the team conducted a hazard analysis, determined critical control points and made recommendations to mitigate the transmission risks at each control point. Findings The collection, transportation, cleaning and shared use of blood-soiled fomites and the shared use of latrines contaminated with blood or bloodied faeces appeared to be associated with particularly high levels of risk of Ebola virus transmission. More moderate levels of risk were associated with the collection and transportation of material contaminated with bodily fluids other than blood, shared use of latrines soiled with such fluids, the cleaning and shared use of fomites soiled with such fluids, and the contamination of the environment during the collection and transportation of blood-contaminated waste. Conclusion The risk of the waste-related transmission of Ebola virus could be reduced by the use of full personal protective equipment, appropriate hand hygiene and an appropriate disinfectant after careful cleaning. Use of the Hazard Analysis of Critical Control Points framework could facilitate rapid responses to outbreaks of emerging infectious disease. PMID:27274594

Risk-based approach in valuation of workplace injury rate for transportation and construction industry

NASA Astrophysics Data System (ADS)

Pykhtin, Kirill; Simankina, Tatiana; Sharmanov, Vladimir; Kopytova, Anna

2017-10-01

The danger of injuries and accidents in various industries such as transportation and construction urges the government to control the occupational health and safety more strictly. However, in order to do so with the minimal costs modern risk management tools, have to be implemented. Risk-based approach is an essential tool for competent risk- assessment and used in a great variety of other countries, demonstrating great results in providing of safe working environment. The article describes the problems that the implementation of the method faces in Russia and suggests certain ways to resolve them.

Effects of rational emotive occupational health therapy intervention on the perceptions of organizational climate and occupational risk management practices among electronics technology employees in Nigeria

PubMed Central

Ogbuanya, Theresa Chinyere; Eseadi, Chiedu; Orji, Chibueze Tobias; Ede, Moses Onyemaechi; Ohanu, Ifeanyi Benedict; Bakare, Jimoh

2017-01-01

Abstract Background: Improving employees’ perception of organizational climate, and coaching them to remain steadfast when managing occupational risks associated with their job, might have an important effect on their psychosocial wellbeing and occupational health. This study examined the effects of a rational emotive occupational health therapy intervention program on the perceptions of organizational climate and occupational risk management practices. Methods: The participants were 77 electronics technology employees in the south-east of Nigeria. The study used a pretest–posttest control group design. Results: The rational emotive occupational health therapy intervention program significantly improved perceptions of the organizational climate for the people in the treatment group compared to those in the waitlist control group at post-intervention and follow-up assessments. Occupational risk management practices of the employees in the treatment group were also significantly better than those in the waitlist control group at the same 2 assessments. Conclusions: Corporate application of a rational emotive behavior therapy as an occupational health therapy intervention program is essential for improving the perceptions of organizational climate and promoting the adoption of feasible occupational risk management strategies in the workplace. PMID:28471971

Motor Behavior Reflects Reduced Hemispheric Asymmetry in the Psychosis Risk Period

PubMed Central

Dean, Derek J.; Orr, Joseph M.; Newberry, Raeana E.; Mittal, Vijay A.

2015-01-01

Background A body of work focusing on brain connectivity, language dominance, and motor laterality research suggests reduced hemispheric asymmetry is a core feature in schizophrenia. However, there is little consensus about whether reduced dominance is present in those at ultrahigh risk (UHR) for psychosis. Methods A total of 94 demonstrated right-handed neuroleptic free participants (38 UHR and 56 matched healthy controls) were assessed with structured clinical interviews and completed an innovative handwriting task using a digital tablet computer. A laterality quotient (LQ) was calculated using kinematic variables from the participant’s left and right hands. A subset of the sample (26 UHR and 29 controls) returned after 12-months to complete clinical interviews in order to examine relationships between handwriting laterality and progression of psychosis risk symptoms. Results The UHR group showed decreased dextrality compared to healthy controls. At the 12-month follow-up, decreased dextrality accounted for 8% of the variance in worsened positive symptoms within the UHR group. Conclusion The current results suggest that disrupted cerebral dominance is also present in the ultrahigh risk period and that decreased dextrality may serve as a novel biomarker for the progression of psychosis risk. PMID:26492987

Effects of antithyroid drugs on radioiodine treatment: systematic review and meta-analysis of randomised controlled trials

PubMed Central

Briel, Matthias; Christ-Crain, Mirjam; Bonnema, Steen J; Connell, John; Cooper, David S; Bucher, Heiner C; Müller-Brand, Jan; Müller, Beat

2007-01-01

Objective To determine the effect of adjunctive antithyroid drugs on the risk of treatment failure, hypothyroidism, and adverse events after radioiodine treatment. Design Meta-analysis. Data sources Electronic databases (Cochrane central register of controlled trials, Medline, Embase) searched to August 2006 and contact with experts. Review methods Three reviewers independently assessed trial eligibility and quality. Pooled relative risks for treatment failure and hypothyroidism after radioiodine treatment with and without adjunctive antithyroid drugs were calculated with a random effects model. Results We identified 14 relevant randomised controlled trials with a total of 1306 participants. Adjunctive antithyroid medication was associated with an increased risk of treatment failure (relative risk 1.28, 95% confidence interval 1.07 to 1.52; P=0.006) and a reduced risk for hypothyroidism (0.68, 0.53 to 0.87; P=0.006) after radioiodine treatment. We found no difference in summary estimates for the different antithyroid drugs or for whether antithyroid drugs were given before or after radioiodine treatment. Conclusions Antithyroid drugs potentially increase rates of failure and reduce rates of hypothyroidism if they are given in the week before or after radioiodine treatment, respectively. PMID:17309884

Bladder cancer and occupation: a case-control study in northern Italy.

PubMed Central

Porru, S; Aulenti, V; Donato, F; Boffetta, P; Fazioli, R; Cosciani Cunico, S; Alessio, L

1996-01-01

OBJECTIVES--A hospital based case-control study was conducted between 1992 and 1993 in the province of Brescia, a highly industrialised area in northern Italy, to evaluate occupational risk factors of bladder cancer. METHODS--The study evaluated 355 histologically confirmed cases of bladder cancer (275 men, 80 women) and 579 controls affected by urological non-neoplastic diseases (397 men, 182 women). Lifetime occupational history, smoking and drinking habits, and sociodemographic characteristics were recorded by means of a structured questionnaire. Odds ratios (ORs) were computed with adjustment for age, smoking, alcohol and coffee consumption, education, and place of residence. RESULTS--A significant (P < 0.05) increase of risk of bladder cancer were found in men for labourers in the construction industry (OR 2.1, 95% confidence interval (95% CI) 1.1-3.9) and for recreational and cultural services (OR 5.0, 95% CI 1.3-18.9). Increased risks, although not significant, were found for various other occupations and industries such as machinery mechanics, metal processers and polishers, blacksmiths, gunsmiths, painters; for transport workers, an increased risk with increasing duration of employment was found. CONCLUSIONS--Occupational exposures seem to contribute to bladder cancer risk in the area under study. PMID:8563860

Advantages and Disadvantages of Physiological Assessment For Next Generation Control Room Design

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

Tuan Q. Tran; Ronald L. Boring; Donald D. Dudenhoeffer

2007-08-01

Abstract - We propose using non-obtrusive physiological assessment (e.g., eye tracking,) to assess human information processing errors (e.g., loss of vigilance) and limitations (e.g., workload) for advanced energy systems early in the design process. This physiological approach for assessing risk will circumvent many limitations of current risk methodologies such as subjective rating (e.g., rater’s biases) and performance modeling (e.g., risk assessment is scripted and is based upon the individual modeler’s judgment). Key uses will be to evaluate (early in the design process) novel control room equipment and configurations as well as newly developed automated systems that will inevitably place amore » high information load on operators. The physiological risk assessment tool will allow better precision in pinpointing problematic design issues and will provide a “real-time” assessment of risk. Furthermore, this physiological approach would extend the state-of-the-art of human reliability methods from a “static” measure to more “dynamic.” This paper will discuss a broad range of the current popular online performance gauges as well as its advantages and disadvantages for use in next generation control room.« less

Can Genetics Predict Response to Complex Behavioral Interventions? Evidence from a Genetic Analysis of the Fast Track Randomized Control Trial

PubMed Central

Albert, Dustin; Belsky, Daniel W.; Crowley, D. Max; Latendresse, Shawn J.; Aliev, Fazil; Riley, Brien; Sun, Cuie; Dick, Danielle M.; Dodge, Kenneth R.

2014-01-01

Early interventions are a preferred method for addressing behavioral problems in high-risk children, but often have only modest effects. Identifying sources of variation in intervention effects can suggest means to improve efficiency. One potential source of such variation is the genome. We conducted a genetic analysis of the Fast Track Randomized Control Trial, a 10-year-long intervention to prevent high-risk kindergarteners from developing adult externalizing problems including substance abuse and antisocial behavior. We tested whether variants of the glucocorticoid receptor gene NR3C1 were associated with differences in response to the Fast Track intervention. We found that in European-American children, a variant of NR3C1 identified by the single-nucleotide polymorphism rs10482672 was associated with increased risk for externalizing psychopathology in control group children and decreased risk for externalizing psychopathology in intervention group children. Variation in NR3C1 measured in this study was not associated with differential intervention response in African-American children. We discuss implications for efforts to prevent externalizing problems in high-risk children and for public policy in the genomic era. PMID:26106668

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

Evaluation and applications of the clinically significant change method with the Violence Risk Scale-Sexual Offender version: implications for risk-change communication.

PubMed

Olver, Mark E; Beggs Christofferson, Sarah M; Wong, Stephen C P

2015-02-01

We examined the use of the clinically significant change (CSC) method with the Violence Risk Scale-Sexual Offender version (VRS-SO), and its implications for risk communication, in a combined sample of 945 treated sexual offenders from three international settings, followed up for a minimum 5 years post-release. The reliable change (RC) index was used to identify thresholds of clinically meaningful change and to create four CSC groups (already okay, recovered, improved, unchanged) based on VRS-SO dynamic scores and amount of change made. Outcome analyses demonstrated important CSC-group differences in 5-year rates of sexual and violent recidivism. However, when baseline risk was controlled via Cox regression survival analysis, the pattern and magnitude of CSC-group differences in sexual and violent recidivism changed to suggest that observed variation in recidivism base rates could be at least partly explained by pre-existing group differences in risk level. Implications for communication of risk-change information and applications to clinical practice are discussed. Copyright © 2015 John Wiley & Sons, Ltd.

A power comparison of generalized additive models and the spatial scan statistic in a case-control setting.

PubMed

Young, Robin L; Weinberg, Janice; Vieira, Verónica; Ozonoff, Al; Webster, Thomas F

2010-07-19

A common, important problem in spatial epidemiology is measuring and identifying variation in disease risk across a study region. In application of statistical methods, the problem has two parts. First, spatial variation in risk must be detected across the study region and, second, areas of increased or decreased risk must be correctly identified. The location of such areas may give clues to environmental sources of exposure and disease etiology. One statistical method applicable in spatial epidemiologic settings is a generalized additive model (GAM) which can be applied with a bivariate LOESS smoother to account for geographic location as a possible predictor of disease status. A natural hypothesis when applying this method is whether residential location of subjects is associated with the outcome, i.e. is the smoothing term necessary? Permutation tests are a reasonable hypothesis testing method and provide adequate power under a simple alternative hypothesis. These tests have yet to be compared to other spatial statistics. This research uses simulated point data generated under three alternative hypotheses to evaluate the properties of the permutation methods and compare them to the popular spatial scan statistic in a case-control setting. Case 1 was a single circular cluster centered in a circular study region. The spatial scan statistic had the highest power though the GAM method estimates did not fall far behind. Case 2 was a single point source located at the center of a circular cluster and Case 3 was a line source at the center of the horizontal axis of a square study region. Each had linearly decreasing logodds with distance from the point. The GAM methods outperformed the scan statistic in Cases 2 and 3. Comparing sensitivity, measured as the proportion of the exposure source correctly identified as high or low risk, the GAM methods outperformed the scan statistic in all three Cases. The GAM permutation testing methods provide a regression-based alternative to the spatial scan statistic. Across all hypotheses examined in this research, the GAM methods had competing or greater power estimates and sensitivities exceeding that of the spatial scan statistic.

A power comparison of generalized additive models and the spatial scan statistic in a case-control setting

PubMed Central

2010-01-01

Background A common, important problem in spatial epidemiology is measuring and identifying variation in disease risk across a study region. In application of statistical methods, the problem has two parts. First, spatial variation in risk must be detected across the study region and, second, areas of increased or decreased risk must be correctly identified. The location of such areas may give clues to environmental sources of exposure and disease etiology. One statistical method applicable in spatial epidemiologic settings is a generalized additive model (GAM) which can be applied with a bivariate LOESS smoother to account for geographic location as a possible predictor of disease status. A natural hypothesis when applying this method is whether residential location of subjects is associated with the outcome, i.e. is the smoothing term necessary? Permutation tests are a reasonable hypothesis testing method and provide adequate power under a simple alternative hypothesis. These tests have yet to be compared to other spatial statistics. Results This research uses simulated point data generated under three alternative hypotheses to evaluate the properties of the permutation methods and compare them to the popular spatial scan statistic in a case-control setting. Case 1 was a single circular cluster centered in a circular study region. The spatial scan statistic had the highest power though the GAM method estimates did not fall far behind. Case 2 was a single point source located at the center of a circular cluster and Case 3 was a line source at the center of the horizontal axis of a square study region. Each had linearly decreasing logodds with distance from the point. The GAM methods outperformed the scan statistic in Cases 2 and 3. Comparing sensitivity, measured as the proportion of the exposure source correctly identified as high or low risk, the GAM methods outperformed the scan statistic in all three Cases. Conclusions The GAM permutation testing methods provide a regression-based alternative to the spatial scan statistic. Across all hypotheses examined in this research, the GAM methods had competing or greater power estimates and sensitivities exceeding that of the spatial scan statistic. PMID:20642827

Acute myeloid and chronic lymphoid leukaemias and exposure to low-level benzene among petroleum workers

PubMed Central

Rushton, L; Schnatter, A R; Tang, G; Glass, D C

2014-01-01

Background: High benzene exposure causes acute myeloid leukaemia (AML). Three petroleum case–control studies identified 60 cases (241 matched controls) for AML and 80 cases (345 matched controls) for chronic lymphoid leukaemia (CLL). Methods: Cases were classified and scored regarding uncertainty by two haematologists using available diagnostic information. Blinded quantitative benzene exposure assessment used work histories and exposure measurements adjusted for era-specific circumstances. Statistical analyses included conditional logistic regression and penalised smoothing splines. Results: Benzene exposures were much lower than previous studies. Categorical analyses showed increased ORs for AML with several exposure metrics, although patterns were unclear; neither continuous exposure metrics nor spline analyses gave increased risks. ORs were highest in terminal workers, particularly for Tanker Drivers. No relationship was found between benzene exposure and risk of CLL, although the Australian study showed increased risks in refinery workers. Conclusion: Overall, this study does not persuasively demonstrate a risk between benzene and AML. A previously reported strong relationship between myelodysplastic syndrome (MDS) (potentially previously reported as AML) at our study's low benzene levels suggests that MDS may be the more relevant health risk for lower exposure. Higher CLL risks in refinery workers may be due to more diverse exposures than benzene alone. PMID:24357793

Performing a preliminary hazard analysis applied to administration of injectable drugs to infants.

PubMed

Hfaiedh, Nadia; Kabiche, Sofiane; Delescluse, Catherine; Balde, Issa-Bella; Merlin, Sophie; Carret, Sandra; de Pontual, Loïc; Fontan, Jean-Eudes; Schlatter, Joël

2017-08-01

Errors in hospitals during the preparation and administration of intravenous drugs to infants and children have been reported to a rate of 13% to 84%. This study aimed to investigate the potential for hazardous events that may lead to an accident for preparation and administration of drug injection in a pediatric department and to describe a reduction plan of risks. The preliminary hazard analysis (PHA) method was implemented by a multidisciplinary working group over a period of 5 months (April-August 2014) in infants aged from 28 days to 2 years. The group identified required hazard controls and follow-up actions to reduce the error risk. To analyze the results, the STATCART APR software was used. During the analysis, 34 hazardous situations were identified, among 17 were quoted very critical and drawn 69 risk scenarios. After follow-up actions, the scenarios with unacceptable risk declined from 17.4% to 0%, and these with acceptable under control from 46.4% to 43.5%. The PHA can be used as an aid in the prioritization of corrective actions and the implementation of control measures to reduce risk. The PHA is a complement of the a posteriori risk management already exists. © 2017 John Wiley & Sons, Ltd.

A comparison study of two different control criteria for the real-time management of urban groundwater works.

PubMed

Bauser, G; Hendricks Franssen, Harrie-Jan; Stauffer, Fritz; Kaiser, Hans-Peter; Kuhlmann, U; Kinzelbach, W

2012-08-30

We present the comparison of two control criteria for the real-time management of a water well field. The criteria were used to simulate the operation of the Hardhof well field in the city of Zurich, Switzerland. This well field is threatened by diffuse pollution in the subsurface of the surrounding city area. The risk of attracting pollutants is higher if the pumping rates in four horizontal wells are increased, and can be reduced by increasing artificial recharge in several recharge basins and infiltration wells or by modifying the artificial recharge distribution. A three-dimensional finite elements flow model was built for the Hardhof site. The first control criterion used hydraulic head differences (Δh-criterion) to control the management of the well field and the second criterion used a path line method (%s-criterion) to control the percentage of inflowing water from the city area. Both control methods adapt the allocation of artificial recharge (AR) for given pumping rates in time. The simulation results show that (1) historical management decisions were less effective compared to the optimal control according to the two different criteria and (2) the distribution of artificial recharge calculated with the two control criteria also differ from each other with the %s-criterion giving better results compared to the Δh-criterion. The recharge management with the %s-criterion requires a smaller amount of water to be recharged. The ratio between average artificial recharge and average abstraction is 1.7 for the Δh-criterion and 1.5 for the %s-criterion. Both criteria were tested online. The methodologies were extended to a real-time control method using the Ensemble Kalman Filter method for assimilating 87 online available groundwater head measurements to update the model in real-time. The results of the operational implementation are also satisfying in regard of a reduced risk of well contamination. Copyright © 2012 Elsevier Ltd. All rights reserved.

Methods of using real-time social media technologies for detection and remote monitoring of HIV outcomes.

PubMed

Young, Sean D; Rivers, Caitlin; Lewis, Bryan

2014-06-01

Recent availability of "big data" might be used to study whether and how sexual risk behaviors are communicated on real-time social networking sites and how data might inform HIV prevention and detection. This study seeks to establish methods of using real-time social networking data for HIV prevention by assessing 1) whether geolocated conversations about HIV risk behaviors can be extracted from social networking data, 2) the prevalence and content of these conversations, and 3) the feasibility of using HIV risk-related real-time social media conversations as a method to detect HIV outcomes. In 2012, tweets (N=553,186,061) were collected online and filtered to include those with HIV risk-related keywords (e.g., sexual behaviors and drug use). Data were merged with AIDSVU data on HIV cases. Negative binomial regressions assessed the relationship between HIV risk tweeting and prevalence by county, controlling for socioeconomic status measures. Over 9800 geolocated tweets were extracted and used to create a map displaying the geographical location of HIV-related tweets. There was a significant positive relationship (p<.01) between HIV-related tweets and HIV cases. Results suggest the feasibility of using social networking data as a method for evaluating and detecting Human immunodeficiency virus (HIV) risk behaviors and outcomes. Copyright © 2014 Elsevier Inc. All rights reserved.

Workplace Bullying as a Predictor of Disability Retirement

PubMed Central

Nielsen, Morten Birkeland; Emberland, Jan Shahid; Knardahl, Stein

2017-01-01

Objective: The aim of this study was to determine 1) whether bullying is related to all-cause disability retirement, 2) whether bullying contributes to the variance in disability retirement above high job demands and lack of job control, and 3) to establish gender differences in the relationship. Methods: Survey data from 14,501 Norwegian employees on exposure factors linked to registry data on all-cause disability retirement. Results: Bullying significantly predicted risk of disability retirement (hazard ratio = 1.55; 95% confidence interval = 1.13 to 2.12). This relationship remained statistically significant after adjusting for job demands and lack of job control. Women had the highest risk of disability, but both bullied men and women had a higher risk of disability than nonbullied employees of the same gender. Conclusion: Bullying is a risk factor for disability retirement. Measures taken to prevent bullying may be beneficial for reducing both health problems and disability retirement. PMID:28445177

First-Year Results of an Obesity Prevention Program at The Dow Chemical Company

PubMed Central

Goetzel, Ron Z.; Baker, Kristin M.; Short, Meghan E.; Pei, Xiaofei; Ozminkowski, Ronald J.; Wang, Shaohung; Bowen, Jennie D.; Roemer, Enid C.; Craun, Beth A.; Tully, Karen J.; Baase, Catherine M.

2010-01-01

Objective To examine first-year results from a workplace environmental obesity prevention program at The Dow Chemical Company. Methods A quasi-experimental cohort study was conducted among employees at nine treatment worksites (n=8,013) who received environmental weight management interventions and three control worksites (n=2,269). Changes in employees’ weight, body mass index (BMI), and other health risks were examined using chi-square and t-tests. Results After one year, a modest treatment effect was observed for weight and BMI largely because the control group subjects gained weight; however, no effect was observed for overweight and obesity prevalence. Other risk factors (tobacco use, high blood pressure, and systolic and diastolic blood pressure values) decreased significantly, although blood glucose (high risk prevalence and values) increased. Conclusions Environmental changes to the workplace can achieve modest improvements in employees’ health risks, including weight and BMI measures, in one year. PMID:19209033

Combining Knowledge and Data Driven Insights for Identifying Risk Factors using Electronic Health Records

PubMed Central

Sun, Jimeng; Hu, Jianying; Luo, Dijun; Markatou, Marianthi; Wang, Fei; Edabollahi, Shahram; Steinhubl, Steven E.; Daar, Zahra; Stewart, Walter F.

2012-01-01

Background: The ability to identify the risk factors related to an adverse condition, e.g., heart failures (HF) diagnosis, is very important for improving care quality and reducing cost. Existing approaches for risk factor identification are either knowledge driven (from guidelines or literatures) or data driven (from observational data). No existing method provides a model to effectively combine expert knowledge with data driven insight for risk factor identification. Methods: We present a systematic approach to enhance known knowledge-based risk factors with additional potential risk factors derived from data. The core of our approach is a sparse regression model with regularization terms that correspond to both knowledge and data driven risk factors. Results: The approach is validated using a large dataset containing 4,644 heart failure cases and 45,981 controls. The outpatient electronic health records (EHRs) for these patients include diagnosis, medication, lab results from 2003–2010. We demonstrate that the proposed method can identify complementary risk factors that are not in the existing known factors and can better predict the onset of HF. We quantitatively compare different sets of risk factors in the context of predicting onset of HF using the performance metric, the Area Under the ROC Curve (AUC). The combined risk factors between knowledge and data significantly outperform knowledge-based risk factors alone. Furthermore, those additional risk factors are confirmed to be clinically meaningful by a cardiologist. Conclusion: We present a systematic framework for combining knowledge and data driven insights for risk factor identification. We demonstrate the power of this framework in the context of predicting onset of HF, where our approach can successfully identify intuitive and predictive risk factors beyond a set of known HF risk factors. PMID:23304365

Perceived Academic Performance, Self-Esteem and Locus of Control as Indicators of Need for Assessment of Adolescent Suicide Risk: Implications for Teachers

ERIC Educational Resources Information Center

Martin, Graham; Richardson, Angela S.; Bergen, Helen A.; Roeger, Leigh; Allison, Stephen

2005-01-01

Introduction: There is currently a need for research into indicators that could be used by non-clinical professionals working with young people, to inform the need for referral for further clinical assessment of those at risk of suicide. Method: Participants of this repeated measures longitudinal study, were 2603, 2485, and 2246 school students…

Risk Factors for Drug Abuse among Nepalese Samples Selected from a Town of Eastern Nepal

ERIC Educational Resources Information Center

Niraula, Surya Raj; Chhetry, Devendra Bahadur; Singh, Girish Kumar; Nagesh, S.; Shyangwa, Pramod Mohan

2009-01-01

The study focuses on the serious issue related to the adolescents' and adults' behavior and health. It aims to identify the risk factors for drug abuse from samples taken from a town of Eastern Nepal. This is a matched case-control study. The conditional logistic regression method was adopted for data analysis. The diagnosis cut off was determined…

Privacy and information security risks in a technology platform for home-based chronic disease rehabilitation and education

PubMed Central

2013-01-01

Background Privacy and information security are important for all healthcare services, including home-based services. We have designed and implemented a prototype technology platform for providing home-based healthcare services. It supports a personal electronic health diary and enables secure and reliable communication and interaction with peers and healthcare personnel. The platform runs on a small computer with a dedicated remote control. It is connected to the patient’s TV and to a broadband Internet. The platform has been tested with home-based rehabilitation and education programs for chronic obstructive pulmonary disease and diabetes. As part of our work, a risk assessment of privacy and security aspects has been performed, to reveal actual risks and to ensure adequate information security in this technical platform. Methods Risk assessment was performed in an iterative manner during the development process. Thus, security solutions have been incorporated into the design from an early stage instead of being included as an add-on to a nearly completed system. We have adapted existing risk management methods to our own environment, thus creating our own method. Our method conforms to ISO’s standard for information security risk management. Results A total of approximately 50 threats and possible unwanted incidents were identified and analysed. Among the threats to the four information security aspects: confidentiality, integrity, availability, and quality; confidentiality threats were identified as most serious, with one threat given an unacceptable level of High risk. This is because health-related personal information is regarded as sensitive. Availability threats were analysed as low risk, as the aim of the home programmes is to provide education and rehabilitation services; not for use in acute situations or for continuous health monitoring. Conclusions Most of the identified threats are applicable for healthcare services intended for patients or citizens in their own homes. Confidentiality risks in home are different from in a more controlled environment such as a hospital; and electronic equipment located in private homes and communicating via Internet, is more exposed to unauthorised access. By implementing the proposed measures, it has been possible to design a home-based service which ensures the necessary level of information security and privacy. PMID:23937965

Urinary Levels of N-Nitroso Compounds in Relation to Risk of Gastric Cancer: Findings from the Shanghai Cohort Study

PubMed Central

Xu, Ling; Qu, Yong-Hua; Chu, Xin-Di; Wang, Renwei; Nelson, Heather H.; Gao, Yu-Tang; Yuan, Jian-Min

2015-01-01

Background N-Nitroso compounds are thought to play a significant role in the development of gastric cancer. Epidemiological data, however, are sparse in examining the associations between biomarkers of exposure to N-nitroso compounds and the risk of gastric cancer. Methods A nested case-control study within a prospective cohort of 18,244 middle-aged and older men in Shanghai, China, was conducted to examine the association between urinary level of N-nitroso compounds and risk of gastric cancer. Information on demographics, usual dietary intake, and use of alcohol and tobacco was collected through in-person interviews at enrollment. Urinary levels of nitrate, nitrite, N-nitroso-2-methylthiazolidine-4-carboxylic acid (NMTCA), N-nitrosoproline (NPRO), N-nitrososarcosine (NSAR), N-nitrosothiazolidine-4-carboxylic acid (NTCA), as well as serum H. pylori antibodies were quantified in 191 gastric cancer cases and 569 individually matched controls. Logistic regression method was used to assess the association between urinary levels of N-nitroso compounds and risk of gastric cancer. Results Compared with controls, gastric cancer patients had overall comparable levels of urinary nitrate, nitrite, and N-nitroso compounds. Among individuals seronegative for antibodies to H. pylori, elevated levels of urinary nitrate were associated with increased risk of gastric cancer. The multivariate-adjusted odds ratios for the second and third tertiles of nitrate were 3.27 (95% confidence interval = 0.76–14.04) and 4.82 (95% confidence interval = 1.05–22.17), respectively, compared with the lowest tertile (P for trend = 0.042). There was no statistically significant association between urinary levels of nitrite or N-nitroso compounds and risk of gastric cancer. Urinary NMTCA level was significantly associated with consumption of alcohol and preserved meat and fish food items. Conclusion The present study demonstrates that exposure to nitrate, a precursor of N-nitroso compounds, may increase the risk of gastric cancer among individuals without a history of H. pylori infection. PMID:25658333

Integrating rapid risk mapping and mobile phone call record data for strategic malaria elimination planning

PubMed Central

2014-01-01

Background As successful malaria control programmes re-orientate towards elimination, the identification of transmission foci, targeting of attack measures to high-risk areas and management of importation risk become high priorities. When resources are limited and transmission is varying seasonally, approaches that can rapidly prioritize areas for surveillance and control can be valuable, and the most appropriate attack measure for a particular location is likely to differ depending on whether it exports or imports malaria infections. Methods/Results Here, using the example of Namibia, a method for targeting of interventions using surveillance data, satellite imagery, and mobile phone call records to support elimination planning is described. One year of aggregated movement patterns for over a million people across Namibia are analyzed, and linked with case-based risk maps built on satellite imagery. By combining case-data and movement, the way human population movements connect transmission risk areas is demonstrated. Communities that were strongly connected by relatively higher levels of movement were then identified, and net export and import of travellers and infection risks by region were quantified. These maps can aid the design of targeted interventions to maximally reduce the number of cases exported to other regions while employing appropriate interventions to manage risk in places that import them. Conclusions The approaches presented can be rapidly updated and used to identify where active surveillance for both local and imported cases should be increased, which regions would benefit from coordinating efforts, and how spatially progressive elimination plans can be designed. With improvements in surveillance systems linked to improved diagnosis of malaria, detailed satellite imagery being readily available and mobile phone usage data continually being collected by network providers, the potential exists to make operational use of such valuable, complimentary and contemporary datasets on an ongoing basis in infectious disease control and elimination. PMID:24512144

Influence of Insulation Monitoring Devices on the Operation of DC Control Circuits

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

Olszowiec, Piotr, E-mail: olpio@o2.pl

The insulation level of DC control circuits is an important safety-critical factor and, thus, should be subject to continuous and periodic monitoring. The methods used for monitoring the insulation in live circuits may, however, disturb the reliable operation of control relays. The risks of misoperation and failure to reset of relays posed by the operation of various insulation monitoring and fault location systems are evaluated.

Guidelines for Risk-Based Changeover of Biopharma Multi-Product Facilities.

PubMed

Lynch, Rob; Barabani, David; Bellorado, Kathy; Canisius, Peter; Heathcote, Doug; Johnson, Alan; Wyman, Ned; Parry, Derek Willison

2018-01-01

In multi-product biopharma facilities, the protection from product contamination due to the manufacture of multiple products simultaneously is paramount to assure product quality. To that end, the use of traditional changeover methods (elastomer change-out, full sampling, etc.) have been widely used within the industry and have been accepted by regulatory agencies. However, with the endorsement of Quality Risk Management (1), the use of risk-based approaches may be applied to assess and continuously improve established changeover processes. All processes, including changeover, can be improved with investment (money/resources), parallel activities, equipment design improvements, and standardization. However, processes can also be improved by eliminating waste. For product changeover, waste is any activity not needed for the new process or that does not provide added assurance of the quality of the subsequent product. The application of a risk-based approach to changeover aligns with the principles of Quality Risk Management. Through the use of risk assessments, the appropriate changeover controls can be identified and controlled to assure product quality is maintained. Likewise, the use of risk assessments and risk-based approaches may be used to improve operational efficiency, reduce waste, and permit concurrent manufacturing of products. © PDA, Inc. 2018.

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

3-DIMENSIONAL EXTERNAL BEAM RADIOTHERAPY FOR PROSTATE CANCER INCREASES THE RISK OF HIP FRACTURE

PubMed Central

Elliott, Sean P.; Jarosek, Stephanie L.; Alanee, Shaheen R.; Konety, Badrinath R.; Dusenbery, Kathryn E.; Virnig, Beth A.

2011-01-01

Background Hip fracture is associated with high morbidity and mortality. Pelvic external beam radiotherapy (EBRT) is known to increase the risk of hip fractures in women but the effect in men is unknown. Methods 45,662 men aged ≥66 years, diagnosed with prostate cancer in 1992–2004 were identified from the SEER-Medicare database. Using Kaplan-Meier methods and Cox proportional hazards models, the primary outcome of hip fracture risk was compared among men who received radical prostatectomy (RP), EBRT, EBRT+androgen suppression therapy (AST) or AST alone, controlling for age, osteoporosis, race and other comorbidities. A secondary outcome was distal forearm fractures as an indicator of fragility fracture risk outside the radiation field. Results After controlling for covariates, EBRT increased the risk of hip fractures by 76% (HR 1.76, 95% CI 1.38–2.40) without increasing the risk of distal forearm fractures (HR 0.80, 95% CI 0.56–1.14). Combination therapy with EBRT+AST increased the risk of hip fracture 145% relative to RP (HR 2.45, 95% CI 1.88–3.19) and by 40% relative to EBRT (HR 1.40, 95% CI 1.17–1.68). EBRT+AST increased the risk of distal forearm fracture by 43% relative to RP (HR 1.43, 95% CI 0.97–2.10). The number needed to treat to result in 1 hip fracture through 10 years was 51 (95% CI 31–103). Conclusion In men with prostate cancer, pelvic 3-D conformal EBRT is associated with a 76% increased risk of hip fracture. This risk is slightly increased further by the addition of short-course AST to EBRT. This risk associated with EBRT is site-specific as there is no increase in the risk of fall-related fractures outside the radiation field. PMID:21412999

Online market research panel members as controls in case-control studies to investigate gastrointestinal disease outbreaks: early experiences and lessons learnt from the UK.

PubMed

Mook, P; McCormick, J; Kanagarajah, S; Adak, G K; Cleary, P; Elson, R; Gobin, M; Hawker, J; Inns, T; Sinclair, C; Trienekens, S C M; Vivancos, R; McCarthy, N D

2018-03-01

Established methods of recruiting population controls for case-control studies to investigate gastrointestinal disease outbreaks can be time consuming, resulting in delays in identifying the source or vehicle of infection. After an initial evaluation of using online market research panel members as controls in a case-control study to investigate a Salmonella outbreak in 2013, this method was applied in four further studies in the UK between 2014 and 2016. We used data from all five studies and interviews with members of each outbreak control team and market research panel provider to review operational issues, evaluate risk of bias in this approach and consider methods to reduce confounding and bias. The investigators of each outbreak reported likely time and cost savings from using market research controls. There were systematic differences between case and control groups in some studies but no evidence that conclusions on the likely source or vehicle of infection were incorrect. Potential selection biases introduced by using this sampling frame and the low response rate are unclear. Methods that might reduce confounding and some bias should be balanced with concerns for overmatching. Further evaluation of this approach using comparisons with traditional methods and population-based exposure survey data is recommended.

Monitoring of Lactic Fermentation Process by Ultrasonic Technique

NASA Astrophysics Data System (ADS)

Alouache, B.; Touat, A.; Boutkedjirt, T.; Bennamane, A.

The non-destructive control by using ultrasound techniques has become of great importance in food industry. In this work, Ultrasound has been used for quality control and monitoring the fermentation stages of yogurt, which is a highly consumed product. On the contrary to the physico-chemical methods, where the measurement instruments are directly introduced in the sample, ultrasound techniques have the advantage of being non-destructive and contactless, thus reducing the risk of contamination. Results obtained in this study by using ultrasound seem to be in good agreement with those obtained by physico-chemical methods such as acidity measurement by using a PH-meter instrument. This lets us to conclude that ultrasound method may be an alternative for a healthy control of yoghurt fermentation process.

Height, height-related SNPs, and risk of non-melanoma skin cancer

PubMed Central

Li, Xin; Liang, Liming; Feng, Yen-Chen Anne; De Vivo, Immaculata; Giovannucci, Edward; Tang, Jean Y; Han, Jiali

2017-01-01

Background: Adult height has been associated with risk of several site-specific cancers, including melanoma. However, less attention has been given to non-melanoma skin cancer (NMSC). Methods: We prospectively examined the risk of squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) in relation to adult height in the Nurses' Health Study (NHS, n=117 863) and the Health Professionals Follow-up Study (HPFS, n=51 111). We also investigated the relationships between height-related genetic markers and risk of BCC and SCC in the genetic data sets of the NHS and HPFS (3898 BCC cases, and 8530 BCC controls; 527 SCC cases, and 8962 SCC controls). Results: After controlling for potential confounding factors, the hazard ratios were 1.09 (95% CI: 1.02, 1.15) and 1.10 (95% CI: 1.07, 1.13) for the associations between every 10 cm increase in height and risk of SCC and BCC respectively. None of the 687 height-related single-nucleotide polymorphisms (SNPs) was significantly associated with the risk of SCC or BCC, nor were the genetic scores combining independent height-related loci. Conclusions: Our data from two large cohorts provide further evidence that height is associated with an increased risk of NMSC. More studies on height-related genetic loci and early-life exposures may help clarify the underlying mechanisms. PMID:27846199

Gene-environment interaction between adiponectin gene polymorphisms and environmental factors on the risk of diabetic retinopathy.

PubMed

Li, Yuan; Wu, Qun Hong; Jiao, Ming Li; Fan, Xiao Hong; Hu, Quan; Hao, Yan Hua; Liu, Ruo Hong; Zhang, Wei; Cui, Yu; Han, Li Yuan

2015-01-01

To evaluate whether the adiponectin gene is associated with diabetic retinopathy (DR) risk and interaction with environmental factors modifies the DR risk, and to investigate the relationship between serum adiponectin levels and DR. Four adiponectin polymorphisms were evaluated in 372 DR cases and 145 controls. Differences in environmental factors between cases and controls were evaluated by unconditional logistic regression analysis. The model-free multifactor dimensionality reduction method and traditional multiple regression models were applied to explore interactions between the polymorphisms and environmental factors. Using the Bonferroni method, we found no significant associations between four adiponectin polymorphisms and DR susceptibility. Multivariate logistic regression found that physical activity played a protective role in the progress of DR, whereas family history of diabetes (odds ratio 1.75) and insulin therapy (odds ratio 1.78) were associated with an increased risk for DR. The interaction between the C-11377 G (rs266729) polymorphism and insulin therapy might be associated with DR risk. Family history of diabetes combined with insulin therapy also increased the risk of DR. No adiponectin gene polymorphisms influenced the serum adiponectin levels. Serum adiponectin levels did not differ between the DR group and non-DR group. No significant association was identified between four adiponectin polymorphisms and DR susceptibility after stringent Bonferroni correction. The interaction between C-11377G (rs266729) polymorphism and insulin therapy, as well as the interaction between family history of diabetes and insulin therapy, might be associated with DR susceptibility.

Comparison through a prospective and randomized study of two replenishment methods at polyvalent hospitalization units with two-bin storage systems

PubMed

Bernal, José Luis; Mera-Flores, Ana María; Baena Lázaro, Pedro Pablo; Sebastián Viana, Tomás

2017-11-27

Two-bin storage systems increase nursing staff satisfaction and decrease inventories, but the implications that logistic staff would determine the needs of replenishment are unknown. This study aimed to evaluate whether entrust to logistics staff this responsibility at the polyvalent hospitalization units with two-bin storage is associated with higher risk of outstanding orders. This was a prospective randomized experiment whit masking. Outstanding orders were considered variable response, those corresponding to assessments of the logistics staff were included in the control group and those corresponding to the nursing staff in the control group. Concordance between observers was analyzed using the Bland-Altman method; the difference between groups, with the U of Mann-Whitney and the cumulative incidence of outstanding orders and their relative risk was calculated. The mean amount requested by the logistic and nursing staff was 29.9 (SD:167.4) and 36 (SD:190) units respectively, the mean difference between observers was 6.11 (SD:128.95) units and no significant differences were found between groups (p = 0.430). The incidence of outstanding orders was 0.64% in the intervention group and 0.15% in the control group; the relative risk, 2.31 (0.83 - 6.48) and the number of cases required for an outstanding order, 516. Outstanding order relative risk is not associated with the category of the staff that identifies the replenishment needs at the polyvalent hospitalization units.

Polymorphism Thr160Thr in SRD5A1, involved in the progesterone metabolism, modifies postmenopausal breast cancer risk associated with menopausal hormone therapy.

PubMed

Hein, R; Abbas, S; Seibold, P; Salazar, R; Flesch-Janys, D; Chang-Claude, J

2012-01-01

Menopausal hormone therapy (MHT) is associated with an increased breast cancer risk in postmenopausal women, with combined estrogen-progestagen therapy posing a greater risk than estrogen monotherapy. However, few studies focused on potential effect modification of MHT-associated breast cancer risk by genetic polymorphisms in the progesterone metabolism. We assessed effect modification of MHT use by five coding single nucleotide polymorphisms (SNPs) in the progesterone metabolizing enzymes AKR1C3 (rs7741), AKR1C4 (rs3829125, rs17134592), and SRD5A1 (rs248793, rs3736316) using a two-center population-based case-control study from Germany with 2,502 postmenopausal breast cancer patients and 4,833 matched controls. An empirical-Bayes procedure that tests for interaction using a weighted combination of the prospective and the retrospective case-control estimators as well as standard prospective logistic regression were applied to assess multiplicative statistical interaction between polymorphisms and duration of MHT use with regard to breast cancer risk assuming a log-additive mode of inheritance. No genetic marginal effects were observed. Breast cancer risk associated with duration of combined therapy was significantly modified by SRD5A1_rs3736316, showing a reduced risk elevation in carriers of the minor allele (p (interaction,empirical-Bayes) = 0.006 using the empirical-Bayes method, p (interaction,logistic regression) = 0.013 using logistic regression). The risk associated with duration of use of monotherapy was increased by AKR1C3_rs7741 in minor allele carriers (p (interaction,empirical-Bayes) = 0.083, p (interaction,logistic regression) = 0.029) and decreased in minor allele carriers of two SNPs in AKR1C4 (rs3829125: p (interaction,empirical-Bayes) = 0.07, p (interaction,logistic regression) = 0.021; rs17134592: p (interaction,empirical-Bayes) = 0.101, p (interaction,logistic regression) = 0.038). After Bonferroni correction for multiple testing only SRD5A1_rs3736316 assessed using the empirical-Bayes method remained significant. Postmenopausal breast cancer risk associated with combined therapy may be modified by genetic variation in SRD5A1. Further well-powered studies are, however, required to replicate our finding.

Effect of employee worktime control on health: a prospective cohort study

PubMed Central

Ala-Mursula, L; Vahtera, J; Pentti, J; Kivimaki, M

2004-01-01

Aims: To investigate the health effects of employee worktime control. Methods: Prospective cohort study among 4218 permanent full time municipal employees linking questionnaire data from 1997 and 2000 with sickness absence records from 1997 and 2001. Worktime control was considered high for the highest tertile in both 1997 and 2000, low for the lowest tertile for both years, and intermediate for all other combinations. Self rated health status, psychological distress, and medically certified periods of sickness absence were used as the health outcomes. Adjustments were made for age, baseline health status, occupational status, marital status, dependent children, and behavioural health risks. Results: In the follow up, women with a low level of worktime control had a 1.9 times (95% CI 1.4 to 2.5) higher odds ratio for poor self rated health, a 1.4 times (95% CI 1.1 to 1.8) higher odds ratio for psychological distress, and a 1.5 times (95% CI 1.3 to 1.7) higher risk of medically certified sickness absences than women with a high level of worktime control. The health effects of worktime control were particularly evident among women with families. Among men, worktime control was not associated with self rated health or distress, but it predicted sickness absences in two subgroups: those with dependent children and those with manual occupations. Conclusions: A low level of worktime control increases the risk of future health problems. The risk is highest among women, especially those with families, and among manual workers. The results suggest that worktime control can help workers integrate their work and private lives successfully. PMID:14985521

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

PubMed Central

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

2016-01-01

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

Reducing sexual risk behaviors: secondary analyses from a randomized controlled trial of a brief web-based alcohol intervention for underage, heavy episodic drinking college women

PubMed Central

Bountress, Kaitlin E.; Metzger, Isha W.; Maples-Keller, Jessica L.; Gilmore, Amanda K.

2017-01-01

Background Alcohol use and sexual risk behaviors (SRBs) are significant problems on college campuses. College women are at particularly high risk for negative consequences associated with sexually transmitted infections (STIs) and unwanted pregnancy. Methods The current study (n = 160) examined the effect of a brief, web-based alcohol intervention (n = 53) for college women on reducing SRBs compared to an assessment only control (n = 107) with a randomized controlled trial. Outcome measures included condom use assertiveness and number of vaginal sex partners and data were collected at baseline and three-month follow-up. Results Regression analyses revealed that the alcohol intervention was associated with higher levels of condom use assertiveness at a three-month follow-up. Additionally, more alcohol use was associated with less condom use assertiveness for those with more significant sexual assault histories. Conclusions These findings suggest that alcohol interventions may impact college women’s beliefs but not behavior, and future interventions should more explicitly target both alcohol and sexual risk to decrease risky behaviors. PMID:28428737

What's in a name? Perceptions of stray and feral cat welfare and control in Aotearoa, New Zealand.

PubMed

Farnworth, Mark J; Campbell, Joanna; Adams, Nigel J

2011-01-01

New Zealanders (n = 354) rated the acceptability of lethal and nonlethal cat control methods and the importance of conservation and welfare. Lethal control was more acceptable for feral cats than strays; for nonlethal control, the inverse was true. More than concern for the welfare of cats subjected to control, perceived conservation benefits, risk of disease transfer, and companion cat welfare dictated the acceptability of control measures. Similarly, the welfare consideration for groups of cats differed, transitioning from companion (highest) to feral (lowest). Differences in attitudes toward acceptability of control methods were evident. In particular, nonhuman animal professionals ranked lethal control as more acceptable than did nonanimal professionals. Cat caregivers (owners) considered both conservation and welfare issues of greater importance than did nonowners. Owners ranked the acceptability of nonlethal control methods higher for stray cats, but not feral, than did nonowners. This research indicates that the use of the terms stray and feral may have significant impact on cats in New Zealand. There is also a greater consideration of conservation values than of welfare in stray and feral cat control.

Implementing Low-Cost, Community-Based Exercise Programs for Middle-Aged and Older Patients with Type 2 Diabetes: What Are the Benefits for Glycemic Control and Cardiovascular Risk?

PubMed Central

Reis, Victor Machado; Themudo-Barata, Jose Luis

2017-01-01

Background: The purpose of this study was to analyze the effects of a long-term, community-based, combined exercise program developed with low-cost exercise strategies on glycemic control and cardiovascular risk factors in middle-aged and older patients with type 2 diabetes. Methods: Participants (n = 124; 63.25 ± 7.20 years old) engaged in either a 9-month supervised exercise program (n = 39; consisting of combined aerobic, resistance, agility/balance, and flexibility exercise; three sessions per week; 70 min per session) or a control group (n = 85) who maintained their usual care. Glycemic control, lipid profile, blood pressure, anthropometric profile, and the 10-year risk of coronary artery disease were assessed before and after the 9-month intervention. Results: A significant time * group interaction effect (p < 0.001) was identified in the values of the glycated hemoglobin, fasting plasma glucose, total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, systolic blood pressure, diastolic blood pressure, body mass index, waist circumference, and the 10-year risk of coronary artery disease. Conclusions: A long-term, community-based, combined exercise program developed with low-cost exercise strategies was effective in inducing significant benefits on glycemic control, lipid profile, blood pressure, anthropometric profile, and the 10-year risk of coronary artery disease in middle-aged and older patients with type 2 diabetes. Clinical Trial Identification Number: ISRCTN09240628. PMID:28902144

[A screening program for detecting children with an increased SIDS risk (sudden and unexpected infant death)].

PubMed

Scholle, S; Zwacka, G; Scheidt, B; Glaser, S; Oehme, P; Rathsack, R

1989-01-01

The prospective study presented conducted to prevent SIDS (sudden infant death syndrome). One of the proposed hypotheses on SIDS postulates a brainstem abnormality in the neuroregulation of cardiorespiratory processes. Therefore we characterized cardiorespiratory control mechanisms by examining the neurotransmitter substance P in plasma and polysomnographic investigations. With respect to the probable multifactorial origin of SIDS we selected children firstly anamnestically by means of an epidemiologically evaluated pre-, peri- and postnatal risk score. We reported the results of 208 polysomnographically and biochemically examined children anamnestically selected from a group of 2500 neonates. Examinations were performed on infants aged 2-4 weeks up to 1 year. To characterize respiratory control, length and frequency of apnoeas were separately estimated by means of polysomnography in the sleep states active and quiet sleep. If there were polygraphic risk factors representing a disturbance of respiratory control, the children were prophylactically treated with aminophylline 3 x 3 mg/kg b.w. for 4 weeks. We found a significant age dependence both of the mean apnoea duration in active sleep and the substance P level in plasma in the SIDS-risk group but not in the controls. High mean apnoea duration was correlated with low substance P level in the first months of age in SIDS risk infants selected anamnestically. This may reflect a delayed maturation of respiratory control mechanisms. In this way the polysomnography and the investigation of the neuropeptide substance P may be useful for a screening method indicating wether the respiratory control mechanisms are mature or not.

Improving adolescent mental health and resilience through a resilience-based intervention in schools: study protocol for a randomised controlled trial

PubMed Central

2014-01-01

Background Research investigating the effectiveness of universal interventions to reduce the risk of mental health problems remains limited. Schools are a promising setting within which adolescents can receive interventions aimed at promoting their mental health. The aim of this study is to assess the effectiveness of a resilience-based prevention-focused intervention in reducing the risk of mental health problems among adolescents attending secondary school in socio-economically disadvantaged areas. Methods/design A cluster randomised control trial will be conducted, with schools as the unit of randomisation. Initially, 32 secondary schools will be randomly allocated to a control or intervention group (12 control and 20 intervention). An intervention focused on improving student internal and external resilience factors will be implemented in intervention schools. A survey of students in Grade 7 in both intervention and control schools will be conducted (baseline) and repeated three years later when the students are in Grade 10. The Strengths and Difficulties Questionnaire will be used to measure the risk of mental health problems. At follow-up, the risk of mental health problems will be compared between Grade 10 students in intervention and control schools to determine intervention effectiveness. Discussion The study presents an opportunity to determine the effectiveness of a comprehensive resilience-based intervention in reducing the risk of mental health problems in adolescents attending secondary schools. The outcomes of the trial are of importance to youth, schools, mental health clinicians and policymakers. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12611000606987, registered 14 June 2011. PMID:25037455

Buffering Syndemic Effects in a Sexual Risk-Reduction Intervention for Male Clients of Female Sex Workers: Results From a Randomized Controlled Trial

PubMed Central

Strathdee, Steffanie A.; Semple, Shirley J.; Chavarin, Claudia V.; Magis-Rodriguez, Carlos; Patterson, Thomas L.

2015-01-01

Objectives. We sought to test the efficacy of a sexual risk intervention for male clients of female sex workers (FSWs) and examine whether efficacy was moderated by syndemic risk. Methods. From 2010 to 2014, we conducted a 2-arm randomized controlled trial (60-minute, theory-based, safer sex intervention versus a didactic time-equivalent attention control) that included 400 male clients of FSWs on the US–Mexico border with follow-up at 4, 8, and 12 months. We measured 5 syndemic risk factors, including substance use and depression. Primary outcomes were sexually transmitted infections incidence and total unprotected sex with FSWs. Results. Although participants in both groups became safer, there was no significant difference in behavior change between groups. However, baseline syndemic risk moderated intervention efficacy. At baseline, there was a positive association between syndemic risk and unprotected sex. Then at 12 months, longitudinal analyses showed the association depended on intervention participation (B = −0.71; 95% confidence interval [CI] = –1.22, –0.20; P = .007). Among control participants there still existed this modest association (B = 0.36; 95% CI = –0.49, 1.22; P = .09); among intervention participants there was a significant negative association (B = −0.35; 95% CI = –0.63, –0.06; P = .02). Conclusion. A brief intervention might attenuate syndemic risks among clients of FSWs. Other populations experiencing syndemic problems may also benefit from such programs. PMID:25713953

Neurochemical deficits in the cerebellar vermis in child offspring of parents with bipolar disorder

PubMed Central

Singh, Manpreet K; Spielman, Daniel; Libby, Allison; Adams, Elizabeth; Acquaye, Tenah; Howe, Meghan; Kelley, Ryan; Reiss, Allan; Chang, Kiki D

2011-01-01

Objectives We aimed to compare concentrations of N-acetyl aspartate, myo-inositol, and other neurometabolites in the cerebellar vermis of offspring at risk for bipolar disorder (BD) and healthy controls to examine whether changes in these neuronal metabolite concentrations occur in at-risk offspring prior to the onset of mania. Methods A total of 22 children and adolescents aged 9–17 years with a familial risk for bipolar I or II disorder [at-risk offspring with non-bipolar I disorder mood symptoms (AR)], and 25 healthy controls (HC) were examined using proton magnetic resonance spectroscopy at 3T to study metabolite concentrations in an 8-cc voxel in the cerebellar vermis. Results Decreased myo-inositol and choline concentrations in the vermis were seen in the AR group compared to HC (p < 0.01). Conclusions Decreased cellular metabolism and interference with second messenger pathways may be present in the cerebellar vermis in youth at risk for BD as evident by decreased myo-inositol and choline concentrations in this region. These results may be limited by a cross-sectional design, co-occurring diagnoses, and medication exposure. Longitudinal studies are necessary to determine whether early neurochemical changes can predict the development of mania. Improved methods for identifying children with certain neurochemical vulnerabilities may inform preventive and early intervention strategies prior to the onset of mania. PMID:21443573

Should in-line filters be used in peripheral intravenous catheters to prevent infusion-related phlebitis? A systematic review of randomized controlled trials.

PubMed

Niël-Weise, Barbara S; Stijnen, Theo; van den Broek, Peterhans J

2010-06-01

In this systematic review, we assessed the effect of in-line filters on infusion-related phlebitis associated with peripheral IV catheters. The study was designed as a systematic review and meta-analysis of randomized controlled trials. We used MEDLINE and the Cochrane Controlled Trial Register up to August 10, 2009. Two reviewers independently assessed trial quality and extracted data. Data on phlebitis were combined when appropriate, using a random-effects model. The impact of the risk of phlebitis in the control group (baseline risk) on the effect of in-line filters was studied by using meta-regression based on the bivariate meta-analysis model. The quality of the evidence was determined by using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) method. Eleven trials (1633 peripheral catheters) were included in this review to compare the effect of in-line filters on the incidence of phlebitis in hospitalized patients. Baseline risks across trials ranged from 23% to 96%. Meta-analysis of all trials showed that in-line filters reduced the risk of infusion-related phlebitis (relative risk, 0.66; 95% confidence interval, 0.43-1.00). This benefit, however, is very uncertain, because the trials had serious methodological shortcomings and meta-analysis revealed marked unexplained statistical heterogeneity (P < 0.0000, I(2) = 90.4%). The estimated benefit did not depend on baseline risk. In-line filters in peripheral IV catheters cannot be recommended routinely, because evidence of their benefit is uncertain.

Risk assessment of the entry of canine-rabies into Papua New Guinea via sea and land routes.

PubMed

Brookes, Victoria J; Keponge-Yombo, Andy; Thomson, David; Ward, Michael P

2017-09-15

Canine-rabies is endemic in parts of Indonesia and continues to spread eastwards through the Indonesian archipelago. Papua New Guinea (PNG) has a land border with Papua Province, Indonesia, as well as logging and fishing industry connections throughout Asia. PNG has a Human Development Index of 0.505; therefore, an incursion of canine-rabies could have devastating impacts on human (7.5 million) and animal populations. Given the known difficulties of rabies elimination in resource-scarce environments, an incursion of rabies into PNG would also likely compromise the campaign for global elimination of rabies. A previous qualitative study to determine routes for detailed risk assessment identified logging, fishing and three land-routes (unregulated crossers ["shopper-crossers"], traditional border crossers and illegal hunters) as potential high risk routes for entry of rabies-infected dogs into PNG. The objective of the current study was to quantify and compare the probability of entry of a rabies-infected dog via these routes into PNG and to identify the highest risk provinces and border districts to target rabies prevention and control activities. Online questionnaires were used to elicit expert-opinion about quantitative model parameter values. A quantitative, stochastic model was then used to assess risk, and parameters with the greatest influence on the estimated mean number of rabies-infected dogs introduced/year were identified via global sensitivity analysis (Sobol method). Eight questionnaires - including 7 online - were implemented and >220 empirical distributions were parameterised using >2900 expert-opinions. The highest risk provinces for combined sea routes were West Sepik, Madang and Western Province, driven by the number of vessels and the probability of bringing dogs. The highest risk border districts for combined land routes were Vanimo-Green River and South Fly, driven by the number of people crossing the border and the number of dogs (with hunters). Overall, the risk posed by land routes was much higher than the risk of rabies introduction by sea routes. This study provides a foundation to develop targeted border control measures, surveillance and response strategies for canine-rabies for the highest risk routes and regions in PNG. Sensitivity analysis using the Sobol method played a key role in this study and directed further data collection to refine risk estimates. The ease of expert-elicitation using online methods demonstrates the feasibility of using such methods for animal and human disease surveillance in PNG. Copyright © 2017 Elsevier B.V. All rights reserved.

Automated electronic reminders to facilitate primary cardiovascular disease prevention: randomised controlled trial

PubMed Central

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

2010-01-01

Background Primary care databases contain cardiovascular disease risk factor data, but practical tools are required to improve identification of at-risk patients. Aim To test the effects of a system of electronic reminders (the ‘e-Nudge’) on cardiovascular events and the adequacy of data for cardiovascular risk estimation. Design of study Randomised controlled trial. Setting Nineteen general practices in the West Midlands, UK. Method The e-Nudge identifies four groups of patients aged over 50 years on the basis of estimated cardiovascular risk and adequacy of risk factor data in general practice computers. Screen messages highlight individuals at raised risk and prompt users to complete risk profiles where necessary. The proportion of the study population in the four groups was measured, as well as the rate of cardiovascular events in each arm after 2 years. Results Over 38 000 patients' electronic records were randomised. The intervention led to an increase in the proportion of patients with sufficient data who were identifiably at risk, with a difference of 1.94% compared to the control group (95% confidence interval [CI] = 1.38 to 2.50, P<0.001). A corresponding reduction occurred in the proportion potentially at risk but requiring further data for a risk estimation (difference = –3.68%, 95% CI = –4.53 to –2.84, P<0.001). No significant difference was observed in the incidence of cardiovascular events (rate ratio = 0.96, 95% CI = 0.85 to 1.10, P = 0.59). Conclusion Automated electronic reminders using routinely collected primary care data can improve the adequacy of cardiovascular risk factor information during everyday practice and increase the visibility of the at-risk population. PMID:20353659

Improving treatment intensification to reduce cardiovascular disease risk: a cluster randomized trial

PubMed Central

2012-01-01

Background Blood pressure, lipid, and glycemic control are essential for reducing cardiovascular disease (CVD) risk. Many health care systems have successfully shifted aspects of chronic disease management, including population-based outreach programs designed to address CVD risk factor control, to non-physicians. The purpose of this study is to evaluate provision of new information to non-physician outreach teams on need for treatment intensification in patients with increased CVD risk. Methods Cluster randomized trial (July 1-December 31, 2008) in Kaiser Permanente Northern California registry of members with diabetes mellitus, prior CVD diagnoses and/or chronic kidney disease who were high-priority for treatment intensification: blood pressure ≥ 140 mmHg systolic, LDL-cholesterol ≥ 130 mg/dl, or hemoglobin A1c ≥ 9%; adherent to current medications; no recent treatment intensification). Randomization units were medical center-based outreach teams (4 intervention; 4 control). For intervention teams, priority flags for intensification were added monthly to the registry database with recommended next pharmacotherapeutic steps for each eligible patient. Control teams used the same database without this information. Outcomes included 3-month rates of treatment intensification and risk factor levels during follow-up. Results Baseline risk factor control rates were high (82-90%). In eligible patients, the intervention was associated with significantly greater 3-month intensification rates for blood pressure (34.1 vs. 30.6%) and LDL-cholesterol (28.0 vs 22.7%), but not A1c. No effects on risk factors were observed at 3 months or 12 months follow-up. Intervention teams initiated outreach for only 45-47% of high-priority patients, but also for 27-30% of lower-priority patients. Teams reported difficulties adapting prior outreach strategies to incorporate the new information. Conclusions Information enhancement did not improve risk factor control compared to existing outreach strategies at control centers. Familiarity with prior, relatively successful strategies likely reduced uptake of the innovation and its potential for success at intervention centers. Trial registration ClinicalTrials.gov Identifier NCT00517686 PMID:22747998

Case-control study on uveal melanoma (RIFA): rational and design

PubMed Central

Schmidt-Pokrzywniak, Andrea; Jöckel, Karl-Heinz; Bornfeld, Norbert; Stang, Andreas

2004-01-01

Background Although a rare disease, uveal melanoma is the most common primary intraocular malignancy in adults, with an incidence rate of up to 1.0 per 100,000 persons per year in Europe. Only a few consistent risk factors have been identified for this disease. We present the study design of an ongoing incident case-control study on uveal melanoma (acronym: RIFA study) that focuses on radiofrequency radiation as transmitted by radio sets and wireless telephones, occupational risk factors, phenotypical characteristics, and UV radiation. Methods/Design We conduct a case-control study to identify the role of different exposures in the development of uveal melanoma. The cases of uveal melanoma were identified at the Division of Ophthalmology, University of Essen, a referral centre for tumours of the eye. We recruit three control groups: population controls, controls sampled from those ophthalmologists who referred cases to the Division of Ophthalmology, University of Duisburg-Essen, and sibling controls. For each case the controls are matched on sex and age (five year groups), except for sibling controls. The data are collected from the study participants by short self-administered questionnaire and by telephone interview. During and at the end of the field phase, the data are quality-checked. To estimate the effect of exposures on uveal melanoma risk, we will use conditional logistic regression that accounts for the matching factors and allows to control for potential confounding. PMID:15318944

Higher dietary folate intake reduces the breast cancer risk: a systematic review and meta-analysis

PubMed Central

Chen, P; Li, C; Li, X; Li, J; Chu, R; Wang, H

2014-01-01

Background: Many epidemiological studies have investigated the association between folate intake, circulating folate level and risk of breast cancer; however, the findings were inconsistent between the studies. Methods: We searched the PubMed and MEDLINE databases updated to January, 2014 and performed the systematic review and meta-analysis of the published epidemiological studies to assess the associations between folate intake level, circulating folate level and the overall risk of breast cancer. Results: In all, 16 eligible prospective studies with a total of 744 068 participants and 26 205 breast cancer patients and 26 case–control studies with a total of 16 826 cases and 21 820 controls that have evaluated the association between folate intake and breast cancer risk were identified. Pooled analysis of the prospective studies and case–control studies suggested a potential nonlinearity relationship for dietary folate intake and breast cancer risk. Prospective studies indicated a U-shaped relationship for the dietary folate intake and breast cancer risk. Women with daily dietary folate intake between 153 and 400 μg showed a significant reduced breast cancer risk compared with those <153 μg, but not for those >400 μg. The case–control studies also suggested a significantly negative correlation between the dietary folate intake level and the breast cancer risk. Increased dietary folate intake reduced breast cancer risk for women with higher alcohol intake level, but not for those with lower alcohol intake. No significant association between circulating folate level and breast cancer risk was found when the results of 8 identified studies with 5924 participants were pooled. Conclusions: Our studies suggested that folate may have preventive effects against breast cancer risk, especially for those with higher alcohol consumption level; however, the dose and timing are critical and more studies are warranted to further elucidate the questions. PMID:24667649

A comparison of five methods of measuring mammographic density: a case-control study.

PubMed

Astley, Susan M; Harkness, Elaine F; Sergeant, Jamie C; Warwick, Jane; Stavrinos, Paula; Warren, Ruth; Wilson, Mary; Beetles, Ursula; Gadde, Soujanya; Lim, Yit; Jain, Anil; Bundred, Sara; Barr, Nicola; Reece, Valerie; Brentnall, Adam R; Cuzick, Jack; Howell, Tony; Evans, D Gareth

2018-02-05

High mammographic density is associated with both risk of cancers being missed at mammography, and increased risk of developing breast cancer. Stratification of breast cancer prevention and screening requires mammographic density measures predictive of cancer. This study compares five mammographic density measures to determine the association with subsequent diagnosis of breast cancer and the presence of breast cancer at screening. Women participating in the "Predicting Risk Of Cancer At Screening" (PROCAS) study, a study of cancer risk, completed questionnaires to provide personal information to enable computation of the Tyrer-Cuzick risk score. Mammographic density was assessed by visual analogue scale (VAS), thresholding (Cumulus) and fully-automated methods (Densitas, Quantra, Volpara) in contralateral breasts of 366 women with unilateral breast cancer (cases) detected at screening on entry to the study (Cumulus 311/366) and in 338 women with cancer detected subsequently. Three controls per case were matched using age, body mass index category, hormone replacement therapy use and menopausal status. Odds ratios (OR) between the highest and lowest quintile, based on the density distribution in controls, for each density measure were estimated by conditional logistic regression, adjusting for classic risk factors. The strongest predictor of screen-detected cancer at study entry was VAS, OR 4.37 (95% CI 2.72-7.03) in the highest vs lowest quintile of percent density after adjustment for classical risk factors. Volpara, Densitas and Cumulus gave ORs for the highest vs lowest quintile of 2.42 (95% CI 1.56-3.78), 2.17 (95% CI 1.41-3.33) and 2.12 (95% CI 1.30-3.45), respectively. Quantra was not significantly associated with breast cancer (OR 1.02, 95% CI 0.67-1.54). Similar results were found for subsequent cancers, with ORs of 4.48 (95% CI 2.79-7.18), 2.87 (95% CI 1.77-4.64) and 2.34 (95% CI 1.50-3.68) in highest vs lowest quintiles of VAS, Volpara and Densitas, respectively. Quantra gave an OR in the highest vs lowest quintile of 1.32 (95% CI 0.85-2.05). Visual density assessment demonstrated a strong relationship with cancer, despite known inter-observer variability; however, it is impractical for population-based screening. Percentage density measured by Volpara and Densitas also had a strong association with breast cancer risk, amongst the automated measures evaluated, providing practical automated methods for risk stratification.

Testing the Job Demand-Control-Support model with anxiety and depression as outcomes: the Hordaland Health Study.

PubMed

Sanne, Bjarte; Mykletun, Arnstein; Dahl, Alv A; Moen, Bente E; Tell, Grethe S

2005-09-01

To test the strain/iso-strain, interaction and buffer hypotheses of the Job Demand-Control-Support model in relation to anxiety and depression. Five thousand five hundred and sixty-two workers with valid Demand-Control-Support Questionnaire (DCSQ) scores were examined with the sub-scales of the Hospital Anxiety and Depression Scale as outcomes. Multiple statistical methods were applied. The strain and iso-strain hypotheses were confirmed. Generally, additive and non-interaction effects were found between psychological demands, control and social support. The buffer hypotheses were refuted. Results from analyses testing different interaction operationalizations were complementary. High demands, low control and low support individually, but particularly combined, are risk factors for anxiety and depression. Support is the DCSQ index most strongly associated with anxiety and depression in women. Assessment of psychosocial work environment may identify workers at risk, and serve as a basis for job-redesign.

Fever in sepsis.

PubMed

Schortgen, F

2012-11-01

Fever is a common symptom of sepsis usually believed to predict better survival. Experimental data suggest that body temperature elevation may slow micro-organism growth and enhance host immune responses. In patients with sepsis, however, the high energy cost of fever may exacerbate the life-threatening situation. Fever control is widely used in the ICU, mainly in patients with infections. The efficacy of antipyretic drugs in lowering body temperature remains uncertain, however, and all antipyretics have well known adverse effects. Surface cooling methods are efficient but require sedation to avoid the harmful effects of shivering. A recent controlled trial in patients with septic shock suggests that external cooling for fever control may diminish vasopressor requirements and improve early survival. In this review, we examine the benefits and risks of fever and of controlled normothermia. The fever control modalities that provide the best risk/benefit ratio in sepsis are discussed.

Community context and sub-neighborhood scale detail to explain dengue, chikungunya and Zika patterns in Cali, Colombia

PubMed Central

Curtis, Andrew; Buritica, Paola; Ajayakumar, Jayakrishnan; Squires, Robert; Dávalos, Diana; Pacheco, Robinson; Bhatta, Madhav P.; James, Mark A.

2017-01-01

Background Cali, Colombia has experienced chikungunya and Zika outbreaks and hypoendemic dengue. Studies have explained Cali’s dengue patterns but lack the sub-neighborhood-scale detail investigated here. Methods Spatial-video geonarratives (SVG) with Ministry of Health officials and Community Health Workers were collected in hotspots, providing perspective on perceptions of why dengue, chikungunya and Zika hotspots exist, impediments to control, and social outcomes. Using spatial video and Google Street View, sub-neighborhood features possibly contributing to incidence were mapped to create risk surfaces, later compared with dengue, chikungunya and Zika case data. Results SVG captured insights in 24 neighborhoods. Trash and water risks in Calipso were mapped using SVG results. Perceived risk factors included proximity to standing water, canals, poverty, invasions, localized violence and military migration. These risks overlapped case density maps and identified areas that are suitable for transmission but are possibly underreporting to the surveillance system. Conclusion Resulting risk maps with local context could be leveraged to increase vector-control efficiency- targeting key areas of environmental risk. PMID:28767730

Significant Synergistic Effect of Peroxisome Proliferator–Activated Receptor γ C-2821T and Diabetes on the Risk of Ischemic Stroke

PubMed Central

Hsieh, Fang-I; Lo, Wei-Cheng; Lin, Huey-Juan; Hsieh, Yi-Chen; Lien, Li-Ming; Bai, Chyi-Huey; Tseng, Hung-Pin; Chiou, Hung-Yi

2009-01-01

OBJECTIVE To explore the relationship between the genetic polymorphisms of PPARγ (Pro12Ala, C1431T, and C-2821T) and the risk of ischemic stroke and to investigate whether these genetic polymorphisms of PPARγ would modify the risk of ischemic stroke among patients with hypertension or diabetes. RESEARCH DESIGN AND METHODS The case-control study was conducted with 537 ischemic stroke patients and 537 control subjects. A structured questionnaire was used to collect information on conventional cardiovascular risk factors and laboratory results. The genetic polymorphisms of PPARγ were determined by PCR–restriction fragment–length polymorphism. RESULTS A significant interaction was seen between the −2821C allele and diabetes but not between this allele and hypertension. A markedly elevated risk of ischemic stroke (odds ratio 9.7) was found in the subjects with diabetes and the −2821C allele compared with that in those without these two risk factors. CONCLUSIONS The −2821C allele of PPARγ was a strong predictor of ischemic stroke for diabetic patients. PMID:19651920

Maternal and Gestational Risk Factors for Hypospadias

PubMed Central

Akre, Olof; Boyd, Heather A.; Ahlgren, Martin; Wilbrand, Kerstin; Westergaard, Tine; Hjalgrim, Henrik; Nordenskjöld, Agneta; Ekbom, Anders; Melbye, Mads

2008-01-01

Background An increase in the prevalence of hypospadias has been reported, but the environmental causes remain virtually unknown. Objectives Our goal was to assess the association between risk of hypospadias and indicators of placental function and endogenous hormone levels, exposure to exogenous hormones, maternal diet during pregnancy, and other environmental factors. Methods We conducted a case–control study in Sweden and Denmark from 2000 through 2005 using self-administered questionnaires completed by mothers of hypospadias cases and matched controls. The response rate was 88% and 81% among mothers of cases and controls, respectively. The analyses included 292 cases and 427 controls. Results A diet during pregnancy lacking both fish and meat was associated with a more than 4-fold increased risk of hypospadias [odds ratio (OR) = 4.6; 95% confidence interval (CI), 1.6–13.3]. Boys born to obese [body mass index (BMI) ≥ 30] women had a more than 2-fold increased risk of hypospadias (OR = 2.6; 95% CI, 1.2–5.7) compared with boys born to mothers with a normal weight (BMI = 20–24). Maternal hypertension during pregnancy and absence of maternal nausea increased a boy’s risk of hypospadias 2.0-fold (95% CI, 1.1–3.7) and 1.8-fold (95% CI, 1.2–2.8), respectively. Nausea in late pregnancy also appeared to be positively associated with hypospadias risk (OR = 7.6; 95% CI, 1.1–53). Conclusions A pregnancy diet lacking meat and fish appears to increase the risk of hypospadias in the offspring. Other risk associations were compatible with a role for placental insufficiency in the etiology of hypospadias. PMID:18709149

Risk Factors for Human Immunodeficiency Virus Infection among Brazilian Blood Donors; a Multicenter Case-Control Study Using Audio Computer-Assisted Structured-Interviews

PubMed Central

de Almeida-Neto, Cesar; Goncalez, Thelma T.; Birch, Rebecca Jeffries; de Carvalho, Silvia Maia F.; Capuani, Ligia; Leão, Silvana Carneiro; Miranda, Carolina; Rocha, Pedro Capuani; Carneiro-Proietti, Anna Barbara; Johnson, Bryce R.; Wright, David J.; Murphy, Edward L.; Custer, Brian

2013-01-01

Background Although risk factors for HIV infection are known, it is important for blood centers to understand local epidemiology and disease transmission patterns. Current risk factors for HIV infection in blood donors in Brazil were assessed. Methods A case-control study was conducted at large public blood centers located in four major cities between April 2009 – March 2011. Cases were persons whose donations were confirmed positive by enzyme immunoassays followed by Western Blot confirmation. Audio computer-assisted structured-interviews (ACASI) were completed by all cases and controls. Multivariable logistic regression was used to estimate adjusted odds ratios (AORs) and associated 95% confidence intervals (CIs). Results There were 341 cases, including 47 with recently-acquired infection, and 791 controls. Disclosed risk factors for both females and males were sex with an HIV-positive person (adjusted odds ratio (AOR) 11.3, 95% CI [4.1, 31.7]) and being an IVDU or sexual partner of an IVDU (AOR 4.65 [1.8, 11.7]). For female blood donors, additional risk factors were having male sex partners who also are MSM (AOR 13.5 [3.1, 59.8]), and having unprotected sex with multiple sexual partners (AOR 5.19 [2.1, 12.9]). The primary risk factor for male blood donors was MSM activity (AOR 21.6 [8.8, 52.9.]). Behaviors associated with recently-acquired HIV were being a MSM or sex partner of MSM (13.82, [4.7, 40.3]), and IVDU (11.47, [3.0, 43.2]). Conclusion Risk factors in blood donors parallel those in the general population in Brazil. Identified risk factors suggest that donor compliance with selection procedures at the participating blood centers is inadequate. PMID:23517235

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

Morbidity and prostate-specific antigen control of external beam radiation therapy plus low-dose-rate brachytherapy boost for low, intermediate, and high-risk prostate cancer.

PubMed

Koontz, Bridget F; Chino, Junzo; Lee, W Robert; Hahn, Carol A; Buckley, Niall; Huang, Samuel; Kim, Jay; Reagan, Robert; Joyner, Raymond; Anscher, Mitchell S

2009-01-01

Dose escalation has been shown beneficial in prostate cancer. Brachytherapy (BT) provides an opportunity for dose escalation beyond what can be safely delivered using only teletherapy methods. The purpose of this study was to determine cancer control and morbidity of external beam radiation therapy (EBRT) plus low-dose-rate (LDR) BT boost in patients with prostate cancer treated at Duke University Health System. Between June 1997 and August 2007, 199 patients were consecutively treated at our facility with 46Gy EBRT followed by 100Gy palladium-103 ((103)Pd) or 120Gy iodine-125 ((125)I) LDR prostate implant. Treatment characteristics and followup data were retrospectively analyzed. Intermediate risk was defined as T2b-c, Gleason score 7 (GS 7), or prostate-specific antigen (PSA) of 10.1-19.9ng/mL. High risk was defined as GS 8-10, PSA>20, T3+, or two intermediate risk factors. The Radiation Therapy Oncology Group toxicity scale was used to report morbidity for gastrointestinal (GI) and genitourinary (GU) effects. PSA recurrence was defined as nadir+2ng/mL. Median followup was 4.2 years for all patients, 4.8 years for high-risk patients. Risk categories were as follows: 20% low risk, 47% intermediate risk, and 33% high risk. Forty five percent of patients received adjuvant androgen deprivation therapy (ADT). The median length of time since end of ADT to last followup was 2.7 years in all patients, 2.0 years for high-risk patients. Five-year biochemical relapse-free survival was 87% for all, 81% for high-risk patients. PSA control was similar at 92% for all and 86% for high-risk patients. Five-year actuarial risk of any and Grade 3 late GI morbidity was 38% and 7% respectively, and any and Grade 3 late GU morbidity was 21% and 3%, respectively. There were no significant differences in risk of Grade 2+GI or GU morbidity with choice of isotope. EBRT plus LDR BT has acceptable morbidity and, with 5-year followup, provides excellent cancer control even in high-risk patients.

Relation of type A behavior pattern and job-related psychosocial factors to nonfatal myocardial infarction: a case-control study of Japanese male workers and women.

PubMed

Yoshimasu, K

2001-01-01

To study the relation of type A behavior pattern and job-related psychosocial factors to the risk of myocardial infarction. Study subjects comprised 290 cases (173 male workers and 117 women) of nonfatal acute myocardial infarction (AMI) and 489 controls (303 male workers and 186 women) recruited from among residents of the study area. Participation rates of cases and controls were 86% and 50%, respectively. Type A behavior pattern, job-related psychosocial factors, and other coronary risk factors were ascertained by interview using a questionnaire. Type A behavior pattern was measured by 12 questions, and job strain by the method of Karasek. Logistic regression analysis was used to calculate odds ratio and 95% confidence interval with adjustment for potential confounding variables. The relation to job strain was examined only in men. Type A behavior pattern was significantly associated with an increased risk of AMI in male workers (adjusted OR = 1.9, 95% CI, 1.2-2.9) and in women (adjusted OR = 2.8, 95% CI, 1.6-4.9). Although job control and job demand showed no material association with AMI, job strain, a combination of low job control and high job demand was associated with an increased risk of AMI (adjusted OR = 2.2, 95% CI, 1.1-4.5). Abbreviated type A score and job demand score were higher among nonparticipant control candidates than participant controls in male workers. Type A behavior pattern may be an important risk factor for AMI especially in Japanese women. The present study also revealed persons in stressful psychosocial circumstances were less likely to participate in the study.

Use of case-time-control design in pharmacovigilance applications: exploration with high-risk medications and unplanned hospital admissions in the Western Australian elderly.

PubMed

Price, Sylvie D; Holman, C D'Arcy J; Sanfilippo, Frank M; Emery, Jon D

2013-11-01

To use a case-time-control design to derive preliminary estimates of unplanned hospitalisations attributable to suspected high-risk medications in elderly Western Australians. Using pharmaceutical claims linked to inpatient and other health records, the study applied a case-time-control design and conditional logistic regression to estimate odds ratios (ORs) for unplanned hospital admissions associated with anticoagulants, antirheumatics, opioids, corticosteroids and four major groups of cardiovascular drugs. Attributable fractions (AFs) were derived from the ORs to estimate the number and proportion of admissions associated with drug exposure. Results were compared with those obtained from a more conventional method using International Classification of Diseases (ICD) external cause codes to identify admissions related to adverse drug events. The study involved 1 899 699 index hospital admissions. Six of the eight drug groups were associated with an increased risk of unplanned hospitalisation, opioids (adjusted OR = 1.81, 95%CI 1.75-1.88; AF = 44.9%) and corticosteroids (1.48, 1.42-1.54; 32.2%) linked with the highest risks. For all six, the estimated number of hospitalisations attributed to the medication in the exposed was higher (two to 31-fold) when derived from the case-time-control design compared with identification from ICD codes. This study provides an alternative approach for identifying potentially harmful medications and suggests that the use of ICD external causes may underestimate adverse drug events. It takes drug exposure into account, can be applied to individual medications and may overcome under-reporting issues associated with conventional methods. The approach shows great potential as part of a post-marketing pharmacovigilance monitoring system in Australia and elsewhere. Copyright © 2013 John Wiley & Sons, Ltd.

Syndromic Management and STI Control in Urban Peru

PubMed Central

Clark, Jesse L.; Lescano, Andres G.; Konda, Kelika A.; Leon, Segundo R.; Jones, Franca R.; Klausner, Jeffrey D.; Coates, Thomas J.; Caceres, Carlos F.

2009-01-01

Background Syndromic management is an inexpensive and effective method for the treatment of symptomatic sexually transmitted infections (STIs), but its effectiveness as a method of STI control in at-risk populations is questionable. We sought to determine the potential utility of syndromic management as a public health strategy to control STI transmission in high-risk populations in urban Peru. Methodology We surveyed 3,285 at-risk men and women from three Peruvian cities from 2003–05. Participants were asked about the presence of genital ulcers, discharge, or dysuria in the preceding six months. Participants reporting symptoms were asked about subsequent health-seeking and partner notification behavior. Urine and vaginal swab samples were tested for Neisseria gonorrhoeae and Chlamydia trachomatis by nucleic acid testing. Serum was tested for syphilis and Herpes Simplex Virus-Type 2 antibodies. Findings Recent urogenital discharge or dysuria was reported by 42.1% of participants with gonorrhea or chlamydia versus 28.3% of participants without infection. Genital ulceration was reported by 6.2% of participants with, and 7.4% of participants without, recent syphilis. Many participants reporting symptoms continued sexual activity while symptomatic, and approximately half of all symptomatic participants sought treatment. The positive and negative predictive values of urogenital discharge or genital ulcer disease in detecting STIs that are common in the study population were 14.4% and 81.5% for chlamydia in women and 8.3% and 89.5% for syphilis among gay-identified men. Conclusions In our study, STIs among high-risk men and women in urban Peru were frequently asymptomatic and symptomatic participants often remained sexually active without seeking treatment. Additional research is needed to assess the costs and benefits of targeted, laboratory-based STI screening as part of a comprehensive STI control program in developing countries. PMID:19779620

Privacy and information security risks in a technology platform for home-based chronic disease rehabilitation and education.

PubMed

Henriksen, Eva; Burkow, Tatjana M; Johnsen, Elin; Vognild, Lars K

2013-08-09

Privacy and information security are important for all healthcare services, including home-based services. We have designed and implemented a prototype technology platform for providing home-based healthcare services. It supports a personal electronic health diary and enables secure and reliable communication and interaction with peers and healthcare personnel. The platform runs on a small computer with a dedicated remote control. It is connected to the patient's TV and to a broadband Internet. The platform has been tested with home-based rehabilitation and education programs for chronic obstructive pulmonary disease and diabetes. As part of our work, a risk assessment of privacy and security aspects has been performed, to reveal actual risks and to ensure adequate information security in this technical platform. Risk assessment was performed in an iterative manner during the development process. Thus, security solutions have been incorporated into the design from an early stage instead of being included as an add-on to a nearly completed system. We have adapted existing risk management methods to our own environment, thus creating our own method. Our method conforms to ISO's standard for information security risk management. A total of approximately 50 threats and possible unwanted incidents were identified and analysed. Among the threats to the four information security aspects: confidentiality, integrity, availability, and quality; confidentiality threats were identified as most serious, with one threat given an unacceptable level of High risk. This is because health-related personal information is regarded as sensitive. Availability threats were analysed as low risk, as the aim of the home programmes is to provide education and rehabilitation services; not for use in acute situations or for continuous health monitoring. Most of the identified threats are applicable for healthcare services intended for patients or citizens in their own homes. Confidentiality risks in home are different from in a more controlled environment such as a hospital; and electronic equipment located in private homes and communicating via Internet, is more exposed to unauthorised access. By implementing the proposed measures, it has been possible to design a home-based service which ensures the necessary level of information security and privacy.

Vitamins, Metabolomics and Prostate Cancer

PubMed Central

Mondul, Alison M; Weinstein, Stephanie J; Albanes, Demetrius

2016-01-01

Purpose How micronutrients might influence risk of developing adenocarcinoma of the prostate has been the focus of a large body of research (especially regarding vitamins E, A, and D). Metabolomic profiling has the potential to discover molecular species relevant to prostate cancer etiology, early detection, and prevention, and may help elucidate the biologic mechanisms by which vitamins influence prostate cancer risk. Methods Prostate cancer risk data related to vitamins E, A, and D and metabolomics profiling from clinical, cohort, and nested case-control studies, along with randomized controlled trials, are examined and summarized, along with recent metabolomic data of the vitamin phenotypes. Results Higher vitamin E serologic status is associated with lower prostate cancer risk, and vitamin E genetic variant data support this. By contrast, controlled vitamin E supplementation trials have mixed results based on differing designs and dosages. Beta-carotene supplementation (in smokers) and higher circulating retinol and 25-hydroxy-vitamin D concentrations appear related to elevated prostate cancer risk. Our prospective metabolomics profiling of fasting serum collected 1-20 years prior to clinical diagnoses found lipid and energy/TCA cycle metabolites, including inositol-1-phosphate, lysolipids, alpha-ketoglutarate, and citrate, significantly associated with risk of aggressive disease. Conclusions Several active leads exist regarding the role of micronutrients and metabolites in prostate cancer carcinogenesis and risk. How vitamins D and A may adversely impact risk, and whether low-dose vitamin E supplementation remains a viable preventive approach, require further study. PMID:27339624

Common genetic variants related to genomic integrity and risk of papillary thyroid cancer

PubMed Central

Neta, Gila; Brenner, Alina V.; Sturgis, Erich M.; Pfeiffer, Ruth M.; Hutchinson, Amy A.; Aschebrook-Kilfoy, Briseis; Yeager, Meredith; Xu, Li; Wheeler, William; Abend, Michael; Ron, Elaine; Tucker, Margaret A.; Chanock, Stephen J.; Sigurdson, Alice J.

2011-01-01

DNA damage is an important mechanism in carcinogenesis, so genes related to maintaining genomic integrity may influence papillary thyroid cancer (PTC) risk. Candidate gene studies targeting some of these genes have identified only a few polymorphisms associated with risk of PTC. Here, we expanded the scope of previous candidate studies by increasing the number and coverage of genes related to maintenance of genomic integrity. We evaluated 5077 tag single-nucleotide polymorphisms (SNPs) from 340 candidate gene regions hypothesized to be involved in DNA repair, epigenetics, tumor suppression, apoptosis, telomere function and cell cycle control and signaling pathways in a case–control study of 344 PTC cases and 452 matched controls. We estimated odds ratios for associations of single SNPs with PTC risk and combined P values for SNPs in the same gene region or pathway to obtain gene region-specific or pathway-specific P values using adaptive rank-truncated product methods. Nine SNPs had P values <0.0005, three of which were in HDAC4 and were inversely related to PTC risk. After multiple comparisons adjustment, no SNPs remained associated with PTC risk. Seven gene regions were associated with PTC risk at P < 0.01, including HUS1, ALKBH3, HDAC4, BAK1, FAF1_CDKN2C, DACT3 and FZD6. Our results suggest a possible role of genes involved in maintenance of genomic integrity in relation to risk of PTC. PMID:21642358

The Discounted Method and Equivalence of Average Criteria for Risk-Sensitive Markov Decision Processes on Borel Spaces

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

Cavazos-Cadena, Rolando, E-mail: rcavazos@uaaan.m; Salem-Silva, Francisco, E-mail: frsalem@uv.m

2010-04-15

This note concerns discrete-time controlled Markov chains with Borel state and action spaces. Given a nonnegative cost function, the performance of a control policy is measured by the superior limit risk-sensitive average criterion associated with a constant and positive risk sensitivity coefficient. Within such a framework, the discounted approach is used (a) to establish the existence of solutions for the corresponding optimality inequality, and (b) to show that, under mild conditions on the cost function, the optimal value functions corresponding to the superior and inferior limit average criteria coincide on a certain subset of the state space. The approach ofmore » the paper relies on standard dynamic programming ideas and on a simple analytical derivation of a Tauberian relation.« less

Support of personalized medicine through risk-stratified treatment recommendations - an environmental scan of clinical practice guidelines

PubMed Central

2013-01-01

Background Risk-stratified treatment recommendations facilitate treatment decision-making that balances patient-specific risks and preferences. It is unclear if and how such recommendations are developed in clinical practice guidelines (CPGs). Our aim was to assess if and how CPGs develop risk-stratified treatment recommendations for the prevention or treatment of common chronic diseases. Methods We searched the United States National Guideline Clearinghouse for US, Canadian and National Institute for Health and Clinical Excellence (United Kingdom) CPGs for heart disease, stroke, cancer, chronic obstructive pulmonary disease and diabetes that make risk-stratified treatment recommendations. We included only those CPGs that made risk-stratified treatment recommendations based on risk assessment tools. Two reviewers independently identified CPGs and extracted information on recommended risk assessment tools; type of evidence about treatment benefits and harms; methods for linking risk estimates to treatment evidence and for developing treatment thresholds; and consideration of patient preferences. Results We identified 20 CPGs that made risk-stratified treatment recommendations out of 133 CPGs that made any type of treatment recommendations for the chronic diseases considered in this study. Of the included 20 CPGs, 16 (80%) used evidence about treatment benefits from randomized controlled trials, meta-analyses or other guidelines, and the source of evidence was unclear in the remaining four (20%) CPGs. Nine CPGs (45%) used evidence on harms from randomized controlled trials or observational studies, while 11 CPGs (55%) did not clearly refer to harms. Nine CPGs (45%) explained how risk prediction and evidence about treatments effects were linked (for example, applying estimates of relative risk reductions to absolute risks), but only one CPG (5%) assessed benefit and harm quantitatively and three CPGs (15%) explicitly reported consideration of patient preferences. Conclusions Only a small proportion of CPGs for chronic diseases make risk-stratified treatment recommendations with a focus on heart disease and stroke prevention, diabetes and breast cancer. For most CPGs it is unclear how risk-stratified treatment recommendations were developed. As a consequence, it is uncertain if CPGs support patients and physicians in finding an acceptable benefit- harm balance that reflects both profile-specific outcome risks and preferences. PMID:23302096

Quantitative Risk Mapping of Urban Gas Pipeline Networks Using GIS

NASA Astrophysics Data System (ADS)

Azari, P.; Karimi, M.

2017-09-01

Natural gas is considered an important source of energy in the world. By increasing growth of urbanization, urban gas pipelines which transmit natural gas from transmission pipelines to consumers, will become a dense network. The increase in the density of urban pipelines will influence probability of occurring bad accidents in urban areas. These accidents have a catastrophic effect on people and their property. Within the next few years, risk mapping will become an important component in urban planning and management of large cities in order to decrease the probability of accident and to control them. Therefore, it is important to assess risk values and determine their location on urban map using an appropriate method. In the history of risk analysis of urban natural gas pipeline networks, the pipelines has always been considered one by one and their density in urban area has not been considered. The aim of this study is to determine the effect of several pipelines on the risk value of a specific grid point. This paper outlines a quantitative risk assessment method for analysing the risk of urban natural gas pipeline networks. It consists of two main parts: failure rate calculation where the EGIG historical data are used and fatal length calculation that involves calculation of gas release and fatality rate of consequences. We consider jet fire, fireball and explosion for investigating the consequences of gas pipeline failure. The outcome of this method is an individual risk and is shown as a risk map.

Statistical methods for studying disease subtype heterogeneity.

PubMed

Wang, Molin; Spiegelman, Donna; Kuchiba, Aya; Lochhead, Paul; Kim, Sehee; Chan, Andrew T; Poole, Elizabeth M; Tamimi, Rulla; Tworoger, Shelley S; Giovannucci, Edward; Rosner, Bernard; Ogino, Shuji

2016-02-28

A fundamental goal of epidemiologic research is to investigate the relationship between exposures and disease risk. Cases of the disease are often considered a single outcome and assumed to share a common etiology. However, evidence indicates that many human diseases arise and evolve through a range of heterogeneous molecular pathologic processes, influenced by diverse exposures. Pathogenic heterogeneity has been considered in various neoplasms such as colorectal, lung, prostate, and breast cancers, leukemia and lymphoma, and non-neoplastic diseases, including obesity, type II diabetes, glaucoma, stroke, cardiovascular disease, autism, and autoimmune disease. In this article, we discuss analytic options for studying disease subtype heterogeneity, emphasizing methods for evaluating whether the association of a potential risk factor with disease varies by disease subtype. Methods are described for scenarios where disease subtypes are categorical and ordinal and for cohort studies, matched and unmatched case-control studies, and case-case study designs. For illustration, we apply the methods to a molecular pathological epidemiology study of alcohol intake and colon cancer risk by tumor LINE-1 methylation subtypes. User-friendly software to implement the methods is publicly available. Copyright © 2015 John Wiley & Sons, Ltd.

Is the efficacy of biological control against plant diseases likely to be more durable than that of chemical pesticides?

PubMed Central

Bardin, Marc; Ajouz, Sakhr; Comby, Morgane; Lopez-Ferber, Miguel; Graillot, Benoît; Siegwart, Myriam; Nicot, Philippe C.

2015-01-01

The durability of a control method for plant protection is defined as the persistence of its efficacy in space and time. It depends on (i) the selection pressure exerted by it on populations of plant pathogens and (ii) on the capacity of these pathogens to adapt to the control method. Erosion of effectiveness of conventional plant protection methods has been widely studied in the past. For example, apparition of resistance to chemical pesticides in plant pathogens or pests has been extensively documented. The durability of biological control has often been assumed to be higher than that of chemical control. Results concerning pest management in agricultural systems have shown that this assumption may not always be justified. Resistance of various pests to one or several toxins of Bacillus thuringiensis and apparition of resistance of the codling moth Cydia pomonella to the C. pomonella granulovirus have, for example, been described. In contrast with the situation for pests, the durability of biological control of plant diseases has hardly been studied and no scientific reports proving the loss of efficiency of biological control agents against plant pathogens in practice has been published so far. Knowledge concerning the possible erosion of effectiveness of biological control is essential to ensure a durable efficacy of biological control agents on target plant pathogens. This knowledge will result in identifying risk factors that can foster the selection of strains of plant pathogens resistant to biological control agents. It will also result in identifying types of biological control agents with lower risk of efficacy loss, i.e., modes of action of biological control agents that does not favor the selection of resistant isolates in natural populations of plant pathogens. An analysis of the scientific literature was then conducted to assess the potential for plant pathogens to become resistant to biological control agents. PMID:26284088

Soy consumption and risk of COPD and respiratory symptoms: a case-control study in Japan

PubMed Central

Hirayama, Fumi; Lee, Andy H; Binns, Colin W; Zhao, Yun; Hiramatsu, Tetsuo; Tanikawa, Yoshimasa; Nishimura, Koichi; Taniguchi, Hiroyuki

2009-01-01

Background To investigate the relationship between soy consumption, COPD risk and the prevalence of respiratory symptoms, a case-control study was conducted in Japan. Methods A total of 278 eligible patients (244 men and 34 women), aged 50–75 years with COPD diagnosed within the past four years, were referred by respiratory physicians, while 340 controls (272 men and 68 women) were recruited from the community. All participants underwent spirometric measurements of respiratory function. Information on demographics, lifestyle characteristics and habitual food consumption was obtained using a structured questionnaire. Results Total soy consumption was positively correlated with observed lung function measures. The mean soy intake was significantly higher among controls (59.98, SD 50.23 g/day) than cases (44.84, SD 28.5 g/day). A significant reduction in COPD risk was evident for highest versus lowest quartile of daily intake of total soybean products, with adjusted odds ratio (OR) 0.392, 95% CI 0.194–0.793, p for trend 0.001. Similar decreases in COPD risk were associated with frequent and higher intake of soy foods such as tofu and bean sprouts, whereas respiratory symptoms were inversely associated with high consumption of soy foods, especially for breathlessness (OR 0.989, 95% CI 0.982–0.996). Conclusion Increasing soy consumption was associated with a decreased risk of COPD and breathlessness. PMID:19558645

The risk of Clostridium difficile infection in patients with pernicious anaemia: a retrospective cohort study using primary care database

PubMed Central

Crooks, Colin J; Card, Timothy R

2017-01-01

Background Studies have found an association between proton pump inhibitor (PPI) use and Clostridium difficile infection. The purpose of this study was to determine whether the mechanism by which PPIs induce an increased risk of C. difficile infection is supported by the same mechanism acting in another cause of achlorhydria, pernicious anaemia. Methods Using a database of anonymised primary care records between 1990 and 2013, we selected exposed patients with a diagnosis of pernicious anaemia treated with vitamin B12 therapy. Each exposed patient was matched by age, gender and general practice to up to 10 controls. Cox regression analysis was used to estimate the hazard ratio (HR) and 95% confidence interval (CI) for C. difficile infection with pernicious anaemia, adjusted for potential confounders. Results We identified 45,467 exposed patients matched to 449,635 controls. The crude incidence rate of C. difficile infection was 1.85/1000 person-years for the exposed cohort and 1.09/1000 person-years for controls. Patients with pernicious anaemia had a greater risk of C. difficile infection than the controls (adjusted HR 1.57, 95% CI 1.40–1.76). Conclusions Pernicious anaemia patients have an increased risk of C. difficile infection. This supports the theory that severe achlorhydria is the mechanism that increases the risk of C. difficile infection in long-term PPI users. PMID:29163961

A Project Assessment of Stabilizing System of WT Generation using Rechargeable Battery

NASA Astrophysics Data System (ADS)

Kojima, Yasuhiro; Takano, Tomihiro; Tanikawa, Ryoichi; Takagi, Tetsuro; Hirooka, Koutaro; Kumagai, Sadatoshi

The expansion of the renewable energy introduction is examined as measures for controlling global warming. Wind power generation is expected as effective power resource, but the negative impact from the difficulty of an unstable output is concerned. In recent years, WT generation with contract of cut-of with shorting adjusting power and with rechargeable battery for stabilizing control are examined, but the introduction has not been accelerated yet because there is an influence in WT generation entrepreneur's business. In this paper, we make a brief summary of relation between the fluctuation of wind power generation and stability of electric power operation, and two types of approach; cut-off contract and stabilization using rechargeable battery. For the stabilization using battery, there are two methods, one is reduction control and the other is constant control. We propose a new control method for constant control based on profit optimization considering WT generation forecast and its risk of deviation. We also propose the estimation method for the .limitation of battery installation. Simulation results show the efficiency of our proposed methods.

The 40-Something randomized controlled trial to prevent weight gain in mid-age women

PubMed Central

2013-01-01

Background Obesity prevention is a major public health priority. Despite the health risks associated with weight gain, there has been a distinct lack of research into effective interventions to prevent, rather than treat, obesity particularly at high risk life stages such as menopause in women. This paper describes the rationale for and design of a 2-year randomized controlled trial (RCT) (the 40-Something Study) aimed at testing the feasibility and efficacy of a relatively low intensity intervention designed to achieve weight control in non-obese women about to enter the menopause transition. Methods and design The study is a parallel-group RCT consisting of 12 months of intervention (Phase 1) and 12 months of monitoring (Phase 2). Non-obese pre-menopausal healthy females 44–50 years of age were screened, stratified according to Body Mass Index (BMI) category (18.5-24.9 and 25–29.9 kg/m2) and randomly assigned to one of two groups: motivational interviewing (MI) intervention (n = 28), or a self-directed intervention (SDI) (control) (n = 26). The MI intervention consisted of five consultations with health professionals (four with a Dietitian and one with an Exercise Physiologist) who applied components of MI counselling to consultations with the women over a 12 month period. The SDI was developed as a control and these participants received print materials only. Outcome measures were collected at baseline, three, 12, 18 and 24 months and included weight (primary outcome), waist circumference, body composition, blood pressure, plasma markers of metabolic syndrome risk, dietary intake, physical activity and quality of life. Analysis of covariance will be used to investigate outcomes according to intervention type and duration (comparing baseline, 12 and 24 months). Discussion The 40-Something study is the first RCT aimed at preventing menopausal weight gain in Australian women. Importantly, this paper describes the methods used to evaluate whether a relatively low intensity, health professional led intervention will achieve better weight control in pre-menopausal women than a self-directed intervention. The results will add to the scant body of literature on obesity prevention methods at an under-researched high-risk life stage, and inform the development of population-based interventions. Trial registration ACTRN12611000064909 PMID:24156558

Estimating and controlling workplace risk: an approach for occupational hygiene and safety professionals.

PubMed

Toffel, Michael W; Birkner, Lawrence R

2002-07-01

The protection of people and physical assets is the objective of health and safety professionals and is accomplished through the paradigm of anticipation, recognition, evaluation, and control of risks in the occupational environment. Risk assessment concepts are not only used by health and safety professionals, but also by business and financial planners. Since meeting health and safety objectives requires financial resources provided by business and governmental managers, the hypothesis addressed here is that health and safety risk decisions should be made with probabilistic processes used in financial decision-making and which are familiar and recognizable to business and government planners and managers. This article develops the processes and demonstrates the use of incident probabilities, historic outcome information, and incremental impact analysis to estimate risk of multiple alternatives in the chemical process industry. It also analyzes how the ethical aspects of decision-making can be addressed in formulating health and safety risk management plans. It is concluded that certain, easily understood, and applied probabilistic risk assessment methods used by business and government to assess financial and outcome risk have applicability to improving workplace health and safety in three ways: 1) by linking the business and health and safety risk assessment processes to securing resources, 2) by providing an additional set of tools for health and safety risk assessment, and 3) by requiring the risk assessor to consider multiple risk management alternatives.

Reliability and Validity of Observational Risk Screening in Evaluating Dynamic Knee Valgus

PubMed Central

Ekegren, Christina L.; Miller, William C.; Celebrini, Richard G.; Eng, Janice J.; MacIntyre, Donna L.

2012-01-01

Study Design Nonexperimental methodological study. Objectives To determine the interrater and intrarater reliability and validity of using observational risk screening guidelines to evaluate dynamic knee valgus. Background A deficiency in the neuromuscular control of the hip has been identified as a key risk factor for non-contact anterior cruciate ligament (ACL) injury in post pubescent females. This deficiency can manifest itself as a valgus knee alignment during tasks involving hip and knee flexion. There are currently no scientifically tested methods to screen for dynamic knee valgus in the clinic or on the field. Methods Three physiotherapists used observational risk screening guidelines to rate 40 adolescent female soccer players according to their risk of ACL injury. The rating was based on the amount of dynamic knee valgus observed on a drop jump landing. Ratings were evaluated for intrarater and interrater agreement using kappa coefficients. Sensitivity and specificity of ratings were evaluated by comparing observational ratings with measurements obtained using 3-dimensional (3D) motion analysis. Results Kappa coefficients for intrarater and interrater agreement ranged from 0.75 to 0.85, indicating that ratings were reasonably consistent over time and between physiotherapists. Sensitivity values were inadequate, ranging from 67–87%. This indicated that raters failed to detect up to a third of “truly high risk” individuals. Specificity values ranged from 60–72% which was considered adequate for the purposes of the screen. Conclusion Observational risk screening is a practical and cost-effective method of screening for ACL injury risk. Rater agreement and specificity were acceptable for this method but sensitivity was not. To detect a greater proportion of individuals at risk of ACL injury, coaches and clinicians should ensure that they include additional tests for other high risk characteristics in their screening protocols. PMID:19721212

Mercury risk assessment combining internal and external exposure methods for a population living near a municipal solid waste incinerator.

PubMed

Deng, Chunyan; Xie, Han; Ye, Xuejie; Zhang, Haoran; Liu, Maodian; Tong, Yindong; Ou, Langbo; Yuan, Wen; Zhang, Wei; Wang, Xuejun

2016-12-01

Risk assessments for human health have been conducted for municipal solid waste incinerators (MSWIs) in many western countries, whereas only a few risk assessments have been performed for MSWIs in developing countries such as China where the use of waste incineration is increasing rapidly. To assess the mercury exposure risks of a population living near the largest MSWI in South China, we combined internal exposure and external exposure assessment with an individual-specific questionnaire. The mercury concentrations in air, soil, and locally collected food around the MSWI were assessed. The total mercury (T-Hg) and methylmercury (MeHg) of 447 blood samples from a control group, residential exposure group, and MSWI workers were measured. The internal and external exposures of the subject population were analyzed. Significant difference in MeHg concentrations was observed between the control group and the exposed group, between the control group and the MSWI workers, and between the exposed group and the MSWI workers (median levels: 0.70 μg/L, 0.81 μg/L, and 1.02 μg/L for the control group, exposed group, and MSWI workers, respectively). The MeHg/T-Hg ratio was 0.51 ± 0.19, 0.59 ± 0.17 and 0.58 ± 0.25, respectively. Multiple linear regression analysis indicated that MeHg concentrations were positively correlated with the gaseous mercury in the air. Combining internal and external exposure assessment showed that the direct contribution of MSWI emissions was minor compared with the dietary contribution. The external and internal exposures were well matched with each other. This study also suggested that an integrated method combining internal and external exposure assessment with an individual-specific questionnaire is feasible to assess the risks for a population living near a MSWI. Copyright © 2016 Elsevier Ltd. All rights reserved.

Role of Hyperhomocysteinemia and Methylene Tetrahydrofolate Reductase C677T Polymorphism in Idiopathic Portal Vein Thrombosis

PubMed Central

Ghaznavi, Habib; Soheili, Zahra; Samiei, Shahram; Soltanpour, Mohammad Soleiman

2016-01-01

Purpose: Portal vein thrombosis (PVT) is a rare and life-threatening vascular disorder characterized by obstruction or narrowing of the portal vein. Hyperhomocysteinemia and methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism has been studied in PVT patients with conflicting results. In the present study the association of hyperhomocysteinemia and MTHFR C677T polymorphism with PVT risk was investigated in Iranians. Materials and Methods: Our study population consisted of 10 idiopathic PVT patients and 80 healthy control subjects matched for age and sex. MTHFR C677T polymorphism was genotyped by the polymerase chain reaction technique combined with restriction enzyme fragment length polymorphism (PCR-RFLP) technique and plasma total homocysteine (tHcy) levels were determined by enzyme immunoassay method. Results: Mean plasma tHcy levels were significantly higher in PVT patients (20.2±6.8) than control subjects (10.9±4.7) (P=0.001). Moreover, plasma tHcy levels were significantly higher in 677T allele carriers relative to 677C allele carriers in both PVT patients (P=0.01) and control subjects (P=0.03). Neither homozygote nor heterozygote genotypes of MTHFR C677T polymorphism correlated significantly with PVT risk (P>0.05). Moreover, MTHFR C677T polymorphism didn’t increase the risk of PVT under dominant (CT+TT vs. CC) or recessive (TT vs. CC+CT) genetic models analyzed (P>0.05). The difference in frequency of minor 677T allele between PVT patients and control subjects was not statistically significant (P>0.05). Conclusion: Based on the current study, we suggest that hyperhomocysteinemia constitutes a significant and common risk factor for PVT. Also, MTHFR C677T polymorphism is not a risk factor for PVT but is a contributing factor for elevated plasma tHcy levels. PMID:27051654

Genetic and environmental risk factors for rheumatoid arthritis in a UK African ancestry population: the GENRA case–control study

PubMed Central

Traylor, Matthew; Curtis, Charles; Patel, Hamel; Breen, Gerome; Hyuck Lee, Sang; Xu, Xiaohui; Newhouse, Stephen; Dobson, Richard; Steer, Sophia; Cope, Andrew P.; Markus, Hugh S.; Lewis, Cathryn M.

2017-01-01

Abstract Objectives. To evaluate whether genetic and environmental factors associated with RA in European and Asian ancestry populations are also associated with RA in African ancestry individuals. Methods. A case–control study was undertaken in 197 RA cases and 868 controls of African ancestry (Black African, Black Caribbean or Black British ethnicity) from South London. Smoking and alcohol consumption data at RA diagnosis was captured. Genotyping was undertaken (Multi-Ethnic Genotyping Array) and human leukocyte antigen (HLA) alleles imputed. The following European/Asian RA susceptibility factors were tested: 99 genome-wide loci combined into a genetic risk score; HLA region [20 haplotypes; shared epitope (SE)]; smoking; and alcohol consumption. The SE was tested for its association with radiological erosions. Logistic regression models were used, including ancestry-informative principal components, to control for admixture. Results. European/Asian susceptibility loci were associated with RA in African ancestry individuals. The genetic risk score provided an odds ratio (OR) for RA of 1.53 (95% CI: 1.31, 1.79; P = 1.3 × 10 −7). HLA haplotype ORs in European and African ancestry individuals were highly correlated (r = 0.83, 95% CI: 0.56, 0.94; P = 1.1 × 10 −4). Ever-smoking increased (OR = 2.36, 95% CI: 1.46, 3.82; P = 4.6 × 10 −4) and drinking alcohol reduced (OR = 0.34, 95% CI: 0.20, 0.56; P = 2.7 × 10 −5) RA risk in African ancestry individuals. The SE was associated with erosions (OR = 2.61, 95% CI: 1.36, 5.01; P = 3.9 × 10 −3). Conclusion. Gene–environment RA risk factors identified in European/Asian ancestry populations are relevant in African ancestry individuals. As modern statistical methods facilitate analysing ancestrally diverse populations, future genetic studies should incorporate African ancestry individuals to ensure their implications for precision medicine are universally applicable. PMID:28407095

Analysis of risk factors for T. brucei rhodesiense sleeping sickness within villages in south-east Uganda

PubMed Central

Zoller, Thomas; Fèvre, Eric M; Welburn, Susan C; Odiit, Martin; Coleman, Paul G

2008-01-01

Background Sleeping sickness (HAT) caused by T.b. rhodesiense is a major veterinary and human public health problem in Uganda. Previous studies have investigated spatial risk factors for T.b. rhodesiense at large geographic scales, but none have properly investigated such risk factors at small scales, i.e. within affected villages. In the present work, we use a case-control methodology to analyse both behavioural and spatial risk factors for HAT in an endemic area. Methods The present study investigates behavioural and occupational risk factors for infection with HAT within villages using a questionnaire-based case-control study conducted in 17 villages endemic for HAT in SE Uganda, and spatial risk factors in 4 high risk villages. For the spatial analysis, the location of homesteads with one or more cases of HAT up to three years prior to the beginning of the study was compared to all non-case homesteads. Analysing spatial associations with respect to irregularly shaped geographical objects required the development of a new approach to geographical analysis in combination with a logistic regression model. Results The study was able to identify, among other behavioural risk factors, having a family member with a history of HAT (p = 0.001) as well as proximity of a homestead to a nearby wetland area (p < 0.001) as strong risk factors for infection. The novel method of analysing complex spatial interactions used in the study can be applied to a range of other diseases. Conclusion Spatial risk factors for HAT are maintained across geographical scales; this consistency is useful in the design of decision support tools for intervention and prevention of the disease. Familial aggregation of cases was confirmed for T. b. rhodesiense HAT in the study and probably results from shared behavioural and spatial risk factors amongmembers of a household. PMID:18590541

Influences of sample interference and interference controls on quantification of enterococci fecal indicator bacteria in surface water samples by the qPCR method

EPA Science Inventory

A quantitative polymerase chain reaction (qPCR) method for the detection of entercocci fecal indicator bacteria has been shown to be generally applicable for the analysis of temperate fresh (Great Lakes) and marine coastal waters and for providing risk-based determinations of wat...

40 CFR 721.4040 - Glycols, polyethylene-, 3-sulfo-2-hydroxypropyl-p-(1,1,3,3-tetra-methylbutyl)phenyl ether, sodium...

Code of Federal Regulations, 2010 CFR

2010-07-01

... information, and any information on methods for protecting against such risk, into an MSDS as described at... Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) TOXIC SUBSTANCES CONTROL ACT SIGNIFICANT NEW USES OF... substance is any manner or method of manufacture, import, or processing associated with any use of this...

40 CFR 721.3152 - Ethanaminium, N-ethyl-2-hydroxy-N,N-bis(2-hydroxyethyl)-, diester with C12-18 fatty acids, ethyl...

Code of Federal Regulations, 2010 CFR

2010-07-01

... must incorporate this new information, and any information on methods for protecting against such risk....3152 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) TOXIC SUBSTANCES CONTROL ACT... significant new use of this substance is any manner or method of manufacture, import, or processing associated...

Determination of osteoporosis risk factors using a multiple logistic regression model in postmenopausal Turkish women.

PubMed

Akkus, Zeki; Camdeviren, Handan; Celik, Fatma; Gur, Ali; Nas, Kemal

2005-09-01

To determine the risk factors of osteoporosis using a multiple binary logistic regression method and to assess the risk variables for osteoporosis, which is a major and growing health problem in many countries. We presented a case-control study, consisting of 126 postmenopausal healthy women as control group and 225 postmenopausal osteoporotic women as the case group. The study was carried out in the Department of Physical Medicine and Rehabilitation, Dicle University, Diyarbakir, Turkey between 1999-2002. The data from the 351 participants were collected using a standard questionnaire that contains 43 variables. A multiple logistic regression model was then used to evaluate the data and to find the best regression model. We classified 80.1% (281/351) of the participants using the regression model. Furthermore, the specificity value of the model was 67% (84/126) of the control group while the sensitivity value was 88% (197/225) of the case group. We found the distribution of residual values standardized for final model to be exponential using the Kolmogorow-Smirnow test (p=0.193). The receiver operating characteristic curve was found successful to predict patients with risk for osteoporosis. This study suggests that low levels of dietary calcium intake, physical activity, education, and longer duration of menopause are independent predictors of the risk of low bone density in our population. Adequate dietary calcium intake in combination with maintaining a daily physical activity, increasing educational level, decreasing birth rate, and duration of breast-feeding may contribute to healthy bones and play a role in practical prevention of osteoporosis in Southeast Anatolia. In addition, the findings of the present study indicate that the use of multivariate statistical method as a multiple logistic regression in osteoporosis, which maybe influenced by many variables, is better than univariate statistical evaluation.